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Chow EPF, Fairley CK. Could antiseptic mouthwash inhibit pharyngeal Neisseria gonorrhoeae? Further research is required. Sex Transm Infect 2018; 93:403. [PMID: 28827305 DOI: 10.1136/sextrans-2017-053139] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 02/11/2017] [Indexed: 11/04/2022] Open
Affiliation(s)
- Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
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2
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Seppings L, Hamill M. A review of an early syphilis outbreak in West Berkshire and Reading 2014-2015. Sex Transm Infect 2018; 92:364. [PMID: 27440932 DOI: 10.1136/sextrans-2016-052579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 05/31/2016] [Indexed: 11/04/2022] Open
Affiliation(s)
- Louise Seppings
- Department of Genitourinary Medicine, Berkshire Healthcare NHS Trust, Slough, UK
| | - Matthew Hamill
- Department of Genitourinary Medicine, Berkshire Healthcare NHS Trust, Slough, UK
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3
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Daskalopoulou M, Rodger AJ, Phillips AN, Sherr L, Elford J, McDonnell J, Edwards S, Perry N, Wilkins E, Collins S, Johnson AM, Burman WJ, Speakman A, Lampe FC. Condomless sex in HIV-diagnosed men who have sex with men in the UK: prevalence, correlates, and implications for HIV transmission. Sex Transm Infect 2017; 93:590-598. [PMID: 28679630 PMCID: PMC5739863 DOI: 10.1136/sextrans-2016-053029] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 04/12/2017] [Accepted: 04/18/2017] [Indexed: 11/18/2022] Open
Abstract
Objective HIV transmission is ongoing among men who have sex with men (MSM) in the UK. Sex without a condom (condomless sex, CLS) is the main risk factor. We investigated the prevalence of and factors associated with types of CLS. Methods Cross-sectional questionnaire study in UK HIV clinics in 2011/2012 (ASTRA). MSM diagnosed with HIV for ≥3 months reported on anal and vaginal sex, CLS with HIV-serodifferent partners (CLS-D) and CLS with HIV-seroconcordant (CLS-C) partners in the previous 3 months. Mutually exclusive sexual behaviours were as follows: (1) Higher HIV risk CLS-D (not on antiretroviral therapy (ART) or clinic-recorded viral load(VL) >50 c/mL), (2) Other CLS-D, (3) CLS-C without CLS-D, (4) Condom-protected sex only and (5) No anal or vaginal sex. Associations were examined of sociodemographic, HIV-related, lifestyle, and other sexual measures with the five categories of sexual behaviour. We examined the prevalence of higher HIV risk CLS-D incorporating (in addition to ART and VL) time on ART, ART non-adherence, and recent sexually transmitted infections (STIs). Results Among 2189 HIV-diagnosed MSM (87% on ART), prevalence of any CLS in the past 3 months was 38.2% (95% CI 36.2% to 40.4%) and that of any CLS-D was 16.3% (14.8%–17.9%). The five-category classification was as follows: (1) Higher HIV risk CLS-D: 4.2% (3.5% to 5.2%), (2) Other CLS-D: 12.1% (10.8% to 13.5%), (3) CLS-C without CLS-D: 21.9% (20.2% to 23.7%), (4) Condom-protected sex only: 25.4% (23.6% to 27.3%) and (5) No anal or vaginal sex: 36.4% (34.3% to 38.4%). Compared with men who reported condom-protected sex only, MSM who reported any CLS in the past 3 months had higher prevalence of STIs, chemsex-associated drug use, group sex, higher partner numbers, and lifetime hepatitis C. Prevalence of higher HIV risk CLS-D ranged from 4.2% to 7.5% according to criteria included. Conclusion CLS was prevalent among HIV-diagnosed MSM, but CLS-D with higher HIV transmission risk was overall low. CLS-D is no longer the most appropriate measure of HIV transmission risk behaviour among people with diagnosed HIV; accounting for VL is important.
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Affiliation(s)
- Marina Daskalopoulou
- Research Department of Infection and Population Health, University College London, London, UK
| | - Alison J Rodger
- Research Department of Infection and Population Health, University College London, London, UK
| | - Andrew N Phillips
- Research Department of Infection and Population Health, University College London, London, UK
| | - Lorraine Sherr
- Research Department of Infection and Population Health, University College London, London, UK
| | | | - Jeffrey McDonnell
- Research Department of Infection and Population Health, University College London, London, UK
| | - Simon Edwards
- Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK
| | - Nicky Perry
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Ed Wilkins
- Pennine Acute Hospitals NHS Trust, Manchester, UK
| | | | - Anne M Johnson
- Research Department of Infection and Population Health, University College London, London, UK
| | | | - Andrew Speakman
- Research Department of Infection and Population Health, University College London, London, UK
| | - Fiona C Lampe
- Research Department of Infection and Population Health, University College London, London, UK
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4
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Cunningham NJ, Beymer MR, Javanbakht M, Shover CL, Bolan RK. Concordance between self-reported STI history and biomedical results among men who have sex with men in Los Angeles, California. Sex Transm Infect 2017; 93:514-519. [PMID: 28554893 DOI: 10.1136/sextrans-2016-052933] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 03/16/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES HIV studies and risk assessments among men who have sex with men (MSM) frequently use self-reported STI history as a proxy for true STI history. The objective of our study was to assess the validity of self-reported STI history through comparison with laboratory-confirmed biomedical results. METHODS Data were analysed for MSM attending the Los Angeles LGBT Center (the Center) from August 2011 to July 2015. We identified 10 529 unique MSM who received testing for chlamydia, gonorrhoea and/or syphilis and had a later visit in which they self-reported their STI history to a clinic counsellor during a risk assessment. RESULTS MSM who had an STI in the past year self-reported their STI history with 51%-56% accuracy, and MSM who had an STI more than a year ago self-reported their STI history with 65%-72% accuracy. Among MSM with any positive STIs at the Center, black/African-American and Hispanic MSM were more likely to inaccurately self-report their positive results for gonorrhoea (adjusted OR (aOR): 1.48, 95% CI 1.09 to 2.01; aOR: 1.39, 95% CI 1.14 to 1.70). Additionally, HIV-positive MSM were more likely to inaccurately self-report their positive results for gonorrhoea (aOR: 1.63, 95% CI 1.22 to 2.18) and/or syphilis (aOR: 2.19, 95% CI 1.08 to 4.47). CONCLUSIONS This is the first study that attempts to evaluate the validity of self-reported STI history among MSM. We found that self-reported STI history may not be an appropriate proxy for true STI history in certain settings and minority populations. Clinical guidelines and research studies that rely on self-reported STI history will need to modify their recommendations in light of the limited validity of these data.
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Affiliation(s)
- Nicole J Cunningham
- Department of Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, California, USA.,Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California, USA
| | - Matthew R Beymer
- Department of Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, California, USA.,Division of Infectious Diseases, Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Marjan Javanbakht
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California, USA
| | - Chelsea L Shover
- Department of Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, California, USA.,Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California, USA
| | - Robert K Bolan
- Department of Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, California, USA
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5
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Mohan K, Hibbert M, Rooney G, Canvin M, Childs T, Jenkins C, Simms I, Kirwan P, Delpech V, Yin Z, Hughes G, Field N. What is the overlap between HIV and shigellosis epidemics in England: further evidence of MSM transmission? Sex Transm Infect 2017; 94:67-71. [PMID: 28490580 DOI: 10.1136/sextrans-2016-052962] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 04/01/2017] [Accepted: 04/18/2017] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Evidence suggests that sexual transmission between men has replaced foreign travel as the predominant mode of Shigella transmission in England. However, sexuality and HIV status are not routinely recorded for laboratory-reported Shigella, and the role of HIV in the Shigella epidemic is not well understood. METHODS The Modular Open Laboratory Information System containing all Shigella cases reported to Public Health England (PHE) and the PHE HIV and AIDS Reporting System holding all adults living with diagnosed HIV in England were matched using a combination of Soundex code, date of birth and gender. RESULTS From 2004 to 2015, 88 664 patients were living with HIV, and 10 269 Shigella cases were reported in England; 9% (873/10 269) of Shigella cases were diagnosed with HIV, of which 93% (815/873) were in men. Shigella cases without reported travel history were more likely to be living with HIV than those who had travelled (14% (751/5427) vs 3% (134/4854); p<0.01). From 2004 to 2015, the incidence of Shigella in men with HIV rose from 47/100 000 to 226/100 000 (p<0.01) peaking in 2014 at 265/100 000, but remained low in women throughout the study period (0-24/100 000). Among Shigella cases without travel and with HIV, 91% (657/720) were men who have sex with men (MSM). HIV preceded Shigella diagnosis in 86% (610/720), and 65% (237/362) had an undetectable viral load (<50 copies/mL). DISCUSSION We observed a sustained increase in the national rate of shigellosis in MSM with HIV, who may experience more serious clinical disease. Sexual history, HIV status and STI risk might require sensitive investigation in men presenting with gastroenteritis.
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Affiliation(s)
- Keerthi Mohan
- Department of HIV and STI, National Infection Service, Public Health England, London, UK
| | - Matthew Hibbert
- Department of HIV and STI, National Infection Service, Public Health England, London, UK
| | - Graeme Rooney
- Department of HIV and STI, National Infection Service, Public Health England, London, UK
| | - Malcolm Canvin
- Department of HIV and STI, National Infection Service, Public Health England, London, UK
| | - Tristan Childs
- Department of HIV and STI, National Infection Service, Public Health England, London, UK
| | - Claire Jenkins
- Gastrointestinal Infection Reference Service, Microbiology Services Centre, National Infection Service, Public Health England, London, UK
| | - Ian Simms
- Department of HIV and STI, National Infection Service, Public Health England, London, UK
| | - Peter Kirwan
- Department of HIV and STI, National Infection Service, Public Health England, London, UK
| | - Valerie Delpech
- Department of HIV and STI, National Infection Service, Public Health England, London, UK
| | - Zheng Yin
- Department of HIV and STI, National Infection Service, Public Health England, London, UK
| | - Gwenda Hughes
- Department of HIV and STI, National Infection Service, Public Health England, London, UK
| | - Nigel Field
- Department of HIV and STI, National Infection Service, Public Health England, London, UK.,Research Department of Infection and Population Health, University College London, London, UK
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Eaton LA, Kalichman SC, Kalichman MO, Driffin DD, Baldwin R, Zohren L, Conway-Washington C. Randomised controlled trial of a sexual risk reduction intervention for STI prevention among men who have sex with men in the USA. Sex Transm Infect 2017; 94:40-45. [PMID: 28404766 DOI: 10.1136/sextrans-2016-052835] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 03/08/2017] [Accepted: 03/27/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Novel interventions to address sexual risk taking and slow rates of STIs are urgently needed, in particular among black men who have sex with men (MSM) in the USA. Serosorting, or limiting condomless sex acts to partners of the same HIV status, is commonly practised among MSM, yet can lead to STI and remains largely unaddressed by public health agencies. METHODS A two-arm, randomised controlled trial was conducted from 2012 to 2015. This trial assessed the effects of a single-session, sexual partner selection and risk decision intervention (experimental arm) versus a single-session, Centers for Disease Control and Prevention-based, sexual risk reduction intervention (control arm) on psychosocial measures, sexual risk taking and STI. RESULTS At study follow-ups, multiple beneficial changes were observed on sexual risk beliefs measures (ie, changes in serosorting and condom use beliefs, and HIV risk perceptions) and sexual risk taking among the experimental arm relative to the control arm. Overall main effects, however, of the intervention on STI outcomes on year-long follow-ups were non-significant. There was evidence for short-term effects on STI outcomes, and self-report of multiple STIs and STI symptoms demonstrated positive effects over the follow-up period. CONCLUSIONS Brief interventions to address sexual risk taking can result in short-term beneficial outcomes and can be incorporated into currently existing infrastructure at healthcare agencies. Additional intervention will be necessary for demonstrating long-term results. TRIAL REGISTRATION NUMBER NCT02128594.
