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Rodrigues DL, Carvalho AC, Prada M, Garrido MV, Balzarini RN, de Visser RO, Lopes D. Condom Use Beliefs Differ According to Regulatory Focus: A Mixed-Methods Study in Portugal and Spain. JOURNAL OF SEX RESEARCH 2024; 61:709-726. [PMID: 36877803 DOI: 10.1080/00224499.2023.2181305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Reports worldwide have been showing increasing rates of sexually transmitted infections (STIs) and condomless sex in recent years. Research has identified several individual and situational variables that can determine the decision to use condoms or forgo their use. We argue that such a decision can also be shaped by motives related to pleasure and safety (i.e., regulatory focus in sexuality). Using open ended questions, we asked 742 Portuguese and Spanish adults to indicate situations and reasons that could inform the decision making process with casual partners and the functions/attributes related to condoms. Using thematic analyses, we coded the drivers of condomless sex and condom use into themes and subthemes, and computed their frequencies. Using quantitative measures, we also asked participants to indicate their condom use expectancies and perceived barriers. Comparing participants according to regulatory focus revealed some differences. Pleasure promotion participants were more likely to consider that condom use decision making is driven by unexpectedness, pleasure, and intimacy pursuit, attached more pleasure reduction functions to condoms, expected more negative outcomes in condom use, and endorsed more sensation and partner barriers in condom use. In contrast, disease prevention participants were more likely to consider that condom use decision making is driven by adequate sexual education, responsibility, and behavioral control, and attached more health protective functions to condoms. These differences can inform the development of tailored intervention and awareness campaigns aimed at helping people to use condoms more consistently with casual partners and to avoid behaviors that put them at risk of STI transmission.
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Affiliation(s)
- David L Rodrigues
- Iscte-Instituto Universitário de Lisboa, CIS-Iscte, Lisboa, Portugal
| | | | - Marília Prada
- Iscte-Instituto Universitário de Lisboa, CIS-Iscte, Lisboa, Portugal
| | | | - Rhonda N Balzarini
- Department of Psychology, Texas State University, San Marcos, TX, USA
- The Kinsey Institute, Indiana University, Bloomington, IN, USA
| | - Richard O de Visser
- Department of Primary Care & Public Health, Brighton and Sussex Medical School, Falmer, UK
| | - Diniz Lopes
- Iscte-Instituto Universitário de Lisboa, CIS-Iscte, Lisboa, Portugal
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Hart TA, Noor SW, Tavangar F, Zahran A, Skakoon-Sparling S, Tan DHS, Lambert G, Grace D, Lachowsky N, Sang JM, Palma PA, Zhang T, Dvorakova M, Cox J, Moore DM. Human Immunodeficiency Virus Treatment Attitudes and Bacterial Sexually Transmitted Infections Among Gay and Bisexual Men. Sex Transm Dis 2024; 51:178-185. [PMID: 38412464 DOI: 10.1097/olq.0000000000001915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUNDS Positive attitudes toward human immunodeficiency virus (HIV) treatment, such as reduced concern about HIV transmissibility, are associated with sexual behaviors that may increase the risk of bacterial sexually transmitted infections (STIs) among gay, bisexual, and other men who have sex with men (GBM). We examined associations between HIV treatment attitudes and bacterial STI diagnoses among GBM in Canada's three largest cities. METHODS We fit a structural equation model between HIV treatment attitudes and bacterial STI diagnoses via sexual behaviors in the Engage study's baseline data. We estimated direct and indirect paths between scores on HIV treatment attitudes and STIs via number of male anal sex partners, condomless anal sex, and oral sex. We conducted sub-analyses with participants stratified by HIV serostatus. RESULTS Among 2449 GBM recruited in 2017 to 2019, there was a direct association between HIV treatment attitudes and current STI diagnoses (β = 0.13; 95% CI, 0.07-0.19; P < 0.001). The mediated model revealed a positive total indirect effect through 2 pathways: (1) engaging in condomless anal sex and (2) number of male anal sex partners and condomless anal sex. These 2 indirect pathways remained in the stratified mediation models for both HIV negative GBM and for GBM living with HIV. CONCLUSIONS The association between HIV treatment attitudes and diagnosed STIs is mediated through a higher number of male anal sex partners and condomless anal sex. The results highlight the importance of providers educating patients when providing effective STI counseling, testing, and prevention for GBM about how accurate HIV treatment attitudes may inadvertently be associated with the bacterial STI epidemic.
