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van Wees D, Coyer L, van den Elshout M, de Coul EO, van Aar F. The Best Predictor of Future Behavior May Be the Past: Exploring Behavior Change in Men Who Have Sex with Men Using Pre-exposure Prophylaxis in the Netherlands. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:2777-2793. [PMID: 38709341 PMCID: PMC11219441 DOI: 10.1007/s10508-024-02863-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 02/01/2024] [Accepted: 03/26/2024] [Indexed: 05/07/2024]
Abstract
Pre-exposure prophylaxis (PrEP) use prevents HIV transmission, and may lead to changes in sexual behavior. We aimed to explore sexual behavior over time, and identify predictors of behavior change in men who have sex with men (MSM) using PrEP at sexual health centers (SHC) in the Netherlands. We used longitudinal data from the national STI surveillance database (January 2018-June 2021) of HIV-negative MSM who first initiated PrEP in the national PrEP pilot. We modelled behavior change after PrEP initiation, and identified predictors of behavior change using multi-state Markov models. The probability of stopping group sex, chemsex, use of poppers or erection stimulants, and having ≥ 10 partners in the past 6 months among included MSM (n = 4,349, n SHC visits = 21,820) was higher compared to the probability of starting with these behaviors after PrEP initiation. However, MSM who used condoms consistently during anal sex had a high probability of changing to inconsistent condom use (0.8) at the next visit, and inconsistent condom users mostly remained inconsistent (0.8). First visit, visiting the SHC more often (vs. regular), and STI diagnosis were predictors of starting or continuing with most of the behaviors associated with increased risk. Behavior change was less likely among older participants (> 34 compared to ≤ 34 years), and during COVID-19 lockdown and post-lockdown periods compared to pre-COVID-19. Although condom use decreased over time, transitions towards stopping with other behaviors associated with increased likelihood of acquiring an STI after PrEP initiation were common. This may suggest increased sexual empowerment, especially among younger MSM. Predictors of behavior change may help to identify MSM who are likely to start with or continue to engage in these behaviors in the near future and to provide suitable and timely counselling about behavior and PrEP adherence.
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Affiliation(s)
- Daphne van Wees
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), P.O Box 1, 3720 BA, Bilthoven, The Netherlands.
| | - Liza Coyer
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Mark van den Elshout
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Municipal Health Service for the Utrecht Region, Utrecht, The Netherlands
| | - Eline Op de Coul
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), P.O Box 1, 3720 BA, Bilthoven, The Netherlands
| | - Fleur van Aar
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), P.O Box 1, 3720 BA, Bilthoven, The Netherlands
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2
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Gibson LP, Kramer EB, Wrigley J, Probst M, Bryan AD. Gay community involvement and the sexual health behaviours of sexual minority men: a systematic review and directions for future research. Health Psychol Rev 2024; 18:299-318. [PMID: 37458157 DOI: 10.1080/17437199.2023.2236180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023]
Abstract
Considerable research has examined how involvement in gay-affiliated communities is associated with sexual health behaviours in sexual minority men (i.e., gay, bisexual, and other men who have sex with men), yet findings in this domain are often contradictory and inconclusive. This systematic review aimed to (a) synthesise the related empirical literature, and (b) identify potential factors driving inconsistent findings. Peer-reviewed publications were included if they contained quantitative data and at least one measure of the statistical association between gay community involvement and sexual health behaviour. The search strategy was implemented in six databases and returned 6,409 articles, of which 86 met the inclusion criteria. There was considerable heterogeneity in how gay community involvement was assessed across studies. Although gay community involvement was consistently associated with greater engagement in protective behaviours across studies, the association between gay community involvement and risk behaviours appeared to depend on how gay community involvement was conceptualised and measured (e.g., nightlife involvement vs. political activism). Findings emphasise a need for studies that employ validated measures that reflect the multidimensional nature of gay community involvement, as well as research designs better suited to address the causal effects of community involvement on HIV/STI transmission and prevention.
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Affiliation(s)
- Laurel P Gibson
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
| | - Emily B Kramer
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
| | - Jordan Wrigley
- Center for Data & Digital Scholarship, University Libraries, University of Colorado Boulder, Boulder, CO, USA
| | - Maxwell Probst
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
| | - Angela D Bryan
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
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3
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Broady TR, Chan C, MacGibbon J, Mao L, Prestage G, Clifton B, Paynter H, Bavinton BR, Holt M. Changing Characteristics of HIV-Positive Gay and Bisexual Men's Relationships in the Era of Biomedical Prevention. J Acquir Immune Defic Syndr 2023; 94:10-17. [PMID: 37195893 DOI: 10.1097/qai.0000000000003224] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 03/06/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVE To assess changes in personal and relationship characteristics among HIV-positive Australian gay and bisexual men (GBM) as rates of antiretroviral therapy and knowledge and confidence regarding the effectiveness of viral suppression in preventing HIV transmission have increased. DESIGN Repeated behavioral surveillance of GBM recruited from venues, events, and online in 7 Australian states and territories. METHODS HIV-positive participants were included. Trends in demographics, HIV treatment, and relationship characteristics were assessed with binary and multivariable logistic regression. RESULTS A total of 3643 survey responses (2016-2020) were included. Over time, HIV-positive GBM became less likely to identify as gay or report an Anglo-Australian ethnicity. The average length of time since HIV diagnosis increased and the frequency of attending HIV-related clinical appointments decreased. There were no changes in the reported number of recent sex partners or proportion reporting regular male partners over time. Among HIV-positive GBM in relationships, the proportion reporting HIV-positive partners decreased and the proportion reporting HIV-negative partners increased. Levels of condomless sex with regular partners increased over time; however, this was concentrated among HIV-positive GBM in serodiscordant relationships. CONCLUSION Findings suggest that increased accessibility and trust in biomedical prevention strategies have contributed to broader relationship and sexual opportunities for HIV-positive GBM in Australia. Our findings suggest that future health promotion activities could highlight the social and relationship benefits of treatment as prevention to further increase trust in it as an HIV prevention strategy among GBM.
