Could sexually transmissible infections be contributing to the increase in HIV infections among men who have sex with men in Australia?

Background: To review existing data on sexually transmissible infections (STI) in men who have sex with men in Australia in order to determine the possible contribution of STI to diverging trends in HIV notifications in different states. Methods: We reviewed data from multiple sources, including routine national surveillance data, laboratory surveillance data, self-reported information on STI testing in men who have sex with men and ad hoc reports of STI prevalence. Results: We found increasing rates of gonorrhoea and infectious syphilis notifications in urban men in Australia between 1997 and 2006, and increasing rates of chlamydia notifications in men aged 30–49 years. There was little difference in these trends by state. Differences in the population groups sampled meant we were unable to gain further information on trends in men who have sex with men from these studies. Data on STI testing showed an increase in anal STI testing between 2003 and 2006, which may have increased the number of diagnoses of chlamydia and gonorrhoea for men who have sex with men during this period. Conclusions: Over the past 10 years, there has been a substantial increase in diagnoses of gonorrhoea and infectious syphilis, and probably chlamydia, in men who have sex with men in Australia. However, it is unlikely that changes in the pattern of STI transmission are responsible for the recent divergence in HIV rates between Australian states because there is little evidence that trends in STI also differ by state.

Download Full-text

HIV incidence trends vary between jurisdictions in Australia: an extended back-projection analysis of men who have sex with men

Sexual Health ◽

10.1071/sh10141 ◽

2012 ◽

Vol 9 (2) ◽

pp. 138 ◽

Cited By ~ 13

Author(s):

Kylie-Ann Mallitt ◽

David P. Wilson ◽

Ann McDonald ◽

Handan Wand

Keyword(s):

South Australia ◽

Hiv Infections ◽

Surveillance Data ◽

Hiv Incidence ◽

Back Projection ◽

Hiv Diagnosis ◽

Incidence Trends ◽

The Past ◽

Sex With Men ◽

Incident Cases

Background Trends in HIV diagnoses differ across Australia and are primarily driven by men who have sex with men (MSM). We use national population surveillance data to estimate the incidence of HIV infections among MSM by jurisdiction and infer the proportion of undiagnosed infections. Methods: Annual surveillance data for AIDS diagnoses, HIV diagnoses and recently acquired HIV infections were obtained from 1980 to 2009. A modified statistical back-projection method was used to reconstruct HIV incidence by jurisdiction. Results: HIV incidence among MSM peaked for all jurisdictions in the early 1980s and then declined into the early 1990s, after which incidence increased. Trends then differ between jurisdictions. In New South Wales (NSW) and South Australia, estimated HIV incidence peaked at 371 and 50 cases respectively in 2003, and has since decreased to 258 and 24 cases respectively in 2009. HIV infections in Queensland (Qld) have more than doubled over the past decade, from 84 cases in 2000 to 192 cases in 2009. Victoria and Western Australia have seen a rise in HIV incidence from 2000 to 2006 (to a peak of 250 and 38 incident cases respectively), followed by a plateau to 2009. HIV incidence in the Northern Territory, Tasmania and Australian Capital Territory have increased since 2000; however, case numbers remain small (<20 per year). The estimated proportion of HIV infections not yet diagnosed to 2009 ranges from 10% (NSW) to 18% (Qld), with an average of 12% across Australia. Conclusions: HIV diagnosis trends among MSM in Australia reflect changes in estimated incidence to 2009, and reveal the largest increase in the past 10 years in Qld.

Download Full-text

Investigating the decline in Lymphogranuloma venereum diagnoses in men who have sex with men in the United Kingdom since 2016: an analysis of surveillance data

Sexual Health ◽

10.1071/sh20001 ◽

2020 ◽

Vol 17 (4) ◽

pp. 344

Author(s):

Hester Allen ◽

Rachel Pitt ◽

Megan Bardsley ◽

Christa Smolarchuk ◽

Ann Sullivan ◽

...