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Affiliation(s)
| | | | | | - Adhm Zahran
- From the Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | | | | | | | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Jordan M Sang
- Community-Based Research Centre, Vancouver, BC, Canada
| | - Paolo A Palma
- From the Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Terri Zhang
- From the Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Milada Dvorakova
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
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Xie Z, Duan Z. Balancing public health and privacy rights: a mixed-methods study on disclosure obligations of people living with HIV to their partners in China. Harm Reduct J 2024; 21:30. [PMID: 38311762 PMCID: PMC10840163 DOI: 10.1186/s12954-023-00920-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 12/24/2023] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND In 2021, a Chinese court, based on the newly enacted Civil Code, first revoked a marriage license due to the spouse's failure to disclose their HIV infection before the marriage. This landmark case ignited a fresh debate on whether people living with HIV (PLHIV) have a legal duty to inform their spouses and sexual partners. Advances in medicine have partially isolated HIV transmission from sexual contact, extending the legal basis for the obligation to disclose beyond disease prevention. This study investigates some possibly unforeseen challenges for PLHIV in China to fulfill this duty, and the outcomes of their decisions in light of the government's goal to promote health. METHODS This study aims to provide a detailed examination of the legal provisions and practices concerning partner notification among PLHIV in China. A mixed-methods research approach was employed between 2019 and 2020, combining questionnaire surveys, in-depth interviews, and participatory observations. A total of 433 valid responses were obtained through a questionnaire posted on a Chinese online platform for PLHIV. Following the collection and random coding of the questionnaire data, 40 individuals living with HIV were selected for in-depth interviews. Subsequently, a six-month field investigation was conducted in Guan ai jia yuan (Caring Home) in Jinhua City to further explore this issue. RESULTS A considerable proportion of PLHIV exhibit a high rate of disclosure to their spouses (nearly 80%). In the context of sexual partners, 56% of PLHIV stated that their sexual partners were aware of their HIV infection. Whether married PLHIV disclosing to their spouses or unmarried/divorced PLHIV disclosing to sexual partners, however, a substantial majority expressed apprehension about the potential disruption to their relationships that the disclosure might cause. The sole exception was observed among married PLHIV in extramarital relationships who demonstrated a slightly diminished level of concern in this context. Reasons for non-disclosure predominantly included undetectable viral load and the adoption of protective measures. DISCUSSION This study reveals that a prevailing "HIV stigma" hinders PLHIV from voluntarily fulfilling the disclosure duties bestowed by Article 38 of the Regulations on the Prevention and Control of HIV/AIDS, and the unclear legal provisions of the new Civil Code play a significant role in this regard. Addressing this issue necessitates not only increasing societal tolerance toward PLHIV and reducing instances of social exclusion but also shifting the legal basis of disclosure duties from disease prevention to rights and obligations within the legal relationships of the parties involved. When it comes to the recipients of disclosure, for instance, it is crucial to differentiate between spouses and sexual partners. As for PLHIV failing to fulfill their disclosure duties, apart from interventions involving indirect notifications, the addition of further legal responsibilities may not be advisable. Intentional transmission actions, on the other hand, should still be subject to severe penalties. CLINICAL TRIAL NUMBER Not applicable.
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Affiliation(s)
- Ziyi Xie
- Macao Polytechnic University, Faculty of Humanities and Social Science, Macao, China
| | - Zhizhuang Duan
- Zhejiang Normal University, Xingzhi College, Jinhua, China.
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Sarwar G, Morshed Khan MN, Gourab G, Irfan SD, Rahman M, Rana AKMM, Khan SI. Can oral sex be performed safely among men who have sex with men (MSM) and transgender women in Bangladesh? Challenges, complexities and the way forward. Heliyon 2023; 9:e15553. [PMID: 37128302 PMCID: PMC10148115 DOI: 10.1016/j.heliyon.2023.e15553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 05/03/2023] Open
Abstract
Introduction There is currently ample research and intervention initiatives addressing anal sex and sexually transmitted infections (STIs) among gender and sexually diverse people (i.e., men who have sex with men (MSM) and transgender women). However, oral sex and oral STIs are not prioritized to the same extent, despite their concerning implications. This article aimed to delineate the underlying contexts of unprotected oral sex and the management challenges of oral STIs. Methodology This qualitative study constituted 30 in-depth interviews, 14 focus group discussions, and 10 key-informant interviews with gender and sexually diverse people, service providers of HIV interventions and sexuality researchers. Thematic analysis conventions were applied. Results Findings revealed various contexts of unprotected oral sex. In particular, we found a discordance between pleasure and protected sex where participants believed the two phenomena were mutually exclusive, therefore they did not want to compromise their pleasure by using condoms. Moreover, their low awareness, risk perception, and unchallenged misconceptions about the harms of unprotected oral sex fueled their hesitancy to use condoms during oral sex. Compared to anal sex and STIs, oral sex and STIs were less prioritized in the current HIV intervention modalities, where healthcare providers lacked adequate knowledge and training about oral sex and oral STIs, as well as their complexities. Conclusions In Bangladesh and several other settings, oral sex is considered a taboo, thus imbuing silence about this issue and its complexities. In this context, it is integral to eradicate the taboos and silence surrounding oral sex and oral STIs in order to strengthen the overall STI management strategy. Therefore, HIV/STI prevention programs and mainstream healthcare facilities need to underscore oral STI interventions, otherwise this issue would remain under-prioritized.
