Objectives Pre-exposure prophylaxis (PrEP) can reduce HIV transmission risk for many gay, bisexual and other men who have sex with men. However, bacterial STI (BSTI) associated with decreasing condom use among HIV PrEP users is a growing concern. Determining the characteristics of current PrEP users at highest BSTI risk fills a critical gap in the literature.
Methods Gay and bisexual men (GBM) in New York City on HIV PrEP for 6 or more months (n=65) were asked about chlamydia, gonorrhoea and syphilis diagnoses in the past 6 months. By design, half (51%) of the sample were club drug users. We examined the associations of length of time on PrEP, type of PrEP care provider, PrEP adherence, number of sexual partners, number of condomless anal sex acts and club drug use on self-reported BSTI using multivariable, binary logistic regressions, adjusting for age, race/ethnicity, education and income.
Results Twenty-six per cent of GBM on HIV PrEP reported a diagnosis of BSTI in the past 6 months. Men who reported club drug use (adjusted OR (AOR)=6.60, p<0.05) and more frequent condomless anal sex in the past 30 days (AOR=1.13, p<0.05) had higher odds of reporting a BSTI. No other variables were significantly associated with self-reported BSTI in the multivariable models.
Conclusions Club drug users could be at a unique BSTI risk, perhaps because of higher risk sexual networks. Findings should be considered preliminary, but suggest the importance of ongoing BSTI screening and risk-reduction counselling for GBM on HIV PrEP.
- hiv pre-exposure prophylaxis
- club drug use
- men who have sex with men
- gay and bisexual men
- sexually transmitted infections
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Handling editor Adam Huw Bourne
Contributors SAJ was responsible for manuscript conceptualisation, data analysis, data interpretation, literature search and manuscript writing. JTP and HJR were coinvestigators of the parent study and were responsible for oversight of measures development, participant recruitment, data management and day-to-day operations. CG is the principal investigator (PI) of the parent study, and his role included conceptualising the study design and oversight of all scientific decisions. JTP, HJR and CG provided feedback on data analysis and interpretation, manuscript revisions, and mentorship to SAJ during the writing of this paper. All authors provided intellectual content to the manuscript and approved the final manuscript. As the study's PI, CG carries the responsibilities of a corresponding author.
Funding The PrEP & Me study was funded by the National Institute on Drug Abuse (NIDA) (R21-DA039019, PI: CG), and HJR was supported by a NIDA Career Development Award (K01-DA039030). The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health (NIH); NIDA/NIH had no role in the production of this manuscript.
Competing interests None declared.
Patient consent Not required.
Ethics approval All procedures were approved by the Institutional Review Board (IRB) of the City University of New York (IRB protocol number 2015–1010).
Provenance and peer review Not commissioned; externally peer reviewed.