A comparison of sexual behavior patterns among men who have sex with men and heterosexual men and women

Gay Dreams: Exploring the Relationship Between Sexual Orientation and Dream Content in Men

Although numerous individual factors influencing dream content have been explored, research on the link between sexual orientation and dreaming remains limited. This study examined this relationship among 119 German-speaking men (mean age = 31.97 years), including 55 homosexual and 64 heterosexual participants. Participants completed a questionnaire on their waking life sexuality and dreams and provided two dream reports. Homosexual men reported more sexual partners in waking life and lower satisfaction with their sexual orientation compared to heterosexual men. No significant differences were found in dream recall frequency, emotional tone, nightmare frequency, or distress, though homosexual men reported more sexual dreams. Dream reports showed no significant differences in sexual interactions or the number of sexual partners between groups, but homosexual men's dreams featured a higher ratio of male to female characters and more romantic relationships with men. These findings partially align with the continuity hypothesis, suggesting that the dream content of homosexual men reflects their social interactions and romantic preferences. Overall, the study suggests that homosexual and heterosexual men share a similar dream pattern. The implications of these findings highlight the importance of considering sexual orientation in dream research to better understand the intersection of sexuality and unconscious processes.

Antimicrobial resistance determinants in the oropharyngeal microbiome of 'men having sex with men' attending an sexually transmitted infection clinic

BACKGROUND

'Men having sex with men' (MSM) represent a key population with a significant prevalence of pharyngeal Neisseria gonorrhoeae (NG) infections and a high rate of antimicrobial resistance genes in the pharyngeal microbiome. As NG can acquire antibiotic resistance genes from other commensal oropharyngeal bacteria, monitoring the prevalence of these resistance determinants is critical to curtail the spread of NG-resistant strains.

PURPOSE AND RESEARCH DESIGN

Here, we assessed the distribution of five resistance genes (pen (A), mtr (R), gyr (A), par (C), msr (D)) in the oropharynx of 164 MSM, attending an Outpatient clinic for STI screening.

RESULTS

The most frequently detected resistance gene was msr (D) (88.4%), followed by gyr (A) (67.1%). The distribution of resistance genes was not influenced by pharyngeal gonorrhea nor by the HIV status, whereas a younger age was associated with mtr (R) presence (p = .008). Subjects using mouthwash exhibited significantly lower levels of mtr (R) (p = .0005). Smoking habit was associated with a higher prevalence of par (C) (p = .02). A noteworthy association was observed between the presence of msr (D) gene and the use of antibiotics (p = .014).

CONCLUSIONS

Our findings reveal an enrichment of antimicrobial resistance genes in the oropharynx of MSM. These insights could aid in the development of screening programs and antimicrobial stewardship initiatives targeting populations at heightened risk of pharyngeal gonorrhea.

Factors Associated with HPV Vaccination Among Middle-Aged Adults in the United States

OBJECTIVE

To examine prevalence of partial and complete HPV vaccination among middle-aged adults and factors associated with vaccination status.

STUDY DESIGN

Nationally representative cross-sectional survey.

SETTING

United States.

METHODS

Cohort includes adults aged 30 to 44 years from 2018 to 2022 Behavioral Risk Factor Surveillance System (BRFSS) survey who completed questions about HPV vaccination status. Survey-weighted multivariable logistic regression was utilized to explore factors associated with partial and complete HPV vaccination status.

RESULTS

In this nationally representative cohort of 26,470 US middle-aged adults, 15.8% [95% confidence interval [CI]: 15.1%-16.6%] reported any HPV vaccination, and 6.5% [95% CI: 6.0%-7.0%] reported complete HPV vaccination. On multivariable regression, younger age, female sex, residence in the West or Northeast, higher educational attainment, unmarried status, having a personal healthcare provider, and gay or lesbian sexual orientation were associated with increased likelihood of vaccination. Race was variably associated with vaccination status. Annual income, insurance status, cancer history, head and neck cancer history, and time of last physician checkup were not associated with HPV vaccination status.

CONCLUSION

HPV vaccination among middle-aged adults who were not previously vaccinated should be based on risk for new HPV infection and possible benefits of vaccination. While our analysis shows that consideration of personal factors likely plays a role in HPV vaccination in this cohort, we also find that gaps in vaccination may exist due to other socioeconomic disparities between sexes, educational attainment levels, racial/ethnic groups, geographic regions, and access to a personal healthcare provider. These factors' influence suggests potential room for improved public health measures.

The Rise of Bisexuality: U.S. Representative Data Show an Increase Over Time in Bisexual Identity and Persons Reporting Sex with Both Women and Men

Recognizing that social forces shape sexual behavior and sexual identities, we examined whether the recent liberalization in attitudes toward same-sex relationships has been accompanied by changes in sexual orientation as indicated by sexual behavior and sexual orientation identity. Using nationally representative data from the General Social Survey (n = 34,524), we compared reported patterns of sexual behavior of respondents from 1989 through 2021. Among the 2012-2018 waves (n = 7144, weighted), we compared patterns of sexual orientation, as indicated by behavior and identity, among different demographic groups. We also examined how sexual behavior varied among respondents with different sexual orientations. Results showed an increase in respondents reporting both male and female partners over time, with 3.1% of respondents reporting both male and female partners since age 18 among the 1989-1994 waves, 9.3% reporting this in the 2012-2018 waves, and 9.6% reporting this in the 2021 sample. Identifying as bisexual was more common among women (3.7%) than men (1.6%) and among younger persons than older persons. Over 6% of 18-29 year-olds but fewer than 2% of respondents over age 40 identified as bisexual. Findings demonstrate that sexual norms and behaviors have changed and that far more persons today than in earlier years identify as bisexual and/or have both male and female partners.

Factors associated with meningitis vaccine awareness and engagement among Latino men who have sex with men in South Florida

Awareness and uptake of the meningitis vaccine remains low among marginalized groups, such as Latino men who have sex with men (LMSM), potentially due to structural and psychosocial barriers in accessing preventative healthcare. The current study explored awareness and uptake of meningitis vaccines among a group of LMSM (N = 99) living in South Florida. A three-pronged variable selection approach was utilized prior to conducting regression models (linear and logistic). Overall, 48.5% of the participants reported little to no knowledge about meningitis vaccines, and 20.2% reported being vaccinated. Living with HIV (OR = 10.48) and time since outbreak (OR = 1.03) were significant predictors of meningitis vaccine uptake. No significant correlates of meningitis vaccine awareness were identified. More research is needed to identify other important factors associated with meningitis vaccine awareness and uptake among LMSM, a multiple marginalized group.

Investigating the cause of increased tetracycline-resistant Neisseria gonorrhoeae in England, 2016-20

BACKGROUND

Antimicrobial resistance in Neisseria gonorrhoeae is a global public health concern. Tetracycline resistance (TetR) increased from 39.4% to 75.2% between 2016 and 2021 in N. gonorrhoeae isolates collected through national surveillance in England, despite the absence of use of tetracyclines for the treatment of gonorrhoea.

OBJECTIVES

We investigated whether there was correlation between bacterial sexually transmitted infection (STI) tests performed and treatment with antimicrobials, with increased TetR in N. gonorrhoeae.

METHODS

We examined correlations between bacterial STI tests, antimicrobial treatment and TetR in N. gonorrhoeae, using national surveillance data from three large sexual health services (SHS) in London during 2016-20. Doxycycline prescribing data and antibiograms of a non-STI pathogen from distinct patient groups (sexual health, obstetric and paediatric), at a large London hospital, were analysed to identify if doxycycline use in SHS was associated with resistance in a non-STI organism.

RESULTS

A substantial increase in TetR was observed, particularly in isolates from gay, bisexual and other MSM (GBMSM). Strong positive correlations were observed exclusively in GBMSM between N. gonorrhoeae TetR and both bacterial STI tests (r = 0.97, P = 0.01) and antimicrobial treatment (r = 0.87, P = 0.05). Doxycycline prescribing increased dramatically during the study period in SHS. Prevalence of TetR in Staphylococcus aureus was higher in isolates sourced from SHS attendees than those from other settings.

CONCLUSIONS

Frequent screening of GBMSM at higher risk of STIs, such as those on pre-exposure prophylaxis (PrEP) leading to/and increased use of doxycycline for the treatment of diagnosed infections, may account for the increase in TetR in N. gonorrhoeae.