Keyword(s):

Laboratory Data ◽

Lymphogranuloma Venereum ◽

Surveillance Data ◽

Multiple Sources ◽

Policy And Practice ◽

Management Guidelines ◽

Asymptomatic Patients ◽

Sexually Transmissible Infections ◽

Sex With Men ◽

The Uk

Abstract Background Following an upward trajectory in Lymphogranuloma venereum (LGV) diagnoses in the UK from 2004 to 2016, with annual diagnoses increasing from 28 to 904, diagnoses fell to 641 in 2017; this was inconsistent with the upward trend in other bacterial sexually transmissible infections (STIs) between 2016 and 2017. An analysis of surveillance data from multiple sources to investigate the possible factors contributing to this decline in LGV was performed. Methods: LGV tests and diagnoses in the UK from 2004 to 2018 were captured through laboratory data from the LGV Reference Laboratories and laboratories conducting in-house LGV testing. These data and clinical diagnoses data from England were analysed alongside the national management guidelines issued over the course of the epidemic. Results: LGV diagnoses increased between 2004 and 2015 and then decreased between 2016 and 2018. LGV testing increased from 2010 to 2018 (2690–10850). Test positivity halved between 2015 (14.8%, 929–6272) and 2018 (7.3%, 791–10850). Peaks in LGV testing and diagnoses appeared to coincide with the publication of national LGV management guidelines and changes to clinical practice. The proportion of LGV diagnoses among HIV-positive men who have sex with men (MSM) fell between 2013 and 2018 (74–48%). Conclusions: The fall in diagnoses and positivity were likely due to increasing earlier clinical diagnosis and treatment. Changes to the national management guidelines, the clinical policy and practice of some larger clinics and potentially changes to the guidelines for the treatment of chlamydia broadened the scope of testing and increased testing in asymptomatic patients which, in combination, likely had a positive effect on the control of LGV infection.

Download Full-text

Self-reported testing and treatment histories among older Australian men and women who may be at risk of a sexually transmissible infection

Sexual Health ◽

10.1071/sh16075 ◽

2017 ◽

Vol 14 (2) ◽

pp. 139 ◽

Cited By ~ 4

Author(s):

Wendy Heywood ◽

Anthony Lyons ◽

Bianca Fileborn ◽

Victor Minichiello ◽

Catherine Barrett ◽

...

Keyword(s):

Older Adults ◽

At Risk ◽

Family Doctor ◽

Cross Sectional Survey ◽

Cross Sectional ◽

The Past ◽

Sti Testing ◽

Sexually Transmissible Infections ◽

Education Campaigns ◽

Sexually Transmissible Infection

Background: Rates of sexually transmissible infections (STIs) are increasing among older adults in many countries. Little is known about the testing and treatment histories of these populations. Correlates of testing in the past 5 years among older adults who may be at risk of a STI were examined. Methods: A cross-sectional survey of 2137 Australians aged 60+ years that involved questions on STIs and STI testing was conducted in 2015. To help inform potential education campaigns, analyses focused on those who may have been at risk of a STI (n = 805, 38%). Results: Less than one in three reported a STI test in the past 5 years (n = 241, 30%) while 6% (n = 51) reported a STI diagnosis. Those diagnosed typically received treatment from a family doctor or general practitioner. Among men, lower testing rates were associated with older age, identifying as heterosexual, lower educational attainment, not using online dating and reporting one partner in the past 5 years. For women, lower rates of testing were found among those who did not use a condom at their most recent sexual encounter and those with one partner in the past 5 years. Conclusions: STI testing rates were low. This study indicates that consideration should be given to the way targeted education campaigns are formulated, such as emphasising the importance of STI testing to older people who are at risk, as well as encouraging healthcare professionals to discuss sexual health with their older patients.