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Affiliation(s)
- Lisa A Eaton
- Human Development and Family Studies, University of Connecticut, Storrs, Connecticut, USA
| | - Seth C Kalichman
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Moira O Kalichman
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Daniel D Driffin
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Robert Baldwin
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Larissa Zohren
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
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Amirkhanian YA. Emerging opportunities and challenges for HIV prevention, treatment and care for MSM in the former Soviet Union and other post-communist states in Eastern Europe. Sex Transm Infect 2017; 93:305-306. [PMID: 28389443 DOI: 10.1136/sextrans-2016-052671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 01/19/2017] [Accepted: 03/16/2017] [Indexed: 11/03/2022] Open
Affiliation(s)
- Yuri A Amirkhanian
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Interdisciplinary Center for AIDS Research and Training (ICART), Municipal Hospital for Infectious Diseases named after S.P. Botkin, St. Petersburg, Russia
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Hughes G, Silalang P, Were J, Patel H, Childs T, Alexander S, Duffell S, Saxon C, Ison C, Mitchell H, Field N, Jenkins C. Prevalence and characteristics of gastrointestinal infections in men who have sex with men diagnosed with rectal chlamydia infection in the UK: an 'unlinked anonymous' cross-sectional study. Sex Transm Infect 2017; 94:518-521. [PMID: 28360379 DOI: 10.1136/sextrans-2016-053057] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 03/05/2017] [Accepted: 03/08/2017] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Gastrointestinal infections (GII) can cause serious ill health and morbidity. Although primarily transmitted through faecal contamination of food or water, transmission through sexual activity is well described, especially among men who have sex with men (MSM). METHODS We investigated the prevalence of GIIs among a convenience sample of MSM who were consecutively diagnosed with rectal Chlamydia trachomatis (CT) at 12 UK genitourinary medicine clinics during 10 weeks in 2012. Residual rectal swabs were coded, anonymised and tested for Shigella, Campylobacter, Salmonella, shiga toxin-producing Escherichia coli and enteroaggregative E. coli (EAEC) using a real-time PCR. Results were linked to respective coded and anonymised clinical and demographic data. Associations were investigated using Fisher's exact tests. RESULTS Of 444 specimens tested, overall GII prevalence was 8.6% (95% CI 6.3% to 11.6%): 1.8% (0.9% to 3.6%) tested positive for Shigella, 1.8% (0.9% to 3.6%) for Campylobacter and 5.2% (3.5% to 7.7%) for EAEC. No specimens tested positive for Salmonella or other diarrhoeagenic E. coli pathotypes. Among those with any GII, 14/30 were asymptomatic (2/7 with Shigella, 3/6 with Campylobacter and 9/17 with EAEC). Shigella prevalence was higher in MSM who were HIV-positive (4.7% (2.1% to 10.2%) vs 0.5%(0.1% to 3.2%) in HIV-negative MSM; p=0.01). CONCLUSIONS In this small feasibility study, MSM with rectal CT appeared to be at appreciable risk of GII. Asymptomatic carriage may play a role in sexual transmission of GII.
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Affiliation(s)
- Gwenda Hughes
- Department of HIV and STI, National Infection Service, Public Health England, London, UK
| | - Panida Silalang
- Gastrointestinal Infection Reference Service, Microbiology Services Centre, National Infection Service, Public Health England, London, UK
| | - John Were
- Department of HIV and STI, National Infection Service, Public Health England, London, UK
| | - Hemanti Patel
- Sexually Transmitted Infection Reference Service, Microbiology Services Centre, National Infection Service, Public Health England, London, UK
| | - Tristan Childs
- Gastrointestinal Infection Reference Service, Microbiology Services Centre, National Infection Service, Public Health England, London, UK
| | - Sarah Alexander
- Sexually Transmitted Infection Reference Service, Microbiology Services Centre, National Infection Service, Public Health England, London, UK
| | - Stephen Duffell
- Department of HIV and STI, National Infection Service, Public Health England, London, UK
| | - Cara Saxon
- Department of Sexual Medicine and HIV, University Hospitals of South Manchester NHS Foundation Trust, Manchester, UK
| | - Cathy Ison
- Sexually Transmitted Infection Reference Service, Microbiology Services Centre, National Infection Service, Public Health England, London, UK
| | - Holly Mitchell
- Department of HIV and STI, National Infection Service, Public Health England, London, UK.,Research Department of Infection and Population Health, University College London, London, UK
| | - Nigel Field
- Department of HIV and STI, National Infection Service, Public Health England, London, UK.,Research Department of Infection and Population Health, University College London, London, UK
| | - Claire Jenkins
- Gastrointestinal Infection Reference Service, Microbiology Services Centre, National Infection Service, Public Health England, London, UK
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9
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Bellhouse C, Walker S, Fairley CK, Chow EP, Bilardi JE. Getting the terminology right in sexual health research: the importance of accurately classifying fuck buddies among men who have sex with men. Sex Transm Infect 2017; 94:487-489. [PMID: 28356437 DOI: 10.1136/sextrans-2016-053000] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 02/28/2017] [Accepted: 03/08/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The aim of this report was to raise the issue of the definition and classification of partner terminology in men who have sex with men (MSM) research, particularly in regards to 'fuck buddies'. If definitions in research differ from general consensus in the MSM population, it is possible that public health strategies will be ineffective as the target population may be inaccurate. METHODS Thirty semistructured interviews with MSM attending the Melbourne Sexual Health Centre were conducted, focusing on the willingness to change sexual practices to reduce the risk of pharyngeal gonorrhoea. As part of these interviews, men were also asked their views on the terminology they used to describe their relationships and sexual partners. RESULTS The degree of emotional attachment often defined the type or classification of relationships. There was a consensus among men that partners they engaged with for 'sex only' were classified as casual partners and partners with whom there was an emotional attachment or formalisation of the relationship were classified as 'regular partners'. However, the classification of 'fuck buddy' as a regular or casual partner was less clear. CONCLUSIONS Further research is needed to ascertain the ways in which men conceptualise sexual relationships and define or classify partner types, particularly 'fuck buddy' relationships. A third category for sexual relationships should be considered to encapsulate fuck buddy relationships.
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Affiliation(s)
- Clare Bellhouse
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Sandra Walker
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Eric Pf Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Jade E Bilardi
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia
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10
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Hickson F, Melendez-Torres GJ, Reid D, Weatherburn P. HIV, sexual risk and ethnicity among gay and bisexual men in England: survey evidence for persisting health inequalities. Sex Transm Infect 2017; 93:508-513. [PMID: 28348021 DOI: 10.1136/sextrans-2016-052800] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 12/16/2016] [Accepted: 02/11/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To examine ethnic group differences in HIV testing and sexual behaviours among a large sample of gay and bisexual men (GBM), 13 years after similar observations were made, assess national HIV prevention responses and inform planning priorities. METHODS Cross-sectional convenience self-completion online survey in summer 2014, designed and recruited in collaboration with community-based health promoters and gay internet services; comparison with earlier findings reporting on similarly designed survey in 2001. RESULTS We recruited 15 388 GBM living in England who self-reported as follows: 18.5% from ethnic minorities; 9.0% tested HIV positive (cf. 17.0% and 5.4% in 2001). Compared with the white British, Asian men were no longer less likely to report diagnosed HIV but had an equal probability of doing so (2001 OR=0.32, 95% CI 0.13 to 0.79; 2014 OR=1.04, 95% CI 0.71 to 1.54); black men remained significantly more likely to report diagnosed HIV (2001 OR=2.06, 95% CI 1.56 to 3.29; 2014 OR=1.62, 95% CI 1.10 to 2.36) as did men in the other white group (2001 OR=1.54, 95% CI 1.23 to 1.93; 2014 OR=1.31, 95% CI 1.10 to 1.55). Overall annual incidence of reported HIV diagnoses in 2014 was 1.1%. Black men were significantly more likely to report diagnosis with HIV in the last 12 months than the white British (adjusted odds ratios (AOR) 2.57, 95% CI 1.22 to 5.39). No minority ethnic group was more or less likely to report condom unprotected anal intercourse (CUAI) in the last year but men in the Asian, black and all others groups were more likely than the white British to report CUAI with more than one non-steady partners. CONCLUSIONS Among GBM in England, HIV prevalence continues to be higher among black men and other white men compared with the white British. The protective effect of being from an Asian background appears no longer to pertain. Sexual risk behaviours may account for some of these differences.
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Affiliation(s)
- Ford Hickson
- Sigma Research, Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - David Reid
- Sigma Research, Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Peter Weatherburn
- Sigma Research, Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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11
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Down I, Ellard J, Triffitt K, Zablotska I, Hurley M, Brown G, Bradley J, Prestage G. High-risk sexual behaviours among gay and bisexual men: comparing event-level casual sex encounters among seroconverters and non-seroconverters. Sex Transm Infect 2017; 93:327-331. [PMID: 28325770 DOI: 10.1136/sextrans-2016-052749] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 01/17/2017] [Accepted: 03/01/2017] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND With increasing use of non-condom-based HIV risk reduction strategies by gay and bisexual men (GBM), we compared occasions of condomless anal intercourse with casual partners (CLAIC) that resulted in HIV transmission and similar occasions when HIV transmission did not occur. METHODS We compared two demographically similar samples of Australian GBM. The HIV Seroconversion Study (SCS) was an online cross-sectional survey of GBM recently diagnosed with HIV. The Pleasure and Sexual Health (PASH) study was an online cross sectional survey of GBM generally. Using logistic regression, we compared accounts of CLAIC reported by men in SCS as being the event which led to them acquiring HIV, with recent CLAIC reported by HIV-negative men in PASH. RESULTS In SCS, 85.1% of men reported receptive CLAIC, including 51.8% with ejaculation; 32.1% reported having previously met this partner and 28.6% believed this partner to be HIV-negative. Among HIV-negative men in PASH reporting recent CLAIC, 65.5% reported receptive CLAIC, including 29.9% with ejaculation; 59.3% reported having previously met this partner and 70.1% believed this partner to be HIV-negative. CONCLUSIONS While both groups of men engaged in CLAIC, how they engaged in CLAIC differed, and the context in which they did so was different. A generic measure of CLAIC conceals the critical elements of HIV risk, particularly the role of receptive CLAIC, among GBM that distinguish those who seroconverted and those who did not. Detailed information about the context and nature of the practise of CLAIC is required for a more complete understanding of HIV risk among GBM.
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Affiliation(s)
- Ian Down
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Jeanne Ellard
- Australian Research Centre in Sex Health and Society, La Trobe University, Melbourne, VIC, Australia
| | - Kathy Triffitt
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Iryna Zablotska
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Michael Hurley
- Australian Research Centre in Sex Health and Society, La Trobe University, Melbourne, VIC, Australia
| | - Graham Brown
- Australian Research Centre in Sex Health and Society, La Trobe University, Melbourne, VIC, Australia
| | - Jack Bradley
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Garrett Prestage
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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12
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Cook S, Lomax N. How to do it: setting up an asymptomatic screening pathway for men who have sex with men. Sex Transm Infect 2017; 93:558-560. [PMID: 28314793 DOI: 10.1136/sextrans-2016-052948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 02/20/2017] [Accepted: 02/25/2017] [Indexed: 11/04/2022] Open
Abstract
Many STIs are known to disproportionately affect men who have sex with men (MSM) in the UK; therefore, regular asymptomatic screening that is easy to access is vital among this group. Asymptomatic screening pathways can reduce long clinic waits, which may encourage more people to attend for screening. We therefore developed and trialled an asymptomatic pathway for MSM within our service. This extended our previous pathway, which allowed asymptomatic service users to fill in a questionnaire and see a healthcare support worker, to include MSM, as it previously had not. The service has been implemented and rolled out successfully. We believe that this model for asymptomatic screening among MSM can reduce clinic visit duration. This should increase accessibility and also allow trained staff to manage more complex patients, while allowing for risk identification and health promotion among those MSM who may be at higher risk.
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Affiliation(s)
- Sinead Cook
- Department of Sexual Health, Cardiff and Vale University Health Board, Cardiff, UK
| | - Nicola Lomax
- Department of Sexual Health, Cardiff and Vale University Health Board, Cardiff, UK
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13
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Bayley J, Mesher D, Nadarzynski T, Hughes G, Soldan K. Attendance of MSM at Genitourinary Medicine services in England: implications for selective HPV vaccination programme (a short communication). Sex Transm Infect 2017; 94:542-544. [PMID: 28280237 DOI: 10.1136/sextrans-2016-052912] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 01/17/2017] [Accepted: 02/11/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Human papillomaviruses (HPV) immunisation programmes for female adolescents in the UK offer relatively little benefit to men who have sex with men (MSM). Targeted HPV vaccination for MSM may reduce the high incidence of HPV-related disease among MSM. We used national data from sexual health clinics to calculate the number of MSM attending these clinics throughout England from 2009 to 2014 and to identify their characteristics, to inform the implementation of a targeted HPV vaccination programme in MSM. METHODS We used the Genitourinary Medicine Clinic Activity Dataset (GUMCADv2) to obtain data for men aged 15-70 years who had attended a GUM clinic in England from 2009 to 2014. We analysed both numbers of MSM attending and number of GUM attendances, age at first attendance, ethnicity and geographical area of the clinic in England. RESULTS A total of 374 983 MSM attended sexual health services in England between 2009 and 2014. Median age of presentation was 32 years (IQR 25-41) and showed regional geographical variation. Of all men attending sexual health clinics in England, the highest proportion of those identifying as MSM was in London (21%). Excluding visits within 1 month of an initial attendance, 49% of all MSM re-attended within 12 months and 58% within 24 months. MSM aged ≥36 years reattended more frequently than younger MSM. 51% reattended at least twice within 24 months of initial visit. CONCLUSIONS The majority of MSM reattend clinic at least once within a 24-month period, potentially facilitating the delivery of a three-dose HPV vaccination programme. This would reduce the burden on sexual health clinics and cost to local authorities due to extra visits if HPV vaccination were to be delivered through these services.