Self-Rated Masculinity and Femininity and Reported Number of Lifetime Sexual Partners Among Cisgender Heterosexual and LGBQ Men and Women

Prior research has quantitatively examined why heterosexual men and women report different numbers of lifetime different-sex sexual partners, whereas qualitative work has analyzed how men's masculinity-and to a lesser extent, women's femininity-is tied to gender norms about sexual activity. Less research, however, has quantitatively examined the associations between self-rated masculinity and femininity and reported number of lifetime sexual partners. This brief report uses a large sample of Canadians (n = 2117) to examine how self-rated masculinity and femininity relate to reported numbers of sexual partners among four groups of cisgender people: (1) heterosexual men (n = 972), (2) heterosexual women (n = 979), (3) gay and bisexual/pansexual men (n = 99), and (4) lesbian and bisexual/pansexual women (n = 67). Results demonstrate that self-rated femininity was negatively, and masculinity positively, associated with reported numbers of lifetime different-sex sexual partners among heterosexual women. No significant associations emerged for other groups. The lack of significant associations among heterosexual men may be attributable to the fact that most rated themselves as very masculine and not very feminine, whereas there was more variation among heterosexual women. In contrast, the non-significance among LGBQ women and men could reflect that subcultural norms and practices more strongly shape the number of sexual partners individuals report having in these communities. These results demonstrate that it would be beneficial for researchers to measure self-rated masculinity and femininity in future studies about sexual partnering practices, especially among heterosexual cisgender women.

A Mixed-Methods Approach to Develop a Combined Model of U.S. College Student Alcohol-Associated Condomless Sex

Unhealthy alcohol use and sexually transmitted infections (STIs) are significant public health concerns for US college students. Because alcohol use and condomless sex often co-occur in this population, alcohol-associated condomless sex has been identified as a behavioral intervention target. Existing theoretical frameworks have not garnered sufficient empirical support to serve as the foundation for interventions. The primary goal of the current study was to use a mixed-methods approach to develop a model of college student alcohol-associated condomless sex that combines elements from well-established health behavior theories. In Aim 1, multilevel modeling was used to predict condomless vaginal sex in a sample of heterosexual college student drinkers (N = 53). Aim 2 consisted of in-depth interviews (n = 18) to gather perceptions about the role of alcohol in sexual activity and identify supplemental constructs omitted from theories in Aim 1. The multilevel model explained a significant proportion of variance in condomless vaginal sex at the between- and within-person level. Themes derived from the in-depth interviews identified complementary elements of condom use decision-making. Findings from both aims were synthesized to construct a combined model of alcohol-associated condomless sex. This model can be further refined and ultimately serve as the foundation of an alcohol-STI prevention-intervention.

Genomic epidemiology of syphilis in England: a population-based study

BACKGROUND

Syphilis is a sexually transmitted bacterial infection caused by Treponema pallidum subspecies pallidum. Since 2012, syphilis rates have risen dramatically in many high-income countries, including England. Although this increase in syphilis prevalence is known to be associated with high-risk sexual activity in gay, bisexual, and other men who have sex with men (GBMSM), cases are rising in heterosexual men and women. The transmission dynamics within and between sexual networks of GBMSM and heterosexual people are not well understood. We aimed to investigate if whole genome sequencing could be used to supplement or enhance epidemiological insights around syphilis transmission.

METHODS

We linked national patient demographic, geospatial, and behavioural metadata to whole T pallidum genome sequences previously generated from patient samples collected from across England between Jan 1, 2012, and Oct 31, 2018, and performed detailed phylogenomic analyses.

FINDINGS

Of 497 English samples submitted for sequencing, we recovered 240 genomes (198 from the UK Health Security Agency reference laboratory and 42 from other laboratories). Three duplicate samples (same patient and collection date) were included in the main phylogenies, but removed from further analyses of English populations, leaving 237 genomes. 220 (92·8%) of 237 samples were from men, nine (3·8%) were from women, and eight (3·4%) were of unknown gender. Samples were mostly from London (n=118 [49·8%]), followed by southeast England (n=29 [12·2%]), northeast England (n=24 [10·1%]), and southwest England (n=15 [6·3%]). 180 (76·0%) of 237 genomes came from GBMSM, compared with 25 (10·5%) from those identifying as men who have sex with women, 15 (6·3%) from men with unrecorded sexual orientation, nine (3·8%) from those identifying as women who have sex with men, and eight (3·4%) from people of unknown gender and sexual orientation. Phylogenomic analysis and clustering revealed two dominant T pallidum sublineages in England. Sublineage 1 was found throughout England and across all patient groups, whereas sublineage 14 occurred predominantly in GBMSM older than 34 years and was absent from samples sequenced from the north of England. These different spatiotemporal trends, linked to demography or behaviour in the dominant sublineages, suggest they represent different sexual networks. By focusing on different regions of England we were able to distinguish a local heterosexual transmission cluster from a background of transmission in GBMSM.

INTERPRETATION

These findings show that, despite extremely close genetic relationships between T pallidum genomes globally, genomics can still be used to identify putative transmission clusters for epidemiological follow-up. This could be of value for deconvoluting putative outbreaks and for informing public health interventions.

FUNDING

Wellcome funding to the Sanger Institute, UK Research and Innovation, National Institute for Health and Care Research, European and Developing Countries Clinical Trials Partnership, and UK Health Security Agency.

Effectiveness and cost-effectiveness of human papillomavirus vaccination strategies among men who have sex with men in China: a modeling study

Introduction

The health and economic benefits of human papillomavirus (HPV) vaccination targeted at men who have sex with men (MSM) in developing settings have been rarely assessed. This study aimed to evaluate the effectiveness and cost-effectiveness of different HPV vaccination strategies among MSM in China.

Methods

A Markov model was developed to simulate HPV transmission dynamics among a total of 30.73 million MSM in China. The corresponding natural history included 6 states: susceptible, infected with low-risk subtypes, high-risk subtypes, anogenital warts and anal cancer, and deaths from anal cancer. MSM were divided into three age groups with cut-off points of 27 and 45 years. Alternative vaccination strategies were built by allocating bivalent, quadrivalent, nine-valent, or no vaccine to each of the groups. We generated the prevented infections and deaths by vaccination compared with baseline (no vaccination) and calculated incremental cost-effectiveness ratios (ICERs) to determine the optimal strategy.

Results

The model showed that in 10 years, at baseline, the existing cases of anogenital warts would reach 5,464,225 (IQR, 4,685,708-6,174,175); that of anal cancer would reach 1,922.95 (1,716.56-2,119.93), resulting in 940.55 (732.27-1,141.87) deaths. Under 50% vaccination coverage among one age group, the prevented cases of anogenital warts were maximized with quadrivalent vaccines allocated to MSM aged 27-45 years; that of anal cancer were maximized when offering nine-valent vaccines to the same group. Under 50% vaccination coverage among all groups, the lowest ICER (34,098.09 USD/QALY, 31,146.54-37,062.88) was reached when only quadrivalent vaccines were provided. Based on this strategy, when the annual vaccination rate increased by 30%, the ICER (33,521.75 USD/QALY, 31,040.73-36,013.92) would fall below three times China's per capita GDP. When the vaccine price decreased by 60%, the ICER was reduced to 7,344.44 USD/QALY (4,392.89-10,309.23), indicating good cost-effectiveness taking China's per capita GDP as a threshold.

Conclusions

HPV vaccination can effectively reduce the prevalence and mortality of related diseases among MSM in China, especially quadrivalent vaccines for anogenital warts and nine-valent vaccines for anal cancer. MSM aged 27-45 years were the optimal group for vaccination. Annual vaccination and appropriate adjustment of vaccine price are necessary to further improve the cost-effectiveness.

Prevalence of Mollicutes among men who have sex with men and transgender women aged 15 to 19 years in Salvador, North-eastern Brazil

BACKGROUND

Some species of Mollicutes have been associated with different pathologies of the urogenital tract in humans, with a high prevalence among adult men who have sex with men (MSM) and transgender women (TGW). However, few studies have been performed to investigate its prevalence among adolescents. In this study, we estimated the initial prevalence of Mycoplasma genitalium (MG), Mycoplasma hominis (MH), Ureaplasma urealyticum (UU), and Ureaplasma parvum (UP); the rate of misdiagnosis at different anatomical sites; and the associated factors with positive tests for Mollicutes among MSM and TGW aged 15 to 19 years enrolled in the PrEP1519 study.

METHODS

PrEP-1519 is the first study to investigate the effectiveness of pre-exposure prophylaxis for human immunodeficiency virus among adolescent MSM and TGW aged 15 to 19 in Latin America. Oral, anal, and urethral swabs were taken from 246 adolescents upon enrolment in the study to detect MG, MH, UU, and UP by quantitative polymerase chain reaction (qPCR). Bivariate and multivariate analyses were conducted by Poisson regression and 95% confidence intervals (95% CI) were estimated.

RESULTS

The prevalence of Mollicutes was 32.1%. UU was the most prevalent species (20.7%), followed by MH (13.4%), MG (5.7%), and UP (3.2%); 67.3% of the positive samples would have been missed if only urethral samples had been taken. Receptive anal sex (prevalence ratio [PR] = 1.79; 95% CI = 1.07-3.01) and clinical suspicion of sexually transmitted infection (PR = 1.62; 95% CI = 1.01-2.61) were factors associated with the detection of Mollicutes in general. Group sex (PR = 1.98; 95% CI = 1.12-3.50) and receptive anal sex (PR = 2.36; 95% CI = 0.95-5.86) were associated with the detection of Mycoplasma spp. No sociodemographic, clinical, or behavioural variable was significantly associated with the detection of Ureaplasma spp.

