Quantifying heterogeneity in sexual behaviour and distribution of STIs before and after pre-exposure prophylaxis among men who have sex with men

2021 ◽  
pp. sextrans-2021-055227
Author(s):  
Daphne Amanda van Wees ◽  
Sophie Diexer ◽  
Ganna Rozhnova ◽  
Amy Matser ◽  
Chantal den Daas ◽  
...  
Keyword(s):  
High Risk ◽  
Risk Score ◽  
Sexual Behaviour ◽  
Sti Prevention ◽  
Gini Coefficients ◽  
Before And After ◽  
High Risk Sexual Behaviour ◽  
Sex With Men ◽  
Exposure Prophylaxis ◽  
The Impact

Objectives: Pre-exposure prophylaxis (PrEP) use may influence sexual behaviour and transmission of STIs among men who have sex with men (MSM). We aimed to quantify the distribution of STI diagnoses among MSM in the Netherlands based on their sexual behaviour before and after the introduction of PrEP.Methods: HIV-negative MSM participating in a prospective cohort study (Amsterdam Cohort Studies) completed questionnaires about sexual behaviour and were tested for STI/HIV during biannual visits (2009–2019). We developed a sexual behaviour risk score predictive of STI diagnosis and used it to calculate Gini coefficients for gonorrhoea, chlamydia and syphilis diagnoses in the period before (2009 to mid-2015) and after PrEP (mid-2015 to 2019). Gini coefficients close to zero indicate that STI diagnoses are homogeneously distributed over the population, and close to one indicate that STI diagnoses are concentrated in individuals with a higher risk score.Results: The sexual behaviour risk score (n=630, n visits=10 677) ranged between 0.00 (low risk) and 3.61 (high risk), and the mean risk score increased from 0.70 (SD=0.66) before to 0.93 (SD=0.80) after PrEP. Positivity rates for chlamydia (4%) and syphilis (1%) remained relatively stable, but the positivity rate for gonorrhoea increased from 4% before to 6% after PrEP. Gini coefficients increased from 0.37 (95% CI 0.30 to 0.43) to 0.43 (95% CI 0.36 to 0.49) for chlamydia, and from 0.37 (95% CI 0.19 to 0.52) to 0.50 (95% CI 0.32 to 0.66) for syphilis comparing before to after PrEP. The Gini coefficient for gonorrhoea remained stable at 0.46 (95% CI 0.40 to 0.52) before and after PrEP.Conclusions: MSM engaged in more high-risk sexual behaviour and gonorrhoea diagnoses increased after PrEP was introduced. Chlamydia and syphilis diagnoses have become more concentrated in a high-risk subgroup. Monitoring the impact of increasing PrEP coverage on sexual behaviour and STI incidence is important. Improved STI prevention is needed, especially for high-risk MSM.

scholarly journals Introducing pre-exposure prophylaxis to prevent HIV acquisition among men who have sex with men in Sweden: insights from a mathematical pair formation model

BMJ Open ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. e033852 ◽  
Author(s):  
Disa Hansson ◽  
Susanne Strömdahl ◽  
Ka Yin Leung ◽  
Tom Britton
Keyword(s):  
High Risk ◽  
Sexual Behaviour ◽  
Casual Sex ◽  
Pair Formation ◽  
Hiv Prevalence ◽  
Formation Model ◽  
Sex With Men ◽  
Exposure Prophylaxis ◽  
The Impact

ObjectivesSince 2017, the Public Health Agency of Sweden recommends that pre-exposure prophylaxis (PrEP) for HIV should be offered to high-risk individuals, in particular to men who have sex with men (MSM). The objective of this study is to develop a mathematical model investigating the effect of introducing PrEP to MSM in Sweden.DesignA pair formation model, including steady and casual sex partners, is developed to study the impact of introducing PrEP. Two groups are included in the model: sexually high active MSM and sexually low active MSM. Three mixing assumptions between the groups are considered.SettingA gay-friendly MSM HIV/sexually transmitted infection testing clinic in Stockholm, Sweden. This clinic started offering PrEP to MSM in October 2018.ParticipantsThe model is calibrated according to detailed sexual behaviour data gathered in 2015 among 403 MSM.ResultsBy targeting sexually high active MSM, a PrEP coverage of 3.5% of the MSM population (10% of all high actives) would result in the long-term HIV prevalence to drop considerably (close to 0%). While targeting only low actives would require a PrEP coverage of 35% for a similar reduction. The main effect of PrEP is the reduced susceptibility, whereas the increased HIV testing rate (every third month) among PrEP users plays a lesser role.ConclusionsTo create a multifaceted picture of the effects of interventions against HIV, we need models that include the different stages of HIV infection and real-world data on detailed sexual behaviour to calibrate the mathematical models. Our findings conclude that targeting HIV high-risk individuals, within HIV risk populations such as MSM, with PrEP programmes could greatly decrease the long-term HIV prevalence in Sweden. Therefore, risk stratification of individuals is of importance in PrEP implementation programmes, to ensure optimising the effect and cost-effectiveness of such programmes.