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Affiliation(s)
| | | | | | | | | | | | - Sharful Islam Khan
- Corresponding author. Head and Scientist Programme for HIV and AIDS Infectious Diseases Division, International Centre for Diarrhoeal Diseases Research, Bangladesh, 68 Shaheed Tajuddin Ahmed Avenue, Mohakhali, 1212 Dhaka, Bangladesh.
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5
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Hart TA, Noor SW, Tavangar F, Berlin GW, Skakoon-Sparling S, Tan DHS, Lambert G, Grace D, Jollimore J, Sang JM, Kirschbaum AL, Kanji R, Apelian H, Cox J, Moore DM, Lachowsky N. Crystal methamphetamine use and bacterial sexually transmitted infections (STIs) among gay, bisexual and other sexual minority men in Canada. Drug Alcohol Depend 2023; 242:109718. [PMID: 36516548 DOI: 10.1016/j.drugalcdep.2022.109718] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 11/17/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE While crystal methamphetamine use by gay, bisexual, and other men who have sex with men (GBM) is associated with increased risk for sexually transmitted infection (STI) transmission, less is understood about the causal pathways between crystal methamphetamine use and STIs. We examined whether the association between greater crystal methamphetamine risk and prevalent bacterial STI diagnosis among GBM was mediated by two types of attitudinal variables: attitudes toward condoms, and sexual escape motives, defined as the use of substances to escape self-awareness during sex, and by sexual behaviors. METHODS We used computer-assisted self-interview questionnaires from 2449 sexually active GBM (18% living with HIV; median age = 33, interquartile range, 27-45) recruited via respondent-driven sampling in Vancouver, Toronto, and Montreal, Canada. Using the baseline data from the Engage cohort study, we fit a series of structural mediation models of the associations between greater crystal methamphetamine risk and bacterial STI (syphilis, gonorrhea, and chlamydia) diagnosis. We estimated indirect paths from greater crystal methamphetamine risk, attitudes toward condoms, sexual escape motives, and sexual risk behaviors, adjusting for self-reported demographic variables. RESULTS In the mediated model, the direct association between greater crystal methamphetamine risk and bacterial STI diagnosis was non-significant; however, five indirect paths were significant. Greater crystal methamphetamine risk was associated with bacterial STIs via condom use attitudes and escape motives, which in turn were associated with number of male anal sex partners, condomless anal sex, and oral sex. DISCUSSION Public health and counselling interventions for GBM who use crystal methamphetamine and who are at higher risk for STIs should target evidence-based causal paths that consider sexual attitudes and sexual practices.
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Affiliation(s)
- Trevor A Hart
- Toronto Metropolitan University, Toronto, Canada; University of Toronto, Toronto, Canada.
| | - Syed W Noor
- Toronto Metropolitan University, Toronto, Canada; Louisiana State University Shreveport, Shreveport, LA, USA
| | - Farideh Tavangar
- Centre for Urban Health Solutions, St. Michael's Hospital, Canada
| | | | | | - Darrell H S Tan
- Centre for Urban Health Solutions, St. Michael's Hospital, Canada; Unity Health, Toronto, Ontario, Canada
| | - Gilles Lambert
- Institut national de santé publique du Québec, Montréal, QC, Canada; Direction régionale de santé publique - Montréal, Montréal, QC, Canada
| | | | - Jody Jollimore
- Community-Based Research Centre for Gay Men's Health, Vancouver, BC, Canada
| | - Jordan M Sang
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | | | - Rahim Kanji
- Toronto Metropolitan University, Toronto, Canada
| | | | - Joseph Cox
- Direction régionale de santé publique - Montréal, Montréal, QC, Canada; McGill University, Montreal, QC, Canada
| | - David M Moore
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Nathan Lachowsky
- University of Victoria, Victoria, BC, Canada; Canadian Institute for Substance Use Research, Victoria, BC, Canada
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6
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Hart TA, Noor SW, Berlin GW, Skakoon-Sparling S, Tavangar F, Tan D, Lambert G, Grace D, Lachowsky NJ, Jollimore J, Sang J, Parlette A, Lal A, Apelian H, Moore D, Cox J. Pre-exposure prophylaxis and bacterial sexually transmitted infections (STIs) among gay and bisexual men. Sex Transm Infect 2022; 99:167-172. [PMID: 35701145 PMCID: PMC10176373 DOI: 10.1136/sextrans-2021-055381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 05/14/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES While pre-exposure prophylaxis (PrEP) prevents HIV acquisition among gay, bisexual and other men who have sex with men (GBM), PrEP-using GBM may be more likely to engage in sexual behaviours associated with bacterial STIs. We examined associations between PrEP use, condomless anal sex (CAS), number of anal sex partners, oral sex and bacterial STI diagnoses among GBM living in Canada's three largest cities. METHODS Among HIV-negative/unknown-status GBM in the baseline of the Engage cohort study, we fit a structural equation model of the associations between any PrEP use, sexual behaviours and bacterial STI diagnosis. We estimated direct and indirect paths between PrEP use and STI via CAS, number of anal sex partners and oral sex. RESULTS The sample included 2007 HIV-negative/unknown status GBM in Montreal, Toronto and Vancouver. There was a significant direct association between PrEP use and current STI diagnosis (β=0.181; 95% CI: 0.112 to 0.247; p<0.001), CAS (β=0.275; 95% CI: 0.189 to 0.361; p<0.001) and number of anal sex partners (β=0.193; 95% CI: 0.161 to 0.225; p<0.001). In the mediated model, the direct association between PrEP use and STIs was non-significant. However, the indirect paths from PrEP to CAS to STIs (β=0.064; 95% CI: 0.025 to 0.120; p=0.008), and from PrEP to greater number of anal sex partners to CAS to STIs were significant (β=0.059; 95% CI: 0.024 to 0.108; p=0.007). CONCLUSIONS Our study adds to the growing awareness that PrEP use among GBM may be associated with bacterial STIs because PrEP users have more anal sex partners and are more likely to engage in CAS. The results underscore the importance of providing effective STI counselling and regular testing to PrEP users, adapting PrEP care and related STI testing to individual needs, and the need for effective prevention strategies for bacterial STIs.