Download Full-text

Prevalence of HIV and sexually transmitted and blood-borne infections, and related preventive and risk behaviours, among gay, bisexual and other men who have sex with men in Montreal, Toronto and Vancouver: results from the Engage Study

Can J Public Health ◽

10.17269/s41997-021-00546-z ◽

2021 ◽

Author(s):

Trevor A. Hart ◽

David M. Moore ◽

Syed W. Noor ◽

Nathan Lachowsky ◽

Daniel Grace ◽

...

Keyword(s):

Scale Up ◽

Hiv Prevalence ◽

Risk Behaviours ◽

Syphilis Infection ◽

Sexually Transmitted ◽

The Past ◽

Sti Testing ◽

History Of ◽

Sex With Men ◽

Exposure Prophylaxis

Abstract Objectives The last Canadian biobehavioural surveillance study of HIV and other sexually transmitted and blood-borne infections (STBBI) among gay, bisexual and other men who have sex with men (GBM) was conducted in 2010. We designed a study to measure STBBI prevalence among GBM in metropolitan Montreal, Toronto and Vancouver and to document related preventive and risk behaviours. Methods The Engage Cohort Study used respondent-driven sampling (RDS) to recruit GBM who reported sex with another man in the past 6 months. At baseline, we examined recruitment characteristics of the samples, and the RDS-II-adjusted distributions of socio-demographics, laboratory-confirmed HIV and other STBBI prevalence, and related behaviours, with a focus on univariate differences among cities. Results A total of 2449 GBM were recruited from February 2017 to August 2019. HIV prevalence was lower in Montreal (14.2%) than in Toronto (22.2%) or Vancouver (20.4%). History of syphilis infection was similar across cities (14–16%). Vancouver had more HIV-negative/unknown participants who reported never being HIV tested (18.6%) than Toronto (12.9%) or Montreal (11.5%). Both Montreal (74.9%) and Vancouver (78.8%) had higher proportions of men who tested for another STBBI in the past 6 months than Toronto (67.4%). Vancouver had a higher proportion of men who used pre-exposure prophylaxis (PrEP) in the past 6 months (18.9%) than Toronto (11.1%) or Montreal (9.6%). Conclusion The three largest cities of Canada differed in HIV prevalence, STBBI testing and PrEP use among GBM. Our findings also suggest the need for scale-up of both PrEP and STI testing among GBM in Canada.

Download Full-text

Characteristics, sexual practices and sexually transmissible infections diagnoses of men who have sex with men and use non-occupational HIV post-exposure prophylaxis in Victoria, Australia

Sexual Health ◽

10.1071/sh16092 ◽

2016 ◽

Vol 13 (6) ◽

pp. 555 ◽

Cited By ~ 2

Author(s):

Jason J. Ong ◽

Andre Landika ◽

Christopher K. Fairley ◽

Catriona Bradshaw ◽

Marcus Chen ◽

...

Keyword(s):