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Affiliation(s)
- Jake Bayley
- Department of Sexual Health and HIV, Barts Healthcare NHS Trust, London, UK.,Public Health England, London, UK
| | | | - Tom Nadarzynski
- Department of Psychology, University of Southampton, Southampton, UK.,Royal South Hants Hospital, Solent NHS Trust, Southampton, UK
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14
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Ramadhani HO, Liu H, Nowak RG, Crowell TA, Ndomb T, Gaydos C, Peel S, Ndembi N, Baral SD, Ake J, Charurat ME. Sexual partner characteristics and incident rectal Neisseria gonorrhoeae and Chlamydia trachomatis infections among gay men and other men who have sex with men (MSM): a prospective cohort in Abuja and Lagos, Nigeria. Sex Transm Infect 2017; 93:348-355. [PMID: 28235839 DOI: 10.1136/sextrans-2016-052798] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 10/25/2016] [Accepted: 11/05/2016] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND STIs including Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) potentiate HIV acquisition and transmission especially among gay men and other men who have sex with men (MSM). We investigated the influence of sexual network composition on incident rectal NG and/or CT infections among Nigerian MSM. METHODS TRUST/RV368 is a cohort of MSM recruited using respondent-driven sampling at trusted community centres in Abuja and Lagos, Nigeria. MSM respondents (egos) provided STI risk factors and demographic information for up to five of their most recent sexual partners (alters) within their sexual networks. Egos were tested for HIV, NG and CT every 3 months. Log-binomial regression was used to assess associations between alter characteristics and incident NG and/or CT. RESULTS Between March 2013 and October 2015, 492 MSM were longitudinally screened for STIs, of which 28.0% (n=138) were positive for incident rectal STI (61 NG only, 42 CT only and 35 NG and CT). Among egos, condom use was associated with STIs (half of the time vs never (adjusted risk ratio (aRR) 0.5; 95% CI 0.3 to 0.8), always/almost always vs never (aRR 0.7; 95% CI 0.5 to 1.0)). Incident STIs were associated with having a younger alter ≤19 versus 30 years (aRR 0.6; 95% CI 0.4 to 1.0), HIV infection (aRR 1.5; 95% CI 1.1 to 2.0) and engaging in sex under the influence of alcohol (aRR 1.4 95% CI 1.1 to 1.7) among regular alters and age ≤19 versus 30 years (aRR 0.3; 95% CI 0.2 to 0.6), HIV infection (aRR 1.4; 95% CI 1.1 to 1.8) and engaging in sex under the influence of alcohol (aRR 1.2 95% CI 1.0 to 1.4) among casual alters. CONCLUSIONS Given the centrality of sexual partner characteristics as risks for incident STIs among Nigerian MSM, there is a need to move beyond individual interventions and syndromic surveillance and get 'out there' in the STI management.
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Affiliation(s)
- Habib O Ramadhani
- Institute of Human Virology University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Hongjie Liu
- University of Maryland School of Public Health, College Park, Maryland, USA
| | - Rebecca G Nowak
- Institute of Human Virology University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Trevor A Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Teclaire Ndomb
- Institute of Human Virology Nigeria, Abuja, Federal Capital Territory, Nigeria
| | - Charlotte Gaydos
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sheila Peel
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Nicaise Ndembi
- Institute of Human Virology Nigeria, Abuja, Federal Capital Territory, Nigeria
| | - Stefan D Baral
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Julie Ake
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Man E Charurat
- Institute of Human Virology University of Maryland School of Medicine, Baltimore, Maryland, USA
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15
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Visser M, Heijne JCM, Hogewoning AA, van Aar F. Frequency and determinants of consistent STI/HIV testing among men who have sex with men testing at STI outpatient clinics in the Netherlands: a longitudinal study. Sex Transm Infect 2017; 93:396-403. [PMID: 28159917 PMCID: PMC5574382 DOI: 10.1136/sextrans-2016-052918] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 12/02/2016] [Accepted: 01/04/2017] [Indexed: 12/13/2022] Open
Abstract
Objectives Men who have sex with men (MSM) are at highest risk for STIs and HIV infections in the Netherlands. However, official guidelines on STI testing among MSM are lacking. They are advised to test for STIs at least every six months, but their testing behaviour is not well known. This study aimed to get insight into the proportion and determinants of consistent 6-monthly STI testing among MSM testing at STI outpatient clinics in the Netherlands. Methods This study included longitudinal surveillance data of STI consultations among MSM from all 26 STI outpatient clinics in the Netherlands between 1 June 2014 and 31 December 2015. Multinomial logistic regression analysis was used to identify determinants of consistent 6-monthly testing compared with single testing and inconsistent testing. Determinants of time between consultations among men with multiple consultations were analysed using a Cox Prentice-Williams-Peterson gap-time model. Results A total of 34 605 STI consultations of 18 634 MSM were included. 8966 (48.1%) men had more than one consultation, and 3516 (18.9%) men tested consistently 6-monthly. Indicators of high sexual risk behaviour, including having a history of STI, being HIV positive and having more than 10 sex partners, were positively associated with both being a consistent tester and returning to the STI clinic sooner. Men who were notified by a partner or who reported STI symptoms were also more likely to return to the STI clinic sooner, but were less likely to be consistent testers, identifying a group of event-driven testers. Conclusions The proportion of consistent 6-monthly testers among MSM visiting Dutch STI outpatient clinics was low. Testing behaviour was associated with sexual risk behaviour, but exact motives to test consistently remain unclear. Evidence-based testing guidelines are needed to achieve optimal reductions in STI transmission in the future.
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Affiliation(s)
- Maartje Visser
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Janneke C M Heijne
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Arjan A Hogewoning
- STI Outpatient Clinic, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Fleur van Aar
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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16
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Achterbergh R, van der Helm JJ, van den Boom W, Heijman T, Stolte IG, van Rooijen MS, de Vries H. Is rectal douching and sharing douching equipment associated with anorectal chlamydia and gonorrhoea? A cross-sectional study among men who have sex with men. Sex Transm Infect 2017; 93:431-437. [PMID: 28108702 DOI: 10.1136/sextrans-2016-052777] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 12/21/2016] [Accepted: 01/04/2017] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Men who have sex with men (MSM) are at high risk for anorectal chlamydia and gonorrhoea infections. Many MSM use rectal douches in preparation for sex, which might break down the mucosal barrier function and facilitate the acquisition of STI. We determined whether rectal douching or sharing douching equipment was associated with anorectal chlamydia and gonorrhoea. METHODS In a cross-sectional study among 994 MSM attending the STI outpatient clinic of Amsterdam between February and April 2011, data were collected on rectal douching, sexual behaviour and STI. We used multivariable logistic regression analysis to determine the association between rectal douching, including sharing of douching equipment, and anorectal chlamydia and gonorrhoea for those reporting receptive anal sex. We adjusted for other risk behaviour, that is, condom use, number of partners and HIV status. RESULTS Of 994 MSM, 46% (n=460) practised rectal douching, of whom 25% (n=117) shared douching equipment. Median age was 39 years (IQR 30-47), median number of sex partners in the 6 months prior to consult was five (IQR 3-10) and 289 (29.0%) participants were HIV positive. The prevalence of anorectal chlamydia and/or gonorrhoea for those reporting receptive anal sex was 9.6% (n=96). In multivariable analysis, HIV positivity (aOR=2.2, 95% CI 1.3 to 3.6), younger age (aOR=2.5, CI 1.4 to 4.5 for those aged <35 years compared with those aged ≥45 years), and more sexual partners (aOR=1.2, 95% CI 1.0 to 1.5 for 1 log increase) were significantly associated with anorectal STI. However, rectal douching or sharing douching equipment were not significantly associated with anorectal chlamydia and/or gonorrhoea (p=0.647). CONCLUSIONS Almost half of MSM used rectal douching and a quarter of these shared douching equipment. Though using douching equipment does not appear to contribute to anorectal chlamydia and gonorrhoea in this study, STI prevalence remains high and prevention strategies like early testing and treatment remain of utmost importance.
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Affiliation(s)
- Rca Achterbergh
- STI outpatient clinic, department of infectious diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands
| | - J J van der Helm
- STI outpatient clinic, department of infectious diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands
| | - W van den Boom
- STI outpatient clinic, department of infectious diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands
| | - T Heijman
- STI outpatient clinic, department of infectious diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands
| | - I G Stolte
- STI outpatient clinic, department of infectious diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands
| | - M S van Rooijen
- STI outpatient clinic, department of infectious diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands
| | - Hjc de Vries
- STI outpatient clinic, department of infectious diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands.,Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Centre for Infection and Immunity Amsterdam (CINIMA), Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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17
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Holt M, Lea T, Schmidt HM, Kolstee J, Ellard J, Murphy D, Truong HH, de Wit J. Willingness to use and have sex with men taking HIV pre-exposure prophylaxis (PrEP): results of online surveys of Australian gay and bisexual men, 2011-2015. Sex Transm Infect 2017; 93:438-444. [PMID: 28108701 DOI: 10.1136/sextrans-2016-052774] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 11/29/2016] [Accepted: 01/04/2017] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Assess willingness to use HIV pre-exposure prophylaxis (PrEP), support for others using it and willingness to have sex with partners using PrEP among Australian gay and bisexual men (GBM). METHODS National, online cross-sectional surveys of Australian GBM were conducted in 2011, 2013 and 2015. Scales measuring support for and willingness to have sex with men using PrEP were developed in 2015 using factor analysis. Trends and associations with key measures were analysed using multivariate logistic regression. RESULTS During 2011-2015, 3850 surveys were completed by GBM. Willingness to use PrEP among HIV-negative and untested men did not change between 2011 (28.2%) and 2015 (31.7%, p=0.13). In 2015, willingness to use PrEP was independently associated with younger age, having an HIV-positive regular partner, recent condomless anal intercourse with casual male partners (CAIC), more than 10 male sex partners in the previous 6 months, ever having taken postexposure prophylaxis and having fewer concerns about using PrEP. In 2015, 54.5% of GBM supported other GBM taking PrEP and 39% were willing to have sex with men using PrEP. Support for and willingness to have sex with PrEP users were both associated with being HIV-positive, having a university degree and having two or more male partners in the previous 6 months. Willingness to have sex with men on PrEP was also associated with recent CAIC and using party drugs for sex, but was less likely among men who consistently used or had a positive experience using condoms. DISCUSSION Interest in and support for using PrEP are concentrated among men who engage in higher risk practices and who know more about living with HIV. This is consistent with the targeting of PrEP in Australia.
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Affiliation(s)
- Martin Holt
- Centre for Social Research in Health, UNSW Australia, Sydney, New South Wales, Australia
| | - Toby Lea
- Centre for Social Research in Health, UNSW Australia, Sydney, New South Wales, Australia
| | - Heather-Marie Schmidt
- Centre for Population Health, New South Wales Ministry of Health, Sydney, New South Wales, Australia
| | | | - Jeanne Ellard
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia
| | - Dean Murphy
- Centre for Social Research in Health, UNSW Australia, Sydney, New South Wales, Australia.,The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia
| | - Hong-Ha Truong
- Center for AIDS Prevention Studies, University of California, San Francisco, California, USA
| | - John de Wit
- Centre for Social Research in Health, UNSW Australia, Sydney, New South Wales, Australia.,Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands
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18
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Tuddenham S, Shah M, Ghanem KG. Syphilis and HIV: Is HAART at the heart of this epidemic? Sex Transm Infect 2017; 93:311-312. [PMID: 28093459 DOI: 10.1136/sextrans-2016-052940] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 12/09/2016] [Indexed: 11/03/2022] Open
Affiliation(s)
- Susan Tuddenham
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Maunank Shah
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Khalil G Ghanem
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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19
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Chow EP, Howden BP, Walker S, Lee D, Bradshaw CS, Chen MY, Snow A, Cook S, Fehler G, Fairley CK. Antiseptic mouthwash against pharyngeal Neisseria gonorrhoeae: a randomised controlled trial and an in vitro study. Sex Transm Infect 2016; 93:88-93. [PMID: 27998950 DOI: 10.1136/sextrans-2016-052753] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 08/14/2016] [Accepted: 09/03/2016] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Gonorrhoea is increasing among men who have sex with men (MSM). We aimed to determine whether Listerine, a commercial mouthwash product, has an inhibitory effect against Neisseria gonorrhoeae in a randomised controlled trial (RCT) and an in vitro study, and therefore may be a potentially useful agent for gonorrhoea control. METHODS In vitro: a suspension of ∼108 colony forming units per mL (CFU/mL) of N. gonorrhoeae was added to a serial of dilutions (up to 1:32) of alcohol-containing Listerine mouthwashes (Cool Mint and Total Care) for 1 min. A 10 µL aliquot was spread over the surface of a gonococcal agar plate and the number of N. gonorrhoeae colonies present at each dilution was calculated. The phosphate buffered saline (PBS) was used as a control. RCT: we recruited MSM with pharyngeal gonorrhoea who returned for treatment at the Melbourne Sexual Health Centre between May 2015 and February 2016. Untreated men were randomised to rinse and gargle either Listerine Cool Mint or saline for 1 min. Pharyngeal swabs were taken before and after rinsing and gargling for culture of N. gonorrhoeae. The analysis included only men who were culture positive for N. gonorrhoeae before using the allocated solution on the day of recruitment. RESULTS In vitro: Listerine mouthwashes at dilutions of up to 1:4 for 1 min resulted in significant reduction of total N. gonorrhoeae counts but PBS has no inhibitory effect against N. gonorrhoeae. RCT: a total of 196 MSM were recruited, 58 (30%) were culture positive before using the solution. After gargling the allocated solution, men in the Listerine group were significantly less likely to be culture positive on the pharyngeal surface (52%) compared with men in the saline group (84%) (p=0.013). CONCLUSIONS This data suggest Listerine, significantly reduces the amount of N. gonorrhoeae on the pharyngeal surface. With daily use it may increase gonococcal clearance and have important implications for prevention strategies. TRIAL REGISTRATION NUMBER ACTRN12615000716561.