CONCLUSIONS

A high prevalence of Mollicutes was observed among adolescent MSM and TGW, especially at extragenital sites. Further research is required to understand the epidemiological profile of high-risk adolescents in different regions and contexts, and to investigate the pathogenesis of Mollicutes in the oral and anal mucosa before routine screening can be recommended in clinical practice.

Lessons Learned From the Implementation of a Pilot Study on Self-collected Specimen Return by Sexual Minority Men (Project Caboodle!): Qualitative Exploration

BACKGROUND

Self-collection of specimens at home and their return by mail might help reduce some of the barriers to HIV and bacterial sexually transmitted infection (STI) screening encountered by gay, bisexual, and other men who have sex with men (GBMSM). To evaluate the benefits and challenges of bringing this approach to scale, researchers are increasingly requesting GBMSM to return self-collected specimens as part of web-based sexual health studies. Testing self-collected hair samples for preexposure prophylaxis drug levels may also be a viable option to identify GBMSM who face adherence difficulties and offer them support.

OBJECTIVE

Project Caboodle! sought to evaluate the acceptability and feasibility of self-collecting at home and returning by mail 5 specimens (a finger-stick blood sample, a pharyngeal swab, a rectal swab, a urine specimen, and a hair sample) among 100 sexually active GBMSM in the United States aged between 18 and 34 years. In this manuscript, we aimed to describe the key lessons learned from our study's implementation and to present recommendations offered by participants to maximize the rates of self-collected specimen return.

METHODS

Following the specimen self-collection phase, a subset of 25 participants (11 who returned all 5 specimens, 4 who returned between 1 and 4 specimens, and 10 who did not return any specimens) was selected for in-depth interviews conducted via a videoconferencing platform. During the session, a semistructured interview guide was used to discuss the factors influencing decisions regarding returning self-collected specimens for laboratory processing. The transcripts were analyzed using template analysis.

RESULTS

University branding of web-based and physical materials instilled a sense of trust in participants and increased their confidence in the test results. Shipping the specimen self-collection box in plain unmarked packaging promoted discretion during transit and on its receipt. Using different colored bags with matching color-coded instructions to self-collect each type of specimen minimized the potential for confusion. Participants recommended including prerecorded instructional videos to supplement the written instructions, providing information on the importance of triple-site bacterial STI testing, and adding a reminder of the types of testing that would and would not be conducted on hair samples. Participants also suggested tailoring the specimen self-collection box to include only the tests that they might be interested in completing at that time, adding real-time videoconferencing to the beginning of the study to introduce the research team, and sending personalized reminders following the delivery of the specimen self-collection box.

CONCLUSIONS

Our results offer valuable insights into aspects that facilitated participant engagement in self-collected specimen return, as well as areas for potential improvement to maximize return rates. Our findings can help guide the design of future large-scale studies and public health programs for home-based HIV, bacterial STI, and preexposure prophylaxis adherence testing.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/13647.

An Experiment Using a Sexual Strategies Explanation to Alleviate Internalized Homophobia Among Men Who Have Sex With Men in China

Some men who have sex with men (MSM) having more casual sex and sexual partners is interpreted to be a sign of mental disorder and used to justify negative attitudes toward them by some. MSM may internalize this attitude causing internalized homophobia (IH). According to the sexual strategies theory, MSM having more casual sex is the result of differences between men's and women's sexual strategies and is unrelated to sexual orientation. We investigated whether this explanation would reduce IH and improve mental health in MSM. We recruited 255 Chinese MSM online using Wenjuanxing, Douban, Weibo, Tieba, and Blued and divided them using simple randomization into an experimental group (n = 77; sexual strategies explanation provided), an active control group (n = 99; minority stress explanation provided), and a control group (n = 79; no intervention) with pretest (N = 255); a 1 week post-test (n = 195); and a 1 month follow-up test (n = 170) of outcome measures. IH, mental distress (MD), sort-term mating orientation, and risky sexual behaviors were measured online. The data were analyzed by SPSS 28. IH was associated with MD while being married was associated with IH and sexual contact with women with both more IH and MD as were not being masculine and self-identifying as straight. The sexual strategies explanation reduced IH related to pathologizing sexual behaviors and high-risk sexual behaviors while the minority stress explanation reduced MD. Providing a sexual strategies explanation may be used to de-stigmatize casual sex among MSM.

Comparison of Different Sexual Behaviors According to Sexual Orientation and the Mediating Role of Attitudes toward Sexual Behaviors between Sexual Orientation and Sexual Behaviors in Young Adults

Objectives

To explore the relationship between sexual orientation and specific sexual and risk behaviors, compare the number of sexual behaviors and attitudes among people of different sexual orientations, and test the mediating effect of attitudes toward sexual behaviors in the relationship between sexual orientation and the number of sexual behaviors.

Methods

A total of 2288 participants completed a checklist of sexual behaviors, indicators of sexual risk behaviors, and a scale of attitudes toward sexual behaviors.

Results

Bisexual women engaged in a greater number of sexual behaviors and had more positive attitudes toward sexual behaviors than heterosexual women. Homosexual men engaged in a greater number of sexual behaviors than heterosexual men, and homosexual and bisexual men had more positive attitudes toward sexual behaviors than heterosexuals. Finally, we show the mediating role of attitudes toward sexual behaviors in the relationship between sexual orientation and the number of sexual behaviors engaged in.

Conclusions

The importance of considering sexual orientation when analyzing sexual behaviors and attitudes is highlighted.

Reducing Human Immunodeficiency Virus and Sexually Transmitted Infections Risk in African American Women with At-Risk Male Partners: A Randomized Trial

Background: We examined the efficacy of the Females of African American Legacy Empowering Self (FemAALES) intervention in a cohort of 203 publicly insured Black women in Los Angeles. Materials and Methods: Women who reported recent sex with a male partner who was at increased risk for infection by human immunodeficiency virus (HIV) and sexually transmitted infections (STI) were randomized to the six-session FemAALES intervention or to a single client-centered family planning and STI/HIV counseling session. Participants were followed at 3 and 9 months post-intervention. To investigate between-group behavioral changes in condomless sex in the prior 90 days and other HIV/STI risks, we used generalized estimating equations that accounted for repeated observations in individuals. Results: Most participants (mean age 34 ± 11 standard deviation) were low-income and unemployed, despite three-quarters having completed high school or the equivalent. The most common HIV/STI risk factors among recent male partners were incarceration (58.8%) and concurrent sex with other women (72.2%). At 3 months, the FemAALEs group showed a larger increase in the odds of asking their partner to test (adjusted odds ratio = 2.14; 95% confidence interval [CI], 1.02-4.47; p = 0.0431) and in sexual health self-efficacy scores (adjβ = 1.82; 95% CI, 0.02-3.62; p = 0.0471) compared to the control group, although these changes did not hold at 9 months. Both groups showed statistically significant declines in the frequency of several sexual risk factors between baseline and 9 months. Conclusion: Although we did not find evidence that the FemAALES intervention was more efficacious than the less-intensive control condition in reducing sexual risk behaviors, the overall declines in risk behaviors we observed warrant further research. ClinicalTrials.gov (Identifier: NCT02189876).

A new mixed agent-based network and compartmental simulation framework for joint modeling of related infectious diseases- application to sexually transmitted infections

Background

A model that jointly simulates infectious diseases with common modes of transmission can serve as a decision-analytic tool to identify optimal intervention combinations for overall disease prevention. In the United States, sexually transmitted infections (STIs) are a huge economic burden, with a large fraction of the burden attributed to HIV. Data also show interactions between HIV and other sexually transmitted infections (STIs), such as higher risk of acquisition and progression of co-infections among persons with HIV compared to persons without. However, given the wide range in prevalence and incidence burdens of STIs, current compartmental or agent-based network simulation methods alone are insufficient or computationally burdensome for joint disease modeling. Further, causal factors for higher risk of coinfection could be both behavioral (i.e., compounding effects of individual behaviors, network structures, and care behaviors) and biological (i.e., presence of one disease can biologically increase the risk of another). However, the data on the fraction attributed to each are limited.

Methods

We present a new mixed agent-based compartmental (MAC) framework for jointly modeling STIs. It uses a combination of a new agent-based evolving network modeling (ABENM) technique for lower-prevalence diseases and compartmental modeling for higher-prevalence diseases. As a demonstration, we applied MAC to simulate lower-prevalence HIV in the United States and a higher-prevalence hypothetical Disease 2, using a range of transmission and progression rates to generate burdens replicative of the wide range of STIs. We simulated sexual transmissions among heterosexual males, heterosexual females, and men who have sex with men (men only and men and women). Setting the biological risk of co-infection to zero, we conducted numerical analyses to evaluate the influence of behavioral factors alone on disease dynamics.

Results

The contribution of behavioral factors to risk of coinfection was sensitive to disease burden, care access, and population heterogeneity and mixing. The contribution of behavioral factors was generally lower than observed risk of coinfections for the range of hypothetical prevalence studied here, suggesting potential role of biological factors, that should be investigated further specific to an STI.