Health Centre ◽

Risk Profile ◽

Sexual Practices ◽

Post Exposure Prophylaxis ◽

Inconsistent Condom ◽

Post Exposure ◽

The Past ◽

Sexually Transmissible Infections ◽

Sex With Men ◽

Exposure Prophylaxis

Background Non-occupational post-exposure prophylaxis (NPEP) is available to people with a potential risk for HIV exposure within the preceding 72 h. We sought to determine if men who have sex with men (MSM) and receive NPEP had a significantly different risk profile (before the preceding 72 h) from MSM not receiving NPEP. If this is the case, NPEP consultations may act as a cue for also discussing pre-exposure prophylaxis. Methods: We conducted a retrospective analysis to compare the demographic characteristics, sexual practices and clinical diagnoses of MSM who were NPEP users and those who were non-NPEP users attending Melbourne Sexual Health Centre from January 2008 to December 2014. Univariate and multivariate logistic regression models were used to examine the association between NPEP use and risk practices. Generalised estimating equations were used to adjust for within-individual correlations related to multiple visits of the same individual. Results: Of the 40 395 MSM consultations included in the study, 1776 consultations (4%) were related to NPEP prescription. NPEP prescribing was associated with ever having injected drugs (adjusted odds ratio (AOR) 1.8, 95% confidence interval (CI): 1.4–2.3), sex with males only (AOR 1.9, 95% CI: 1.6–2.3), more than three male partners in the past 3 months (AOR 1.5, 95% CI: 1.4–1.7) and inconsistent condom use with these partners within the past 3 months (AOR 2.1, 95% CI: 1.9–2.4). Sex workers (AOR 0.6, 95% CI: 0.3–0.9), and men reporting sex overseas within the past 12 months (AOR 0.7, 95% CI: 0.6–0.8) were less likely to receive NPEP. MSM who used NPEP were more likely to test positive for any sexually transmissible infection (AOR 1.2, 95% CI: 1.0–1.4). Conclusions: MSM receiving NPEP generally had a higher risk profile than MSM not requesting NPEP, indicating that NPEP was used by MSM at higher risk for HIV. Therefore, consultations for NPEP may be an opportune time for also discussing pre-exposure prophylaxis for HIV.

Download Full-text

Population-based methods for estimating the number of men who have sex with men: a systematic review

Sexual Health ◽

10.1071/sh18172 ◽

2019 ◽

Vol 16 (6) ◽

pp. 527

Author(s):

Daniel E. Mauck ◽

Merhawi T. Gebrezgi ◽

Diana M. Sheehan ◽

Kristopher P. Fennie ◽

Gladys E. Ibañez ◽

...

Keyword(s):

Systematic Review ◽

Population Size ◽

Survey Data ◽

Census Data ◽

Population Based ◽

Surveillance Data ◽

European Countries ◽

Sexually Transmissible Infections ◽

The Us ◽

Sex With Men

The objective of this systematic review was to summarise population-based methods (i.e. methods that used representative data from populations) for estimating the population size of men who have sex with men (MSM), a high-risk group for HIV and other sexually transmissible infections (STIs). Studies using population-based methods to estimate the number or percentage of MSM or gay men were included. Twenty-eight studies met the inclusion criteria. Seven studies used surveillance data, 18 studies used survey data, and six studies used census data. Sixteen studies were conducted in the US, five were conducted in European countries, two were conducted in Canada, three were conducted in Australia, one was conducted in Israel, and one was conducted in Kenya. MSM accounted for 0.03–6.5% of men among all studies, and ranged from 3.8% to 6.4% in the US, from 7000 to 39100 in Canada, from 0.03% to 6.5% in European countries, and from 127947 to 182624 in Australia. Studies using surveillance data obtained the highest estimates of the MSM population size, whereas those using survey data obtained the lowest estimates. Studies also estimated the MSM population size by dimensions of sexual orientation. In studies examining these dimensions, fewer people identified as MSM than reported experience with or attraction to other men. Selection bias, differences in recall periods and sampling, or stigma could affect the estimate. It is important to have an estimate of the number of MSM to calculate disease rates, plan HIV and STI prevention efforts, and to allocate resources for this group.

Download Full-text

Preventive HIV Vaccines-Leveraging on Lessons from the Past to Pave the Way Forward

Vaccines ◽

10.3390/vaccines9091001 ◽

2021 ◽

Vol 9 (9) ◽

pp. 1001

Author(s):

Parveen Sobia ◽

Derseree Archary

Keyword(s):

