Human Immunodeficiency Virus Pre-exposure Prophylaxis and Increased Incidence of Sexually Transmitted Infections in the United States

2019 ◽  
Vol 70 (9) ◽  
pp. 1884-1890 ◽  
Author(s):  
Jose A Serpa ◽  
Gabriel N Huynh ◽  
Julie B Nickell ◽  
Hongyu Miao
Keyword(s):  
United States ◽  
Human Immunodeficiency Virus ◽  
Sexually Transmitted Infections ◽  
State Level ◽  
The United States ◽  
Incidence Rates ◽  
Interrupted Time Series Analysis ◽  
Sexually Transmitted ◽  
Immunodeficiency Virus ◽  
Exposure Prophylaxis

Abstract Background Human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) decreases HIV transmission. Some studies have raised concerns about a potential association between the implementation of HIV PrEP and the growing incidence rates of sexually transmitted infections (STIs) in the United States. Methods We conducted a quasi-experimental (interrupted time series) analysis of STI (syphilis, gonorrhea, and chlamydia) rates before (2000–2012) and after (2013–2017) the implementation of HIV PrEP. We also performed correlations between HIV PrEP utilization and STI cases at the national (2012–2017) and state (2017) levels. We defined HIV PrEP utilization as the number of people taking tenofovir disoproxil fumarate/emtricitabine for HIV prevention. Results HIV PrEP implementation was associated with 25% (relative risk [RR] 1.254, 95% confidence interval [CI] 1.245–1.263; P < .001) and 26% (RR 1.260, 95% CI 1.257–1.264; P < .001) increases in syphilis and gonorrhea rates, respectively, and a 12% reduction in chlamydia rates (RR: 0.884, 95% CI 0.883–0.885; P < .001). HIV PrEP utilization was correlated with the numbers of syphilis, gonorrhea, and chlamydia cases (spearman coefficients 1.00, 0.94, and 0.94, respectively; P < .001, P < .01, and P < .01, respectively). At the state level, HIV PrEP was also correlated with the number of cases of syphilis, gonorrhea, and chlamydia (spearman coefficients 0.85, 0.81, and 0.85, respectively; Ps < .001 for all correlations). Conclusions The implementation and utilization of HIV PrEP in the United States were associated with increased rates of STIs. Further studies to confirm these associations and to elucidate potential causes are needed.

‘How come they don’t talk about it in school?’ Identifying adolescent barriers to PrEP use

2021 ◽  
Author(s):  
Leslie Gailloud ◽  
Tatiana Gonzalez-Argoti ◽  
Sophia Philip ◽  
Lena S Josephs ◽  
Joanne E Mantell ◽  
...  
Keyword(s):  
United States ◽  
Human Immunodeficiency Virus ◽  
Thematic Analysis ◽  
The United States ◽  
Health Centers ◽  
Perceived Need ◽  
School Based ◽  
Immunodeficiency Virus ◽  
School Based Health Centers ◽  
Exposure Prophylaxis

Abstract Although 21% of new human immunodeficiency virus (HIV) diagnoses in the United States are in youth aged 13–24 years, adolescent awareness and uptake of the HIV prevention medication pre-exposure prophylaxis (PrEP) are low. This study explores the attitudes and challenges that adolescents face while taking PrEP. Thirty interviews were conducted with Black and Latine (we use the gender-inclusive term Latine rather than Latinx for more appropriate Spanish pronunciation) students aged 15–17 who received care at school-based health centers (SBHCs) in the Bronx, NY. Transcripts were coded inductively and deductively using thematic analysis. Most participants were unaware of PrEP, but nearly all were enthusiastic when informed about it; a majority denied that they would feel any stigma when taking PrEP. Despite this high receptivity, multiple barriers were identified, particularly confidentiality from parents, low perceived need of PrEP and concerns about daily adherence and side effects. Adolescents overall were enthusiastic about the availability of PrEP and felt it empowered them to have control over their health. SBHCs were considered trusted sources of confidential, accessible care, and we believe that they can be uniquely positioned to mitigate barriers to PrEP distribution in the future.

scholarly journals Human Immunodeficiency Virus in the State of Texas of the United States: Past Reflections, Present Shortcomings, and Future Needs of the Public Health Response

2020 ◽  
Vol 7 (10) ◽  
Author(s):  
Ume L Abbas ◽  
Camden J Hallmark ◽  
Marlene McNeese ◽  
Vagish Hemmige ◽  
Joseph Gathe ◽  
...  
Keyword(s):  
United States ◽  
Human Immunodeficiency Virus ◽  
The United States ◽  
Lessons Learned ◽  
Accelerated Expansion ◽  
Public Health Response ◽  
Treatment And Prevention ◽  
Health Response ◽  
Immunodeficiency Virus ◽  
Exposure Prophylaxis