Conclusions

The purpose of this study is to present a new simulation technique for jointly modeling infectious diseases that have common modes of transmission but varying epidemiological features. The numerical analysis serves as proof-of-concept for the application to STIs. Interactions between diseases are influenced by behavioral factors, are sensitive to care access and population features, and are likely exacerbated by biological factors. Social and economic conditions are among key drivers of behaviors that increase STI transmission, and thus, structural interventions are a key part of behavioral interventions. Joint modeling of diseases helps comprehensively simulate behavioral and biological factors of disease interactions to evaluate the true impact of common structural interventions on overall disease prevention. The new simulation framework is especially suited to simulate behavior as a function of social determinants, and further, to identify optimal combinations of common structural and disease-specific interventions.

HIV/AIDS Mathematical Model of Triangle Transmission

In this paper, a mathematical analysis of the HIV/AIDS deterministic model studied in the paper called Mathematical Model of HIV/AIDS Considering Sexual Preferences Under Antiretroviral Therapy, a case study in the previous works preformed by Espitia is performed. The objective is to gain insight into the qualitative dynamics of the model determining the conditions for the persistence or effective control of the disease in the community through the study of basic properties such as positiveness and boundedness; the calculus of the basic reproduction number; stationary points such as disease-free equilibrium (DFE), boundary equilibrium (BE) and endemic equilibrium (EE); and the local stability (LAS) of disease-free equilibrium. The findings allow us to conclude that the best way to reduce contagion and consequently reach a DFE is thought to be the reduction in the rate of homosexual partners, as they are the most affected population by the virus and are therefore the most likely to become infected and spread it. Increasing the departure rate of infected individuals leads to a decrease in untreated infected heterosexual men and untreated infected women.

Comparing Sexual Network Mean Active Degree Measurement Metrics Among Men Who Have Sex With Men

BACKGROUND

Mean active degree is an important proxy measure of cross-sectional network connectivity commonly used in HIV/sexually transmitted infection epidemiology research. No current studies have compared measurement methods of mean degree using a cross-sectional study design for men who have sex with men (MSM) in the United States. We compared mean degree estimates based on reported ongoing main and casual sexual partnerships (current method) against dates of first and last sex (retrospective method).

METHODS

We used data from ARTnet, a cross-sectional survey of MSM in the United States (2017-2019). ARTnet collected data on the number and types of sexual partners in the past year, limited to the 5 most recent partners (data truncation). We quantified partnerships for months 0 to 12 before the survey date (retrospective method) and compared that with ongoing partnerships on the day of survey (current method). We used linear regression to understand the impact of truncated partnership data on mean degree estimation.

RESULTS

The retrospective method yielded similar degree estimates to the current for months proximate to the day of survey. The retrospective method mean degree systematically decreased as the month increased from 0 to 12 months before survey date. This was driven by data truncation: among participants with >5 partners in the past year compared with those with ≤5, the average change in main partnership degree between 12 and 0 months before survey date was -0.05 (95% confidence interval, -0.08 to -0.03) after adjusting for race/ethnicity, age, and education. The adjusted average change in casual partnership degree was -0.40 (95% confidence interval, -0.45 to -0.35).

CONCLUSIONS

The retrospective method underestimates mean degree for MSM in surveys with truncated partnership data, especially for casual partnerships. The current method is less prone to bias from partner truncation when the target population has high rate of partners per year.

Validation of new, gender-neutral questions on recent sexual behaviors among plasma donors and men who have sex with men

BACKGROUND AND OBJECTIVES

Several blood services might eventually interview donors with gender-neutral questions on sexual behaviors to improve the inclusivity of blood donation. We tested two ways (i.e., "scenarios") of asking donors about their recent sexual behaviors.

MATERIALS AND METHODS

The study comprised 126 regular source plasma donors and 102 gay, bisexual, and other men who have sex with men (gbMSM), including 73 cis-gbMSM (i.e., the "cis-gbMSM subgroup," which excluded nonbinary, genderqueer, and trans individuals). In Scenario 1, participants were asked if, in the last 3 months, they "have […] had a new sexual partner or more than one sexual partner." In Scenario 2, they were asked "Have you had a new sexual partner?" and "have you had more than one sexual partner?". Validation questions included more specific questions on the type of partners and sexual activity.

RESULTS

Among plasma donors, sensitivity was 100.0% for both scenarios; specificity was 100.0% and 99.1% for Scenarios 1 and 2, respectively. Among gbMSM, sensitivity was 74.5% and 82.9% for Scenarios 1 and 2, respectively; specificity was 100.0% for both scenarios. Among cis-gbMSM, sensitivity was 88.6% and 100.0% for Scenarios 1 and 2, respectively; specificity was 100.0% for both scenarios. The area under the receiver operating characteristic curve of Scenario 2 was significantly higher than that of Scenario 1 among gbMSM and in the cis-gbMSM subgroup (all p < .05).

CONCLUSION

Scenario 2 questions performed well among plasma donors and cis-gbMSM, but less so in the broader gbMSM population.

Why does age at HIV infection correlate with set point viral load? An evolutionary hypothesis

BACKGROUND

Set-point viral load (SPVL) correlates with the age at which people acquire HIV. Although immunosenescence may seem like a parsimonious explanation for this, it does not easily explain the observation that the relationship between age and SPVL attenuates when accounting for source partner SPVL. Here we propose an alternative explanation that encompasses this latter finding: that decreasing risk of acquisition with older age generates a selection bottleneck that selects for more virulent strains with age.

METHODS

We adapted a previously published model of HIV transmission and evolution (EvoNetHIV), parameterized here for men who have sex with men (MSM). We conducted a series of simulation experiments that vary seven behavioral or clinical parameters that affect exposure risk as people age. We conducted regressions to determine the mean increase in SPVL per 10-year increase in seroconversion age, with and without source SPVL in the model.

RESULTS

All runs generated significant relationships between seroconversion age and SPVL when not including source SPVL. All saw attenuated relationships, most to near 0, with source SPVL included. Four of our behavioral measures (relational duration, age-related homophily, coital frequency, and mean age at relationship formation) had clear effects on this relationship, all in the hypothesized direction. Combining multiple forms of behavioral heterogeneity yielded an increase of 0.056 log10 copies/mL SPVL per 10-year increase in seroconversion age, nearly as large as that seen in two empirical studies of age-SPVL correlations in MSM.

CONCLUSION

The higher virulence of HIV among those infected later in life may be partly explained by a combination of selective bottlenecks and behavioral heterogeneity by age. Variation in the strength of this effect across populations may be in part due to different behavioral, epidemiological and clinical conditions, and not require assumptions about differences in patterns of immunosenescence among populations.

Biological, Behavioral, and Demographic Drivers of Recent Syphilis Infection Among Emerging Adult Sexual Minority Men in New York City: The P18 Cohort Study

The rate of syphilis infections among sexual minority men (SMM) has continued to increase in recent decades. As such, this analysis sought to identify demographic, biological, and behavioral factors associated with recent syphilis infection in emerging adult SMM. Data were drawn from a 3-year cohort study of emerging adult SMM (n = 665), from July 2014 to March 2019. Biannual study assessments included rapid HIV testing and behavioral surveys. At baseline, and at the 18- and 36-month time points, participants underwent chlamydia, gonorrhea, and syphilis screening. Generalized estimating equations were used to generate four models of repeated syphilis screening. In this racially/ethnically and socioeconomically diverse sample of SMM, 5.0% of participants tested positive for syphilis at baseline and 9.0% had an infection at the subsequent time points. Across all models, racial/ethnic minority SMM had higher odds of syphilis. Higher odds of syphilis infection were also significantly associated with more frequent condomless anal sex, more frequent marijuana use, HIV seropositivity, not currently using pre-exposure prophylaxis (PrEP), and not receiving syphilis testing in the previous 6 months; lower odds were associated with more frequent oral sex and more frequent alcohol use. These findings support current screening guidelines based on SMM who may be at increased risk for sexually transmitted infection (STI) acquisition, such as people living with HIV or those who engage in condomless sex. Further, our findings of reduced syphilis incidence among those who are on PrEP and engaged in regular STI testing support existing efforts to increase the availability and accessibility of preventive sexual health care for SMM.

Incidence and mortality of non-AIDS-defining cancers among people living with HIV: A systematic review and meta-analysis

Background

Non-AIDS-defining cancers (NADCs) are now becoming a rising cause of morbidity among people living with HIV (PLHIV) in the highly active antiretroviral therapy (HAART) era. We conducted a systematic review and meta-analysis to estimate the summary risk of incidence and mortality of a wide range of NADCs among PLHIV compared with the general population.