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Affiliation(s)
- Timothy R Broady
- Centre for Social Research in Health, UNSW, Sydney, NSW, Australia
| | - Curtis Chan
- Kirby Institute, UNSW, Sydney, NSW, Australia
| | - James MacGibbon
- Centre for Social Research in Health, UNSW, Sydney, NSW, Australia
| | - Limin Mao
- Centre for Social Research in Health, UNSW, Sydney, NSW, Australia
| | | | - Brent Clifton
- National Association of People With HIV Australia, Sydney, NSW, Australia; and
| | | | | | - Martin Holt
- Centre for Social Research in Health, UNSW, Sydney, NSW, Australia
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4
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Dowell-Day A, Dobbins T, Chan C, Fraser D, Holt M, Vaccher SJ, Clifton B, Zablotska I, Grulich A, Bavinton BR. Attitudes Towards Treatment as Prevention Among PrEP-Experienced Gay and Bisexual Men in Australia. AIDS Behav 2023:10.1007/s10461-023-04019-x. [PMID: 36877254 PMCID: PMC10386911 DOI: 10.1007/s10461-023-04019-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2023] [Indexed: 03/07/2023]
Abstract
The introduction of HIV pre-exposure prophylaxis (PrEP) has the potential to impact the attitudes gay and bisexual men (GBM) who consequently choose to take PrEP have towards treatment as prevention (TasP), and the extent to which they are willing to have condomless anal intercourse (CLAI) with an HIV-positive sexual partner who has an undetectable viral load (UVL). Using a cross-sectional sample from an observational cohort study conducted from August 2018 to March 2020, we examined the extent to which PrEP-experienced GBM are willing to have CLAI with a partner who has a UVL. Simple and multiple logistic regression models were used to identify associated variables. Of the 1386 participants included in the analyses, 79.0% believed in the effectiveness of TasP, and 55.3% were willing to have CLAI with a partner who has a UVL. Wiling participants were less worried about getting HIV when taking PrEP and more likely to believe in TasP. Further research is needed to better understand the gap between belief in TasP and willingness to have CLAI with a partner who has a UVL among PrEP-experienced GBM.
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Affiliation(s)
- Alexander Dowell-Day
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
| | - Timothy Dobbins
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
| | - Curtis Chan
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Doug Fraser
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | | | - Brent Clifton
- National Association of People with HIV Australia, Newtown, NSW, Australia
| | - Iryna Zablotska
- Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Westmead, Australia.,Sydney Infectious Diseases Institute, University of Sydney, Westmead, Australia.,Western Sydney Sexual Health Centre, Western Sydney Local Health District, Parramatta, Australia
| | - Andrew Grulich
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
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5
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Curley CM, Rosen AO, Mistler CB, Eaton LA. Pleasure and PrEP: A Systematic Review of Studies Examining Pleasure, Sexual Satisfaction, and PrEP. JOURNAL OF SEX RESEARCH 2022; 59:848-861. [PMID: 35089110 PMCID: PMC9329484 DOI: 10.1080/00224499.2021.2012638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Pre-exposure prophylaxis (PrEP) is an effective form of Human Immunodeficiency Virus (HIV) prevention for people at potential risk for exposure. Despite its demonstrated efficacy, PrEP uptake and adherence have been discouraging, especially among groups most vulnerable to HIV transmission. A primary message to persons who are at elevated risk for HIV has been to focus on risk reduction, sexual risk behaviors, and continued condom use, rarely capitalizing on the positive impact on sexuality, intimacy, and relationships that PrEP affords. This systematic review synthesizes the findings and themes from 16 quantitative, qualitative, and mixed methods studies examining PrEP motivations and outcomes focused on sexual satisfaction, sexual pleasure, sexual quality, and sexual intimacy. Significant themes emerged around PrEP as increasing emotional intimacy, closeness, and connectedness; PrEP as increasing sexual options and opportunities; PrEP as removing barriers to physical closeness and physical pleasure; and PrEP as reducing sexual anxiety and fears. It is argued that positive sexual pleasure motivations should be integrated into messaging to encourage PrEP uptake and adherence, as well as to destigmatize sexual pleasure and sexual activities of MSM.
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Affiliation(s)
- Christine M. Curley
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
- The first two authors are co-authors on this manuscript, as they contributed equally to design and analyses
| | - Aviana O. Rosen
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
- The first two authors are co-authors on this manuscript, as they contributed equally to design and analyses
| | - Colleen B. Mistler
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | - Lisa A. Eaton
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
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6
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Sudarto B, Chow EPF, Medland N, Fairley CK, Wright EJ, Armishaw J, Price B, Phillips TR, Ong JJ. "How PrEPared are you?": Knowledge of and attitudes toward PrEP among overseas-born and newly arrived gay, bisexual, and other men who have sex with men in Australia. Front Public Health 2022; 10:946771. [PMID: 36062118 PMCID: PMC9437584 DOI: 10.3389/fpubh.2022.946771] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 07/22/2022] [Indexed: 01/21/2023] Open
Abstract
Introduction Overseas-born and newly arrived gay and bisexual men and men who have sex with men (GBMSM) are at higher risk of acquiring HIV in comparison to Australian-born GBMSM. Pre-exposure prophylaxis (PrEP) is subsidized by the Australian government under Medicare, Australia's universal health insurance scheme, however many members of this population are Medicare-ineligible, which could prevent them from accessing PrEP. We wanted to explore participants' knowledge of and attitudes toward PrEP and their opinions of new PrEP modalities, namely injectable PrEP and PrEP implants. Methods We conducted in-depth qualitative interviews between February 2021 to September 2021 with 22 overseas-born, newly arrived (<5 years in Australia) GBMSM of varying PrEP use. We asked their opinions of PrEP and their preferences of new PrEP modalities. Interviews were audio recorded and transcribed verbatim. We conducted a reflexive thematic analysis to interpret the data. Results Participants' views reflect the intersections between systemic factors, such as Medicare ineligibility and the high cost of PrEP, with socio-cultural factors, such as lack of knowledge about PrEP, internalized stigma stemming from homo- and sex-negativity, and stigmatizing attitudes toward PrEP and PrEP users. For participants who were on PrEP, being community connected, having a positive relationship with doctors and nurses, and being informed of the option to purchase PrEP from overseas pharmacies at a low cost helped them to overcome some of these barriers. Additionally, there was a strong preference for injectable PrEP but not PrEP implants. Participants stressed the importance of providing a comprehensive information about PrEP specific to this population and to make PrEP free for all. Conclusions We concluded that resources about PrEP specific to this population that address both systemic and socio-cultural factors are needed, and for these resources to be available in languages other than English. This is to coincide with on-going advocacy to increase the capacity of publicly funded sexual health clinics to provide multilingual PrEP services for people without Medicare, and to make PrEP free for all. These combined strategies have the potential to increase PrEP knowledge and uptake among this population.
