Regular STI Testing amongst Men Who Have Sex with Men & Use Social Media Is Suboptimal - A Cross-Sectional Study

Sexually transmitted infections (STIs) disproportionately affect men who have sex with men, with marked increases in most STIs in recent years. These are likely underpinned by coterminous increases in behavioural risks which have coincided with the development of Internet and geospatial sociosexual networking. 

Current guidelines advocate regular, annual sexually transmitted infection testing amongst sexually active men who have sex with men (MSM), as opposed to symptom-driven testing. This paper explores sexually transmitted infection testing regularity amongst MSM who use social and sociosexual media. 

Data were collected from 2668 men in Scotland, Wales, Northern Ireland and the Republic of Ireland, recruited via social and gay sociosexual media. Only one-third of participants report regular (yearly or more frequent) STI testing, despite relatively high levels of male sex partners, condomless anal intercourse and high-risk unprotected anal intercourse. The following variables were associated with regular STI testing; being more 'out' (adjusted odds ratio = 1.79; confidence interval = 1.20-2.68), HIV-positive (adjusted odds ratio = 14.11; confidence interval = 7.03-28.32); reporting ≥10 male sex partners (adjusted odds ratio = 2.15; confidence interval = 1.47-3.14) or regular HIV testing (adjusted odds ratio = 48.44; confidence interval = 28.27-83.01). Men reporting long-term sickness absence from work/carers (adjusted odds ratio = 0.03; confidence interval = 0.00-0.48) and men aged ≤25 years (adjusted odds ratio = 0.36; 95% confidence interval = 0.19--0.69) were less likely to test regularly for STIs. 

As such, we identify a complex interplay of social, health and behavioural factors that each contribute to men's STI testing behaviours. In concert, these data suggest that the syndemics placing men at elevated risk may also mitigate against access to testing and prevention services. Moreover, successful reduction of STI transmission amongst MSM will necessitate a comprehensive range of approaches which address these multiple interrelated factors that underpin MSM's STI testing.

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By:  Frankis J1, Goodall L2, Clutterbuck D3, Abubakari R4, Flowers P5.

• 1School of Health and Life Sciences, Glasgow Caledonian University, Glasgow j.frankis@gcu.ac.uk.
• 2Cobridge Sexual Health Centre, Church Terrace, Cobridge, Stoke on Trent.
• 3Chalmers Sexual Health Centre, NHS Lothian, Edinburgh.
• 4School of Health and Life Sciences, GCU London, Glasgow Caledonian University, Glasgow.
• 5School of Health and Life Sciences, Glasgow Caledonian University, Glasgow. 
• Int J STD AIDS. 2016 Mar 4. pii: 0956462416636780.

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Inter-Group Conflict & Cooperation: Field Experiments Before, During & After Sectarian Riots in Northern Ireland

The idea that cooperative groups out-compete less cooperative groups has been proposed as a theoretical possibility for the evolution of cooperation through cultural group selection. Previous studies have found an association between increased cooperation and exposure to inter-group violence, but most have not been able to identify the specific target of cooperation and are based on correlational data making it difficult to establish causality. 

In this study we test the hypothesis that inter-group conflict promotes parochial altruism (i.e., in-group altruism and out-group hostility) by using longitudinal data of a real-world measure of cooperation-charity and school donations-sampled before, during and after violent sectarian riots between Catholics and Protestants in Belfast, Northern Ireland. 

We find that conflict is associated with reductions in all types of cooperation, with reduced donations to a neutral charity, and both in-group and out-group primary schools. After the conflict, both in-group and out-group donations increased again. In this context we find no evidence that inter-group conflict promotes parochial altruism.

Below:  Map of Belfast with the neighborhoods Ballymacarrett 1 and Bellevue 2 in green and the 4 primary schools used in the donations experiments before, during and after the sectarian riots. Catholic primary schools (green markers) and Protestant primary schools (red markers).

Below:  Predicted donations by type over time. Predicted value (£) of an individual donating to the neutral charity Save the Children, an in-group primary school, an out-group primary school and all combined donations over time (before, during, and after the riots). These predicted values are controlled for individual household income, educational level, age, gender and religion. Error bars represent the standard errors.

Full article at:   http://goo.gl/mfidL5

By:   Silva AS1, Mace R1.

• 1Department of Anthropology, University College London London, UK. 