Methods

This systematic review and meta-analysis was registered in the PROSPERO (registration number CRD42020222020). We searched PubMed, EMBASE, Cochrane library, and Web of Science for relevant studies published before Jan 24, 2022. Cohort or registry linkage studies comparing the incidence or mortality of individual NADCs in PLHIV with that in the general population were included. Studies simply reporting outcomes of cancer precursor lesions or combined NADCs were excluded. We calculated pooled standardised incidence (SIRs) and standardised mortality ratios (SMRs) and their 95% confidence intervals (CIs) using random-effects models, and used robust variance estimation to account for non-independence in study-level effect sizes.

Findings

We identified 92 publications arising from 46 independent studies including 7 articles out of 7 studies from developing countries. Among the 40 types of NADCs investigated, all of the 20 infection-related NADCs, cancers related with human papillomavirus infection in particular, and half of the 20 non-infection-related NADCs occurred in excess in PLHIV compared with the general population. This risk pattern was consistent in most WHO regions and in both high-income and low-and middle-income countries. The increased SIRs for various NADCs were more evident among PLHIV with advanced immunodeficiency, and was explored by HIV transmission route, and use of HAART. PLHIV had increased mortality for anal cancer (SMR 124·07, 95% CI 27·31-563·72), Hodgkin lymphoma (41·03, 2·91-577·88), liver cancer (8·36, 3·86-18·11), lung cancer (3·95, 1·52-10·26), and skin melanoma (3·95, 1·28-12·2).

Interpretation

PLHIV had increased incidence and mortality for a wide spectrum of NADCs. Primary prevention and effective treatment for NADCs in this population is urgently needed.

Funding

Natural Science Foundation of China Excellent Young Scientists Fund, Natural Science Foundation of China International/Regional Research Collaboration Project, National Science and Technology Major Project of China, Sanming Project of Medicine in Shenzhen, High Level Project of Medicine in Longhua, Shenzhen, Shenzhen Science and Technology Innovation Commission Basic Research Program, Special Support Plan for High-Level Talents of Guangdong Province, the Guangzhou Basic Research Program on People's Livelihood Science and Technology, the National Natural Science Foundation of China.

Factors Associated With New Sexual Partnerships During the COVID-19 Pandemic: A Survey of Online Sexually Transmitted Infection Testing Platform Users

BACKGROUND

The COVID-19 pandemic has coincided with an explosion of online platforms for sexually transmitted infections (STIs) testing using self-collected, mail-in specimens. Reports on the effect of COVID-19-associated restrictions on sexual behaviors have been mixed, but STI transmissions have continued during the pandemic. We sought to understand the pandemic impact on sexual habits associated with STIs among IWantTheKit users.

METHODS

Users of IWantTheKit, a free, online STI testing platform, were invited to complete an anonymous questionnaire. Descriptive statistics were used to describe survey responses. Associations with reports of new sex partnerships were explored as a marker of STI risk. Descriptive statistics, univariate and multivariate logistic regression models were used to analyze individual characteristics and reported behaviors associated with self-reported new sexual partnerships during the first 2 COVID-19 pandemic waves.

RESULTS

Of the 3462 users of the online STI testing platform between June 2020 and February 2021, 1088 (31.4%) completed the online survey; 705 (66.2%) of 1065 reported a new sex partner. One-quarter met their sex partners using apps. Overall, 10% were symptomatic and almost 18% were concerned that their partner had an STI. White race in men (odds ratio, 1.81; 95% confidence interval, 1.04-3.16), women younger than 25 years (odds ratio, 1.85; 95% confidence interval, 1.09-3.14), and increased condom use in both men and women were significantly associated with reports of new sexual partnerships in adjusted analysis.

CONCLUSIONS

Despite pandemic restrictions on social gatherings, new sexual partnerships were common in this population, associated with common risk factors, and may help to explain ongoing STI transmission.

Variations in sexual network connectivity may explain dramatic variations in sexually transmitted infection prevalence between populations and over time: a selected four-country analysis

Background: The incidence of sexually transmitted infections (STIs) has been noted to vary dramatically between population groups and over time. Here, the hypothesis that changes in network connectivity underpin these changes is explored.

Methods: The incidence/prevalence estimates of HIV, herpes simplex virus-2, syphilis, chlamydia, and gonorrhoea, as well as two markers of sexual network connectivity (partner concurrency and multiple partnering) by ethnic group and sexual orientation in Kenya, South Africa, the United Kingdom (UK) and the United States (USA) were extracted from published studies. Pearson’s correlation was used to test the association between the markers of network connectivity and the incidence/prevalence of these five STIs. A literature review was performed to evaluate the possible causes of the increases and decreases in syphilis incidence over the past 60 years.

Results: In each country, the five STIs were found to cluster in particular ethnic groups and sexual orientations and to be positively associated with the two markers of network connectivity. Syphilis incidence in the UK and USA was found to increase dramatically in the 1960s/1970s, decline in the 1980s and again increase in the late 1990s. These changes took place predominantly in men who have sex with men, and were preceded by corresponding changes in network connectivity. The large decline in antenatal syphilis prevalence in Kenya and South Africa in the 1990s were likewise preceded by declines in network connectivity.

Conclusions: Although other explanatory variables are not controlled for, the present analysis is compatible with the hypothesis that differential network connectivity is a parsimonious explanation for variations in STI incidence over time and between populations.

Factors Associated with Syphilis Transmission and Acquisition Among Men Who Have Sex with Men (MSM): Protocol for a Multi-Site Egocentric Network Study (Preprint)

BACKGROUND

In the United States, the rates of primary and secondary syphilis have increased more rapidly among men who have sex with men (MSM) than among any other subpopulation. Rising syphilis rates among MSM reflect changes in both individual behaviors and the role of sexual networks (eg, persons linked directly or indirectly by sexual contact) in the spread of the infection. Decades of research examined how sexual networks influence sexually transmitted infections (STIs) among MSM; however, few longitudinal data sources focusing on syphilis have collected network characteristics. The Centers for Disease Control and Prevention, in collaboration with 3 sites, enrolled a prospective cohort of MSM in 3 US cities to longitudinally study sexual behaviors and STIs, including HIV, for up to 24 months.

OBJECTIVE

The Network Epidemiology of Syphilis Transmission (NEST) study aimed to collect data on the factors related to syphilis transmission and acquisition among MSM.

METHODS

The NEST study was a prospective cohort study that enrolled 748 MSM in Baltimore, Maryland; Chicago, Illinois; and Columbus, Ohio. NEST recruitment used a combination of convenience sampling, venue-based recruitment, and respondent-driven sampling approaches. At quarterly visits, participants completed a behavioral questionnaire and were tested for syphilis, HIV, gonorrhea, and chlamydia. The participants also provided a list of their sexual partners and described their 3 most recent partners in greater detail.

RESULTS

The NEST participants were enrolled in the study from July 2018 to December 2021. At baseline, the mean age of the participants was 31.5 (SD 9.1) years. More than half (396/727. 54.5%) of the participants were non-Hispanic Black, 29.8% (217/727) were non-Hispanic White, and 8.8% (64/727) were Hispanic or Latino. Multiple recruitment strategies across the 3 study locations, including respondent-driven sampling, clinic referrals, flyers, and social media advertisements, strengthened NEST participation. Upon the completion of follow-up visits in March 2022, the mean number of visits per participant was 5.1 (SD 3.2; range 1-9) in Baltimore, 2.2 (SD 1.6; range 1-8) in Chicago, and 7.2 (SD 2.9; range 1-9) in Columbus. Using a community-based participatory research approach, site-specific staff were able to draw upon collaborations with local communities to address stigma concerning STIs, particularly syphilis, among potential NEST participants. Community-led efforts also provided a forum for staff to describe the NEST study objectives and plans for research dissemination to the target audience. Strategies to bolster data collection during the COVID-19 pandemic included telehealth visits (all sites) and adaptation to self-collection of STI specimens (Baltimore only).

CONCLUSIONS

Data from NEST will be used to address important questions regarding individual and partnership-based sexual risk behaviors among MSM, with the goal of informing interventions to prevent syphilis in high-burden areas.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR1-10.2196/40095.

Three-site screening for STIs in men who have sex with men using online self-testing in an English sexual health service

OBJECTIVES

Among men who have sex with men (MSM) in the UK,Chlamydia trachomatis (CT) and Neisseria gonorrhoea (NG) infections commonly occur asymptomatically at extragenital sites. Therefore, MSM seeking sexual health services are offered three-site (oropharyngeal, rectal and urogenital) STI screening. To increase access to screening, some UK sexual health services enable asymptomatic service users to order free STI screening kits online for self-sampling at home. We sought to assess prevalence of overall and extragenital CT/NG infection among asymptomatic MSM who used online self-testing in Hampshire, UK.

METHODS

We assessed prevalence of CT/NG infections from non-pooled samples among asymptomatic cisgender MSM using an administrative database with results from 5601 STI screening kits returned between 20 December 2016 and 31 January 2020. We compared number of diagnoses of extragenital infection with urogenital results of the same individuals to determine prevalence of infection that would have been missed with urine testing alone.

