HIV Incidence among Men Who Have Sex with Men After Diagnosis with Sexually Transmitted Infections

BACKGROUND:

Men who have sex with men (MSM) are at high risk for acquiring HIV infection after diagnosis with other sexually transmitted infections (STIs). Identifying the STIs associated with the greatest risk of subsequent HIV infection could help target prevention interventions, particularly preexposure prophylaxis (PrEP).

METHODS:

Using matched HIV and STI surveillance data from Washington State from January 1, 2007, to June 30, 2013, we calculated the incidence of new HIV diagnoses after different STI diagnoses among MSM. Men entered observation at the time of their first STI diagnosis during the study period and exited at HIV diagnosis or June 30, 2013. Cox proportional hazards regression was used to conduct a global comparison of rates.

RESULTS:

From January 1, 2007, to June 30, 2013, 6577 HIV-negative MSM were diagnosed as having 10,080 bacterial STIs at 8371 unique time points and followed for 17,419 person-years. Two hundred eighty (4.3%) men were subsequently diagnosed as having HIV infection for an overall incidence of 1.6 per 100 person-years (95% confidence interval, 1.4-1.8). The estimated incidence of HIV diagnoses among all MSM in the state was 0.4 per 100 person-years. Men who have sex with men were at the greatest risk for HIV diagnosis after being diagnosed as having rectal gonorrhea (HIV incidence, 4.1 per 100 person-years), followed by early syphilis (2.8), urethral gonorrhea (1.6), rectal chlamydial infection (1.6), pharyngeal gonorrhea (1.1), late syphilis (1.0), and urethral chlamydial infection (0.6; P < 0.0001 overall).

CONCLUSIONS:

Men who have sex with men diagnosed as having rectal gonorrhea and early syphilis were at the greatest risk for being diagnosed as having HIV infection after STI diagnosis. These men should be prioritized for more intensive prevention interventions, including PrEP.

Below:  Cumulative hazard of HIV diagnosis following bacterial STIs (STI) GC = gonorrhea. CT = chlamydial infection

Below:  Percent of 736 MSM newly diagnosed as having HIV infection from July 2011 to June 2013 with a reported STI diagnosis in the 2 years before HIV diagnosis GC indicates gonorrhea; CT, chlamydial infection.

Full article at:   http://goo.gl/N3Kb5L

By:  Katz DA1, Dombrowski JC, Bell TR, Kerani RP, Golden MR.

• 1From the Departments of *Medicine and †Epidemiology, University of Washington, Seattle, WA; ‡HIV/STD Program, Public Health-Seattle & King County, Seattle, WA; and §Infectious Disease Assessment Unit, Washington State Department of Health, Olympia, WA. 
• Sex Transm Dis. 2016 Apr;43(4):249-54. doi: 10.1097/OLQ.0000000000000423.

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Sexual Abstinence & Other Behaviours Immediately Following a New STI Diagnosis among STI Clinic Patients: Findings from The Safe in the City Triala

BACKGROUND:

Few studies have assessed patients' sexual behaviours during the period immediately following a new diagnosis of a curable sexually transmitted infection (STI).

METHODS:

Data were analysed from a behavioural study nested within the Safe in the City trial, which evaluated a video-based STI/HIV prevention intervention in three urban STI clinics. We studied 450 patients who reported having received a new STI diagnosis, or STI treatment, 3 months earlier. Participants reported on whether they seriously considered, attempted and succeeded in adopting seven sex-related behaviours in the interval following the diagnostic visit. We used multivariable logistic regression to identify, among men, correlates of two behaviours related to immediately reducing reinfection risk and preventing further STI transmission: sexual abstinence until participants were adequately treated and abstinence until their partners were tested for STIs.

RESULTS:

Most participants reported successfully abstaining from sex until they were adequately treated for their baseline infection (89%-90%) and from sex with potentially exposed partners until their partners were tested for HIV and other STIs (66%-70%). Among men who intended to be abstinent until they were adequately treated, those who did not discuss the risks with a partner who was possibly exposed were more likely not to be abstinent (OR, 3.7; 95% CI 1.5 to 9.0) than those who had this discussion. Similarly, among men who intended to abstain from sex with any potentially exposed partner until the partner was tested for HIV and other STIs, those who reported not discussing the risks of infecting each other with HIV/STIs were more likely to be sexually active during this period (OR, 3.5; 95% CI 1.6 to 8.1) than were those who reported this communication.