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Clustering of Sex and Substance Use Behaviors in Adolescence

Adolescents often experiment with substance use and sexual activity, which can impact upon their health and well-being, and establish harmful patterns of behavior which continue into adulthood. While substance use and participation in sexual behaviors often co-occur, few studies have examined whether these behaviors cluster in adolescence.

To investigate clustering of sexual activity and substance use among youth in Northern Ireland.

Data from 875 young people (aged 16) who participated in the 2008 Northern Ireland Life and Times Survey were used to investigate clustering using the Odds/Expected ratio method. Gender differences in clustering were explored.

Alcohol consumption was the most prevalent risk behavior (75%), followed by cigarette smoking, sexual intercourse, illicit substance use, and solvent use the least prevalent. Over 40% of young people participated in multiple risk behaviors (2 or more). Several behavior combinations were statistically clustered, for most the reported prevalence was lower than expected, however, participation in all five risk behaviors occurred at a much higher rate than expected, particularly for male youth.

While experimentation with risky behaviors is often considered developmentally appropriate in adolescence it is important to understand how young people experience these behaviors, and the potential for multiple risk exposures as a result of participation in substance use and sexual behaviors. These findings highlight the clustering of substance use and sexual behaviors, and indicate variations in vulnerability to participation in multiple risk behaviors by gender.

Via:  http://goo.gl/GKMY2m

By: McAloney K1.

• 1a Psychology and Allied Health Sciences, Glasgow Caledonian University , Glasgow , United Kingdom. 

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Does Antiretroviral Therapy Reduce HIV-Associated Tuberculosis Incidence to Background Rates? A National Observational Cohort Study From England, Wales & Northern Ireland

Whether the incidence of tuberculosis in HIV-positive people receiving long-term antiretroviral therapy (ART) remains above background population rates is unclear. We compared tuberculosis incidence in people receiving ART with background rates in England, Wales, and Northern Ireland.

We analysed a national cohort of HIV-positive individuals linked to the national tuberculosis register. Tuberculosis incidence in the HIV-positive cohort (2007-11) was stratified by ethnic origin and time on ART and compared with background rates (2009). Ethnic groups were defined as follows: the black African group included all individuals of black African origin, including those born in the UK and overseas; the white ethnic group included all white individuals born in the UK and overseas; the south Asian group included those of Indian, Pakistani, and Bangladeshi origin, born in the UK and overseas; and the other ethnic group included all other ethnic origins, including black Afro-Caribbeans.

The HIV-positive cohort comprised 79 919 individuals, in whom there were 1550 incident cases in 231 664 person-years of observation (incidence 6·7 cases per 1000 person-years). Incidence of tuberculosis in the HIV-positive cohort was 13·6 per 1000 person-years in black Africans and 1·7 per 1000 person-years in white individuals. Incidence of tuberculosis during long-term ART (≥5 years) in black Africans with HIV was 2·4 per 1000 person-years, similar to background rates of 1·9 per 1000 person-years in this group (rate ratio 1·2, 95% CI 0·96-1·6; p=0·083); but in white individuals with HIV on long-term ART the incidence of 0·5 per 1000 person-years was higher than the background rate of 0·04 per 1000 person-years (rate ratio 14·5, 9·4-21·3; p<0·0001). The increased incidence relative to background in white HIV-positive individuals persisted when analysis was restricted to person-time accrued on ART with CD4 counts of at least 500 cells per μL and when white HIV-positive individuals born abroad were excluded.

Tuberculosis incidence is unacceptably high irrespective of HIV status in black Africans. In white individuals with HIV, tuberculosis incidence is significantly higher than background rates in white people despite long-term ART. Expanded testing and treatment for latent tuberculosis infection to all HIV-infected adults, irrespective of ART status and CD4 cell count, might be warranted.

Via: http://goo.gl/3IOp4z  Purchase full article at: http://goo.gl/SRMAeE

By: Gupta RK1, Rice B2, Brown AE2, Thomas HL3, Zenner D4, Anderson L3, Pedrazzoli D5, Pozniak A6, Abubakar I7, Delpech V2, Lipman M8.

• 1Division of Medicine, University College London, London, UK; HIV/STI Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
• 2HIV/STI Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK.
• 3TB Section, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK.
• 4TB Section, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK; Centre for Infectious Disease Epidemiology, University College London, London, UK.
• 5TB Section, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK; Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
• 6Chelsea & Westminster Hospitals NHS Foundation Trust, London, UK.
• 7TB Section, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK; MRC Clinical Trials Unit and Centre for Infectious Disease Epidemiology, University College London, London, UK.
• 8Division of Medicine, University College London, London, UK. 

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