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Affiliation(s)
- Budiadi Sudarto
- Central Clinical School, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, VIC, Australia,*Correspondence: Budiadi Sudarto
| | - Eric P. F. Chow
- Central Clinical School, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, VIC, Australia,Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Nicholas Medland
- Central Clinical School, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, VIC, Australia,Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia,The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Christopher K. Fairley
- Central Clinical School, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, VIC, Australia,Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
| | - Edwina J. Wright
- The Burnet Institute, Melbourne, VIC, Australia,The Peter Doherty Institute for Infection and Immunity, University of Melbourne and the Royal Melbourne Hospital, Melbourne, VIC, Australia,Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, VIC, Australia
| | - Jude Armishaw
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, VIC, Australia
| | - Brian Price
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, VIC, Australia
| | - Tiffany R. Phillips
- Central Clinical School, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, VIC, Australia,Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
| | - Jason J. Ong
- Central Clinical School, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, VIC, Australia,Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
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7
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Coyer L, Prins M, Davidovich U, van Bilsen WP, Schim van der Loeff MF, Hoornenborg E, Matser A, Boyd A. Trends in Sexual Behavior and Sexually Transmitted Infections After Initiating Human Immunodeficiency Virus Pre-Exposure Prophylaxis in Men Who Have Sex with Men from Amsterdam, the Netherlands: A Longitudinal Exposure-Matched Study. AIDS Patient Care STDS 2022; 36:208-218. [PMID: 35687814 PMCID: PMC9242711 DOI: 10.1089/apc.2021.0219] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Men who have sex with men (MSM) initiating human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) may increase condomless anal sex (CAS) and number of partners, and, consequently, more often acquire sexually transmitted infections (STIs). Using data from the Amsterdam Cohort Studies, we compared sexual behavior and STI among MSM after PrEP-initiation with controls not initiating PrEP. The MSM reported on sexual behavior and were tested for HIV, chlamydia, gonorrhea, and syphilis semi-annually. We matched MSM who initiated PrEP between January 1, 2015 and December 31, 2019 1:1 to MSM who did not use time-dependent propensity scores based on age, sexual behavior, and STI. Primary end-points were number of casual partners, and proportion with CAS and receptive CAS (rCAS) with casual partners, sexualized drug use (SDU), any STI, and anal STI. We modeled end-points during the 4 years before and 2 years after PrEP-initiation or matched PrEP-initiation timepoint by using logistic regression (dichotomous end-points) or negative binomial regression (count end-point), adjusted for calendar year. Two hundred twenty-eight out of the 858 (26.6%) MSM initiated PrEP. We matched 198 out of 228 (86.8%) to a control. Before PrEP-initiation, end-points increased over time in both groups, with no statistically significant difference. The odds of CAS, rCAS, and anal STI were on average higher after than before PrEP-initiation in PrEP initiators, whereas after versus before differences were not observed in controls. After PrEP-initiation, PrEP initiators had statistically significantly more casual partners, and higher odds of CAS, rCAS, SDU, any STI, and anal STI than controls. These findings support frequent STI screening and counseling in MSM using PrEP.
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Affiliation(s)
- Liza Coyer
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands.,Department of Infectious Diseases, Amsterdam Institute for Infection & Immunity (AII), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Address correspondence to: Liza Coyer, MSc, Department of Infectious Diseases, Public Health Service of Amsterdam, Nieuwe Achtergracht 100, Amsterdam 1018 WT, the Netherlands
| | - Maria Prins
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands.,Department of Infectious Diseases, Amsterdam Institute for Infection & Immunity (AII), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Udi Davidovich
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands.,Department of Social Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Ward P.H. van Bilsen
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Maarten F. Schim van der Loeff
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands.,Department of Infectious Diseases, Amsterdam Institute for Infection & Immunity (AII), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Elske Hoornenborg
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Amy Matser
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands.,Department of Infectious Diseases, Amsterdam Institute for Infection & Immunity (AII), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Anders Boyd
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands.,Stichting HIV Monitoring, Amsterdam, the Netherlands
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8
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Van Dijk M, De Wit JBF, Guadamuz TE, Martinez JE, Jonas KJ. Quality of Sex Life and Perceived Sexual Pleasure of PrEP Users in the Netherlands. JOURNAL OF SEX RESEARCH 2022; 59:303-308. [PMID: 34128741 DOI: 10.1080/00224499.2021.1931653] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Next to its benefits for HIV prevention, PrEP may have psychosocial benefits relating to improved quality of sex life. The aim of the current study was to investigate the onset of changes in the quality of sex life and sexual pleasure of PrEP users in the first months of commencing PrEP use. Moreover, we investigated what factors were related to the quality of sex life of PrEP users. We recruited 145 participants via the Dutch PrEP-advocacy website PrEPnu.nl, and they received follow-up questionnaires after three and six months. We found that PrEP users reported an increase in the quality of their sex life, which was related to reduced fear of HIV since they started using PrEP but not to decreased condom use. PrEP users were more interested in experimenting with sex practices, but they did not always feel more desirable as a sex partner because of PrEP use. Health-care providers and health promotion campaigns could emphasize the positive effects of PrEP on the quality of sex life, in addition to the HIV-preventive effects of PrEP, to decrease PrEP stigma and increase PrEP uptake.