scholarly journals Double trouble: modelling the impact of low risk perception and high-risk sexual behaviour on chlamydia transmission

2018 ◽  
Vol 15 (141) ◽  
pp. 20170847 ◽  
Author(s):  
Daphne A. van Wees ◽  
Chantal den Daas ◽  
Mirjam E. E. Kretzschmar ◽  
Janneke C. M. Heijne
Keyword(s):  
Risk Perception ◽  
High Risk ◽  
Mathematical Models ◽  
Sexual Behaviour ◽  
Sexually Transmitted ◽  
Pair Model ◽  
High Risk Sexual Behaviour ◽  
Testing Uptake ◽  
Risk Sexual Behaviour ◽  
The Impact

Risk perception plays an important role in testing behaviour for sexually transmitted infections, but is rarely included in mathematical models exploring the impact of testing. We explored the impact of incorporating sexual behaviour (SB), risk perception (RP) and differential testing uptake in SB–RP groups on prevalence, using chlamydia as an example. We developed a pair model with a susceptible–infected–susceptible structure representing heterosexuals aged 16–26 years. The effect of testing on chlamydia prevalence was compared between a model with only SB (SB model) and a model with SB and RP (SB–RP model). In the SB–RP model, a scenario without differential testing uptake in SB–RP groups was compared to scenarios with differential testing uptake in SB–RP groups. Introducing testing into the SB–RP model resulted in a slightly smaller reduction in chlamydia prevalence (−38.0%) as compared to the SB model (−40.4%). In the SB–RP model, the scenario without differential testing uptake in SB–RP groups overestimated the reduction in chlamydia prevalence (with 4.8%), especially in the group with high SB and low RP (19.8%). We conclude that mathematical models incorporating RP and differential testing uptake in SB–RP groups improve the impact assessment of testing and treatment on chlamydia prevalence.

Demand for pre-exposure prophylaxis for HIV and the impact on clinical services: Scottish men who have sex with men perspectives

2017 ◽  
Vol 29 (3) ◽  
pp. 273-277
Author(s):  
RI Gilson ◽  
DJ Clutterbuck ◽  
ZE Chen
Keyword(s):  
High Risk ◽  
Lower Risk ◽  
Clinical Services ◽  
Anonymous Questionnaire ◽  
Sex With Men ◽  
Hiv Acquisition ◽  
Risk Of Hiv Acquisition ◽  
Exposure Prophylaxis ◽  
The Impact ◽  
Ability And Willingness

There is a lack of data on ability and willingness of men who have sex with men (MSM) to self-fund HIV pre-exposure prophylaxis (PrEP). We aimed to explore how many eligible (PROUD study criteria) men may want PrEP and how many lower-risk MSM would be willing and able to self-fund this intervention. A self-completed anonymous questionnaire was distributed to MSM populations attending services. Of 377 participants, 81.5% were aware of PrEP. Fifty-three (15.5 %) were eligible, of whom 43 (81%) were very/extremely likely to want it. Of those ineligible, 229 (80%) were aware of PrEP and 106 (37.3%) were very/extremely likely to want it. Of eligible respondents 23% would be willing and able to pay at least £50 a month for PrEP. Of ineligible respondents this proportion was 21%. Our survey revealed high levels of awareness, understanding and willingness to take PrEP among MSM at high and lower risk of HIV acquisition. It indicated that over 70% of high-risk men would be unwilling or unable to self-fund PrEP, should it not be available on the NHS. For lower-risk MSM we estimated that capacity requirements for monitoring self-funded PrEP will be 50% higher than numbers eligible for PrEP. These factors will need to be taken into account when planning services.

Persistent high-risk sexual behaviour in men who have sex with men after symptomatic lymphogranuloma venereum proctitis

2007 ◽  
Vol 18 (10) ◽  
pp. 715-716 ◽  
Author(s):  
R R van den Bos ◽  
W I van der Meijden
Keyword(s):  
High Risk ◽  
Sexual Behaviour ◽  
Sexually Transmitted Disease ◽  
Transmitted Disease ◽  
Lymphogranuloma Venereum ◽  
Patient Records ◽  
Sexually Transmitted ◽  
High Risk Sexual Behaviour ◽  
Risk Sexual Behaviour ◽  
Sex With Men

In this brief paper, we report persistent high-risk sexual behaviour in a group of men who have sex with men (MSM) after symptomatic lymphogranuloma venereum (LGV) proctitis. Patient records were retrospectively studied and the number of newly acquired sexually transmitted disease (STD) was investigated. It was concluded that a high number of MSM (65%) contracted an STD relatively shortly after the diagnosis of LGV proctitis.

