Which HIV-infected men who have sex with men in care are engaging in risky sex and acquiring sexually transmitted infections: findings from a Boston community health centre
- 1Brown Medical School/Miriam Hospital, Providence, Rhode Island, USA
- 2The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
- 3Harvard Medical School/Massachusetts General Hospital, Boston, Massachusetts, USA
- 4Harvard School of Public Health, Boston, Massachusetts, USA
- Correspondence to Dr K H Mayer, The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, USA;
Contributors KHM is the principal investigator of the study, conceptualised the manuscript and led the manuscript writing. CO and MS conducted the statistical analyses and contributed to the preparation of the manuscript. CC, EL and RV consulted on the project and contributed to the preparation of the manuscript. SAS is the co-principal investigator of the study and contributed to the development of the assessments used in the study and the preparation of the manuscript.
- Accepted 10 August 2009
- Published Online First 30 August 2009
Objectives The primary objective was to determine the prevalence of sexually transmitted infections (STI) in a cohort of HIV-infected men who have sex with men (MSM) in their primary care setting, and to identify the demographic and behavioural characteristics of those infected with STI and the correlates of sexual transmission risk behaviour.
Methods At study entry, participants (n = 398) were tested for STI and their medical charts were reviewed for STI results in the previous year. Data on demographics, substance use, sexual behaviour and HIV disease characteristics were collected through a computer-assisted self-assessment and medical record extraction. Logistic regression analyses assessed characteristics of those with recent STI and recent transmission risk behaviour.
Results The sample was predominantly white (74.6%) and college educated (51.7%). On average, participants were 41.5 years old (SD 8.4) and had been HIV infected for 8.6 years (SD 6.7); 9% of the sample had an STI, with 6.4% testing positive for syphilis, 3.1% for gonorrhoea and 0.25% for chlamydia. Age and years since HIV diagnosis were significantly associated with testing positive for an STI, as was engaging in transmission risk behaviour and using methamphetamine, ketamine and inhalants. Substance use, particularly methamphetamine use, and being more recently diagnosed with HIV were each uniquely associated with transmission risk behaviour in a multivariable model.
Conclusions These results underscore the need to develop more effective secondary prevention interventions for HIV-infected MSM, tailored to more recently diagnosed patients, particularly those who are younger and substance users.
See Editorial, p2
Funding This study was supported by NIMH grant 5R01MH068746-05 and HRSA grant H97HA01293 awarded to KHM and SAS.
Competing interests None.
Ethics approval Ethics approval was obtained from Fenway Health, Boston, MA.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.