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Affiliation(s)
- Mart Van Dijk
- Department of Work & Social Psychology, Maastricht University
| | - John B F De Wit
- Department of Interdisciplinary Social Science, Utrecht University
| | | | | | - Kai J Jonas
- Department of Work & Social Psychology, Maastricht University
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9
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COVID-19 Vaccine Uptake and Its Impacts in a Cohort of Gay and Bisexual Men in Australia. AIDS Behav 2022; 26:2692-2702. [PMID: 35132480 PMCID: PMC8821860 DOI: 10.1007/s10461-022-03611-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2022] [Indexed: 11/21/2022]
Abstract
Successful use of biomedical forms of HIV risk-reduction may have predisposed many gay and bisexual men (GBM) to vaccination against COVID-19, which may, in turn, affect their sexual behavior. A total of 622 Australian GBM provided weekly data on COVID-19 vaccination history and sexual behaviour between 17 January 2021 and 22 June 2021. We identify factors associated with COVID-19 vaccination, and compare sexual behavior before and since vaccination. Mean age was 47.3 years (SD 14.0). At least one-dose vaccination coverage had reached 57.2%, and 61.3% reported that the majority of their friends intended to be vaccinated. Vaccinated men reported a mean of 1.11 (SD 2.10) weekly non-relationship sex partners before vaccination and 1.62 (SD 3.42) partners following vaccination. GBM demonstrated high confidence in COVID-19 vaccines. Their sexual activity increased following vaccination suggesting that greater sexual freedom may be a specific motivation for vaccine uptake among some men.
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10
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Basten MGJ, van Wees DA, Matser A, Boyd A, Rozhnova G, den Daas C, Kretzschmar MEE, Heijne JCM. Time for change: Transitions between HIV risk levels and determinants of behavior change in men who have sex with men. PLoS One 2021; 16:e0259913. [PMID: 34882698 PMCID: PMC8659368 DOI: 10.1371/journal.pone.0259913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 10/28/2021] [Indexed: 11/23/2022] Open
Abstract
As individual sexual behavior is variable over time, the timing of interventions might be vital to reducing HIV transmission. We aimed to investigate transitions between HIV risk levels among men who have sex with men (MSM), and identify determinants associated with behavior change. Participants in a longitudinal cohort study among HIV-negative MSM (Amsterdam Cohort Studies) completed questionnaires about their sexual behavior during biannual visits (2008-2017). Visits were assigned to different HIV risk levels, based on latent classes of behavior. We modelled transitions between risk levels, and identified determinants associated with these transitions at the visit preceding the transition using multi-state Markov models. Based on 7,865 visits of 767 participants, we classified three risk levels: low (73% of visits), medium (22%), and high risk (5%). For MSM at low risk, the six-month probability of increasing risk was 0.11. For MSM at medium risk, the probability of increasing to high risk was 0.08, while the probability of decreasing to low risk was 0.33. For MSM at high risk, the probability of decreasing risk was 0.43. Chemsex, erection stimulants and poppers, high HIV risk perception, and recent STI diagnosis were associated with increased risk at the next visit. High HIV risk perception and young age were associated with decreasing risk. Although the majority of MSM showed no behavior change, a considerable proportion increased HIV risk. Determinants associated with behavior change may help to identify MSM who are likely to increase risk in the near future and target interventions at these individuals, thereby reducing HIV transmission.
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Affiliation(s)
- Maartje G. J. Basten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Daphne A. van Wees
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Amy Matser
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Anders Boyd
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Stichting HIV Monitoring, Amsterdam, The Netherlands
| | - Ganna Rozhnova
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- BioISI – Biosystems & Integrative Sciences Institute, Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal
| | - Chantal den Daas
- Center for Infectious Diseases Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Aberdeen Health Psychology Group, Institute of Applied Health Sciences, Aberdeen, Scotland
| | - Mirjam E. E. Kretzschmar
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Janneke C. M. Heijne
- Center for Infectious Diseases Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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11
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Bavinton BR, Hammoud MA, Holt M, Saxton P, Bourne A, MacGibbon J, Jin F, Maher L, Prestage GP. Changes in Sexual Behaviour Following PrEP Initiation Among Australian Gay and Bisexual Men in Relationships: Results from a Prospective Observational Study. AIDS Behav 2021; 25:3704-3711. [PMID: 33782881 DOI: 10.1007/s10461-021-03232-w] [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] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
Few studies have examined changes in sexual behaviour following HIV pre-exposure prophylaxis (PrEP) initiation among gay, bisexual and other men who have sex with men (GBM) in relationships. In a national, online, prospective study of GBM in Australia, we compared sexual behaviours prior to and after PrEP initiation among HIV-negative and unknown-HIV-status men (recruited 2014-2017) not taking PrEP at baseline and who completed at least one six-monthly follow-up by July 2018. Among men in relationships who did not initiate PrEP (n = 339), we compared their most recent survey to their prior one, while among men in relationships who initiated PrEP (n = 81), we compared follow-ups before and after PrEP initiation. Among the 81 PrEP-initiators who were in a relationship both before and after initiation, the proportion reporting their regular partner was on PrEP increased from 8.3 to 44.4% (p < 0.001) and the proportion reporting receptive CLAIC increased from 27.2 to 44.4% (p = 0.009). Overall, men who initiated PrEP were more likely to be in a relationship with a partner on PrEP, and it appeared they started PrEP around the same time. Receptive CLAIC also became more common.
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12
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Razmjou S, Charest M, O’Byrne P, MacPherson P. Pre-Exposure Prophylaxis Among Gay, Bisexual, and Other Men Who Have Sex With Men in Ottawa: A Real World View With Benefits Beyond HIV Risk Reduction. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2021; 34:105-117. [PMID: 38595688 PMCID: PMC10903656 DOI: 10.1080/19317611.2021.1946731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 05/04/2021] [Accepted: 06/15/2021] [Indexed: 04/11/2024]
Abstract
The number of gay, bisexual, and other men who have sex with men taking pre-exposure prophylaxis (PrEP) has grown since its approval in Canada. While there are sound clinical data on PrEP efficacy, there is less research describing outcomes in routine clinical practice. We conducted a cross-sectional study with 113 men attending our PrEP clinic. Participants completed a one-time survey and chart reviews were conducted. We found that men in our clinic were educated and affluent. While PrEP did not lead to more reported sexual partners, condom use declined, as did sexual anxiety. These results reinforce that PrEP benefits extend beyond HIV prevention.