Immune Responses ◽

Female Genital Tract ◽

Hiv Infections ◽

Hiv Vaccine ◽

Effective Vaccine ◽

Hiv Vaccines ◽

The Past ◽

Sex With Men ◽

Exposure Prophylaxis ◽

Female Genital

Almost four decades on, since the 1980’s, with hundreds of HIV vaccine candidates tested in both non-human primates and humans, and several HIV vaccines trials later, an efficacious HIV vaccine continues to evade us. The enormous worldwide genetic diversity of HIV, combined with HIV’s inherent recombination and high mutation rates, has hampered the development of an effective vaccine. Despite the advent of antiretrovirals as pre-exposure prophylaxis and preventative treatment, which have shown to be effective, HIV infections continue to proliferate, highlighting the great need for a vaccine. Here, we provide a brief history for the HIV vaccine field, with the most recent disappointments and advancements. We also provide an update on current passive immunity trials, testing proof of the concept of the most clinically advanced broadly neutralizing monoclonal antibodies for HIV prevention. Finally, we include mucosal immunity, the importance of vaccine-elicited immune responses and the challenges thereof in the most vulnerable environment–the female genital tract and the rectal surfaces of the gastrointestinal tract for heterosexual and men who have sex with men transmissions, respectively.

Download Full-text

Polydrug use is associated with new HIV infections among men who have sex with men in China: a multicenter cross-sectional survey

10.21203/rs.2.10999/v1 ◽

2019 ◽

Author(s):

Xiang Mao ◽

Sequoia I. Leuba ◽

Qinghai Hu ◽

Hongjing Yan ◽

Zhe Wang ◽

...

Keyword(s):

Hiv Infection ◽

Hiv Infections ◽

Developed Countries ◽

Dose Effect ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Polydrug Use ◽

The Past ◽

Sex With Men ◽

Recent Hiv Infection

Abstract Background Recreational drug use is popular among men who have sex with men (MSM), while there is limited information about polydrug use and its consequent impact on sexual health and human immunodeficiency virus (HIV) acquisition. Methods MSM were recruited from a multicenter cross-sectional survey conducted in seven Chinese cities. Participants were divided into four subgroups based on the number of recreational drugs (RDs) used in the past 6 months. “Polydrug use” was defined as simultaneous use of ≥2 types of RDs. Information on demographics and HIV high-risk behaviors (HIV-HRBs) was collected, and blood samples were tested for recent HIV infection by the BED capture enzyme immunoassay. Results A total of 4,496 Chinese MSM participated, of which 28.4% used RDs, and 5% were polydrug users. Polydrug users commonly took poppers with one or more types of other RDs (e.g. methamphetamine). Polydrug users were likely to be aged 26–30 years, have low educational attainment, be internal migrants, have a high monthly income, use versatile positions during anal intercourse, and have inadequate knowledge about prevention of HIV infection (P<0.05 for all). As the number of RDs used in the past 6 months increased, the prevalence of HIV-HRBs increased (P<0.05 for all). The odds of recent HIV infection were higher among those who used one type (aOR = 2.2, 95%CI: 1.5–3.0) or two types of RDs (2.3, 1.0–5.2) in the past 6 months compared with those who did not use RDs. The population-attributable fractions of most HIV-HRBs for recent HIV infection were higher among polydrug users compared with those who used only one type of RD or used no RD in the past 6 months. Conclusion The level and pattern of polydrug use among Chinese MSM were different from developed countries. Polydrug use had a dose-effect relationship with HIV-HRBs. Polydrug users who have greater levels of RDs use are more likely to engage in various sexual risks, thus may associated with new HIV infections.

Download Full-text

Sociodemographic and behavioural factors associated with testing for HIV and STIs in a US nationwide sample of transgender men who have sex with men

Sexually Transmitted Infections ◽

10.1136/sextrans-2020-054474 ◽

2020 ◽

Vol 96 (6) ◽

pp. 422-427 ◽

Cited By ~ 1

Author(s):

Nadav Antebi-Gruszka ◽

Ali J Talan ◽

Sari L Reisner ◽

H Jonathon Rendina

Keyword(s):

