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Lb3.261 Trends in condom use and sexual positioning among men-who-have-sex-with-men in the era of hiv pre-exposure prophylaxis, and risk for diagnoses of incident hiv and other sexually transmitted infections – new york city, 2011–2015
  1. Preeti Pathela,
  2. Kelly Jamison,
  3. Sarah Braunstein,
  4. Julia Schillinger
  1. New York City Department of Health And Mental Hygiene, Queens, USA

Abstract

Introduction Men-who-have- sex-with-men (MSM) may modify sexual practices to reduce HIV and sexually transmitted infection (STI) risk. HIV pre-exposure prophylaxis (PrEP) may impact risk behaviour and STI acquisition.

Methods We matched HIV-negative MSM attending New York City (NYC) sexual health clinics during 2011–2015 to the NYC HIV registry in 01/2017. We used visit-level data to assess trends in condom use during anal sex (consistent, inconsistent, no use; referent period=3 months), overall and by sexual positioning behaviour. We examined associations between condomless (inconsistent/no use) insertive, condomless receptive, and condomless versatile sex and incident HIV or STI (chlamydia/gonorrhoea/early syphilis). We used regression with generalised estimating equations (referent group=anal sex with condoms), controlling for demographics, partner number, and STI history.

Results The proportion of visits with reported consistent condom use decreased from 2011–2015 (39% to 31%%, p<0.001); inconsistent use increased (48% to 55%%), and no condom use was stable (13%–14%).There were significant declines in consistent condom use across all positioning categories. From all visits, MSM reported positioning as: 19% condomless insertive, 9% condomless receptive, 37% condomless versatile, 35% sex with condoms. For 25,216 STI testing visits that yielded 7438 diagnoses, all condomless-positioning categories were associated with incident STI; highest risk was with condomless insertive sex (aOR 1.8, 95% CI 1.6–1.9). For MSM tested for HIV at 9744 visits, condomless receptive (aOR 2.8; 95% CI 1.9–4.1) and condomless versatile sex (aOR 2.2; 95% CI 1.6–2.8) were associated with incident HIV. Black MSM (~25% of MSM) had the highest risk for STI and HIV (41% of 368 new HIV diagnoses).

Conclusion We documented increases in condomless sex among a sentinel high risk group prior to and during the PrEP era. Insertive sex, perhaps perceived as a safer strategy, was associated with substantial STI risk when condoms were not consistently used. Assuring PrEP access for black MSM is critical.

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