RESULTS

Among 5051 valid CT and 5040 valid NG asymptomatic test results, overall prevalence was 5.9% (298/5051) and 4.5% (228/5040), respectively. Among MSM with asymptomatic CT, 71.8% (214/298) had extragenital infection only, χ² (1, n=298)=56.71, p<0.001. Among those with asymptomatic NG, 89.9% (205/228) had extragenital infection only, χ² (1, n=228)=145.281, p<0.001.

CONCLUSIONS

Overall, most CT/NG infections among asymptomatic MSM who used online self-testing were extragenital. Given this and the likelihood of onward transmission from asymptomatic infection, it is recommended that three-site testing remain standard for MSM and free screening services be expanded in easily accessible ways.

Mathematical Model of HIV/AIDS Considering Sexual Preferences Under Antiretroviral Therapy, a Case Study in San Juan de Pasto, Colombia

While several studies on human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) in the homosexual and heterosexual population have demonstrated substantial advantages in controlling HIV transmission in these groups, the overall 2benefits of the models with a bisexual population and initiation of antiretroviral therapy have not had enough attention in dynamic modeling. Thus, we used a mathematical model based on studying the impacts of bisexual behavior in a global community developed in the PhD thesis work of Espitia (2021). The model is governed by a nonlinear ordinary differential equation system, the parameters of which are calibrated with data from the cumulative cases of HIV infection and AIDS reported in San Juan de Pasto in 2019. Our model estimations show which parameters are the most influential and how to modulate them to decrease the HIV infection.

Human Papillomavirus Vaccination Initiation and Completion Among Heterosexual and Sexual Minority U.S. Adults

Purpose: The current study examined the relationship between sexual orientation and human papillomavirus (HPV) vaccination status (no vaccination vs. vaccination initiation [one to two doses] or completion [three or more doses]) among a nationally representative sample of U.S. adults. Methods: Pooled Integrated Public Use Microdata Series-National Health Interview Survey data from 2013 to 2017 were used. The analysis sample (N = 35,266) reported on HPV vaccination status, sexual orientation, and demographic covariates. Multinomial logistic regression, stratified by sex, was conducted to assess the relationship between sexual orientation and HPV vaccination status. Results: Most of the sample (80.37%) had not received any HPV vaccination dose, and only ∼10% reported vaccine completion (three or more doses). After adjusting for demographic covariates, gay and bisexual males were more likely than heterosexual males to initiate (gay: adjusted odds ratio [AOR] = 2.46, 95% confidence interval [CI] = 1.67-3.62; bisexual: AOR = 2.30, 95% CI = 1.28-4.12) and complete (gay: AOR = 2.59, 95% CI = 1.45-4.65; bisexual: AOR = 3.20, 95% CI = 1.56-6.55) HPV vaccination. Bisexual females were more likely than heterosexual females to initiate (AOR = 1.99, 95% CI = 1.55-2.54) and complete (AOR = 1.45, 95% CI = 1.23-1.86) HPV vaccination. Females of another sexual orientation were less likely than heterosexual females to complete HPV vaccination (AOR = 0.49, 95% CI = 0.26-0.92). Conclusions: HPV vaccination remains low across sexual orientation groups. Sexual minority status may be a promotive factor in HPV vaccination for specific subgroups.

Factors Associated with Sexually Transmitted Infections among Users of Voluntary HIV Counseling and Testing Centers in Portugal

Objective: Users of publicly funded voluntary HIV Counseling and Testing Centers (VCT C) in the Portuguese National Service have been found to have higher rates of HIV risk behavior than the general population, but data concerning the relationship between socio-demographic, behavioral, and cognitive variables, and Sexually Transmitted Infections (ST Is) in this specific population are limited. This study tests the impact of socio-demographic, behavioral and cognitive variables on ST Is in a sample of 168 users of VCT C. Methods: A cross-sectional study using structured questionnaires was conducted. Results: Being older, being gay or bisexual, and having more barriers towards safer sex (e.g., negative attitudes toward safer sex behavior) were associated with increased odds of having had a ST I diagnosis. We found significant differences between heterosexual and gay men for number of sexual partners, frequency of anal sex, exchanging sex for money or drugs, history of ST Is, AIDS knowledge, and risk beliefs about the partner, with gay men showing higher rates. Conclusions: ST Is education should target older, gay or bisexual individuals, and focus on information as well as on changing barriers towards safer sex and associated health beliefs.

COVID-19 Vaccine Uptake and Its Impacts in a Cohort of Gay and Bisexual Men in Australia

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.

How Alcohol Influences Mechanisms of Sexual Risk Behavior Change: Contributions of Alcohol Challenge Research to the Development of HIV Prevention Interventions

This paper examines the contributions of laboratory-based alcohol challenge research (ACR) to the development of HIV prevention interventions. Following a brief overview of HIV prevention interventions and related health behavior change models, we discuss how alcohol may influence mechanisms of behavior change. The paper highlights the value of ACR for: (1) elucidating mechanisms of action through which alcohol affects sexual risk behavior, (2) testing how alcohol may influence mechanisms thought to underlie HIV prevention interventions, (3) clarifying moderators of the causal influences of alcohol, (4) identifying novel intervention targets, and (5) developing strategies to reduce sexual risk among those who consume alcohol. We conclude with a discussion of the importance of using experimental research to identify mechanisms of behavior change that are specific to populations at high risk for HIV and outline some key implications for developing HIV prevention interventions that integrate the role of alcohol.

Sexual discounting: A systematic review of discounting processes and sexual behavior

Behavioral processes underlying sexual behavior are important for understanding normal human functioning and risk behavior leading to sexually transmitted infections (STIs). This systematic review examines delay and probability discounting in human sexual behavior through synthesis of 50 peer-reviewed, original research articles. Sixteen studies focusing exclusively on monetary delay discounting found small effect size positive correlations with sexual risk behaviors. Eleven studies examined delay or probability discounting of sexual behavior itself using tasks that varied duration, frequency, or quality of sex to determine value. Results show delay and uncertainty of sex causes systematic decreases in value. These studies also show consistent medium effect size relationships between sexual discounting measures and sexual health and substance use, supporting utility above and beyond monetary discounting. Twenty-three studies have modeled clinically relevant decision-making, examining effects of delay until condom availability and STI contraction probability on condom use. Observational and experimental designs found condom-use discounting is elevated in high-risk substance use populations, is sensitive to context (e.g., partner desirability), and is more robustly related to sexual risk compared with monetary discounting or condom use decisions when no delay/uncertainty was involved. Administering cocaine, alcohol, and, for some participants, methamphetamine increased condom-use discounting with minimal effect on monetary discounting or condom use when no delay/uncertainty was involved. Reviewed studies robustly support that sexual behavior is highly dependent on delay and probability discounting, and that these processes strongly contribute to sexual risk. Future research should exploit these systematic relationships to design behavioral and pharmacological approaches to decrease sexual risk behavior. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Cheating under the Circumstances in Marital Relationships: The Development and Examination of the Propensity towards Infidelity Scale

Most of the previously developed scales addressing infidelity were developed on young samples in dating relationships and with limited couple experience. The present study proposes an instrument to measure the proneness for infidelity among married people with substantial experience as a couple. Specific contexts described by the items, in which unfaithful behavior might occur, were selected from those revealed by previous research on people’s motives of past infidelity. Across two studies (N = 618) we examined the factorial structure and the psychometric characteristics of the Propensity towards Infidelity Scale (PTIS). Results revealed a one-dimensional structure of the PTIS and supported its reliability, its construct, criterion and incremental validity. PTIS emerged as negatively associated with two measures of adherence to moral standards, and positively related to past unfaithful behavior. Furthermore, the new instrument was found to bring a significant contribution in explaining these behaviors beyond two other scales of infidelity intentions.

"Safe Behind My Screen": Adolescent Sexual Minority Males' Perceptions of Safety and Trustworthiness on Geosocial and Social Networking Apps

Dating and social media application ("app") use for sexual and romantic partner-seeking is increasingly ubiquitous among adolescent sexual minorities assigned male at birth (ASMM). Previous work suggests that ASMM use the Internet, including apps, for normative aspects of sexual identity exploration and development. However, there may be risks associated with their use of sexualized apps designed for adults and with sexual interaction with adult app users. Little is known about how they assess and mitigate risk or gauge the trustworthiness of potential partners on such apps. We recruited ASMM in the U.S. (N = 268; ages 15-18 years, mean age = 16.9) to complete an online survey with open- and closed-ended questions about their perceptions of safety and trustworthiness of others while using apps to find partners. Participants perceived various risks on apps (e.g., physical harm, being "catfished") but did not appear to have clear strategies for measuring or mitigating it. They often assessed trustworthiness by observing other users' behavior or profiles. Participants frequently described interacting with older app users as risky or untrustworthy. Sexual health risks were seldom mentioned and the legal risks of sexual interaction with adults were never mentioned. Although app use may meet some of ASMM's sexual development needs, they may lack the knowledge and skills to do so safely in sexualized online adult spaces. These findings suggest that sex education for sexual minority adolescents should address online sexual safety.

