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Syphilis Among Men Who Have Sex With Men (MSM) in Taiwan: Its Association With HIV Prevalence, Awareness of HIV Status, and Use of Antiretroviral Therapy

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Abstract

To understand how awareness of HIV-positivity and the use of antiretroviral therapy associated with syphilis infection, 361 MSM attending 16 Hong-Pa (drug-and-sex parties) in Taiwan were studied. The syphilis rate of individuals within their first 2 years after HIV diagnosis (awareness) was lower than that in individuals who had not been diagnosed HIV infection prior to Hong-Pa (unawareness) (Adj OR = 0.24, P < 0.05). Notably, there was a decrease in the beneficial effect of HIV-positive status awareness on syphilis prevention with an increase in time since notification. Moreover, antiretroviral therapy was not associated with a lower incidence of syphilis, and syphilis infection peaked during the treatment dropout period. In conclusion, the duration of a protective effect of knowing one’s HIV-positivity against syphilis infection was short, and the highest risk of syphilis infection was observed when patients discontinued antiretroviral therapy. Future research should examine the behavioral mechanisms involved in this prevention failure.

Resumen

Para conocer la concienciación respecto al VIH positivo y del uso de la terapia antirretroviral asociada con la infección de la sífilis se estudiaron en Taiwán 361 casos de HSH (hombres que tienen sexo con hombres) en 16 “Hong-Pa” (fiestas de droga y sexo).La tasa de sífilis entre los individuos que habían sido diagnosticados como portadores del VIH solo durante los primeros dos años (de ser conscientes de su enfermedad) fue menor que entre los individuos que no habían sido diagnosticados como portadores del VIH antes de asistir a una “Hong-Pa” (desconociendo su enfermedad). (razón de posibilidades ajustada = 0.24, P < 0.05). En particular, hubo un efecto beneficioso desde la notificación de ser portadores del VIH en la disminución de contagios de sífilis pero esta va aumentando según va pasando el tiempo.Por otra parte, la terapia antirretroviral no se asoció con una menor incidencia de la sífilis, y la infección por sífilis alcanzó su punto máximo durante el período del abandono del tratamiento. En conclusión, la duración del efecto protector contra la infección de sífilis por tener consciencia de ser portador del VIH-positivo fue corto, y el mayor riesgo de infección por sífilis se observó cuando los pacientes abandonaron la terapia antirretroviral. En el futuro, las investigaciones deberían examinar los mecanismos de comportamiento involucrados en esta falta de prevención.

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Acknowledgments

This research project was supported in part by a research grant from the Taiwan Centers for Disease Control (DOH100-DC-2008). The authors also thank Dr. Nicole Crepaz of the U.S. Centers for Disease Control and Prevention for her assistance in reviewing the manuscript and making helpful suggestions to improve the manuscript.

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Authors and Affiliations

  1. Department of Health, Centers for Disease Control, Taipei, Taiwan

    Yen-Fang Huang, Yu-Ting Lin, Chin-Hui Yang & Feng-Yee Chang

  2. Institute of Health Policy and Management, College of Public Health, National Taiwan University, No. 17, Xu-Zhou Road, Taipei, Taiwan

    Yen-Fang Huang & Chih-Yin Lew-Ting

  3. Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA

    Kenrad E. Nelson

  4. Department of Public Health, National Taiwan University, Taipei, Taiwan

    Chih-Yin Lew-Ting

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  1. Yen-Fang Huang
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Correspondence to Chih-Yin Lew-Ting.

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Huang, YF., Nelson, K.E., Lin, YT. et al. Syphilis Among Men Who Have Sex With Men (MSM) in Taiwan: Its Association With HIV Prevalence, Awareness of HIV Status, and Use of Antiretroviral Therapy. AIDS Behav 17, 1406–1414 (2013). https://doi.org/10.1007/s10461-012-0405-9

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