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Affiliation(s)
- Eric Pf Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Faculty of Medicine, Nursing and Health Sciences, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Benjamin P Howden
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Sandra Walker
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Faculty of Medicine, Nursing and Health Sciences, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - David Lee
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Catriona S Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Faculty of Medicine, Nursing and Health Sciences, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Faculty of Medicine, Nursing and Health Sciences, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Anthony Snow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Stuart Cook
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Glenda Fehler
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Faculty of Medicine, Nursing and Health Sciences, Central Clinical School, Monash University, Melbourne, Victoria, Australia
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20
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van Aar F, den Daas C, van der Sande MAB, Soetens LC, de Vries HJC, van Benthem BHB. Outbreaks of syphilis among men who have sex with men attending STI clinics between 2007 and 2015 in the Netherlands: a space-time clustering study. Sex Transm Infect 2016; 93:390-395. [PMID: 27986969 DOI: 10.1136/sextrans-2016-052754] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 11/14/2016] [Accepted: 11/28/2016] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Infectious syphilis (syphilis) is diagnosed predominantly among men who have sex with men (MSM) in the Netherlands and is a strong indicator for sexual risk behaviour. Therefore, an increase in syphilis can be an early indicator of resurgence of other STIs, including HIV. National and worldwide outbreaks of syphilis, as well as potential changes in sexual networks were reason to explore syphilis trends and clusters in more depth. METHODS National STI/HIV surveillance data were used, containing epidemiological, behavioural and clinical data from STI clinics. We examined syphilis positivity rates stratified by HIV status and year. Additionally, we performed space-time cluster analysis on municipality level between 2007 and 2015, using SaTScan to evaluate whether or not there was a higher than expected syphilis incidence in a certain area and time period, using the maximum likelihood ratio test statistic. RESULTS Among HIV-positive MSM, the syphilis positivity rate decreased between 2007 (12.3%) and 2011 (4.5%), followed by an increasing trend (2015: 8.0%). Among HIV-negative MSM, the positivity rate decreased between 2007 (2.8%) and 2011 also (1.4%) and started to increase from 2013 onwards (2015: 1.8%). In addition, we identified three geospatial clusters. The first cluster consisted of MSM sex workers in the South of the Netherlands (July 2009-September 2010, n=10, p<0.001). The second cluster were mostly HIV-positive MSM (58.5%) (Amsterdam; July 2011-December 2015; n=1123, p<0.001), although the proportion of HIV-negative MSM increased over time. The third cluster was large in space (predominantly the city of Rotterdam; April-September 2015, n=72, p=0.014) and were mostly HIV-negative MSM (62.5%). CONCLUSIONS Using SaTScan analysis, we observed several not yet recognised outbreaks and a rapid resurgence of syphilis among known HIV-positive MSM first, but more recently, also among HIV-negative MSM. The three identified clusters revealed locations, periods and specific characteristics of the involved MSM that could be used when developing targeted interventions.
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Affiliation(s)
- F van Aar
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - C den Daas
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - M A B van der Sande
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
| | - L C Soetens
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.,Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
| | - H J C de Vries
- STI Outpatient Clinic, Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands.,Department of Dermatology, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands.,Center for Infection and Immunology Amsterdam (CINIMA), Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - B H B van Benthem
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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Mebrahtu H, Furegato M, Sile B, Were J, Mohammed H, Hughes G. Access of non-specialist sexual health services by men who have sex with men: do they differ from those attending specialist services? Sex Transm Infect 2016; 94:72-74. [PMID: 27888206 DOI: 10.1136/sextrans-2016-052755] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 09/30/2016] [Accepted: 10/29/2016] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Men who have sex with men (MSM) bear a disproportionate burden of STIs. While routine STI surveillance data suggest MSM regularly access specialist genitourinary medicine (GUM) clinics for their sexual healthcare, the extent to which MSM attend non-specialist sexual health services (SHSs) is unclear. METHODS We used data from the GUM Clinic Activity Data Set (GUMCADv2), the national STI surveillance system, to compare the characteristics, service usage and STI outcomes of MSM accessing specialist and non-specialist (non-GUM) SHSs in England in 2014. Pearson's χ2, Student's t-test and logistic regression analysis were used. RESULTS Where sexual orientation was recorded (92%), 11% (4552/41 597) of non-GUM attendances were among MSM compared with 28% (280 466/999 331) of GUM attendances (p<0.001). Compared with those attending GUM services, MSM attending non-GUM services were younger (mean age: 30.2 years vs 37.7 years; p<0.001) and were more likely to be of mixed ethnicity (4.9% vs 3.5%; p<0.001), to have had a full sexual health screen (chlamydia, gonorrhoea, syphilis and HIV tests) (48.0% vs 37.0%; p<0.001) and to be diagnosed with chlamydia (7.4% vs 4.1%; p<0.001) and gonorrhoea (8.5% vs 6.5%: p<0.001). MSM attending non-GUM services had slightly lower HIV test uptake (87.0% vs 95.0%; p=0.157) and were less likely to be diagnosed with HIV (0.5% vs 0.8%; p=0.019), compared with those attending GUM clinics. CONCLUSIONS Non-specialist SHSs play an important role in the care of MSM and should ensure services meet their needs.
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22
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Hightow-Weidman LB, Muessig KE. New media challenges and opportunities. Sex Transm Infect 2016; 93:309-310. [PMID: 27888207 DOI: 10.1136/sextrans-2016-052673] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 09/21/2016] [Accepted: 11/08/2016] [Indexed: 11/03/2022] Open
Affiliation(s)
- Lisa B Hightow-Weidman
- Departme nt of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kathryn E Muessig
- Departme nt of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Health Behavior, University of North Carolina, Chapel Hill, North Carolina, USA
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Reyniers T, Hoornenborg E, Vuylsteke B, Wouters K, Laga M. Pre-exposure prophylaxis (PrEP) for men who have sex with men in Europe: review of evidence for a much needed prevention tool. Sex Transm Infect 2016; 93:363-367. [PMID: 27872326 DOI: 10.1136/sextrans-2016-052699] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 10/09/2016] [Accepted: 10/29/2016] [Indexed: 11/04/2022] Open
Abstract
In many Western countries with good coverage of antiretroviral treatment (ART) programmes the annual number of HIV infections is still high and not (yet) declining among men who have sex with men (MSM). This might indicate that antiretroviral treatment roll-out alone will not turn around the course of the epidemic and that new, additional tools are needed. Antiretrovirals used as prevention tools for people not yet infected with HIV, such as pre-exposure prophylaxis (PrEP) could be such important additional tools. PrEP is a new type of biomedical prevention, which involves the use of antiretrovirals before, during and after (periods of) sexual exposure to HIV. In this review, we will focus on PrEP as a new prevention tool for MSM at high risk in Europe, including its evidence for effectiveness, challenges for implementation, ongoing European demonstration studies; as well as how PrEP relates to other existing prevention tools. In light of European Medicines Agency's recent recommendation for approval of PrEP we briefly review the potential implications.
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Affiliation(s)
- Thijs Reyniers
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Elske Hoornenborg
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, Netherlands
| | - Bea Vuylsteke
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Kristien Wouters
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Marie Laga
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Bissio E, Cisneros V, Lopardo GD, Cassetti LI. Very high incidence of syphilis in HIV-infected men who have sex with men in Buenos Aires city: a retrospective cohort study. Sex Transm Infect 2016; 93:323-326. [PMID: 27856515 DOI: 10.1136/sextrans-2016-052893] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 10/20/2016] [Accepted: 10/29/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The incidence of sexually transmitted infections (STIs), particularly syphilis, is high and continues to rise among some populations, especially among men who have sex with men (MSM). Furthermore, a higher incidence of STIs has been reported in HIV-positive than in HIV-negative MSM. OBJECTIVE To determine the incidence of syphilis in a cohort of men with HIV in Buenos Aires city. METHODS Retrospective cohort study. We examined the records and visits made by men with HIV aged >18 years in our institution during a 1-year period. Venereal Disease Reference Laboratory (VDRL) results for all the men in our cohort during the study period were analysed. We considered a case of syphilis as incident if a person had a VDRL result of ≥16 DILS, provided that this was increased at least fourfold compared with a previous determination. All VDRL results ≤8 were investigated, and analysed together with the medical records, to determine if they were new cases. RESULTS We analysed the VDRL results and the clinical records of 1150 men followed up in our centre during the study period. Mean age was 40.9 years. According to the definition used, we registered 171 new cases of syphilis-that is, an incidence of 14.9/100 patients/year (95% CI 12.9 to 17.0). No significant differences in incidence according to age group were found, but there was a trend towards a lower incidence in older men. Ten men had two new episodes during the study. CONCLUSIONS The incidence of syphilis in this cohort of men with HIV (predominantly MSM) was very high. In addition to maintaining high surveillance for early diagnosis and treatment, it is necessary to implement newer and more effective measures to prevent syphilis and other STIs in this population.
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Affiliation(s)
- E Bissio
- Fundación Centro de Estudios Infectológicos (FUNCEI), Ciudad de Buenos Aires, Argentina
| | - V Cisneros
- Fundación Centro de Estudios Infectológicos (FUNCEI), Ciudad de Buenos Aires, Argentina
| | - G D Lopardo
- Fundación Centro de Estudios Infectológicos (FUNCEI), Ciudad de Buenos Aires, Argentina.,Hospital Bernardo Houssay, Vicente López, Provincia de Buenos Aires, Argentina
| | - L I Cassetti
- Fundación Centro de Estudios Infectológicos (FUNCEI), Ciudad de Buenos Aires, Argentina.,HELIOS SALUD, Ciudad de Buenos Aires, Argentina
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25
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Nadol P, O’Connor S, Duong H, Mixson-Hayden T, Tram TH, Xia GL, Kaldor J, Law M, Nguyen T. High hepatitis C virus (HCV) prevalence among men who have sex with men (MSM) in Vietnam and associated risk factors: 2010 Vietnam Integrated Behavioural and Biologic Cross-Sectional Survey. Sex Transm Infect 2016; 92:542-549. [PMID: 27044267 PMCID: PMC10925267 DOI: 10.1136/sextrans-2015-052518] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 03/08/2016] [Accepted: 03/12/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) is an increasing health issue among key populations such as men who have sex with men (MSM). We sought to assess the burden of and risk factors for HCV among MSM in Vietnam. METHODS We analysed behavioural and demographic data and stored specimens from MSM surveyed in four provinces through Vietnam's 2009-2010 Integrated Biologic and Behavioural Survey, which used probability-based, respondent-driven sampling. Commercial hepatitis B surface antigen (HBsAg) and HCV/antibody (HCV Ag/Ab) testing were performed on archived sera with follow-up PCR for HCV RNA and genotype determination. RESULTS Among the 1588 MSM surveyed, the median (range) frequency, by province, of HCV Ag/Ab detection was 28.4% (13.7%-38.8%); 84.5% (83.1%-100%) among HIV-infected and 21.9% (8.9%-28.2%) among HIV-uninfected. HCV prevalence was higher in northern Hanoi and Hai Phong provinces than in southern Ho Chi Minh City and Chan Tho provinces. Among a convenience sample of 67 HCV Ag/Ab+ MSM, 67.2% were HCV RNA+; of 41 genotyped, 73.2% were genotype 1. HBsAg prevalence varied from 8.5% to 27.4%. In the multivariable logistic regression analysis, being HIV-infected (adjusted OR (aOR) 19.0; 7.0-51.9), ever having used injected drugs (aOR 4.4; 1.6-12.4) and age >25 years were significant risk factors for testing HCV Ag/Ab+. CONCLUSIONS HCV infection in Vietnam appears to be high among MSM, particularly among HIV-infected MSM, with a north-south gradient. Given overlapping risk behaviours and associations between HCV and HIV, integrating HIV and HCV programme services to prevent both HIV and HCV transmission among MSM is indicated.
