Incidence & Factors Associated with the Risk of Sexually Transmitted Diseases in HIV-Infected People Seen for Care in Italy

Objectives

The aims of this study were to identify temporal trends in the incidence of sexually transmitted diseases (STDs) in a cohort of HIV-infected people and to evaluate factors associated with the risk of a new STD diagnosis.

Methods

All HIV-infected patients in the Icona Foundation Study cohort enrolled after 1998 were included in this study. STD incidence rates (IRs) were calculated and stratified by calendar period. Predictors of STDs were identified using a Poisson regression model with sandwich estimates for standard errors.

Results

Data for 9168 participants were analysed [median age 37.3 (range 18–81) years; 74% male; 30% men who have sex with men (MSM)]. Over 46 736 person-years of follow-up (PYFU), 996 episodes of STDs were observed [crude IR 21.3/1000 PYFU; 95% confidence interval (CI) 20.0–22.6/1000 PYFU]. In multivariable Poisson regression analysis, MSM [rate ratio (RR) 3.03; 95% CI 2.52–3.64 versus heterosexuals], calendar period (RR 1.67; 95% CI 1.42–1.97 for 2008–2012 versus 1998–2002), HIV RNA > 50 HIV-1 RNA copies/mL (RR 1.44; 95% CI 1.19–1.74 versus HIV RNA ≤ 50 copies/mL) and a current CD4 count < 100 cells/μL (RR 4.66; 95% CI 3.69–5.89; P < 0.001 versus CD4 count > 500 cells/μL) were associated with an increased risk of STDs. In contrast, older age (RR 0.82 per 10 years older; 95% CI 0.77–0.89) and being currently on ART (RR 0.38; 95% CI 0.33–0.45) compared with being ART-naïve or on a treatment interruption were associated with a lower risk of developing STDs.

Conclusions

An increase in the incidence of STDs was observed in more recent years. Interventions to prevent STDs and potential spread of HIV should target the younger population, MSM and people currently not receiving ART.

Table 1

Crude incidence of sexually transmitted diseases (STDs) in the whole population (n = 9168)

	Number of events	PYFU	IR (95% CI)
Women	204	13912	14.6 (12.7–16.8)
Men	792	32824	24.1 (22.4–25.8)
Age
18–30 years	181	3982	45.4 (39.0–52.5)
31–40 years	441	18421	23.9 (21.7–26.2)
41–50 years	276	16992	16.2 (14.3–18.2)
51–70 years	93	7021	13.2 (10.7–16.2)
> 70 years	5	329	15.1 (4.9–35.4)
HIV transmission route
Heterosexual	229	18557	15.7 (13.9–17.6)
MSM	561	10843	51.7 (47.5–56.2)
IDU	87	14926	5.8 (4.6–7.1)
Other	56	2410	23.2 (17.5–30.1)
Period of STDs
1998–2002	272	15745	17.2 (15.2–19.4)
2003–2007	269	15399	17.4 (15.4–19.6)
2008–2012	455	15592	29.1 (26.5–31.9)
CD4 count at STD diagnosis
> 500 cells/μL	457	24789	18.4 (16.7–20.2)
351–500 cells/μL	203	10765	18.8 (16.3–21.6)
101–350 cells/μL	247	9832	25.1 (22.0–28.4)
< 100 cells/μL	89	1350	65.9 (52.9–81.1)
HIV RNA at STD diagnosis
< 50 copies/mL	174	16289	10.6 (9.1–12.3)
> 50 copies/mL	822	30446	27.0 (25.1–28.9)
Years since HIV diagnosis
< 10 years	860	28932	29.7 (27.7–31.7)
11–20 years	122	14956	8.1 (6.7–9.7)
> 20 years	11	2680	4.1 (2.0–7.3)
Missing	3	168	18.8 (3.6–52.1)
Education
Primary	79	4393	17.98 (14.2–22.4)
Secondary	248	16531	15.00 (13.2–17.0)
College	349	12855	27.15 (24.4–30.1)
University	113	2614	43.23 (35.6–52.0)
Missing	207	10343	20.01 (17.4–22.9)
Ethnicity
Caucasian	909	44132	20.60 (19.3–22.0)
Afro-American	34	1364	24.93 (17.2–34.8)
Hispanic	45	968	46.50 (33.9–62.2)
Asian	8	217	36.91 (15.9–72.6)
ART status
Naïve	534	11962	44.64 (40.9–48.6)
On ART	400	31297	12.78 (11.5–14.1)
On treatment interruption	62	3478	17.83 (13.6–22.8)

ART, antiretroviral therapy; CI, confidence interval; IDU, injecting drug use; IR, incidence rate; MSM, men who have sex with men; PYFU, person-years of follow-up.