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Affiliation(s)
- Trevor A Hart
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada .,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Syed W Noor
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada.,Department of Kinesiology and Health Science, Louisiana State University in Shreveport, Shreveport, Louisiana, USA
| | - Graham W Berlin
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | | | - Farideh Tavangar
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada.,Division of Infectious Diseases, St Michael's Hospital, Toronto, Ontario, Canada
| | - Darrell Tan
- Division of Infectious Diseases, St Michael's Hospital, Toronto, Ontario, Canada.,Centre for Urban Health Solutions, St Michael's Hospital, Toronto, Ontario, Canada
| | - Gilles Lambert
- Direction Régionale de Santé Publique, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal du Québec, Montreal, Quebec, Canada.,Direction des Risques Biologiques et de la Santé au Travail, Institut national de santé publique du Québec Montréal, Montreal, Quebec, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Nathan John Lachowsky
- School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada.,Community Based Research Centre, Vancouver, British Columbia, Canada
| | - Jody Jollimore
- Community Based Research Centre, Vancouver, British Columbia, Canada
| | - Jordan Sang
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Abbie Parlette
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - Allan Lal
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Herak Apelian
- Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - David Moore
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Joseph Cox
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montreal, Quebec, Canada.,Direction régionale de santé publique, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal du Québec, Montreal, Quebec, Canada
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7
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Blair CS, Needleman J, Javanbakht M, Comulada WS, Ragsdale A, Bolan R, Shoptaw S, Gorbach PM. Risk Behaviors Associated with Patterns of Sexualized Stimulant and Alcohol Use among Men Who Have Sex with Men: a Latent Class Analysis. J Urban Health 2022; 99:293-304. [PMID: 35028876 PMCID: PMC9033896 DOI: 10.1007/s11524-021-00600-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2021] [Indexed: 01/03/2023]
Abstract
Substance use during sexual encounters (sexualized substance use) is an important driver of HIV and sexually transmitted infection (STI) disparities that are experienced by men who have sex with men (MSM). This analysis aimed to identify patterns of sexualized substance use and their associations with HIV risk behaviors. We utilized visit-level data from a longitudinal cohort of predominantly Black/Latinx MSM, half with HIV and half with substance use in Los Angeles, California. Every 6 months from 8/2014 to 3/2020, participants underwent STI testing and completed surveys on demographics, sexualized substance use (stimulant and/or alcohol intoxication during oral sex, receptive anal intercourse [RAI] and/or insertive anal intercourse [IAI]), transactional sex, biomedical HIV prevention (pre-/post-exposure prophylaxis use or undetectable viral load), and depressive symptoms. Latent class analysis was used to identify patterns of sexualized substance use. Multinomial logit models evaluated risk behaviors associated with latent classes. Among 2386 study visits from 540 participants, 5 classes were identified: no substance use, sexualized stimulant use, sexualized alcohol use, sexualized stimulant and alcohol use, and stimulant/alcohol use during oral sex and RAI. Compared to the no sexualized substance use class, sexualized stimulant use was associated with transactional sex, current diagnosis of STIs, not using HIV biomedical prevention, and depressive symptoms. Sexualized alcohol use had fewer associations with HIV risk behaviors. Patterns of sexual activities, and the substances that are used during those activities, confer different risk behavior profiles for HIV/STI transmission and demonstrate the potential utility of interventions that combine substance use treatment with HIV prevention.