CONCLUSIONS:

Improved partner communication could facilitate an important role in the adoption of protective behaviours in the interval immediately after receiving a new STI diagnosis.

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By:   Gallo MF1, Margolis AD2, Malotte CK3, Rietmeijer CA4, Klausner JD5, O'Donnell L6, Warner L7; Safe in the City Study Group.

• 1Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA.
• 2Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
• 3Center for Health Equity Research, California State University, Long Beach, California, USA.
• 4Rietmeijer Consulting, LLC, Denver, Colorado, USA.
• 5David Geffen School of Medicine and Fielding School of Public Health, University of California-Los Angeles, Los Angeles, California, USA.
• 6Health and Human Development, EDC, Waltham, Massachusetts, USA.
• 7Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. 

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Intimate Partner Violence After the Diagnosis of Sexually Transmitted Diseases

OBJECTIVE To assess the prevalence and factors associated with intimate partner violence after the diagnosis of sexually transmitted diseases.

METHODS This cross-sectional study was conducted in Fortaleza, CE, Northeastern Brazil, in 2012 and involved 221 individuals (40.3% male and 59.7% female) attended to at reference health care units for the treatment of sexually transmitted diseases. Data were collected using a questionnaire applied during interviews with each participant. A multivariate analysis with a logistic regression model was conducted using the stepwise technique. Only the variables with a p value < 0.05 were included in the adjusted analysis. The odds ratio (OR) with 95% confidence interval (CI) was used as the measure of effect.

RESULTS A total of 30.3% of the participants reported experiencing some type of violence (27.6%, psychological; 5.9%, physical; and 7.2%, sexual) after the diagnosis of sexually transmitted disease. In the multivariate analysis adjusted to assess intimate partner violence after the revelation of the diagnosis of sexually transmitted diseases, the following variables remained statistically significant: extramarital relations, alcohol consumption by the partner, history of violence prior to diagnosis, and fear of disclosing the diagnosis to the partner.

CONCLUSIONS Individuals who had extramarital relations, experienced violence prior to the diagnosis of sexually transmitted disease, feared disclosing the diagnosis to the partner, and those whose partner consumed alcohol had an increased likelihood of suffering violence. The high prevalence of intimate partner violence suggests that this population is vulnerable and therefore intervention efforts should be directed to them. Referral health care services for the treatment of sexually transmitted diseases can be strategic places to identify and prevent intimate partner violence.

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

By:  Andrade RF, Araújo MA, Vieira LJ, Reis CB, Miranda AE.

^IPrograma de Pós-Graduação em Saúde Coletiva. Centro de Ciências da Saúde. Universidade de Fortaleza. Fortaleza, CE, Brasil

^IIDepartamento de Medicina Social. Centro de Ciências da Saúde. Universidade Federal do Espírito Santo. Vitória, ES, Brasil

Correspondence: Roumayne Fernandes Vieira Andrade. Rua Antônio de Souza Lopes, 100 apto 1801-B Catolé. 58410-180 Campina Grande, PB, Brasil. E-mail: moc.liamtoh@vfenyamuor

 

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Sexually Transmitted Disease Diagnoses among Hispanic Immigrant & Migrant Men Who Have Sex with Men in the United States

Hispanic immigrant/migrant men who have sex with men should be at higher risk for sexually transmitted disease/human immunodeficiency virus (STD/HIV) infections given individual-level factors associated with the migration process that have been theorised to increase susceptibility to STD/HIV infections among migrant populations, yet relatively little is known if these individual level factors are actually associated with a sexually transmitted disease infection among this population.

During 2005-2007, 2576 men and women foreign-born Hispanics were surveyed at three community-based organisations offering services to immigrant/migrant communities. We analysed demographic characteristics, sexual risk behaviours, migration patterns, and factors associated with a sexually transmitted disease diagnoses (syphilis, chlamydia, and gonorrhea) in the past 12 months among Hispanic immigrant/migrant men who have sex with men.

Of 1482 Hispanic immigrant/migrant men surveyed who reported having sex in the past 12 months, 353 (24%) reported sex with a man, and of these, 302 answered questions regarding whether or not they had been diagnosed with a bacterial sexually transmitted disease in the past year. Of these 302 men, 25% reported being married; 42% self-identified as being heterosexual and 20% as bisexual. Twenty-nine (9.6%) men reported that they received a sexually transmitted disease diagnosis in the past year. In the multivariate logistic regression model, men who reported receiving money or goods for sex had increased odds of a self-reported sexually transmitted disease diagnosis.