Sexual Positioning Practices and Anal Human Papillomavirus Infection Among Young Men Who Have Sex with Men and Transgender Women-Chicago, Illinois, 2016-2018

BACKGROUND

Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States; men who have sex with men (MSM) have higher prevalence of infection and related disease compared with other men. We assessed whether differences in HPV acquisition exist among MSM according to their sexual positioning practices, as well as self-reported receipt of HPV vaccination.

METHODS

We enrolled young MSM and transgender women aged 18 to 26 years in Chicago, IL (N = 666). Participants self-reported their history of HPV vaccination and submitted self-collected anal swab specimens for type-specific HPV detection using an L1-consensus PCR assay. Multivariable logistic regression analyses were used to assess relationships between sexual positioning practices and detection of any HPV or quadrivalent HPV vaccine (4vHPV) types by vaccination status, defined as self-reported receipt of ≥1 HPV vaccine dose versus none.

RESULTS

Among 666 participants, 400 (60.1%) had any anal HPV, and 146 (21.9%) had a 4vHPV type. Among vaccinated participants, 18, 36, and 177 reported exclusively insertive, exclusively receptive, or both sexual positioning practices, respectively. Compared with participants reporting exclusively insertive anal sex, odds of any HPV were significantly higher among participants engaging exclusively in receptive anal sex (adjusted odds ratio [aOR], 5.90; 95% confidence interval [CI], 2.52-13.78), as well as those engaging in both (aOR, 3.32; 95% CI, 1.71-6.44). Vaccinated participants, compared with unvaccinated participants, had lower odds of 4vHPV-type HPV regardless of sexual positioning practices (aOR, 0.56; 95% CI, 0.34-0.92).

CONCLUSIONS

Adult men and transgender women who practice anal receptive sex have high prevalence of infection with any HPV. Routine vaccination of all adolescents is expected to reduce HPV-related disease incidence among adult MSM and transgender women as vaccinated cohorts age.

Awareness, Utilization, and Preferences for Traditional and Contemporary HIV Prevention Strategies Among Facebook and Instagram-Using MSM in the United States

HIV prevention research among men who have sex with men (MSM) has traditionally focused on individual risk reduction strategies. Our study evaluated awareness, utilization, and preferences for 10 complementary HIV prevention strategies among 1,286 MSM recruited via Facebook and Instagram from June-August 2018. Ages ranged from 18-85 years, and the majority were non-Hispanic white (n = 1,019, 79.24%), college-educated (n = 819, 63.69%), gay-identifying (n = 1,074, 83.51%), and partnered (n = 808, 62.83%). Post-exposure prophylaxis was the least familiar option, and engaging in sexual activities other than anal sex was the most utilized option. Progressively older and bisexual-identifying MSM were less likely, but those with higher educational levels and easy access to local HIV resources were more likely to be aware of and to be utilizing a greater number of strategies. Additionally, Hispanic MSM were less likely to be aware of, and those in a “closed” relationship were less likely to be utilizing a greater number of strategies. In a subset of 775 multiple strategy users, pre-exposure prophylaxis, regularly testing for HIV, and limiting the number of sex partners emerged as the most preferred options. Combination intervention packages for MSM should be tailored to personal circumstances, including sexual orientation, relationship characteristics and access to local HIV resources.

Sexual Behavior Change Among Gay and Bisexual Men During the First COVID-19 Pandemic Wave in the United States

Background

After decades of navigating HIV and other sexually transmitted infections, gay and bisexual men are responding to new and uncertain risks presented by the coronavirus (COVID-19) pandemic by adapting their sexual behavior.

Methods

This paper uses data from a national sample of 728 gay and bisexual men collected from April 10 to May 10, 2020, to examine changes to sexual behavior in response to the first wave of the pandemic in the USA. We also assess whether behavior modifications are associated with exposure to statewide public health measures, including Stay-at-Home orders.

Results

Sexual minority men report significant changes to their sexual behavior and partner selection during the first wave. Nine out of 10 men reported having either one sexual partner or no sexual partner in the last 30 days at the time of interview, a decrease compared to just before the pandemic for nearly half of men surveyed. Reporting no sexual partners in the last 30 days was significantly predicted by increased exposure to a Stay-at-Home order. Sexual minority men also reduced interactions with casual partners, increased no-contact sexual behaviors (e.g., masturbation and virtual sex), and engaged in new strategies to reduce their risks of infection from partners. HIV-positive men were particularly likely to adopt strategies including avoiding casual partners and avoiding public transportation to meet sexual partners.

Conclusion

Sexual minority men's behavior changes during the first wave may have reduced the impact of the coronavirus pandemic on their communities. Despite substantial changes in sexual behavior for most men in our sample during the initial first wave, we identify some concerns around the sustainability of certain behavioral changes over time and nondisclosure of COVID-19 symptoms to partners.

Sexually Transmitted Infections Treatment Guidelines, 2021

These guidelines for the treatment of persons who have or are at risk for sexually transmitted infections (STIs) were updated by CDC after consultation with professionals knowledgeable in the field of STIs who met in Atlanta, Georgia, June 11-14, 2019. The information in this report updates the 2015 guidelines. These guidelines discuss 1) updated recommendations for treatment of Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis; 2) addition of metronidazole to the recommended treatment regimen for pelvic inflammatory disease; 3) alternative treatment options for bacterial vaginosis; 4) management of Mycoplasma genitalium; 5) human papillomavirus vaccine recommendations and counseling messages; 6) expanded risk factors for syphilis testing among pregnant women; 7) one-time testing for hepatitis C infection; 8) evaluation of men who have sex with men after sexual assault; and 9) two-step testing for serologic diagnosis of genital herpes simplex virus. Physicians and other health care providers can use these guidelines to assist in prevention and treatment of STIs.

Patterns of Online and Offline Partnering, Partnership Characteristics, and Condomless Sex Among Adolescent Sexual Minority Males in the USA

Online partner-seeking among adolescent sexual minority males (ASMM) has been associated with condomless anal sex. Two hypotheses may explain this association: that online venues facilitate HIV transmission risk behavior more than offline venues (accentuation), or that individuals who tend to engage in these behaviors are more likely to seek partners online (self-selection). We examined these hypotheses in 700 13-18 year-old ASMM who completed the baseline survey of an effectiveness trial of an HIV prevention program in 2018-2020. The survey assessed demographic, sexual, and venue characteristics of male anal sex partnerships in the past 3 months. Many participants (83%) reported ≥ 1 online-met partner; most were met via sexual networking applications and were older than offline-met partners. Having met partners online, but not whether a particular partner was met online, was associated with greater odds of receptive condomless sex. Findings support the self-selection hypothesis, which has implications for HIV prevention in ASMM.

Sexual Partner Accumulation From Adolescence to Early Adulthood in Populations With Physical Disabilities in the U.S

PURPOSE

This study aimed to examine the lifetime and pre-18 sexual partnering patterns of populations with physical disabilities from adolescence to early adulthood and how these patterns further vary by biological sex, race/ethnicity, and sexual orientation.

METHODS

Data were from 13,458 respondents to Waves I and IV of the National Longitudinal Study of Adolescent to Adult Health. Poisson regression models were used to assess differences in pre-18 and lifetime sexual partner counts among populations with physical disabilities compared with those without disabilities. Moderation analyses by biological sex, race/ethnicity, and sexual orientation were used to consider further differences among minority subgroups.

RESULTS

The results indicated more similarities than differences in sexual partnering patterns across disability severity groups. Specifically, populations with disabilities had just as many pre-18 and lifetime sexual partners as peers without disabilities. There was variation by biological sex, race/ethnicity, and sexual orientation, although this was not tied to disability status.

CONCLUSIONS

These results fill an important gap in the literature by considering the sexual partnering behaviors of populations with physical disabilities in the U.S. over the life course. Future research should continue to include populations with disabilities and other minority groups to ensure that their experiences are represented in sexual health policies and programs.

Age of Sexual Debut among Young Gay-identified Sexual Minority Men: The P18 Cohort Study

Age of sexual debut is a critical health indicator for young sexual minority men (YSMM), associated with an increased likelihood of HIV acquisition, use of alcohol, tobacco, and other substances, and psychological distress. This study examined the age of same-sex sexual debut for five sexual behaviors in a sample of racially/ethnically and socioeconomically diverse gay-identified YSMM in New York City. The mean age of sexual debut of any behavior was 14.5 years old and 19% of the sample reported sexual debut prior to age 13. Overall, mutual masturbation occurred at the youngest mean age, followed by performed oral, received oral, receptive anal, and insertive anal intercourse. There were significant differences by race/ethnicity and perceived familial socioeconomic status (SES), such that Black and Hispanic/Latino men had earlier ages of debut for performed oral and receptive and insertive anal sex, while upper SES men had later ages of debut for receptive and insertive anal intercourse. These findings are relevant to trends in HIV incidence in the U.S., which are highest among Black and Hispanic/Latino YSMM and may be associated with earlier age of sexual debut. These findings also underscore a need for comprehensive and inclusive sex education at younger ages.