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Affiliation(s)
- Cheríe S Blair
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, 10833 LeConte Avenue, CHS 52-215, Los Angeles, CA, 90095, USA.
| | - Jack Needleman
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Marjan Javanbakht
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - W Scott Comulada
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Amy Ragsdale
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, 10833 LeConte Avenue, CHS 52-215, Los Angeles, CA, 90095, USA
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Robert Bolan
- Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, USA
| | - Steven Shoptaw
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Pamina M Gorbach
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, 10833 LeConte Avenue, CHS 52-215, Los Angeles, CA, 90095, USA
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
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Hermosa-Bosano C, Paz C, Hidalgo-Andrade P, Aguayo-Romero R. Sexual Behaviors and HIV/STI Prevention Strategies Among Sexual Minority Men in Ecuador Who Use Geosocial Networking Apps. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:3011-3021. [PMID: 34585282 PMCID: PMC8563564 DOI: 10.1007/s10508-021-02093-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 06/15/2021] [Accepted: 06/24/2021] [Indexed: 06/13/2023]
Abstract
Around the world, geosocial networking apps have become widely popular among sexual minority men (SMM). This research analyzed the sexual behaviors and HIV and STI prevention strategies (HIV/STI testing, HIV/STI inquiry, and HIV/STI disclosure) of an online-recruited sample of 284 SMM living in Ecuador. Sexting and oral sex were the most common sexual behaviors among SMM in the sample. Most participants had low perceptions of HIV and STI risk; 85% reported being tested for HIV and 70% for STIs. Being older predicted higher odds of being tested for either HIV or STIs at least once. Being single also predicted HIV testing. Future interventions in the country should explore apps' utility as intervention tools to spread information about sexual health and HIV prevention strategies, such as condom use and event-driven PrEP. Apps can also facilitate connections to sexual health services, including programs for PrEP initiation and linkage to HIV treatment. They should also focus on promoting sexual harm reduction conversations among potential app-met sexual partners.
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Affiliation(s)
- Carlos Hermosa-Bosano
- School of Psychology, Universidad de Las Américas, Redondel del Ciclista, Antigua Vía a Nayón, Campus UDLAPark, Quito, 170124, Ecuador.
| | - Clara Paz
- School of Psychology, Universidad de Las Américas, Redondel del Ciclista, Antigua Vía a Nayón, Campus UDLAPark, Quito, 170124, Ecuador
| | - Paula Hidalgo-Andrade
- School of Psychology, Universidad de Las Américas, Redondel del Ciclista, Antigua Vía a Nayón, Campus UDLAPark, Quito, 170124, Ecuador
| | - Rodrigo Aguayo-Romero
- Brigham and Women's Hospital, Harvard Medical School, The Fenway Institute, Boston, MA, USA
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9
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Ramoni S, Genovese G, Pastena A, Casazza G, Lunghi G, Marzano AV, Cusini M. Clinical and laboratory features of 244 men with primary syphilis: a 5-year single-centre retrospective study. Sex Transm Infect 2021; 97:479-484. [PMID: 33431607 DOI: 10.1136/sextrans-2020-054705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 12/13/2020] [Accepted: 12/22/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Syphilis incidence has exponentially increased in recent decades, particularly among men who have sex with men (MSM). Primary syphilis is characterised by a chancre appearing at the site of Treponema pallidum (TP) inoculation. Atypical morphological variants of syphilitic chancre are frequent. Clinical suspicion must be confirmed either by the demonstration of TP within the lesion through direct tests, such as dark field microscopy (DFM) or T. pallidum nucleic acid amplification technique (TP-NAAT), or by serological tests. OBJECTIVES To analyse the clinical features, the sexual behaviour and the role of diagnostic tests in a cohort of men with primary syphilis in Milan. METHODS Epidemiological, clinical and laboratory data of male patients with primary syphilis seen at the STI Center of the University of Milan between 2015 and 2019 were retrospectively evaluated. Diagnosis was confirmed by at least one positive diagnostic test of either DFM, TP-NAAT or serology. RESULTS Among a total of 244 patients, 160 (65.6%) were MSM and 32 (13.1%) were living with HIV. One hundred twenty-four (50.8%) patients had a clinically atypical chancre. Chancres were exclusively extragenital in 30 (12.3%) patients, with MSM being more commonly affected (MSM vs heterosexuals: 16.3% vs 4.8%, respectively; p=0.012), and anal region the most frequently involved site. Chancres were multiple in 68/242 (28.1%) patients and morphologically atypical in 76/244 (31.1%). Diagnosis was obtained by (1) both serology and direct methods in 158/244 patients (64.7%), (2) serology solely in 47/244 (19.3%) and (3) direct methods solely in 39/244 (16%). DFM yielded positive results in 83/139 (59.7%) patients, while TP-NAAT gave positive results in 114/121 (94.2%) patients. CONCLUSIONS Patients with primary syphilis frequently present with morphologically atypical chancres. Furthermore, MSM commonly exhibit extragenital involvement. A combined diagnostic approach including both direct and indirect tests is needed.