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Affiliation(s)
- Sahar Razmjou
- Clinical Epidemiology and Chronic Diseases Programs, The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Maxime Charest
- Clinical Epidemiology and Chronic Diseases Programs, The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Patrick O’Byrne
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Paul MacPherson
- Clinical Epidemiology and Chronic Diseases Programs, The Ottawa Hospital Research Institute, Ottawa, Canada
- Division of Infectious Diseases, The Ottawa Hospital, Ottawa, Canada
- Department of Medicine and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
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Grov C, Westmoreland DA, D’Angelo AB, Pantalone DW. How Has HIV Pre-Exposure Prophylaxis (PrEP) Changed Sex? A Review of Research in a New Era of Bio-behavioral HIV Prevention. JOURNAL OF SEX RESEARCH 2021; 58:891-913. [PMID: 34180743 PMCID: PMC9729849 DOI: 10.1080/00224499.2021.1936440] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
In 2012, the U.S. FDA approved the first drug for use as HIV Pre-Exposure Prophylaxis (PrEP), which is nearly 99% effective when taken as prescribed. Although the manifest function of PrEP is to prevent HIV infection in the event of exposure, the drug has also had a significant impact on various facets of sexuality. In this review, we focus on research that emerged in the near decade since PrEP's approval, with a specific focus on the ways in which different elements of sex and sexuality have been impacted by gay, bisexual, and other men who have sex with men (GBMSM), cisgender women, and transgender individuals. We highlight evidence showing how PrEP has enhanced sexual self-esteem, improved sexual pleasure, reduced sexual anxiety, and has increased sexual agency for those taking it. For many, PrEP also serves as a gateway to improve routine health and increase sexual health-care utilization. Additionally, we review the question of whether PrEP is associated with increased sexual risk taking (i.e. risk compensation), and note that, although some data are mixed, PrEP is not intended as an intervention to reduce condomless anal sex or STIs: it aims to prevent HIV. Finally, our review highlights that, although the volume of research on PrEP among GBMSM is robust, it is underdeveloped for cisgender women and transgender populations and insufficient for inclusion in such a review for cisgender heterosexual men was. PrEP research with these populations is an important direction for future research. Finally, from 2012 to 2019, a single PrEP formulation and delivery method was FDA approved (oral emtricitabine/tenofovir disoproxil fumarate). As additional drug formulations (ie.g., emtricitabine/tenofovir alafenamide) and delivery methods (e.g., microbiocides, vaginal ring, injectable) come to market, it will be important to examine how these, too, impact the spectrum of sexuality.
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Affiliation(s)
- Christian Grov
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, NY
- CUNY Institute for Implementation Science in Population Health, New York, NY
| | | | - Alexa B. D’Angelo
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, NY
- CUNY Institute for Implementation Science in Population Health, New York, NY
| | - David W. Pantalone
- Department of Psychology, University of Massachusetts Boston
- The Fenway Institute, Fenway Health, Boston, MA
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Socio-Sexual Experiences and Access to Healthcare Among Informal PrEP Users in the Netherlands. AIDS Behav 2021; 25:1236-1246. [PMID: 33196938 PMCID: PMC7973587 DOI: 10.1007/s10461-020-03085-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2020] [Indexed: 10/25/2022]
Abstract
The aim of this qualitative study was to explore the experiences of informal PrEP users regarding access to PrEP and PrEP-related healthcare, community responses, sexual behavior and well-being. We interviewed 30 men who have sex with men (MSM) in semi-structured online interviews between March and August 2018. Interviews were analyzed using interpretive description. Informal PrEP users were well informed about the use of PrEP, but sometimes did not make use of renal testing. Participants reported a lack of PrEP knowledge among healthcare providers, which limited their access to PrEP and put them at risk, as they received incorrect information. Although some participants reported negative reactions from potential sex partners, most received positive reactions and were sometimes seen as more desirable sex partners. PrEP healthcare services should not only be accessible to formal PrEP users, but also to PrEP users who procure PrEP informally.
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15
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Sexual Behaviors After PrEP Discontinuation Among HIV Serodiscordant Couples in Kenya and Uganda. J Acquir Immune Defic Syndr 2021; 85:174-181. [PMID: 32658130 PMCID: PMC7495981 DOI: 10.1097/qai.0000000000002434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is Available in the Text. A strategy of pre-exposure prophylaxis (PrEP) transitioning to treatment as prevention is highly efficacious and cost effective for prevention of HIV transmission within HIV serodiscordant couples. We assessed whether couples who adopted this strategy experienced changes in sexual behaviors after HIV-negative partners discontinued PrEP and transitioned to rely primarily on their partner's adherence to antiretroviral therapy (ART) for prevention.
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16
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Wong IKJ, Poynten IM, Cornall A, Templeton DJ, Molano M, Garland SM, Fairley CK, Law C, Hillman RJ, Polizzotto MN, Grulich AE, Jin F. Sexual behaviours associated with incident high-risk anal human papillomavirus among gay and bisexual men. Sex Transm Infect 2021; 98:101-107. [PMID: 33727339 PMCID: PMC8862078 DOI: 10.1136/sextrans-2020-054851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 01/18/2021] [Accepted: 02/24/2021] [Indexed: 02/03/2023] Open
Abstract
Objective High-risk human papillomavirus (HRHPV) causes anal cancer, which disproportionately affects gay and bisexual men (GBM). We examined sexual behaviours associated with incident anal HRHPV in an observational cohort study of GBM in Sydney, Australia. Methods GBM aged 35 years and above were enrolled in the Study of the Prevention of Anal Cancer. Detailed information on sexual practices in the last 6 months, including receptive anal intercourse (RAI) and non-intercourse receptive anal practices, was collected. Anal human papillomavirus (HPV) testing was performed at the baseline and three annual follow-up visits. Risk factors for incident HRHPV were determined by Cox regression using the Wei-Lin-Weissfeld method. Results Between 2010 and 2015, 617 men were recruited and 525 who had valid HPV results at baseline and at least one follow-up visit were included in the analysis. The median age was 49 years (IQR 43–56) and 188 (35.8%) were HIV-positive. On univariable analysis, incident anal HRHPV was associated with being HIV-positive (p<0.001), having a higher number of recent RAI partners regardless of condom use (p<0.001 for both), preference for the receptive position during anal intercourse (p=0.014) and other non-intercourse receptive anal sexual practices, including rimming, fingering and receptive use of sex toys (p<0.05 for all). In multivariable analyses, being HIV-positive (HR 1.46, 95% CI 1.09 to 1.85, p=0.009) and reporting condom-protected RAI with a higher number of sexual partners (p<0.001) remained significantly associated with incident HRHPV. When stratified by recent RAI, non-intercourse receptive anal practices were not associated with incident HRHPV in men who reported no recent RAI. Conclusion GBM living with HIV and those who reported RAI were at increased of incident anal HRHPV. Given the substantial risk of anal cancer and the difficulty in mitigating the risk of acquiring anal HRHPV, HPV vaccination should be considered among sexually active older GBM. Trial registration number ANZCTR365383.