Abstract A strategy titled “Ending the HIV Epidemic: A Plan for America” aims to reduce human immunodeficiency virus (HIV) incidence in the United States by at least 90% by 2030, using diagnosis, treatment, and prevention strategies. Texas is a Southern state that has one of the highest numbers of new HIV diagnoses and people with HIV in the country, and where HIV disproportionately impacts minorities. We retrace the historical epidemic in its largest city, Houston, to illustrate the lessons learned and milestones accomplished, which could serve as guideposts for the future. We examine the current epidemic in Texas, including the achieved levels of HIV testing, treatment continua, and pre-exposure prophylaxis prescription, and compare and contrast these with the national estimates and Plan targets. Our findings call for urgent and accelerated expansion of efforts to end HIV in Texas.

scholarly journals Epidemiology of Sexually Transmitted Infections among Human Immunodeficiency Virus Positive United States Military Personnel

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Jeff S. Tzeng ◽  
Leslie L. Clark ◽  
Eric C. Garges ◽  
Jean Lin Otto
Keyword(s):  
United States ◽  
Human Immunodeficiency Virus ◽  
Sexually Transmitted Infections ◽  
Military Personnel ◽  
Hiv Positive ◽  
Hiv Diagnosis ◽  
Military Population ◽  
Sexually Transmitted ◽  
Immunodeficiency Virus ◽  
Hiv Seropositive

Background. Minimal data exist that describe the epidemiology of sexually transmitted infections (STI) in human immunodeficiency virus (HIV) positive populations across the pre- and post-diagnosis periods for HIV. Purpose. The purpose of this study was to identify and describe the epidemiology of gonorrhea, chlamydia, syphilis, herpes simplex virus, and human papillomavirus in an HIV-positive population. Methods. All 1,961 HIV seropositive United States active duty military personnel from 2000–2010 were identified. STI diagnoses relative to HIV diagnosis from 1995, which was the earliest electronic medical record available, to 2010 were examined. Results. The incidence diagnosis rates of STI generally increased during the period leading up to eventual HIV diagnosis. The rates of STI during the post-HIV diagnosis period fluctuated, but remained elevated compared to pre-HIV diagnosis period. Approximately 45%–69% with an STI in the HIV seropositive military population were diagnosed with their first STI greater than one year after their HIV diagnosis. Of those who were diagnosed with an STI in the post-HIV diagnosis period, 70.6% had one STI diagnosis, 23.5% had two STI diagnoses, and 5.8% had three or more STI diagnoses. Conclusions. Despite aggressive counseling, high-risk sexual behavior continues to occur in the HIV-positive military population.

scholarly journals Incidence and Time-Varying Predictors of HIV and Sexually Transmitted Infections Among Male Sex Workers in Mexico City

2020 ◽  
Author(s):  
Karla Ganley ◽  
Marta Wilson-Barthes ◽  
Andrew R. Zullo ◽  
Sandra G. Sosa-Rubí ◽  
Carlos J. Conde-Glez ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Sexually Transmitted Infections ◽  
Mexico City ◽  
Sex Workers ◽  
Incidence Rates ◽  
Time Varying ◽  
Male Sex Workers ◽  
Sexually Transmitted ◽  
Immunodeficiency Virus ◽  
Male Sex

Abstract Introduction: Male sex workers are at high-risk for acquisition of sexually transmitted infections, including human immunodeficiency virus. We quantified incidence rates of sexually transmitted infections and identified their time-varying predictors among male sex workers in Mexico City.
 Methods: Male sex workers recruited from the largest human immunodeficiency virus clinic and community sites in Mexico City were tested for chlamydia, gonorrhea, syphilis, hepatitis, and human immunodeficiency virus at baseline, 6-months, and 12-months. Incidence rates with 95% bootstrapped confidence limits were calculated. We examined potential time-varying predictors using generalized estimating equations for a population averaged model. Results and Discussion: Among 227 male sex workers, median age was 24 and baseline human immunodeficiency virus prevalence was 32%. Incidence rates (per 100 person-years) were as follows: human immunodeficiency virus (5.23; 95% confidence interval [CI]: 2.15, 10.31), chlamydia (5.15; 95% CI: 2.58, 9.34), gonorrhea (3.93; 95% CI: 1.88, 7.83), syphilis (13.04; 95% CI: 8.24, 19.94), hepatitis B (2.11; 95% CI: 0.53, 4.89), hepatitis C (0.95; 95% CI: 0.00, 3.16), any sexually transmitted infection except human immunodeficiency virus (30.99; 95% CI: 21.73, 40.26), and any sexually transmitted infection including human immunodeficiency virus (50.08; 95% CI: 37.60, 62.55). In the multivariable-adjusted model, incident sexually transmitted infections (excluding human immunodeficiency virus) were lower among those who reported consistently using condoms during anal and vaginal intercourse (odds ratio = 0.03, 95% 0.00, 0.68) compared to those who reported inconsistently using condoms during anal and vaginal intercourse. Conclusions: Incidence of sexually transmitted infections is high among male sex workers in Mexico City. Consistent condom use is an important protective factor for sexually transmitted infections, and should be an important component of interventions to prevent incident infections.

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