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Affiliation(s)
- Stefano Ramoni
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Genovese
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Andrea Pastena
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Casazza
- Department of Biomedical and Clinical Sciences "L. Sacco", Universita' degli Studi di Milano, Milan, Italy
| | - Giovanna Lunghi
- Microbiology and Virology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano Policlinico, Milan, Italy
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Marco Cusini
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Chow EPF, Maddaford K, Trumpour S, Fairley CK. Translating mouthwash use for gonorrhoea prevention into a public health campaign: identifying current knowledge and research gaps. Sex Health 2020; 16:433-441. [PMID: 31099331 DOI: 10.1071/sh18237] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 02/13/2019] [Indexed: 11/23/2022]
Abstract
The gonorrhoea rate among gay and bisexual men who have sex with men (MSM) has been increasing rapidly in many Western countries. Furthermore, gonorrhoea is becoming increasingly resistant to antibiotics and only limited options remain for treatment. Recent evidence suggests that the oropharynx may play an important role in gonorrhoea transmission. It is hypothesised that reducing the prevalence of oropharyngeal gonorrhoea will also reduce the population incidence of gonorrhoea. Mouthwash has been proposed as a novel non-antibiotic intervention to prevent oropharyngeal gonorrhoea; hence, reducing the probability of antibiotic resistance developing. However, its efficacy is yet to be confirmed by a randomised controlled trial - the findings of which will be available in 2019. If the trial shows mouthwash is effective in preventing gonorrhoea, this finding could potentially be translated into a public health campaign to increase the mouthwash use in the MSM population. This article summarises the current evidence of the effectiveness of mouthwash against gonorrhoea and discusses the potential literature gaps before implementing the mouthwash intervention at a population level.
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Affiliation(s)
- Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia; and Central Clinical School, Monash University, 99 Commercial Road, Melbourne, Vic. 3004, Australia; and Corresponding author.
| | - Kate Maddaford
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia
| | - Sabrina Trumpour
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia; and Central Clinical School, Monash University, 99 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia; and Central Clinical School, Monash University, 99 Commercial Road, Melbourne, Vic. 3004, Australia
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11
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Robbins SJ, Dauda W, Kokogho A, Ndembi N, Mitchell A, Adebajo S, Gaydos CA, Peel S, Ramadhani HO, Robb ML, Baral SD, Ake JA, Charurat ME, Crowell TA, Nowak RG. Oral sex practices among men who have sex with men and transgender women at risk for and living with HIV in Nigeria. PLoS One 2020; 15:e0238745. [PMID: 32886722 PMCID: PMC7473579 DOI: 10.1371/journal.pone.0238745] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/21/2020] [Indexed: 12/15/2022] Open
Abstract
Background Men who have sex with men (MSM) and transgender women (TGW) are at risk for sexually transmitted infections (STIs), including those of the oropharynx. We estimated the prevalence and factors associated with oral sex practices and characterized oropharyngeal STIs among a cohort of MSM and TGW in Nigeria. Methods From 2013 to 2018, TRUST/RV368 recruited MSM and TGW into HIV/STI diagnosis and treatment at community-based clinics in Nigeria. Participants who completed HIV testing and oral sex questions at enrollment were selected. Cross-sectional analyses with bivariate and multivariable logistic regression models estimated odds ratios (ORs) and 95% confidence intervals (CIs). Oropharyngeal swab testing for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) began in 2014 and for those with diagnostic results at enrollment, the unadjusted association of oral sex practices with oropharyngeal STIs was conducted. Results A total of 1342 participants had a median age of 25 years (interquartile range: 22–29), 58% were living with HIV, and 69% reported oral sex practices. Factors associated with increased odds of engaging in oral sex included living with HIV (adjusted [a]OR: 1.4, 95% CI: 1.1–1.8), self-identifying as a woman (aOR:1.8, 95% CI: 1.1–2.8), mobile phone ownership (aOR:2.3, 95% CI: 1.3–3.9), receptive anal sex (aOR:1.7, 95% CI:1.3–2.3) and multiple male sexual partners (2 to 4 vs. ≤1, aOR:1.5, 95% CI: 1.0–2.2; 5+ vs ≤1, aOR:2.9, 95% CI:1.9–4.3). Oropharyngeal STI prevalence was 7% (52/752) and higher among those who engaged in oral sex compared to those who did not (unadjusted OR: 2.5, 95% CI:1.2–5.3). Conclusions Oral sex was common and associated with an increased odds of oropharyngeal STIs among MSM and TGW from Nigeria. In the absence of screening and treatment guidelines, condoms continue to be the mainstay for oral STI prevention. A pre-exposure prophylaxis for bacterial STIs would complement current prevention strategies to curb transmission.
