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Sex Transm Infect doi:10.1136/sti.2009.036608

Which HIV-infected MSM in care are engaging in risky sex and acquiring sexually transmitted infections: Findings from a Boston community health center

  1. Kenneth Mayer (kenneth_mayer{at}brown.edu)
  1. Fenway Health and Brown Medical School/Miriam Hospital, United States
    1. Conall O’Cleirigh (cocleirigh{at}partners.org)
    1. Fenway Health and Harvard Medical School/Massachusetts General Hospital, United States
      1. Margie Skeer (mskeer{at}fenwayhealth.org)
      1. Fenway Health and Harvard School of Public Health, United States
        1. Charles Covahey (ccovahey{at}fenwayhealth.org)
        1. Fenway Health, United States
          1. Esther Leidolf (eleidolf{at}fenwayhealth.org)
          1. Fenway Health, United States
            1. Rodney Vanderwarker
            1. Fenway Health, United States
              1. Steven Safren (ssafren{at}partners.org)
              1. Fenway Health and Harvard Medical School/Massachusetts General Hospital, United States
                • Published Online First 30 August 2009

                Abstract

                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 behavioral characteristics of those infected with STIs and the correlates of sexual transmission risk behavior (TRB).

                Methods: At study entry, participants (n=398) were tested for STIs and their medical charts were reviewed for STI results in the previous year. Data on demographics, substance use, sexual behavior, 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 STIs and recent TRB.

                Results: The sample was predominantly Caucasian (74.6%) and college educated (51.7%). On average, participants were 41.5 (SD=8.4) years old and had been HIV-infected for 8.6 years (SD=6.7). Nine percent of the sample had an STI, with 6.4% testing positive for syphilis, 3.1% for gonorrhea, and 0.25% for Chlamydia. Age (OR=0.63, CI=0.44-0.91) and years since HIV-diagnosis (OR=0.66, CI=0.45-0. 97) were significantly associated with testing positive for an STI, as was engaging in TRB (OR=4.4, CI=1.88-10.36) and using methamphetamine (OR=3.37, CI=1.67-6.81), ketamine (OR: 4.48; CI: 1.83-11.00), and inhalants (OR: 2.60; CI: 1.28-5.30). Substance use, particularly methamphetamine use, and being more recently diagnosed with HIV were each uniquely associated with TRB 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.

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