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Affiliation(s)
- Ian K J Wong
- The Kirby Insitute, UNSW Sydney, Sydney, New South Wales, Australia
| | | | - Alyssa Cornall
- Department of Obstetrics and Gynaecology, University of Melbourne, Infection & Immunity, The Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Centre for Women's Infectious Disease, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - David J Templeton
- The Kirby Insitute, UNSW Sydney, Sydney, New South Wales, Australia.,Department of Sexual Health and Sexual Assault Medicine, Sydney Local Health District, Camperdown, New South Wales, Australia.,Discipline of Medicine, Central Clincal School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Monica Molano
- Centre for Women's Infectious Disease, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Suzanne M Garland
- Department of Obstetrics and Gynaecology, University of Melbourne, Infection & Immunity, The Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Centre for Women's Infectious Disease, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | | | - Carmella Law
- HIV and Immunology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Richard J Hillman
- HIV and Immunology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | | | - Andrew E Grulich
- The Kirby Insitute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Fengyi Jin
- The Kirby Insitute, UNSW Sydney, Sydney, New South Wales, Australia
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17
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Marcus U, Mirandola M, Schink SB, Gios L, Schmidt AJ. Changes in the prevalence of self-reported sexually transmitted bacterial infections from 2010 and 2017 in two large European samples of men having sex with men-is it time to re-evaluate STI-screening as a control strategy? PLoS One 2021; 16:e0248582. [PMID: 33720969 PMCID: PMC7959389 DOI: 10.1371/journal.pone.0248582] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 03/02/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND/OBJECTIVES Many European countries reported increased numbers of syphilis, gonorrhoea and chlamydia diagnoses among men who have sex with men (MSM) in recent years. Behaviour changes and increased testing are thought to drive these increases. METHODS In 2010 and 2017, two large online surveys for MSM in Europe (EMIS-2010, EMIS-2017) collected self-reported data on STI diagnoses in the previous 12 months, diagnostic procedures, STI symptoms when testing, number of sexual partners, and sexual behaviours such as condom use during the last intercourse with a non-steady partner in 46 European countries. Multivariate regression models were used to analyse factors associated with diagnoses of syphilis, gonorrhoea/chlamydia, and respective diagnoses classified as symptomatic and asymptomatic. If applicable, they included country-level screening rates. RESULTS Questions on STI diagnoses and sexual behaviours were answered by 156,018 (2010) and 125,837 (2017) participants. Between 2010 and 2017, overall diagnoses with gonorrhoea/chlamydia and syphilis increased by 76% and 83% across countries. Increases were more pronounced for asymptomatic compared to symptomatic infections. The proportion of respondents screened and the frequency of screening grew considerably. Condomless anal intercourse with the last non-steady partner rose by 62%; self-reported partner numbers grew. Increased syphilis diagnoses were largely explained by behavioural changes (including more frequent screening). Gonorrhoea/chlamydia increases were mainly explained by more screening and a change in testing performance. A country variable representing the proportion of men screened for asymptomatic infection was positively associated with reporting symptomatic gonorrhoea/chlamydia, but not syphilis. DISCUSSION/CONCLUSION The positive association of country-level screening rates with the proportion of symptomatic infections with gonorrhoea/chlamydia may indicate a paradoxical effect of screening on incidence of symptomatic infections. Treatment of asymptomatic men might render them more susceptible to new infections, while spontaneous clearance may result in reduced susceptibility. Before expanding screening programmes, evidence of the effects of screening and treatment is warranted.
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Affiliation(s)
- Ulrich Marcus
- Department for Infectious Diseases Epidemiology, Robert Koch Institute, Berlin, Germany
- * E-mail:
| | - Massimo Mirandola
- Department of Diagnostics and Public Health, Infectious Diseases Section, University of Verona, Verona, Italy
| | - Susanne B. Schink
- Department for Infectious Diseases Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Lorenzo Gios
- Department of Diagnostics and Public Health, Infectious Diseases Section, University of Verona, Verona, Italy
| | - Axel J. Schmidt
- Sigma Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Division of Infectious Diseases, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
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18
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McDaid L, Flowers P, Ferlatte O, Young I, Patterson S, Gilbert M. Sexual health literacy among gay, bisexual and other men who have sex with men: a conceptual framework for future research. CULTURE, HEALTH & SEXUALITY 2021; 23:207-223. [PMID: 32118515 DOI: 10.1080/13691058.2019.1700307] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 11/29/2019] [Indexed: 06/10/2023]
Abstract
Good sexual health requires navigating intimate relationships within diverse power dynamics and sexual cultures, coupled with the complexities of increasing biomedicalisation of sexual health. Understanding this is important for the implementation of biomedical HIV prevention. We propose a socially nuanced conceptual framework for sexual health literacy developed through a consensus building workshop with experts in the field. We use rigorous qualitative data analysis to illustrate the functionality of the framework by reference to two complementary studies. The first collected data from five focus groups (FGs) in 2012 (n = 22), with gay, bisexual and other men who have sex with men aged 18-75 years and 20 in-depth interviews in 2013 with men aged 19-60 years. The second included 12 FGs in 2014/15 with 55 patients/service providers involved in the use/implementation of HIV self-testing or HIV prevention/care. Sexual health literacy goes well beyond individual health literacy and is enabled through complex community practices and multi-sectoral services. It is affected by emerging (and older) technologies and demands tailored approaches for specific groups and needs. The framework serves as a starting point for how sexual health literacy should be understood in the evaluation of sustainable and equitable implementation of biomedical sexual healthcare and prevention internationally.