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Affiliation(s)
- Sarah J. Robbins
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Wuese Dauda
- Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Afoke Kokogho
- HJF Medical Research International, Abuja, Nigeria
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
| | - Nicaise Ndembi
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States of America
- Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Andrew Mitchell
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Sylvia Adebajo
- Maryland Global Initiatives Corporation- A University of Maryland Baltimore Affiliate, Abuja, Nigeria
| | - Charlotte A. Gaydos
- Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Sheila Peel
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
| | - Habib O. Ramadhani
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Merlin L. Robb
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States of America
| | - Stefan D. Baral
- Johns Hopkins School of Public Health, Baltimore, MD, United States of America
| | - Julie A. Ake
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
| | - Man E. Charurat
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Trevor A. Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States of America
| | - Rebecca G. Nowak
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States of America
- * E-mail:
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12
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Kabapy AF, Shatat HZ, Abd El-Wahab EW. Attributes of HIV infection over decades (1982-2018): A systematic review and meta-analysis. Transbound Emerg Dis 2020; 67:2372-2388. [PMID: 32396689 DOI: 10.1111/tbed.13621] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 05/03/2020] [Accepted: 05/05/2020] [Indexed: 01/19/2023]
Abstract
Understanding the risk factors for HIV infection is the foundation of successful preventive strategies, which must bundle sociocultural, behavioural and biomedical interventions to halt disease transmission. We aimed in this study to provide a pooled estimation of HIV risk factors and trace changes across decades in order to drive consensus and accurate assessment of disease transmission risk. We comprehensively searched PubMed, ISI Web of Knowledge, Medline, EMBASE, ScienceDirect, Ovid, EBSCO, Google Scholar and the Egyptian Universities Library Consortium from October to December 2018. Two independent reviewers extracted data from eligible studies. Funnel plots were inspected to identify publication bias. Heterogeneity across studies was checked using the Q and I2 statistics. The results were reported based on the pooled odds ratio (pOR) with 95% CI using a random-effects model. Meta-analysis of HIV risk factors revealed a superior role for risky sexual practices (unprotected vaginal/anal sex), injecting drug use (IDU), sharing needles, sexually transmitted infections (STIs), child sexual abuse and vertical transmissions. Trends across decades (1982-1999 and 2000-2018, respectively) showed rising evidence for prostitution [pOR (95% CI)= 2.3 (1.12-4.68) versus 2.69 (1.67-4.32)] and men who have sex with men (MSM) [pOR (95% CI)= 2.28 (1.64-3.17) versus 3.67 (1.88-7.17)], while transmission through IDU [pOR (95% CI)= 3.42 (2.28-5.12) versus 2.16 (1.74-2.70)], alcoholism [pOR (95% CI)= 2.35 (0.73-7.59) versus 1.71(1.08-2.72)], and sharing syringes [pOR (95% CI)= 6.10 (2.57-14.5) versus 2.70 (2.01-6.35)] showed notable decline. Harm reduction programs and condom use have been recognized as chief HIV prevention strategies, while male circumcision contributed a partial role. Collectively, sexual risk factors continue to be a key driver of the global HIV epidemic. Persistent and emerging risk factors identified in our analysis should constitute the forefront targets of HIV prevention programmes to accelerate efforts towards HIV elimination.
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Affiliation(s)
- Ahmed F Kabapy
- Fellow of Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt.,Department of Endemic and Infectious Diseases, Alexandria Fever Hospital, Alexandria, Egypt
| | - Hanan Z Shatat
- Department of Tropical Health, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Ekram W Abd El-Wahab
- Department of Tropical Health, High Institute of Public Health, Alexandria University, Alexandria, Egypt
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13
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Tymejczyk O, Jamison K, Pathela P, Braunstein S, Schillinger JA, Nash D. HIV Care and Viral Load Suppression After Sexual Health Clinic Visits by Out-of-Care HIV-Positive Persons. AIDS Patient Care STDS 2018; 32:390-398. [PMID: 30277815 DOI: 10.1089/apc.2018.0097] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Outcomes among people living with HIV (PLWH) in New York City (NYC) remain suboptimal. To assess the potential role of the city's sexual health clinics (SHCs) in improving HIV outcomes and reducing HIV transmission, we examined HIV care status and its correlates among HIV-positive SHC patients in NYC. Clinic electronic medical records were merged with longitudinal NYC HIV surveillance data to identify HIV-positive patients and derive their retrospective and prospective HIV care status. Evidence of HIV care and viral load suppression (VLS) after clinic visit were considered outcomes. Logistic regression models were used to assess their correlates. A third of the 1045 PLWH who visited NYC SHCs in 2012 were out of HIV care (OOC) in the 12 months preceding the clinic visit, and were less likely than those previously in HIV care (IC) to have subsequent evidence of HIV care (42% vs. 72%) or VLS in the 12 months after the visit (39% vs. 76%). VLS was particularly low among patients diagnosed with ≥2 sexually transmitted infections (46%). The odds of VLS were lowest among those OOC before the clinic visit [versus those IC, adjusted odds ratio (aOR): 0.21, 95% confidence interval (CI): 0.16-0.29], non-Hispanic blacks (versus non-Hispanic whites, aOR: 0.58, 95% CI: 0.37-0.90), and residents of high-poverty neighborhoods (>30% vs. <10%, aOR: 0.51, 95% CI: 0.29-0.89). Our findings suggest that SHCs could serve as an intervention point to (re-)link PLWH to HIV care. Real-time provider alerts about patients' OOC status could help achieve that goal.