The prevalence of bacterial sexually transmitted diseases among Hispanic immigrant/migrant men who have sex with men is lower than the prevalence of bacterial sexually transmitted diseases among other men who have sex with men in the United States. Nevertheless, receiving money or goods for sex was significantly associated with a self-reported sexually transmitted disease diagnosis among Hispanic immigrant/migrant men who have sex with men. It is important to understand factors contributing to participation in exchange sex among this population. Human immunodeficiency virus/sexually transmitted disease prevention interventions tailored to non-gay identifying men who have sex with men are important for Hispanic immigrant/migrant men who have sex with men.

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By: Valverde EE1, DiNenno EA2, Schulden JD3, Oster A2, Painter T2.

• 1Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA evalverde@cdc.gov.
• 2Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
• 3National Institute on Drug Abuse (NIDA), National Institutes of Health (NIH) Neuroscience Center, Bethesda, MD, USA.  

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STI Diagnosis and HIV Testing among OEF/OIF/OND Veterans

Patients with sexually transmitted infection (STI) diagnosis should be tested for human immunodeficiency virus (HIV), regardless of previous HIV test results.

Estimate HIV testing rates among recent service Veterans with an STI diagnosis and variation in testing rates by patient characteristics.

The sample comprised 243,843 Veterans who initiated Veterans Health Administration (VHA) services within 1 year after military separation. Participants were followed for 2 years to determine STI diagnoses and HIV testing rates. We used relative risks regression to examine variation in testing rates.

We used VHA administrative data to identify STI diagnoses and HIV testing and results.

Veterans with an STI diagnosis (n = 1815) had higher HIV testing rates than those without (34.9% vs. 7.3%), but were not more likely to have a positive test result (1.1% vs. 1.4%). Among Veterans with an STI diagnosis, testing increased from 25% to 45% over the observation period; older age was associated with a lower rate of testing, whereas race and ethnicity, multiple deployments, posttraumatic stress disorder, and substance abuse disorders were associated with a higher rate.

Since VHA implemented routine HIV testing, overall rates of testing have increased. However, among Veterans at significant risk for HIV because of an STI diagnosis, only 45% had an HIV test in the most recent year of observation. Other patient characteristics such as alcohol and drug abuse were associated with being tested for HIV. Providers should be reminded that an STI is a sufficient reason to test for HIV.

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By: Goulet JL1, Martinello RA, Bathulapalli H, Higgins D, Driscoll MA, Brandt CA, Womack JA.

• 1*VA Connecticut Healthcare System †Department of Psychiatry, Yale School of Medicine, New Haven, CT ‡Office of Public Health, Department of Veterans Affairs, Washington, DC Departments of §Internal Medicine and Pediatrics, Emergency Medicine, Yale School of Medicine, Yale School of Nursing, New Haven, CT. 

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Partner Notification among Men Who Have Sex with Men & Heterosexuals with STI/HIV: Different Outcomes and Challenges

Partner notification effectiveness among index clients diagnosed with HIV, syphilis and/or gonorrhoea at sexually transmitted infection (STI) clinics was evaluated between 2010 and 2012. We explored percentages of identifiable, notified and tested partners by sexual preference and gender. Partner notification trends were studied using the national STI database. Men who have sex with men (n = 304), heterosexual men (n = 33) and women (n = 35) reported, respectively, 6.7, 3.8 and 2.3 partners per index. Percentages of identifiable partners differed between groups (men who have sex with men: 46%, heterosexual men: 63%, women: 87%). 

The percentage of notified partners (of those identifiable) was lowest for heterosexual men (76%; men who have sex with men: 92%; women: 83%; p < 0.001). STI positivity rates among notified partners were high: 33%-50% depending on sexual preference. 

Among men who have sex with men, having HIV was associated with not notifying all identifiable partners. 

Percentages of notified clients at STI clinics increased between 2010 and 2012: from 13% to 19% among men who have sex with men, from 13% to 18% among heterosexual men and from 8% to 11% among women. The percentage of STI/HIV detected through partner notification increased among men who have sex with men (from 22% to 30%) and women (from 25% to 29%). 

Unidentifiable partners among men who have sex with men, lower partner notification effectiveness for HIV and the relative large proportion of heterosexual men not notifying their partners appear to be important partner notification challenges.

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