Below:  Incidence rate for any sexually transmitted disease (STD) according to HIV transmission route in different periods of observation. IDU, injecting drug use; MSM, men who have sex with men

Full article at:   http://goo.gl/iq87Yg

By:   A Cingolani,¹ S Zona,² E Girardi,³ A Cozzi-Lepri,⁴ L Monno,⁵ E Quiros Roldan,⁶ G Guaraldi,² A Antinori,⁷ A D’Arminio Monforte,⁸ and S Marcotullio^9,*

¹Department of Public Health, Infectious Diseases, Catholic University, Rome, Italy

²Clinic of Infectious Diseases, Univeristy of Modena and Reggio Emilia, Modena, Italy

³Department of Epidemiology, National Institute for Infectious Diseases ‘L. Spallanzani’, Rome, Italy

⁴Department of Infection and Population Health, Division of Population Health, University College London Medical School, Royal Free Campus, London, UK

⁵Institute of Infectious Diseases, University of Bari, Bari, Italy

⁶Institute of Infectious Diseases, University of Brescia, Brescia, Italy

⁷Clinical Department, National Institute for Infectious Diseases ‘L. Spallanzani’, Rome, Italy

⁸Clinic of Infectious and Tropical Diseases, Department of Health Sciences, San Paolo University Hospital, Milan, Italy

⁹Nadir Foundation Onlus, Rome, Italy

Correspondence: Dr Antonella Cingolani, Department of Public Health, Infectious Diseases, Catholic University, L.go A. Gemelli, 8, 00167 Roma, Italy. Tel: +390630157021; fax: +39063054519; e-mail: ti.ttacinu.mr@inalognic.a

  

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Experiences with Food Insecurity & Risky Sex among Low-Income People Living with HIV/AIDS in a Resource-Rich Setting

Forty-nine million individuals are food insecure in the United States, where food insecurity and HIV/AIDS are prevalent among the urban poor. Food insecurity is associated with risky sexual behaviours among people living with HIV/AIDS (PLHIV). No qualitative studies, however, have investigated the mechanisms underlying this relationship either in a resource-rich setting or among populations that include men who have sex with men (MSM).

Semi-structured in-depth interviews were conducted with 34 low-income PLHIV receiving food assistance in the San Francisco Bay Area. The interviews explored experiences with food insecurity and perceived associations with sexual risk behaviours. Interviews were conducted in English, audio-recorded and transcribed verbatim. Transcripts were coded and analyzed according to content analysis methods using an inductive-deductive approach.

Food insecurity was reported to be a strong contributor to risky sexual practices among MSM and female participants. Individuals described engaging in transactional sex for food or money to buy food, often during times of destitution. Participants also explained how food insecurity could lead to condomless sex despite knowledge of and desire to use safe sexual practices, largely because the need to obtain food in the short term was prioritized over the desire to use barrier protection.

Our data extend previous research by demonstrating that food insecurity contributes to transactional and unprotected sex among urban poor individuals in a resource-rich setting, including among MSM. These findings underscore the importance of public health and social intervention efforts focused on structural inequalities.

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

By: Whittle HJ¹, Palar K², Napoles T², Hufstedler LL², Ching I³, Hecht FM², Frongillo EA⁴, Weiser SD^3,2,5.

¹Global Health Sciences, University of California, San Francisco (UCSF), San Francisco, CA, USA; harrywhittle@gmail.com.

²Division of HIV/AIDS, ID and Global Medicine, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA.

³Global Health Sciences, University of California, San Francisco (UCSF), San Francisco, CA, USA.

⁴Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA.

⁵Center for AIDS Prevention Studies, University of California, San Francisco (UCSF), San Francisco, CA, USA

 

More at:  https://twitter.com/hiv_insight

And: http://twitter.com/Prison_Health