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Affiliation(s)
- Olga Tymejczyk
- Institute of Implementation Science in Population Health, City University of New York, New York, New York
- Graduate School of Public Health and Health Policy, City University of New York, New York, New York
| | - Kelly Jamison
- Bureau of STD Prevention and Control, New York City Department of Health and Mental Hygiene, New York, New York
| | - Preeti Pathela
- Bureau of STD Prevention and Control, New York City Department of Health and Mental Hygiene, New York, New York
| | - Sarah Braunstein
- Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, New York, New York
| | - Julia A. Schillinger
- Bureau of STD Prevention and Control, New York City Department of Health and Mental Hygiene, New York, New York
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Denis Nash
- Institute of Implementation Science in Population Health, City University of New York, New York, New York
- Graduate School of Public Health and Health Policy, City University of New York, New York, New York
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14
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González-Baeza A, Dolengevich-Segal H, Pérez-Valero I, Cabello A, Téllez MJ, Sanz J, Pérez-Latorre L, Bernardino JI, Troya J, De La Fuente S, Bisbal O, Santos I, Arponen S, Hontañon V, Casado JL, Ryan P. Sexualized Drug Use (Chemsex) Is Associated with High-Risk Sexual Behaviors and Sexually Transmitted Infections in HIV-Positive Men Who Have Sex with Men: Data from the U-SEX GESIDA 9416 Study. AIDS Patient Care STDS 2018; 32:112-118. [PMID: 29620925 DOI: 10.1089/apc.2017.0263] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The magnitude of sexualized drug use (SDU), also known as chemsex, and its association with sexually transmitted infections (STI) has not been systematically explored in HIV-positive patients. This study aimed to calculate the prevalence of SDU and associated factors in a sample of HIV-positive men who have sex with men (MSM) in Spain. We calculated the frequency of SDU in a sample of HIV-positive MSM who responded to an anonymous online survey on sexual behavior and recreational drug use. We also analyzed differences between those who responded and those who did not (data taken from the physician's registry). The association between SDU, sexual risk behaviors, and STI was evaluated using a univariate and a multivariate analysis. Data were collected and managed using Research Electronic Data Capture (REDCap). The survey was completed by 742 HIV-positive MSM, of whom 60% had had unprotected anal intercourse (UAI), 62% had been diagnosed with a STI, and 216 (29.1%) reported recent SDU (slamsex in 16% of cases). In the multivariate analysis, patients who engaged in SDU were more likely to have had high-risk sexual behaviors and a diagnosis of STI than participants who did not engage in SDU. A diagnosis of hepatitis C was independently associated with slamsex (5.2 [95% confidence interval (CI), 2.06-13.13]; p < 0.001), chemsex (2.51 [95% CI, 1.28-4.91]; p = 0.007), and UAI (1.82 [95% CI, 0.90-3.70]; p = 0.094). The magnitude of SDU or chemsex in our sample is relatively high. We found a clear association between SDU, high-risk sexual behaviors, and STI including hepatitis C.
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Affiliation(s)
| | - Helen Dolengevich-Segal
- Dual Pathology Program, Henares University Hospital and Francisco de Vitoria University, Madrid, Spain
| | | | - Alfonso Cabello
- Infectious Diseases and HIV Unit, Fundación Jimenez Diaz, Madrid, Spain
| | - María Jesús Téllez
- Infectious Diseases and HIV Unit, Clínico San Carlos University Hospital, Madrid, Spain
| | - José Sanz
- Internal Medicine and HIV Unit, Alcala University Hospital, Madrid, Spain
| | - Leire Pérez-Latorre
- Infectious Diseases and HIV Unit, Gregorio Marañón University Hospital, Madrid, Spain
| | | | - Jesús Troya
- Internal Medicine Service, Infanta Leonor University Hospital, Madrid, Spain
| | - Sara De La Fuente
- Internal Medicine Department, Puerta de Hierro Research Institute and University Hospital, Madrid, Spain
| | - Otilia Bisbal
- HIV Unit, 12 de Octubre University Hospital, Madrid, Spain
| | - Ignacio Santos
- Infectious Diseases Unit, La Princesa University Hospital, Madrid, Spain
| | - Sari Arponen
- Internal Medicine, Torrejón Hospital, Madrid, Spain
| | | | - José Luis Casado
- Infectious Diseases and HIV Unit, Ramon y Cajal University Hospital, Madrid, Spain
| | - Pablo Ryan
- Internal Medicine Service, Infanta Leonor University Hospital, Madrid, Spain
- Medicine Department, Universidad Complutense de Madrid, Madrid, Spain
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