Socio-Demographic Characteristics and Sexual Behavioral Factors of Patients with Sexually Transmitted Infections Attending a Hospital in Southern Italy

Sexually transmitted infections (STIs) are a serious global health problem. In Italy, data describing the vulnerability to STIs of specific sexual minorities and the influence of sociodemographic and behavioral determinants are limited, as most infections are not subject to mandatory notification. This retrospective study describes the sociodemographic profile and main sexual behaviors of patients attending a hospital in Palermo (Sicily, Italy) from January 2018 to March 2019 as predictors of STI risk. Patients were divided in subgroups: men-who-have-sex-with-men (MSM), men-who-have-sex-with-women (MSW), bisexual men and females. Data were obtained through an anonymous questionnaire. Patients were tested for chlamydia, syphilis, Mycoplasma genitalium infection, genital herpes and HPV infection. A total of 294 subjects with STIs (male/female ratio about 2:1) were screened. Of the total sample, 79.6% of patients were Italian. MSM accounted for 34.3%, MSW for 29.6%, bisexual men for 5.8% and females for 30.3%. A total of 44.5% of patients had a high education level, 42.5% reported irregular use of condoms, 20.7% reported having had 5-10 partners in the six months prior to the visit and 32.9% were HIV-positive. HPV infection and syphilis were the most prevalent STIs. Conclusions: The most common profile of patients attending our clinic was that of an adult, Italian man with a high level of education, poor use of condoms and a high number of partners. MSM had the highest sex-behavior-related risk for STIs. In addition, our results suggest that all STD teams need to implement counselling topics and recommendations to share with patients, as well as tips on how to approach sexual health education/counselling, thereby promoting patient-centered approaches and educational programs.

County-Level Social Capital and Bacterial Sexually Transmitted Infections in the United States

BACKGROUND

The association between county-level social capital indices (SCIs) and the 3 most commonly reported sexually transmitted infections (STIs) in the United States is lacking. In this study, we determined and examined the association between 2 recently developed county-level SCIs (ie, Penn State Social Capital Index [PSSCI] vs United States Congress Social Capital Index [USCSCI]) and the 3 most commonly reported bacterial STIs (chlamydia, gonorrhea, and syphilis) using spatial and nonspatial regression techniques.

METHODS

We assembled and analyzed multiyear (2012-2016) cross-sectional data on STIs and 2 SCIs (PSSCI vs USCSCI) on counties in all 48 contiguous states. We explored 2 nonspatial regression models (univariate and multiple generalized linear models) and 3 spatial regression models (spatial lag model, spatial error model, and the spatial autoregressive moving average model) for comparison.

RESULTS

Without exception, all the SCIs were negatively associated with all 3 STI morbidities. A 1-unit increase in the SCIs was associated with at least 9% (P < 0.001) decrease in each STI. Our test of the magnitude of the estimated associations indicated that the USCSCI was at least 2 times higher than the estimates for the PSSCI for all STIs (highest P value = 0.01).

CONCLUSIONS

Overall, our results highlight the potential benefits of applying/incorporating social capital concepts to STI control and prevention efforts. In addition, our results suggest that for the purpose of planning, designing, and implementing effective STI control and prevention interventions/programs, understanding the communities' associational life (as indicated by the factors/data used to develop the USCSCI) may be important.

Exploration of the Complex Relationships Among Multilevel Predictors of PrEP Use Among Men Who Have Sex with Men in the United States

To explore the relationships among individual-, social-, and contextual- (state-level characteristics, including LBGTQ + and racial inequality) level factors and PrEP use. A cross-sectional survey was conducted in 2015-2016 among a geographically diverse group of men who have sex with men (MSM). Survey data was linked to publicly available state-level data based on participant zip code. Multivariable multilevel logistic regression was used to explore the association between multilevel variables and PrEP use. Of 4165 HIV-negative MSM, 13.4% were taking PrEP. In the regression analysis, several demographic and behavioral factors were associated with higher odds of PrEP use. Importantly, after adjusting for individual- and social-level factors, residents of states with high LGBTQ + equality had significantly higher odds of taking PrEP (OR 1.57; 95% CI 1.119, 2.023) compared to low equality states. LGBTQ + inequality between states may hinder PrEP use. States may need to take proactive measures to reduce LGBTQ + inequality as this may negatively impact the ability to reach the federal administration's stated goal to end the HIV epidemic in the US.

Prevalence and genotype distribution of human papillomavirus infection in different anatomical sites among men who have sex with men: A systematic review and meta-analysis

Men who have sex with men (MSM) are at increased risk of human papillomavirus (HPV) infection because of their high-risk sexual behaviours. In this study, a meta-analytic approach was used to systematically analyse the literature to elucidate the prevalence and genotype distribution of anal, penile, oral and urethral HPV infection among MSM in the world. To carry out this systematic review, five electronic databases including Web of Science, PubMed, Scopus, Embase, and Google Scholar were searched for relevant studies published from January 2012 to November 2019, and pertinent data were collected from the eligible articles. The pooled HPV prevalence was calculated for each anatomical region using a random-effect model weighted by the inverse variance method. The meta-analysis was performed using the "Metaprop" function in the R package Meta. The overall pooled prevalence of anal, penile, oral and urethral HPV infection among MSM were 78.4% (95% confidence interval [CI]: 75.6%-81.0%), 36.2% (95% CI: 29.1%-44.0%), 17.3% (95% CI: 13.6%-21.7%) and 15.4% (95% CI: 7.8%-27.9%), respectively. Stratified analyses showed that the prevalences of HPV were significantly higher in HIV-positive than HIV-negative MSM. The most frequent HPV high-risk type detected in the anus, penis and oral cavity was HPV-16 (19.9%, 4.9% and 3.1%, respectively). HPV infection is rising in MSM because of high-risk sexual behaviours, suggesting an increased future risk of developing HPV-related diseases and malignancies in this population.

An Investigation of Early Syphilis Among Men Who have Sex with Men: Alaska, 2018: Findings from a 2018 Rapid Ethnographic Assessment

The state of Alaska had a sharp increase in cases of primary and secondary syphilis among gay, bisexual, and other men who have sex with men (GBMSM) in 2018, centered in Anchorage. A rapid ethnographic assessment was conducted in October 2018 to examine contextual factors contributing to local increases in syphilis. The assessment team conducted qualitative interviews with 64 (N=49 interviews) key informants in Anchorage and Matanuska-Susitna Valley identified through the STD/HIV program at the Alaska Department of Health and Social Services, Division of Public Health (ADPH):  ADPH staff (n = 11; 22%) Medical Providers (n = 18; 37%), Community-Based Organizations/Partners (n = 9; 18%), and GBMSM Community Members (n = 11; 22%). This project was deemed exempt from IRB review. Primary factors affecting syphilis transmission, care, and treatment among GBMSM were: (1) Low awareness about the current syphilis outbreak and ambivalence about syphilis and other STIs; (2) Aspects of sexual partnering such as travel, tourism, and the use of online sites and apps to facilitate anonymous sex and multiple (both sequential/concurrent) partnering; (3) The synergistic effects of substance use, homelessness, and transactional sex; (4) Choosing condomless sex; and (5) Challenges accessing healthcare, including the ability to find appropriate and culturally competent care. Syphilis increases may have been influenced by factors which spanned multiple sectors of the Anchorage community, including individual behavior, community-level risk and protective factors, and use of and interactions with resources offered by ADPH, community-based organizations, and medical providers.

Test-and-treat coverage and HIV virulence evolution among men who have sex with men

HIV set point viral load (SPVL), the viral load established shortly after initial infection, is a proxy for HIV virulence: higher SPVLs lead to higher risk of transmission and faster disease progression. Three models of test-and-treat scenarios, mainly in heterosexual populations, found that increasing treatment coverage selected for more virulent viruses. We modeled virulence evolution in a population of men who have sex with men (MSM) with increasing test-and-treat coverage. We extended a stochastic, dynamic network model (EvoNetHIV). We varied relationship patterns (MSM vs. heterosexual), HIV transmission models (increasing vs. plateauing probability of transmission at very high viral loads), and treatment roll-out (with explicit testing or fixed intervals between infection and treatment). In scenarios most similar to previous models (longer relational durations and the plateauing transmission function), we replicated trends previously found: increasing treatment coverage led to increased virulence (0.12 log10 increase in mean population SPVL between 20% and 100% treatment coverage). In scenarios reflecting MSM behavioral data using the increasing transmission function, increasing treatment coverage selected for viruses with lower virulence (0.16 log10 decrease in mean population SPVL between 20% and 100% treatment coverage). These findings emphasize the impact of sexual network conditions and transmission function details on predicted epidemiological and evolutionary outcomes. Varying these features creates very different evolutionary environments, which in turn lead to opposite effects in mean population SPVL evolution. Our results suggest that, under some realistic conditions, effective test-and-treat strategies may not face the previously reported tradeoff in which increasing coverage leads to evolution of greater virulence. This suggests instead that a virtuous cycle of increasing treatment coverage and diminishing virulence is possible.