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Affiliation(s)
- Lisa McDaid
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
- Institute for Social Science Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Paul Flowers
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Olivier Ferlatte
- School of Public Health, University of Montréal, Montréal, QC, Canada
| | - Ingrid Young
- Centre for Biomedicine, Self and Society, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Susan Patterson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Mark Gilbert
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
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19
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Hammoud MA, Grulich A, Holt M, Maher L, Murphy D, Jin F, Bavinton B, Haire B, Ellard J, Vaccher S, Saxton P, Bourne A, Degenhardt L, Storer D, Prestage G. Substantial Decline in Use of HIV Preexposure Prophylaxis Following Introduction of COVID-19 Physical Distancing Restrictions in Australia: Results From a Prospective Observational Study of Gay and Bisexual Men. J Acquir Immune Defic Syndr 2021; 86:22-30. [PMID: 33027151 PMCID: PMC7727320 DOI: 10.1097/qai.0000000000002514] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 09/17/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND In response to the novel coronavirus disease (COVID-19) pandemic, Australia introduced public health and physical distancing restrictions in late March 2020. We investigated the impact of these restrictions on HIV preexposure prophylaxis (PrEP) use among Australian gay and bisexual men (GBM). METHODS Participants in an ongoing online cohort study previously reported PrEP use from 2014 to 2019. In April 2020, 847 HIV-negative and untested participants completed questionnaires assessing changes in PrEP use as a result of COVID-19 public health measures. Binary logistic multiple regression was used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) to compare changes in PrEP use behaviors. RESULTS Among 847 men, mean age was 44.1 years (SD: 12.7). PrEP use rose from 4.9% in 2015 to 47.2% in 2020. Among those, 41.8% (n = 167) discontinued PrEP use during COVID-19 restrictions. Discontinuing PrEP during COVID-19 restrictions was independently associated with being less likely to have recently tested for HIV (aOR: 0.17; 95% CI: 0.09 to 0.34; P < 0.001) and less likely to report sex with casual partners (aOR: 0.28; 95% CI: 0.14 to 0.54; P < 0.001). CONCLUSIONS By April 2020, following the introduction of COVID-19 restrictions, GBM dramatically reduced PrEP use, coinciding with a reduction in sexual activity. Longer-term impacts of COVID-19 restrictions on sexual behaviors among GBM need to be monitored because they may foreshadow fluctuations in prevention coverage and risk of HIV infection. Our findings indicate a potential need for clear, targeted information about resumption of PrEP and on-demand optimal dosing regimens in response to ongoing changes in restrictions.
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Affiliation(s)
| | | | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Kensington, Australia
| | - Lisa Maher
- Kirby Institute, UNSW Sydney, Kensington, Australia
| | - Dean Murphy
- Kirby Institute, UNSW Sydney, Kensington, Australia
| | - Fengyi Jin
- Kirby Institute, UNSW Sydney, Kensington, Australia
| | | | | | - Jeanne Ellard
- Australian Federation of AIDS Organisations (AFAO), Newtown, Australia
| | | | - Peter Saxton
- Department of Social and Community Health, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia; and
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, Kensington, Australia
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Rowlinson E, Golden MR, Berzkalns A, Thibault C, Barbee LA. Epidemiologic Treatment for Contacts to Neisseria gonorrhoeae and Chlamydia trachomatis Infection in Sexually Transmitted Disease Clinic Patients in Seattle, WA; 1994 to 2018. Sex Transm Dis 2020; 47:665-671. [PMID: 32649579 PMCID: PMC8549494 DOI: 10.1097/olq.0000000000001234] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Current Centers for Disease Control and Prevention guidelines recommend that clinicians empirically treat the sex partners of persons with Neisseria gonorrhoeae (GC) or Chlamydia trachomatis (CT) infection before confirming that they are infected. It is possible that this practice, known as epidemiologic treatment, results in overtreatment for uninfected persons and may contribute to development of antimicrobial resistance. We sought to quantify the number of patients who received epidemiologic treatment and the proportion of those who were overtreated. METHODS We reviewed records from a municipal sexually transmitted disease clinic in Seattle, WA, from 1994 to 2018 to identify visits by asymptomatic patients seeking care because of sexual contact to a partner with GC and/or CT. We defined overtreatment as receipt of antibiotic(s) in the absence of a positive GC/CT test result and calculated the proportions of contacts epidemiologically treated and tested positive for GC/CT and overtreated in five 5-year periods stratified by sex and gender of sex partner. We used the Cochran-Armitage test to assess for temporal trends. RESULTS The number of asymptomatic contacts epidemiologically treated for GC/CT increased from 949 to 3159 between the 1994-1998 and 2014-2018 periods. In 2014-2018, 55% of persons were overtreated, most (82.1%) of these were men who have sex with men (MSM). The proportion of MSM overtreated decreased from 74% to 65% (P < 0.01), but the total number of overtreated MSM increased from 172 to 1428. DISCUSSION A high proportion of persons receiving epidemiologic treatment of GC/CT are uninfected. The current practice of routinely treating all sex partners of persons with GC/CT merits reconsideration in light of growing antimicrobial resistance.
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Affiliation(s)
| | - Matthew R. Golden
- Department of Epidemiology, University of Washington
- Department of Medicine, Division of Infectious Diseases, University of Washington
- HIV/STD Program, Public Health—Seattle & King County, Seattle, WA
| | - Anna Berzkalns
- HIV/STD Program, Public Health—Seattle & King County, Seattle, WA
| | | | - Lindley A. Barbee
- Department of Medicine, Division of Infectious Diseases, University of Washington
- HIV/STD Program, Public Health—Seattle & King County, Seattle, WA
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21
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Use of HIV Pre-exposure Prophylaxis (PrEP) Associated With Lower HIV Anxiety Among Gay and Bisexual Men in Australia Who Are at High Risk of HIV Infection: Results From the Flux Study. J Acquir Immune Defic Syndr 2020; 83:119-125. [PMID: 31935203 DOI: 10.1097/qai.0000000000002232] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Many gay and bisexual men (GBM) experience HIV anxiety, particularly around condomless anal intercourse. HIV pre-exposure prophylaxis (PrEP) is an effective HIV prevention strategy that may reduce HIV anxiety among GBM. METHODS The Following Lives Undergoing Change (Flux) Study is a national, online, open-prospective observational study of licit and illicit drug use among GBM in Australia. In 2018, participants responded to newly included items regarding anxiety about HIV transmission. Stratifying GBM as high or low risk as determined by the Australian PrEP Guidelines, we assess whether PrEP use is associated with lower levels of HIV anxiety. Multivariate logistic regression was used to compare factors associated with PrEP use among GBM at high risk (PrEP-eligible) and low risk (PrEP-ineligible) of HIV infection. Results are reported as adjusted odds ratios and corresponding 95% confidence intervals. RESULTS Among 1547 men, the mean age was 37.1 years (SD 13.1). Men aged 25 years or younger had higher HIV anxiety scores than older men. Among PrEP-eligible men, men who use PrEP reported lower levels of HIV anxiety (adjusted odds ratio = 0.92; 95% confidence interval = 0.87 to 0.99; P < 0.001). No differences were observed on HIV anxiety among PrEP-ineligible men. CONCLUSIONS Among PrEP-eligible men, PrEP use was independently associated with lower levels of HIV anxiety. In addition to avoiding HIV infection, PrEP use may help reduce anxiety among men at risk of HIV. This feature of PrEP could be promoted as part of demand creation initiatives to increase PrEP uptake.