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Affiliation(s)
- Patrick Nadol
- Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention, Hanoi, Vietnam
- Kirby Institute for Infection and Immunity, University of New South Wales, Sydney, Australia
| | - Siobhan O’Connor
- Division of Viral Hepatitis, U. S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Hao Duong
- Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention, Hanoi, Vietnam
| | - Tonya Mixson-Hayden
- Division of Viral Hepatitis, U. S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Tran Hong Tram
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Guo-Liang Xia
- Division of Viral Hepatitis, U. S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - John Kaldor
- Kirby Institute for Infection and Immunity, University of New South Wales, Sydney, Australia
| | - Matthew Law
- Kirby Institute for Infection and Immunity, University of New South Wales, Sydney, Australia
| | - Tuan Nguyen
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
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26
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Tang W, Best J, Zhang Y, Liu FY, Tso LS, Huang S, Yang B, Wei C, Tucker JD. Gay mobile apps and the evolving virtual risk environment: a cross-sectional online survey among men who have sex with men in China. Sex Transm Infect 2016; 92:508-514. [PMID: 27288414 PMCID: PMC5148710 DOI: 10.1136/sextrans-2015-052469] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 05/03/2016] [Accepted: 05/18/2016] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The expansion of gay sex-seeking application (gay app) use among men who have sex with men (MSM) may create new virtual risk environments that facilitate STI transmission. The goals of this study were to compare sexual behaviours between gay app users and non-users, and to describe sexual behaviours among gay app users in China. METHODS In October 2014, we recruited MSM from three Chinese gay websites. Data on sociodemographics, sexual behaviours and gay app use were collected. Logistic regressions were used to compare gay app users with non-app users and to identify factors associated with condomless sex among gay app users. RESULTS Of the 1424 participants, most were <30 years old (77.5%), single (83.8%) and self-identified as gay (72.9%). Overall, 824 (57.9%) had used gay apps for partner-seeking in the last 6 months. Among gay app users, 36.4% met their last partner within 24 hours of first message exchange through gay apps, and 59.0% negotiated condom use before in-person meeting. Compared with non-users, gay app users reported engaging in more condomless sex in the last 6 months (adjusted OR (aOR) =1.52, 95% CI 1.19 to 1.94) and more group sex (aOR =1.49, 95% CI 1.02 to 2.18). Negotiating condom use before in-person meeting was positively associated with condom use with partners met through gay apps (aOR =1.83, 95% CI 1.29 to 2.60). CONCLUSIONS Gay apps are linked to risky sexual behaviours and may foster a virtual risk environment for STI transmission among Chinese MSM. App-based interventions could target young gay man and facilitate condom negotiation.
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Affiliation(s)
- Weiming Tang
- University of North Carolina Project-China, Guangzhou, China
- Guangdong Provincial Centres for Skin Diseases and STI Control, Guangzhou, China
- SESH Global, Guangzhou, China
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - John Best
- University of North Carolina Project-China, Guangzhou, China
- Guangdong Provincial Centres for Skin Diseases and STI Control, Guangzhou, China
- School of Medicine, University of California, San Francisco, San Francisco California, USA
| | - Ye Zhang
- University of North Carolina Project-China, Guangzhou, China
- Guangdong Provincial Centres for Skin Diseases and STI Control, Guangzhou, China
- SESH Global, Guangzhou, China
| | - Feng-Ying Liu
- Guangdong Provincial Centres for Skin Diseases and STI Control, Guangzhou, China
- SESH Global, Guangzhou, China
| | - Lai Sze Tso
- University of North Carolina Project-China, Guangzhou, China
- SESH Global, Guangzhou, China
| | - Shujie Huang
- Guangdong Provincial Centres for Skin Diseases and STI Control, Guangzhou, China
- SESH Global, Guangzhou, China
| | - Bin Yang
- Guangdong Provincial Centres for Skin Diseases and STI Control, Guangzhou, China
- SESH Global, Guangzhou, China
| | - Chongyi Wei
- Department of Epidemiology and Biostatistics & Global Health Sciences, University of California, San Francisco, San Francisco California, USA
| | - Joseph D Tucker
- University of North Carolina Project-China, Guangzhou, China
- SESH Global, Guangzhou, China
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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27
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van de Laar TJ, Richel O. Emerging viral STIs among HIV-positive men who have sex with men: the era of hepatitis C virus and human papillomavirus. Sex Transm Infect 2016; 93:368-373. [PMID: 27789574 DOI: 10.1136/sextrans-2016-052677] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 09/14/2016] [Accepted: 10/10/2016] [Indexed: 12/26/2022] Open
Abstract
The number of infectious disease outbreaks and the number of unique pathogens responsible have significantly increased since the 1980s. HIV-positive men who have sex with men (MSM) are a vulnerable population with regards to the introduction, spread and clinical consequences of (newly introduced) STIs. After the introduction of combination antiretroviral treatment (cART), the incidence of sexually acquired hepatitis C virus (HCV) infection and human papillomavirus (HPV)-induced anal cancers have significantly increased among HIV-positive MSM. The introduction and expansion of HCV is the result of increased sexual risk behaviour and sexually acquired mucosal trauma within large interconnected networks of HIV-positive MSM in particular. With the availability of cART, postexposure and pre-exposure prophylaxis (PEP and PrEP) and direct-acting antivirals (DAAs) for HCV, less concern for HIV and HCV might require a new approach to develop effective behavioural intervention strategies among MSM. The marked rise in HPV-induced anal cancers can be ascribed to the long-term immunologic defects in an ageing population affected by HIV. More evidence with regards to effective treatment options for anal dysplastic lesions and the usefulness of anal malignancy screening programmes is urgently needed. Most anal cancers in the future generation of HIV-positive MSM could be prevented with the inclusion of boys in addition to girls in current HPV vaccination programmes.
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Affiliation(s)
- Thijs Jw van de Laar
- Department of Blood-Borne Infections, Sanquin Research, Amsterdam, The Netherlands
| | - Olivier Richel
- Department of Infectious Diseases, University of Amsterdam/Academic Medical Centre, Amsterdam, The Netherlands
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28
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Girometti N, Gutierrez A, Nwokolo N, McOwan A, Whitlock G. High HIV incidence in men who have sex with men following an early syphilis diagnosis: is there room for pre-exposure prophylaxis as a prevention strategy? Sex Transm Infect 2016; 93:320-322. [PMID: 28729516 DOI: 10.1136/sextrans-2016-052865] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 09/24/2016] [Accepted: 09/29/2016] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES HIV pre-exposure prophylaxis (PrEP) is becoming a pivotal strategy for HIV prevention. Understanding the impact of risk factors for HIV transmission to identify those at highest risk would favour the implementation of PrEP, currently limited by costs. In this service evaluation, we estimated the incidence of bacterial STIs in men who have sex with men (MSM) diagnosed with early syphilis attending a London sexual health clinic according to their HIV status. In addition, we estimated the incidence of HIV infection in HIV-negative MSM, following a diagnosis of early syphilis. METHODS We undertook a retrospective case note review of all MSM patients diagnosed with early syphilis between January and June 2014. A number of sexual health screens and diagnoses of chlamydia, gonorrhoea and HIV were prospectively analysed following the syphilis diagnosis. RESULTS 206 MSM were diagnosed with early syphilis. 110 (53%) were HIV-negative at baseline, 96 (47%) were HIV-positive. Only age (37 vs 32 years, p=0.0005) was significantly different according to HIV status of MSM at baseline. In HIV-negative versus HIV-positive MSM, incidence of rectal chlamydia infection at follow-up was 27 cases vs 50/100 person-years of follow-up (PYFU) (p=0.0039), 33 vs 66/100 PYFU (p=0.0044) for rectal gonorrhoea and 10 vs 26/100 PYFU (p=0.0044) for syphilis reinfection, respectively. Total follow-up for 110 HIV-negative MSM was 144 person-years. HIV incidence was 8.3/100 PYFU (CI 4.2 to 14). CONCLUSIONS A diagnosis of early syphilis carries a high risk of consequent HIV seroconversion and should warrant prioritised access to prevention measures such as PrEP and regular STI screening to prevent HIV transmission.
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Affiliation(s)
- Nicolò Girometti
- Infectious Diseases Unit, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy.,Chelsea & Westminster Hospital NHS Foundation Trust, London, UK
| | | | - Nneka Nwokolo
- Chelsea & Westminster Hospital NHS Foundation Trust, London, UK
| | - Alan McOwan
- Chelsea & Westminster Hospital NHS Foundation Trust, London, UK
| | - Gary Whitlock
- Chelsea & Westminster Hospital NHS Foundation Trust, London, UK
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29
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Hui BB, Whiley DM, Donovan B, Law MG, Regan DG. Identifying factors that lead to the persistence of imported gonorrhoeae strains: a modelling study. Sex Transm Infect 2016; 93:221-225. [PMID: 28432206 DOI: 10.1136/sextrans-2016-052738] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 09/15/2016] [Accepted: 09/29/2016] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The importation of Neisseria gonorrhoeae (NG) strains from overseas is believed to be the main source of antimicrobial resistance in Australia. With recent sporadic cases of ceftriaxone-resistant gonorrhoea reported in Australia and elsewhere, we sought to model the potential for imported NG strains to persist in the men who have sex with men (MSM) population in Australia. METHODS We developed an individual-based model to simulate the transmission of NG in a population of urban MSM, and used this model to investigate factors contributing to the probability that an imported NG strain will persist. RESULTS The probability of the imported NG strain persisting as the result of a single importation event is less than 1%, but the probability increases to 1% if the imported NG strain is resistant to treatment, and further increases to 3.1% if the imported NG strain can also form mixed infections with the local NG strain. The probability of the imported NG strain persisting increases to 4.4% if there are at least three importation events per month within a 1-year period. CONCLUSION The imported NG strain is unlikely to persist as a result of a single importation event. However, the probability of persistence increases if the imported NG strain is resistant to treatment, can form mixed infections with the local NG strain or there are frequent importation events. Identification of the factors that determine the likelihood of persistence of an imported NG strain could contribute to our capacity to respond appropriately and in a timely fashion.
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Affiliation(s)
- Ben B Hui
- The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia
| | - David M Whiley
- University of Queensland Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia
| | - Basil Donovan
- The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia.,Sydney Sexual Health Centre, Sydney Hospital, Sydney, New South Wales, Australia
| | - Matthew G Law
- The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia
| | - David G Regan
- The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia
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30
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Yu YQ, Xu JJ, Hu QH, Yan HJ, Wang Z, Lu L, Zhuang MH, Chen X, Fu JH, Qin YL, Jiang YJ, Geng WQ, Shang H. High-risk behaviour and HIV infection risk among non-local men who have sex with men with less than a single year's residence in urban centres: a multicentre cross-sectional study from China. Sex Transm Infect 2016; 94:51-54. [PMID: 29348258 DOI: 10.1136/sextrans-2016-052744] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 07/24/2016] [Accepted: 08/20/2016] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Traditionally, subjects' migration status has usually been defined on the basis of their registered residency status. We attempted to redefine migration based on the duration of residency in their cities of migration and to explore more precisely the impact of migration on HIV infection risk in men who have sex with men (MSM). METHODS A multisite cross-sectional study was conducted during 2012-2013 in seven Chinese cities. Questionnaire surveys were conducted and blood was drawn to test for antibodies to HIV, syphilis and herpes simplex virus-2 (HSV-2). MSM who were unregistered local residents and had resided in their cities of migration for ≤1 or >1 year were defined as migrant MSM, or transitional MSM, respectively. RESULTS Compared with transitional MSM and local MSM, migrant MSM had poorer HIV knowledge and higher rates of high-risk behaviour, including earlier sexual debut, multiple sexual partners, participation in commercial sex and recreational drug use. Multivariate logistic regression analysis showed that HIV prevalence among migrant MSM was higher than local MSM (p<0.05). This relationship, however, did not hold for transitional MSM and local MSM (p>0.05). Male sex work, recreational drug use, syphilis infection and HSV-2 infection were independently associated with HIV infection among migrant MSM. CONCLUSIONS Non-local MSM with shorter residence were at greater risk of HIV acquisition. More focus should be placed on HIV behavioural interventions targeting non-local MSM with temporary residence.
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Affiliation(s)
- Yan-Qiu Yu
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Jun-Jie Xu
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Qing-Hai Hu
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Hong-Jing Yan
- Jiangsu Provincial Centers for Disease Control and Prevention, Nanjing, China
| | - Zhe Wang
- He'nan Provincial Centers for Disease Control and Prevention, Zhengzhou, China
| | - Lin Lu
- Yunnan Provincial Centers for Disease Control and Prevention, Kunming, China
| | - Ming-Hua Zhuang
- Shanghai Municipal Centers for Disease Control and Prevention, Shanghai, China
| | - Xi Chen
- Hu'nan Provincial Centers for Disease Control and Prevention, Changsha, China
| | - Ji-Hua Fu
- Shandong Provincial Centers for Disease Control and Prevention, Jinan, China
| | - Yi-Lu Qin
- University of North Carolina Project-China, Guangzhou, China
| | - Yong-Jun Jiang
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Wen-Qing Geng
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Hong Shang
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
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32
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Callander D, Read P, Prestage G, Minichiello V, Chow EPF, Lewis DA, McNulty A, Ali H, Hellard M, Guy R, Donovan B. A cross-sectional study of HIV and STIs among male sex workers attending Australian sexual health clinics. Sex Transm Infect 2016; 93:299-302. [PMID: 27591189 DOI: 10.1136/sextrans-2016-052578] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 06/22/2016] [Accepted: 08/18/2016] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Although sex work is frequently characterised as a practice with high risk for HIV and other STIs, little is known about the epidemiology of these infections among men who sell sex in Australia. This study reports the prevalence of chlamydia, gonorrhoea, infectious syphilis and HIV among men who have sex with men attending Australian publicly funded sexual health clinics and compares prevalence between sex workers and non-sex workers. METHODS From 2011 to 2014, de-identified patient data were extracted from 40 sexual health clinics in four Australian jurisdictions. The χ2 and multiple logistic regression analyses were used to compare the prevalence of HIV and STIs among men attending these services who did and did not report sex work in the 12 months prior to consultation. All analyses were restricted to men who reported sex with other men and to each patient's first consultation at participating services. RESULTS In total, 27 469 gay, bisexual and other men who have sex with men attended participating clinics; 443 (1.6%) reported sex work. At first consultation, 18% of sex workers and 17% of non-sex workers were diagnosed with HIV or an STI (p=0.4): 13% of sex workers were newly diagnosed with chlamydia, 15% with gonorrhoea, 0.5% with infectious syphilis and 0.6% with HIV. After controlling for demographic and behavioural factors, sex work was not independently associated with an HIV or STI diagnosis. CONCLUSIONS These findings provide estimates of HIV and STI prevalence among men who sell sex in Australia and they challenge assumptions of sex work as inherently risky to the sexual health of gay bisexual and other men who have sex with men.