Hiv Testing ◽

Anal Sex ◽

Lower Odds ◽

Condomless Anal Sex ◽

Factors Associated ◽

The Past ◽

Sti Testing ◽

Lifetime Testing ◽

Behavioural Factors ◽

Sex With Men

ObjectivesTransgender men who have sex with men (TMSM) represent an understudied population in relation to screening for HIV and sexually transmitted infections (STIs). We examined HIV and STI testing prevalence among TMSM along with the factors associated with testing in a diverse US nationwide sample of TMSM.MethodsData from a cross-sectional online convenience sample of 192 TMSM were analysed using multivariable binary logistic regression models to examine the association between sociodemographic and behavioural factors and lifetime testing for HIV, bacterial STIs and viral STIs, as well as past year testing for HIV.ResultsMore than two-thirds of TMSM reported lifetime testing for HIV (71.4%), bacterial STIs (66.7%), and viral STIs (70.8%), and 60.9% had received HIV testing in the past year. Engaging in condomless anal sex with a casual partner whose HIV status is different or unknown and having fewer than two casual partners in the past 6 months were related to lower odds of lifetime HIV, bacterial STI, viral STI and past year HIV testing. Being younger in age was related to lower probability of testing for HIV, bacterial STIs and viral STIs. Furthermore, TMSM residing in the South were less likely to be tested for HIV and viral STIs in their lifetime, and for HIV in the past year. Finally, lower odds of lifetime testing for viral STIs was found among TMSM who reported no drug use in the past 6 months.ConclusionsThese findings indicate that a notable percentage of TMSM had never tested for HIV and bacterial and viral STIs, though at rates only somewhat lower than among cisgender MSM despite similar patterns of risk behaviour. Efforts to increase HIV/STI testing among TMSM, especially among those who engage in condomless anal sex, are needed.

Download Full-text

Prevalence of sexually transmissible infections and HIV in men attending sex-on-premises venues in Australia: a systematic review and meta-analysis of observational studies

Sexual Health ◽

10.1071/sh19150 ◽

2020 ◽

Vol 17 (2) ◽

pp. 135

Author(s):

Catriona Ooi ◽

Fabian Y. S. Kong ◽

David A. Lewis ◽

Jane S. Hocking

Keyword(s):

Meta Analysis ◽

Participation Rate ◽

Anatomical Site ◽

Cross Sectional ◽

Sti Testing ◽

Pooled Prevalence ◽

Sexually Transmissible Infections ◽

Sex With Men ◽

Sexual Health Clinics ◽

Exposure Prophylaxis

Background In Australia, men who have sex with men (MSM) have high rates sexually transmissible infections (STIs) and sex-on-premises venue (SOPV) patrons are at risk. This paper assesses Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), syphilis and HIV prevalence in men tested at Australian SOPVs and describes testing services. Methods: EMBASE, Medline, PubMed and international conference proceedings were searched for articles reporting on-site SOPV testing between 1 January 2000 and 31 January 2017. Meta-analysis calculated pooled prevalence estimates of STIs by anatomical site. Results: Twelve cross-sectional studies were identified. Most (8/12) were local sexual health clinics (SHC) outreach services. Participants’ mean age was 41.1 years (95% confidence interval (CI) 37.0–43.3; range 17 to 84 years). Testing included CT and NG (9/12), HIV (8/12) and syphilis (5/12). CT and NG prevalence overall summary estimates were 3.4% (95% CI 1.9–5.2%, I2 = 88.7%, P < 0.01) and 1.3% (95% CI 0.7–2.2%, I2 = 75.5%, P < 0.01) respectively. CT and NG prevalence was highest in the ano-rectum and oro-pharynx respectively. The HIV and syphilis pooled estimates were 2.3% (95% CI 1.6–2.9%, I2 = 93.1%, P < 0.01) and 3.2% (95% CI 1.8–4.6%, I2 = 72.8%, P < 0.01) respectively. Participation rate varied. Conclusion: This review examines HIV and STI testing in Australian SOPVs before HIV pre-exposure prophylaxis (PrEP). Findings indicate a high prevalence of STIs. PrEP use and resultant condomless sex may influence STI prevalence. Further research is required to determine the effect of PrEP on the STI prevalence among SOPV patrons.

Download Full-text