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22
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Ortblad KF, Stalter RM, Bukusi EA, Ngure K, Mujugura A, Celum C, Baeten JM, Heffron R. No Evidence of Sexual Risk Compensation Following PrEP Initiation Among Heterosexual HIV Serodiscordant Couples in Kenya and Uganda. AIDS Behav 2020; 24:1365-1375. [PMID: 31696370 PMCID: PMC7156350 DOI: 10.1007/s10461-019-02720-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Recent studies among men who have sex with men suggest that sexual behaviors associated with risk of sexually transmitted infections increase following initiation of pre-exposure prophylaxis (PrEP) for HIV prevention. We used longitudinal data from HIV-uninfected participants (n = 1013) enrolled in an open-label study of PrEP delivered to Ugandan and Kenyan heterosexual HIV serodiscordant couples to understand the association between PrEP initiation and HIV risk-related sexual behaviors among these couples. In the month following PrEP initiation, the mean number of monthly sex acts within couples decreased from 7.9 to 6.9 (mean difference: - 1.1; 95% CI - 1.5, - 0.7) and the proportion of couples having condomless sex decreased from 65% to 32% (percentage point change: - 33%; 95% CI - 37%, - 30%); these behaviors then remained relatively constant over 2 years. We found no evidence of sexual risk compensation following PrEP initiation within African serodiscordant couples. However, roughly a third of couples continued to engage in condomless sex during follow up, emphasizing the importance of continued PrEP use to sustain HIV protection.
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Affiliation(s)
- Katrina F Ortblad
- Department of Global Health, University of Washington, 908 Jefferson St, 12th floor, Seattle, WA, 98104, USA.
| | - Randy M Stalter
- Department of Global Health, University of Washington, 908 Jefferson St, 12th floor, Seattle, WA, 98104, USA
- Department of Epidemiology, University of Washington, Seattle, USA
| | - Elizabeth A Bukusi
- Department of Global Health, University of Washington, 908 Jefferson St, 12th floor, Seattle, WA, 98104, USA
- Department of Obstetrics and Gynecology, University of Washington, Seattle, USA
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Kenneth Ngure
- Department of Community Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Andrew Mujugura
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Connie Celum
- Department of Global Health, University of Washington, 908 Jefferson St, 12th floor, Seattle, WA, 98104, USA
- Department of Medicine, University of Washington, Seattle, USA
| | - Jared M Baeten
- Department of Global Health, University of Washington, 908 Jefferson St, 12th floor, Seattle, WA, 98104, USA
- Department of Epidemiology, University of Washington, Seattle, USA
- Department of Medicine, University of Washington, Seattle, USA
| | - Renee Heffron
- Department of Global Health, University of Washington, 908 Jefferson St, 12th floor, Seattle, WA, 98104, USA
- Department of Medicine, University of Washington, Seattle, USA
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23
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Rietmeijer CA. Improving care for sexually transmitted infections. J Int AIDS Soc 2019; 22 Suppl 6:e25349. [PMID: 31468743 PMCID: PMC6715945 DOI: 10.1002/jia2.25349] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 06/21/2019] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Rising rates of reported sexually transmitted infections (STIs) in the US and Europe are a public health priority and require a public health response. The diagnosis and treatment of STIs have been the cornerstone of STI control and prevention for many decades and, historically, publicly funded STI clinics have played a central role in the provision of STI care. Innovations in non-invasive diagnostic techniques, especially nucleic acid amplification tests in the mid-1990s, have facilitated the expansion of STI testing and treatment outside traditional STI clinics, including primary care, family planning, school-based health, outreach, corrections, emergency departments and HIV prevention and care settings. As a result, the continued need for categorical STI clinics has been debated. In this Commentary, we discuss how practice can be improved at each level of STI care. DISCUSSION STI practice improvement plans should be tailored to the strengths of each care setting. Thus, in primary care, the focus should be on improving STI screening rates, the provision of hepatitis B and human papillomavirus vaccines and, in jurisdictions where this is legal, expedited partner therapy for gonorrhoea and chlamydia. Extragenital (pharyngeal and rectal) testing for gonorrhoea and chlamydia should be available in settings serving populations more vulnerable to STI acquisition at these anatomical sites, including men who have sex with men. In family planning settings with a mostly female patient population, there are opportunities to serve male partners with both contraceptive and STI services. STI screening rates can also be improved in other settings serving populations at increased risk for STIs, including school-based clinics, emergency departments, correctional health facilities and providers of HIV care and prevention. These improvements are predominantly logistical in nature and not dependent on extensive STI clinical expertise. While some providers in these settings may have the clinical knowledge and skills to evaluate symptomatic patients, many do not, and STI speciality clinics must be available for consultation and referral and evolve from "safety net" providers of last resort to STI centres of excellence. CONCLUSIONS A tailored practice improvement plan can be envisioned to achieve an optimally functioning STI care continuum.
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Affiliation(s)
- Cornelis A Rietmeijer
- Rietmeijer ConsultingDenverCOUSA
- Colorado School of Public HealthUniversity of ColoradoDenverCOUSA
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Mycoplasma genitalium Nongonococcal Urethritis Is Likely to Increase in Men Who Have Sex With Men Who Practice Unsafe Sex: What Should We Do? Sex Transm Dis 2019; 46:518-520. [DOI: 10.1097/olq.0000000000001030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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