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Affiliation(s)
- Denton Callander
- The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia
| | - Phillip Read
- The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia.,Kirketon Road Centre, Sydney, New South Wales, Australia
| | - Garrett Prestage
- The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia.,The Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia
| | - Victor Minichiello
- The Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Faculty of Medicine, Nursing and Health Sciences, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - David A Lewis
- Western Sydney Sexual Health Centre, Parramatta, New South Wales, Australia.,Centre for Infectious Diseases and Microbiology & Marie Bashir Institute for Infectious Diseases and Biosecurity, Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Anna McNulty
- Sydney Sexual Health Centre, Sydney Hospital, Sydney, New South Wales, Australia
| | - Hammad Ali
- The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia
| | - Margaret Hellard
- Burnet Institute, Melbourne, Victoria, Australia.,Infectious Disease Unit, Alfred Hospital, Melbourne, Victoria, Australia
| | - Rebecca Guy
- The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia
| | - Basil Donovan
- The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia.,Sydney Sexual Health Centre, Sydney Hospital, Sydney, New South Wales, Australia
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33
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Snowden JM, Chen YH, McFarland W, Raymond HF. Prevalence and characteristics of users of pre-exposure prophylaxis (PrEP) among men who have sex with men, San Francisco, 2014 in a cross-sectional survey: implications for disparities. Sex Transm Infect 2016; 93:52-55. [PMID: 27356041 DOI: 10.1136/sextrans-2015-052382] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 06/01/2016] [Accepted: 06/11/2016] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Pre-exposure prophylaxis (PrEP) has gained a central role in prevention of HIV infection among men who have sex with men (MSM), particularly in San Francisco, California, USA. Programmes to enrol men in PrEP are being undertaken by a range of public and private organisations. PrEP will have the largest population impact if it reaches men who are most at risk for HIV infection, and is used in a manner that enables maximal efficacy. Access to PrEP also needs to be equitable. We report on the characteristics of men eligible for and using PrEP. METHODS Data were from the 2014 implementation of National HIV Behavioural Surveillance (NHBS) among MSM in San Francisco. NHBS uses venue-based sampling as the national standard for sampling MSM. We compare proportions of demographic characteristics of MSM using versus not using PrEP who are HIV-negative and meet Centers for Disease Control and Prevention guidelines to recommend PrEP. RESULTS Overall, 64.1% of HIV-negative MSM in San Francisco would meet guidelines for PrEP use, while 9.2% of MSM overall and 14.5% of MSM eligible were using PrEP as of 2014. Men using PrEP are more likely to be white and of older age. There were no differences between men using and not using PrEP in terms of education, income and health insurance. CONCLUSIONS PrEP roll-out efforts should attempt to increase reach for young, black and Hispanic MSM. Failure to equitably provide access to PrEP could exacerbate the US disparity in new HIV infections for men of colour.
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Affiliation(s)
| | | | - Willi McFarland
- San Francisco Department of Public Health, San Francisco, California, USA
| | - Henry F Raymond
- HIV AIDS Statistics and Epidemiology, San Francisco Department of Public Health, San Francisco, California, USA
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Elliot E, Rossi M, McCormack S, McOwan A. Identifying undiagnosed HIV in men who have sex with men (MSM) by offering HIV home sampling via online gay social media: a service evaluation. Sex Transm Infect 2016; 92:470-3. [PMID: 27221475 DOI: 10.1136/sextrans-2015-052090] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 12/23/2015] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND An estimated one in eight men who have sex with men (MSM) in London lives with HIV, of which 16% are undiagnosed. It is a public health priority to minimise time spent undiagnosed and reduce morbidity, mortality and onward HIV transmission. 'Dean Street at Home' provided an online HIV risk self-assessment and postal home HIV sampling service aimed at hard-to-reach, high-risk MSM. OBJECTIVES This 2-year service evaluation aims to determine the HIV risk behaviour of users, the uptake of offer of home sampling and the acceptability of the service. METHODS Users were invited to assess their HIV risk anonymously through messages or promotional banners on several gay social networking websites. Regardless of risk, they were offered a free postal HIV oral fluid or blood self-sampling kit. Reactive results were confirmed in clinic. A user survey was sent to first year respondents. RESULTS 17 361 respondents completed the risk self-assessment. Of these, half had an 'identifiable risk' for HIV and a third was previously untested. 5696 test kits were returned. 121 individuals had a reactive sample; 82 (1.4% of returned samples) confirmed as new HIV diagnoses linked to care; 14 (0.25%) already knew their diagnosis; and 14 (0.25%) were false reactives. The median age at diagnosis was 38; median CD4 505 cells/µL and 20% were recent infections. 61/82 (78%) were confirmed on treatment at the time of writing. The post-test email survey revealed a high service acceptability rate. CONCLUSIONS The service was the first of its kind in the UK. This evaluation provides evidence to inform the potential roll-out of further online strategies to enhance community HIV testing.
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Affiliation(s)
- E Elliot
- HIV/GUM directorate, Chelsea and Westminster Hospital, London, UK
| | - M Rossi
- HIV/GUM directorate, Chelsea and Westminster Hospital, London, UK
| | - S McCormack
- HIV/GUM directorate, Chelsea and Westminster Hospital, London, UK
| | - A McOwan
- HIV/GUM directorate, Chelsea and Westminster Hospital, London, UK
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DeSilva M, Hedberg K, Robinson B, Toevs K, Neblett-Fanfair R, Petrosky E, Hariri S, Schafer S. A case-control study evaluating the role of internet meet-up sites and mobile telephone applications in influencing a syphilis outbreak: Multnomah County, Oregon, USA 2014. Sex Transm Infect 2016; 92:353-8. [PMID: 27188272 DOI: 10.1136/sextrans-2015-052509] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 04/20/2016] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Early syphilis in Multnomah County, Oregon, USA, increased 16-fold during 2007-2013. Cases predominantly occurred among men who have sex with men (MSM); 55% were HIV coinfected. We conducted a case-control study to evaluate the association between meeting sex partners online and early syphilis. METHODS Cases subjects (cases) were Multnomah County resident, English speaking, MSM, aged ≥18 years with laboratory-confirmed early syphilis reported 1 January to 31 December 2013. We recruited two MSM controls subjects (controls) per case, frequency matched by HIV status and age. Participants completed self-administered questionnaires. We performed multivariable logistic regression. RESULTS Seventy per cent (40/57) of cases and 42% (50/119) of controls met partners online (p<0.001). Cases more frequently met partners online (adjusted OR (aOR)=3.0; 95% CI 1.2 to 6.7), controlling for presumptive confounders. Cases reported more partners than controls (medians 5, 2; p<0.001). When including number of partners, aOR decreased to 1.4 (95% CI 0.5 to 3.9). CONCLUSIONS Early syphilis was associated with meeting partners online. We believe this association may be related to number of sex partners acting as an intermediate variable between use of online resources to meet sex partners and early syphilis. Online meet-up sites might represent areas for public health interventions targeting at-risk individuals.
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Affiliation(s)
- Malini DeSilva
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, CDC, Atlanta, Georgia, USA
| | | | - Byron Robinson
- Epidemiology Workforce Branch, Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, CDC, Atlanta, Georgia, USA
| | - Kim Toevs
- Adolescent Health Promotion and STD/HIV/HCV Programs, Multnomah County Health Department, Portland, Oregon, USA
| | - Robyn Neblett-Fanfair
- Epidemiology and Surveillance Branch, Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC, Atlanta, Georgia, USA
| | - Emiko Petrosky
- Epidemiology and Surveillance Branch, Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC, Atlanta, Georgia, USA
| | - Susan Hariri
- Epidemiology and Surveillance Branch, Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC, Atlanta, Georgia, USA
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Grewal R, Allen VG, Gardner S, Moravan V, Tan DHS, Raboud J, Bayoumi AM, Kaul R, Mazzulli T, McGee F, Rourke SB, Burchell AN. Serosorting and recreational drug use are risk factors for diagnosis of genital infection with chlamydia and gonorrhoea among HIV-positive men who have sex with men: results from a clinical cohort in Ontario, Canada. Sex Transm Infect 2016; 93:71-75. [PMID: 27154185 PMCID: PMC5293859 DOI: 10.1136/sextrans-2015-052500] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 03/31/2016] [Accepted: 04/16/2016] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Rates of chlamydia and gonorrhoea have been rising in urban centres in Canada, particularly among HIV-positive men who have sex with men (MSM). Our objective was to identify behavioural risk factors for diagnosis with chlamydia and gonorrhoea in this population, with a focus on the HIV status of sexual partners. METHODS The OHTN Cohort Study follows people in HIV care across Ontario. We restricted the analysis to 1997 MSM who completed questionnaires in 2010-2013 at one of seven clinics that submit all chlamydia and gonorrhoea tests to the provincial public health laboratory; we obtained test results via record linkage. We estimated cumulative incidences using Kaplan-Meier methods and identified risk factors for diagnosis of a composite outcome (chlamydia or gonorrhoea infection) using Cox regression. RESULTS At follow-up, there were 74 new chlamydia/gonorrhoea diagnoses with a 12-month cumulative incidence of 1.7% (95% CI 1.1% to 2.2%). Risk factors for chlamydia/gonorrhoea diagnosis were: 5+ HIV-positive partners (HR=3.3, 95% CI 1.4 to 7.8; reference=none) and recreational drug use (HR=2.2, 95% CI 1.2 to 3.9). CONCLUSIONS Heightened risks with recreational drug use and multiple HIV-positive partners suggest that chlamydia/gonorrhoea may have achieved high prevalence in certain sexual networks among HIV-positive MSM. Interventions to promote safer sex and timely testing among MSM are needed.
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Affiliation(s)
- Ramandip Grewal
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Vanessa G Allen
- Public Health Laboratories, Public Health Ontario, Toronto, Ontario, Canada
| | - Sandra Gardner
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Baycrest Health Science, Toronto, Ontario, Canada
| | | | - Darrell H S Tan
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada.,Division of Infectious Diseases, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Janet Raboud
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Ahmed M Bayoumi
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada.,Division of Infectious Diseases, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Rupert Kaul
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tony Mazzulli
- Public Health Laboratories, Public Health Ontario, Toronto, Ontario, Canada.,Department of Microbiology, Mount Sinai Hospital/University Health Network, Toronto, Ontario, Canada
| | - Frank McGee
- AIDS Bureau, Ontario Ministry of Health and Long-Term Care, Toronto, Ontario, Canada
| | - Sean B Rourke
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Ontario HIV Treatment Network, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Ann N Burchell
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
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Pakianathan MR, Lee MJ, Kelly B, Hegazi A. How to assess gay, bisexual and other men who have sex with men for chemsex. Sex Transm Infect 2016; 92:568-570. [PMID: 27102811 DOI: 10.1136/sextrans-2015-052405] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 03/22/2016] [Accepted: 03/31/2016] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Sexualised substance use, 'chemsex', is being increasingly reported by gay, bisexual and other men who have sex with men (GBMSM) in sexual health clinics. We aim to describe the evidence base and practical ways in which clinicians can assess and advise patients disclosing chemsex. METHODS We review published literature on chemsex, discuss vulnerability to substance use, highlight the importance of clinical communication and discuss a management approach. RESULTS GBMSM are vulnerable to substance use problems, which interplay with mental, physical and sexual health. Knowledge on sexualised drug use and related communication skills are essential to facilitating disclosure. Identifying sexual health and other consequences of harmful drug use may motivate patients to seek change. CONCLUSIONS Sexual health clinicians are well placed to make more holistic assessments of GBMSM accessing their services to promote broader sexual health and well-being beyond the management of HIV and sexually transmitted infections (STIs) alone.