A case report of proctitis associated with Mycoplasma genitalium in a man who has sex with men

2019 ◽  
Vol 30 (6) ◽  
pp. 623-625
Author(s):  
Anna Isabel Lázaro-Simó ◽  
Juliana Esperalba-Esquerra ◽  
Martí Vall-Mayans
Keyword(s):  
Case Report ◽  
High Risk ◽  
Chlamydia Trachomatis ◽  
Antimicrobial Resistance ◽  
Sexual Behaviour ◽  
Reproductive Tract ◽  
Mycoplasma Genitalium ◽  
High Risk Sexual Behaviour ◽  
Risk Sexual Behaviour ◽  
Sex With Men

Mycoplasma genitalium is an infection of increasing concern due to its potential to cause sequelae in the reproductive tract and the development of antimicrobial resistance. Its role as a cause of proctitis in people with high-risk sexual behaviour has not been properly defined yet but it seems to be less symptomatic than proctitis caused by Chlamydia trachomatis or Neisseria gonorrhoeae. We present a case of a man who has sex with men with proctitis associated with M. genitalium after excluding other infections known to cause STI proctitis.

scholarly journals PrEPping for a healthier future – a concise update of current pharmacological HIV-prophylaxis practices

2020 ◽  
pp. 77-78
Author(s):  
SF Steyn ◽  
DW Wolmarans ◽  
L Brand
Keyword(s):  
Human Immunodeficiency Virus ◽  
High Risk ◽  
Clinical Outcome ◽  
Sexual Behaviour ◽  
Antiretroviral Drugs ◽  
Immunodeficiency Virus ◽  
High Risk Sexual Behaviour ◽  
High Risk Populations ◽  
Risk Sexual Behaviour ◽  
Exposure Prophylaxis

Pre-exposure prophylaxis (PrEP) refers to the use of antiretroviral drugs to prevent one from acquiring human immunodeficiency virus (HIV) infection when engaging in high-risk sexual behaviour. Adequate PrEP initiation is key in the clinical outcome and survival of not only vulnerable and high-risk populations, but also to ensure that a society which is free of HIV, is built.

scholarly journals COVID-19 restrictions and changing sexual behaviours in HIV-negative MSM at high risk of HIV infection in London, UK

2021 ◽  
pp. sextrans-2020-054768
Author(s):  
Iain Hyndman ◽  
Diarmuid Nugent ◽  
Gary George Whitlock ◽  
Alan McOwan ◽  
Nicolò Girometti
Keyword(s):  
High Risk ◽  
Hiv Infection ◽  
Sexual Activity ◽  
Sexual Behaviour ◽  
Well Being ◽  
Categorical Variables ◽  
Cross Sectional ◽  
The Impact ◽  
Mental Well Being ◽  
Hiv Negative

ObjectivesThe COVID-19 pandemic and its related restrictions have affected attendance to and delivery of UK sexual healthcare services (SHS). We surveyed the impact on sexual behaviour of men having sex with men (MSM) to inform future SHS provision.MethodsWe conducted a cross-sectional, anonymous, web-based survey among HIV-negative MSM at high risk of HIV infection who attended 56 Dean Street, a sexual health and HIV clinic. The survey was conducted over a 7-day period in August 2020. Data on sociodemographic characteristics, sexual behaviour and related mental well-being experienced during lockdown (defined as 23 March–30 June 2020) were extracted. Categorical and non-categorical variables were compared according to HIV pre-exposure prophylaxis (PrEP) use.Results814 MSM completed the questionnaire: 75% were PrEP users; 76% reported they have been sexually active, of which 76% reported sex outside their household. 75% reported fewer partners than prior to lockdown. Isolation/loneliness (48%) and anxiety/stress (27%) triggered sexual activity, and 73% had discussed COVID-19 transmission risks with their sexual partners. While 46% reported no change to emotions ordinarily experienced following sex, 20% reported guilt for breaching COVID-19 restrictions. 76% implemented one or more changes to their sexual behaviour, while 58% applied one or more steps to reduce COVID-19 transmission during sex. 36% accessed SHS and 30% reported difficulties in accessing testing/treatment. Of those who accessed SHS, 28% reported an STI diagnosis. PrEP users reported higher partner number, engagement in ‘chemsex’ and use of SHS than non-PrEP users.ConclusionsCOVID-19 restrictions had a considerable impact on sexual behaviour and mental well-being in our survey respondents. High rates of sexual activity and STI diagnoses were reported during lockdown. Changes to SHS provision for MSM must respond to high rates of psychological and STI-related morbidity and the challenges faced by this population in accessing services.

Sign in / Sign up

Export Citation Format

Share Document