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Affiliation(s)
- M R Pakianathan
- Department of Genitourinary Medicine, The Courtyard Clinic, Wandsworth Integrated Sexual Health, St. George's University Hospital Foundation Trust, London, UK
| | - M J Lee
- Department of Genitourinary Medicine, The Courtyard Clinic, Wandsworth Integrated Sexual Health, St. George's University Hospital Foundation Trust, London, UK
| | - B Kelly
- Department of Genitourinary Medicine, The Courtyard Clinic, Wandsworth Integrated Sexual Health, St. George's University Hospital Foundation Trust, London, UK
| | - A Hegazi
- Department of Genitourinary Medicine, The Courtyard Clinic, Wandsworth Integrated Sexual Health, St. George's University Hospital Foundation Trust, London, UK
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Hull P, Mao L, Prestage G, Zablotska I, de Wit J, Holt M. The use of mobile phone apps by Australian gay and bisexual men to meet sex partners: an analysis of sex-seeking repertoires and risks for HIV and STIs using behavioural surveillance data. Sex Transm Infect 2016; 92:502-507. [PMID: 27095378 DOI: 10.1136/sextrans-2015-052325] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 03/14/2016] [Accepted: 04/01/2016] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Mobile phone apps are now the most popular method that Australian gay men use to find sex partners. Partner-seeking mobile phone apps use location functions to identify like-minded men and display their proximity. This study examines whether meeting partners via mobile apps is associated with a greater risk of HIV and sexually transmitted infections (STIs) than with other ways of meeting partners. METHODS Data were analysed from the Gay Community Periodic Surveys, community-based, cross-sectional surveys conducted in Australian state capital cities between 2010 and 2014. χ2 tests and multinomial logistic regression were used to analyse differences in risk profiles of men who used different methods to meet partners. RESULTS Data were analysed from 36 428 men who participated in the Gay Community Periodic Surveys between 2010 and 2014. In 2014, 4116 men reported meeting sex partners with the use of mobile apps, increasing from 23.9% in 2011 to 42.5% in 2014. Men who used a combination of online and offline methods reported a greater number of sex partners and were more likely to report a recent STI than men who used online methods only or offline methods only. CONCLUSIONS There has been a steep increase in the use of mobile phone apps by gay men in Australia to meet male partners. However, men who use a combination of mobile phone apps, internet websites and offline places to meet partners appear to be at increased risk of STIs or HIV compared with men who use a narrower range of online and offline methods.
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Affiliation(s)
- Peter Hull
- Centre for Social Research in Health, UNSW, Sydney, Australia
| | - Limin Mao
- Centre for Social Research in Health, UNSW, Sydney, Australia
| | | | | | - John de Wit
- Centre for Social Research in Health, UNSW, Sydney, Australia
| | - Martin Holt
- Centre for Social Research in Health, UNSW, Sydney, Australia
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Libois A, Feoli F, Nkuize M, Delforge M, Konopnicki D, Clumeck N, De Wit S. Prolonged antiretroviral therapy is associated with fewer anal high-grade squamous intraepithelial lesions in HIV-positive MSM in a cross-sectional study. Sex Transm Infect 2016; 93:15-17. [PMID: 27030607 DOI: 10.1136/sextrans-2015-052444] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 02/17/2016] [Accepted: 03/12/2016] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE HIV-positive men who have sex with men (MSM) are at increased risk of anal cancer. We evaluate the risk factors for anal high-grade squamous intraepithelial lesion (HSIL) (the precursor of anal cancer) in HIV-positive MSM. METHODS In this cross-sectional study within a cohort, 320 HIV-positive MSM were screened by anal cytology followed by high-resolution anoscopy (HRA) in case of abnormal cytology. Risk factors for anal HSIL were analysed. RESULTS Men were mostly middle-aged Caucasians with median CD4+ T lymphocytes of 638 cells/µL, 87% on combined antiretroviral therapy (cART) for a median of 5 years. 198 anal cytology samples were normal. In the 122 patients with abnormal cytology, HRA with biopsies were performed: 12% (n=15) normal, 36% (n=44) anal low-grade squamous intraepithelial lesion (LSIL) and 51% (n=63) anal HSIL. Comparing patients with or without anal HSIL (normal cytology or normal biopsy or LSIL), we found in multivariate analysis significantly fewer anal HSIL in patients with cART ≥24 months (OR 0.32 CI 95% 0.162 to 0.631, p=0.001). CONCLUSIONS Prolonged cART (≥24 months) is associated with fewer anal HSIL.
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Affiliation(s)
- Agnès Libois
- Department of Infectious Diseases, University Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Francesco Feoli
- Department of Pathology, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Marcel Nkuize
- Department of Gastroenterology, University Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Marc Delforge
- Department of Infectious Diseases, University Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Deborah Konopnicki
- Department of Infectious Diseases, University Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Nathan Clumeck
- Department of Infectious Diseases, University Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Stéphane De Wit
- Department of Infectious Diseases, University Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels, Belgium
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Prah P, Hickson F, Bonell C, McDaid LM, Johnson AM, Wayal S, Clifton S, Sonnenberg P, Nardone A, Erens B, Copas AJ, Riddell J, Weatherburn P, Mercer CH. Men who have sex with men in Great Britain: comparing methods and estimates from probability and convenience sample surveys. Sex Transm Infect 2016; 92:455-63. [PMID: 26965869 PMCID: PMC5013102 DOI: 10.1136/sextrans-2015-052389] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 02/06/2016] [Indexed: 11/05/2022] Open
Abstract
Objective To examine sociodemographic and behavioural differences between men who have sex with men (MSM) participating in recent UK convenience surveys and a national probability sample survey. Methods We compared 148 MSM aged 18–64 years interviewed for Britain's third National Survey of Sexual Attitudes and Lifestyles (Natsal-3) undertaken in 2010–2012, with men in the same age range participating in contemporaneous convenience surveys of MSM: 15 500 British resident men in the European MSM Internet Survey (EMIS); 797 in the London Gay Men's Sexual Health Survey; and 1234 in Scotland's Gay Men's Sexual Health Survey. Analyses compared men reporting at least one male sexual partner (past year) on similarly worded questions and multivariable analyses accounted for sociodemographic differences between the surveys. Results MSM in convenience surveys were younger and better educated than MSM in Natsal-3, and a larger proportion identified as gay (85%–95% vs 62%). Partner numbers were higher and same-sex anal sex more common in convenience surveys. Unprotected anal intercourse was more commonly reported in EMIS. Compared with Natsal-3, MSM in convenience surveys were more likely to report gonorrhoea diagnoses and HIV testing (both past year). Differences between the samples were reduced when restricting analysis to gay-identifying MSM. Conclusions National probability surveys better reflect the population of MSM but are limited by their smaller samples of MSM. Convenience surveys recruit larger samples of MSM but tend to over-represent MSM identifying as gay and reporting more sexual risk behaviours. Because both sampling strategies have strengths and weaknesses, methods are needed to triangulate data from probability and convenience surveys.
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Affiliation(s)
- Philip Prah
- Research Department of Infection & Population Health, University College London, London, UK
| | - Ford Hickson
- Sigma Research, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Lisa M McDaid
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Anne M Johnson
- Research Department of Infection & Population Health, University College London, London, UK
| | - Sonali Wayal
- Research Department of Infection & Population Health, University College London, London, UK
| | - Soazig Clifton
- Research Department of Infection & Population Health, University College London, London, UK
| | - Pam Sonnenberg
- Research Department of Infection & Population Health, University College London, London, UK
| | | | - Bob Erens
- Research Department of Infection & Population Health, University College London, London, UK Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Andrew J Copas
- Research Department of Infection & Population Health, University College London, London, UK
| | - Julie Riddell
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Peter Weatherburn
- Department of Social & Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Catherine H Mercer
- Research Department of Infection & Population Health, University College London, London, UK
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Chow EPF, Cornelisse VJ, Read TRH, Lee D, Walker S, Hocking JS, Chen MY, Bradshaw CS, Fairley CK. Saliva use as a lubricant for anal sex is a risk factor for rectal gonorrhoea among men who have sex with men, a new public health message: a cross-sectional survey. Sex Transm Infect 2016; 92:532-536. [PMID: 26941362 DOI: 10.1136/sextrans-2015-052502] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 02/02/2016] [Accepted: 02/14/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Apart from penile-anal intercourse, other anal sexual practices (rimming, fingering and saliva use as a lubricant for anal sex) are common among men who have sex with men (MSM). The aim of this study is to evaluate whether these anal sexual practices are risk factors for rectal gonorrhoea in MSM. METHOD A cross-sectional survey was conducted among MSM attending Melbourne Sexual Health Centre between 31 July 2014 and 30 June 2015. Rectal gonorrhoea cases were identified by culture. RESULTS Among 1312 MSM, 4.3% (n=56) had rectal gonorrhoea. Other anal sexual practices were common among MSM: receptive rimming (70.5%), receptive fingering or penis dipping (84.3%) and using partner's saliva as a lubricant for anal sex (68.5%). Saliva as a lubricant (adjusted OR 2.17; 95% CI 1.00 to 4.71) was significantly associated with rectal gonorrhoea after adjusting for potential confounding factors. Receptive rimming and fingering or penis dipping were not statistically associated with rectal gonorrhoea. The crude population-attributable fraction of rectal gonorrhoea associated with use of partner's saliva as a lubricant for anal sex was 48.9% (7.9% to 71.7%). CONCLUSIONS Saliva use as a lubricant for anal sex is a common sexual practice in MSM, and it may play an important role in gonorrhoea transmission. Almost half of rectal gonorrhoea cases may be eliminated if MSM stopped using partner's saliva for anal sex.
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Affiliation(s)
- Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Faculty of Medicine, Central Clinical School, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Vincent J Cornelisse
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Faculty of Medicine, Central Clinical School, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Tim R H Read
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Faculty of Medicine, Central Clinical School, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - David Lee
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Sandra Walker
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Faculty of Medicine, Central Clinical School, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Jane S Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Faculty of Medicine, Central Clinical School, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Catriona S Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Faculty of Medicine, Central Clinical School, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Faculty of Medicine, Central Clinical School, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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Frankis JS, Young I, Lorimer K, Davis M, Flowers P. Towards preparedness for PrEP: PrEP awareness and acceptability among MSM at high risk of HIV transmission who use sociosexual media in four Celtic nations: Scotland, Wales, Northern Ireland and The Republic of Ireland: an online survey. Sex Transm Infect 2016; 92:279-85. [PMID: 26801225 DOI: 10.1136/sextrans-2015-052101] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 11/28/2015] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To assess the awareness and acceptability of pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) and use sociosexual media at high risk of HIV infection in four Celtic nations. DESIGN Cross-sectional study. METHODS Online self-complete survey of 386 HIV-negative/status unknown MSM who reported condomless anal intercourse (CAI) with ≥2 men in the last year, recruited from gay sociosexual media. RESULTS One-third (34.5%, 132/386) of the participants were aware of PrEP but over half (58.5%, 226/356) reported that they would be willing to use PrEP if it were available to them. Only men who regularly tested for HIV every 6 months (adjusted OR 2.89, 95% CI 1.54 to 5.42) were more likely to be aware of PrEP. PrEP acceptability was only associated with reporting ≥5 CAI partners (OR 2.04, 95% CI 1.2 to 3.46) in the last year. CONCLUSIONS Low levels of PrEP awareness were reported across these Celtic nations. Only one-third of high-risk MSM had heard of PrEP but over one-half would be willing to take a daily pill to prevent HIV infection. Sociodemographic factors, commercial gay scene proximity and social network use were unrelated to considering PrEP use. However, those reporting most CAI partners were more likely to consider PrEP use.
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Affiliation(s)
- Jamie S Frankis
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Ingrid Young
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Karen Lorimer
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Mark Davis
- School of Social Sciences, Monash University, Melbourne, Victoria, Australia
| | - Paul Flowers
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
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Lorimer K, Flowers P, Davis M, Frankis J. Young men who have sex with men's use of social and sexual media and sex-risk associations: cross-sectional, online survey across four countries. Sex Transm Infect 2016; 92:371-6. [PMID: 26792089 DOI: 10.1136/sextrans-2015-052209] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 12/23/2015] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE There has been an increase in new HIV diagnoses among young men who have sex with men (YMSM) over the past decade in both UK and US contexts, with online sex-seeking implicated in driving this development. This study sought to examine YMSM's use of a variety of social and sexual networking websites and 'apps', and assess sexual risk behaviours. DESIGN YMSM were recruited from across four countries in Britain and Ireland, via an online survey using convenience sampling. Data were collected from 2668 men, of whom 702 were aged 18-25 years. RESULTS Facebook use was almost ubiquitous and for largely social reasons; sexual media use was common with 52% using gay sexual networking (GSN) websites frequently and 44% using similar apps frequently. We found increased odds of high-risk condomless anal intercourse associated with the length of time users had been using GSN websites and lower levels of education. We found no significant differences across the four countries in sexual risk behaviours. CONCLUSIONS YMSM are a heterogeneous population with varied sexual health needs. For young men with digital literacy, individual-level online interventions, targeted and tailored, could be directed towards frequent users with lower levels of education. Variation in demographic characteristics of GSN websites and app users may affect who interventions are likely to reach, depending on where they are targeted. However, interventions, which may catch young men earlier, also provide a major opportunity for reducing sexual health inequalities.
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Affiliation(s)
- Karen Lorimer
- School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Paul Flowers
- School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Mark Davis
- School of Social Sciences, Monash University, Melbourne, Victoria, Australia
| | - Jamie Frankis
- School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, UK
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Chow EPF, Lee D, Tabrizi SN, Phillips S, Snow A, Cook S, Howden BP, Petalotis I, Bradshaw CS, Chen MY, Fairley CK. Detection of Neisseria gonorrhoeae in the pharynx and saliva: implications for gonorrhoea transmission. Sex Transm Infect 2015; 92:347-9. [PMID: 26622046 DOI: 10.1136/sextrans-2015-052399] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 11/07/2015] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES This study aimed to determine the proportion of untreated pharyngeal swabs or saliva samples positive by culture or nucleic acid amplification tests (NAATs) for Neisseria gonorrhoeae up to 14 days after an initial culture-positive pharyngeal swab. METHODS Men who have sex with men who tested positive for pharyngeal gonorrhoea at Melbourne Sexual Health Centre (MSHC) and returned to MSHC for treatment within 14 days between 13 October 2014 and 25 March 2015 were included in this study. Pharyngeal swabs and saliva samples were collected for culture and NAAT. RESULTS Of 33 initially culture-positive pharyngeal swabs, 32 saliva samples and 31 pharyngeal swabs were positive by NAAT and 14 pharyngeal and 6 saliva samples were positive by culture within 14 days. There was a significant decline in the proportion of repeated pharyngeal culture samples positive by culture over time (p<0.001). CONCLUSIONS The rapid decline suggests pharyngeal gonorrhoea is short-lived, and the finding of gonorrhoea commonly in the saliva implicates this body fluid in its transmission without direct throat inoculation.
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Affiliation(s)
- Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - David Lee
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Sepehr N Tabrizi
- Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Samuel Phillips
- Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Anthony Snow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Stuart Cook
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Benjamin P Howden
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Irene Petalotis
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Catriona S Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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Labiran C, Marsh P, Zhou J, Bannister A, Clarke IN, Goubet S, Soni S. Highly diverse MLVA-ompA genotypes of rectal Chlamydia trachomatis among men who have sex with men in Brighton, UK and evidence for an HIV-related sexual network. Sex Transm Infect 2015; 92:299-304. [PMID: 26487754 DOI: 10.1136/sextrans-2015-052261] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 09/26/2015] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES In this prospective study, we aimed to determine the distribution of genotypes by multilocus variable number tandem repeat (VNTR) analysis plus analysis of the ompA gene (MLVA-ompA) of rectal Chlamydia trachomatis among men who have sex with men (MSM) attending Brighton Genitourinary Medicine (GUM) Clinic and to examine any correlations with clinical variables, including HIV status, and to isolate rectal C. trachomatis cultures maximising the possibility of obtaining complete genotyping data. METHODS Samples were assigned genotypes by PCR and sequencing of the markers of the MLVA-ompA genotyping system. Rectal C. trachomatis was isolated in cell culture using McCoy cells. Data regarding demographics, HIV status, rectal symptoms and history of sexually transmitted infections, including C. trachomatis, were collected. RESULTS 1809 MSM attending the clinic between October 2011 and January 2013 took part in the study, 112 (6.2%) of whom had rectal samples that tested positive for C. trachomatis. 85/112 (75.9%) C. trachomatis-positive rectal samples were assigned 66 different genotypes. Two distinct genotype subclusters were identified: subcluster 1 consisted of more HIV-negative men than subcluster 2 (p=0.025), and the MLVA-ompA genotypes in these subclusters reflected this. Isolates were successfully cultured from 37 of the 112 specimens, from which 27 otherwise unobtainable (from direct PCR) MLVA-ompA genotypes were gained. CONCLUSIONS The most prevalent genotypes were G, E and D representing some overlap with the heterosexual distribution in UK. Subcluster 1 consisted of more 'heterosexual genotypes' and significantly more HIV-negative men than subcluster 2, associated with 'MSM genotypes'. There was a higher diversity of C. trachomatis strains among MSM in Brighton than observed in other cities.
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Affiliation(s)
- Clare Labiran
- Department of Molecular Microbiology, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Peter Marsh
- Public Health England, Public Health Laboratory Southampton, Southampton General Hospital, Southampton, UK
| | - Judith Zhou
- Claude Nicol Clinic, Royal Sussex County Hospital, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Alan Bannister
- Claude Nicol Clinic, Royal Sussex County Hospital, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Ian Nicholas Clarke
- Department of Molecular Microbiology, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Stephanie Goubet
- Clinical Investigation Research Unit, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Suneeta Soni
- Claude Nicol Clinic, Royal Sussex County Hospital, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
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Stahlman S, Johnston LG, Yah C, Ketende S, Maziya S, Trapence G, Jumbe V, Sithole B, Mothopeng T, Mnisi Z, Baral S. Respondent-driven sampling as a recruitment method for men who have sex with men in southern sub-Saharan Africa: a cross-sectional analysis by wave. Sex Transm Infect 2015; 92:292-8. [PMID: 26424712 DOI: 10.1136/sextrans-2015-052184] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 09/12/2015] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Respondent-driven sampling (RDS) is a popular method for recruiting men who have sex with men (MSM). Our objective is to describe the ability of RDS to reach MSM for HIV testing in three southern African nations. METHODS Data collected via RDS among MSM in Lesotho (N=318), Swaziland (N=310) and Malawi (N=334) were analysed by wave in order to characterise differences in sample characteristics. Seeds were recruited from MSM-affiliated community-based organisations. Men were interviewed during a single study visit and tested for HIV. χ(2) tests for trend were used to examine differences in the proportions across wave category. RESULTS A maximum of 13-19 recruitment waves were achieved in each study site. The percentage of those who identified as gay/homosexual decreased as waves increased in Lesotho (49% to 27%, p<0.01). In Swaziland and Lesotho, knowledge that anal sex was the riskiest type of sex for HIV transmission decreased across waves (39% to 23%, p<0.05, and 37% to 19%, p<0.05). The percentage of participants who had ever received more than one HIV test decreased across waves in Malawi (31% to 12%, p<0.01). In Lesotho and Malawi, the prevalence of testing positive for HIV decreased across waves (48% to 15%, p<0.01 and 23% to 11%, p<0.05). Among those living with HIV, the proportion of those unaware of their status increased across waves in all study sites although this finding was not statistically significant. CONCLUSIONS RDS that extends deeper into recruitment waves may be a promising method of reaching MSM with varying levels of HIV prevention needs.
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Affiliation(s)
- Shauna Stahlman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights, Baltimore, Maryland, USA
| | - Lisa G Johnston
- Department of Global Health Sciences, University of California San Francisco, San Francisco, California, USA
| | - Clarence Yah
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights, Baltimore, Maryland, USA Department of Biochemistry and Microbiology, Nelson Mandela Metropolitan University, South Africa
| | - Sosthenes Ketende
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights, Baltimore, Maryland, USA
| | | | - Gift Trapence
- Center for the Development of People, Blantyre, Malawi
| | - Vincent Jumbe
- Malawi College of Medicine, Blantyre, Malawi Centre for Global Health, Trinity College, Dublin, Ireland
| | | | | | | | - Stefan Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights, Baltimore, Maryland, USA
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Poynten IM, Machalek D, Templeton D, Jin F, Hillman R, Zablotzska I, Prestage G, Holt M, Grulich A. Comparison of age-specific patterns of sexual behaviour and anal HPV prevalence in homosexual men with patterns in women. Sex Transm Infect 2015; 92:228-31. [PMID: 26306829 DOI: 10.1136/sextrans-2015-052032] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 08/04/2015] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Anal human papillomavirus (HPV) is highly prevalent in men who have sex with men (MSM) of all ages, whereas cervical HPV declines with age. We explore the hypothesis that different sexual behavioural patterns are the basis of this difference in age distribution. METHODS Published data on age-specific HPV prevalence for women (cervical HPV) were extracted from a large meta-analysis and for MSM (anal HPV) from the EXPLORE study of HIV-negative MSM. Age-specific data on recent sexual activity were extracted from two behavioural surveys: the second Australian Study of Health and Relationships survey and the 2013 Gay Community Periodic Survey. RESULTS At least 50% of MSM at all ages reported more than one sexual partner in the past 6 months. In comparison, 33% of women aged 16-19 years reported more than one partner over the past year. This decreased to 19% and 6% in women aged 20-29 and 30-39 years, respectively, and to fewer than 5% of women in older age groups. Prevalent anal HPV was detected in over 50% of MSM in each age group. Prevalence did not decline with age. In contrast, there was a steady decrease in cervical HPV prevalence with age. Cervical HPV prevalence fell from 23% among North American women aged <25 years to 3% in women aged ≥65 years. CONCLUSIONS In contrast to the decreasing prevalence with age among heterosexual women, the high prevalence and lack of decline in prevalent anal HPV among older MSM are likely to be related to continuing high rates of newly acquired HPV infection from ongoing sexual exposure through new partners.
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Affiliation(s)
| | - Dorothy Machalek
- Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - David Templeton
- Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia Royal Prince Alfred Hospital Sexual Health, Sydney, New South Wales, Australia
| | - Fengyi Jin
- Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia
| | - Richard Hillman
- Western Sydney Sexual Health Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Iryna Zablotzska
- Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia
| | - Garrett Prestage
- Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia
| | - Martin Holt
- Centre for Social Research in Health, UNSW Australia, Sydney, New South Wales, Australia
| | - Andrew Grulich
- Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia
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Bourne A, Reid D, Hickson F, Torres-Rueda S, Weatherburn P. Illicit drug use in sexual settings ('chemsex') and HIV/STI transmission risk behaviour among gay men in South London: findings from a qualitative study. Sex Transm Infect 2015; 91:564-8. [PMID: 26163510 DOI: 10.1136/sextrans-2015-052052] [Citation(s) in RCA: 203] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 06/18/2015] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND 'Chemsex' is a colloquial term used in the UK that describes sex under the influence of psychoactive substances (typically crystal methamphetamine, mephedrone and gamma-hydroxybutyric acid (GHB)/gamma-butyrolactone (GBL)). Recently, concern has been raised as to the impact of such behaviour on HIV/sexually transmitted infection (STI) transmission risk behaviour, which this qualitative study aimed to explore via semistructured interviews with gay men living in three South London boroughs. METHODS Interviews were conducted with 30 community-recruited gay men (age range 21-53) who lived in the boroughs of Lambeth, Southwark and Lewisham, and who had used crystal methamphetamine, mephedrone or GHB/GBL either immediately before or during sex with another man during the previous 12 months. Data were subjected to a thematic analysis. RESULTS Chemsex typically featured more partners and a longer duration than other forms of sex, and the relationship between drug use and HIV/STI transmission risk behaviour was varied. While some men believed that engaging in chemsex had unwittingly led them to take risks, others maintained strict personal rules about having safer sex. Among many participants with diagnosed HIV, there was little evidence that the use of drugs had significantly influenced their engagement in condomless anal intercourse (primarily with other men believed to be HIV positive), but their use had facilitated sex with more men and for longer. CONCLUSIONS Analysis revealed that, within this sample, chemsex is never less risky than sex without drugs, and is sometimes more so. Targeted clinic-based and community-based harm reduction and sexual health interventions are required to address the prevention needs of gay men combining psychoactive substances with sex.
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Affiliation(s)
- A Bourne
- Sigma Research, Department of Social & Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| | - D Reid
- Sigma Research, Department of Social & Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| | - F Hickson
- Sigma Research, Department of Social & Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| | - S Torres-Rueda
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - P Weatherburn
- Sigma Research, Department of Social & Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
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Melendez-Torres GJ, Hickson F, Reid D, Weatherburn P, Bonell C. Drug use moderates associations between location of sex and unprotected anal intercourse in men who have sex with men: nested cross-sectional study of dyadic encounters with new partners. Sex Transm Infect 2015; 92:39-43. [PMID: 26136509 DOI: 10.1136/sextrans-2014-051954] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 06/13/2015] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES This nested cross-sectional study of dyadic sexual encounters with new male partners reported by men living in England who have sex with men tested moderation between drug use and location of sex in associations with unprotected anal intercourse (UAI). METHODS Data were drawn from two waves of a longitudinal monthly internet survey of men living in England who have sex with men conducted in 2011. Using generalised estimating equations and logit link, we tested the relationship with UAI of any respondent drug use before sex, specific respondent drug use before sex, location of sex (distinguishing private, sex-on-premises venue and cruising locations) and location-drug use interactions. RESULTS Any respondent drug use (OR 1.57, 95% CI 1.31 to 1.88) was associated with increased odds of UAI. Relative to encounters in private locations, encounters in sex-on-premises venues (0.69, 95% CI 0.52 to 0.91), but not cruising locations, were associated with decreased odds of UAI. Any respondent drug use, respondent use of poppers and respondent use of alcohol were each associated with increased UAI in sex-on-premises venues. DISCUSSION This analysis presents evidence of moderation between drug use and location of sex in associations with UAI. Though this analysis used a large sample, it relied on community-recruited respondents. Our findings may reflect either 'totalising' effects of drug use across venues or site-specific use of drugs as a mechanism for cognitive escape. Additional qualitative research is necessary to understand these findings in context.
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Affiliation(s)
- G J Melendez-Torres
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Ford Hickson
- Sigma Research, London School of Hygiene and Tropical Medicine, University of London, London, UK
| | - David Reid
- Sigma Research, London School of Hygiene and Tropical Medicine, University of London, London, UK
| | - Peter Weatherburn
- Sigma Research, London School of Hygiene and Tropical Medicine, University of London, London, UK
| | - Chris Bonell
- Social Science Research Unit, Department of Childhood, Families and Health, UCL Institute of Education, University College London, London, UK
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