HIV testing behaviour and associated factors in men who have sex with men by level of urbanisation: a cross-sectional study in the Netherlands

ObjectivesRegular HIV testing in men who have sex with men (MSM) enables timely entry into care and reduces the likelihood of HIV transmission. We aimed to assess HIV-testing behaviour and associated factors in MSM by urbanisation of place of residence.DesignData were derived from online survey (‘Men & Sexuality’) in the Netherlands, which was mainly advertised on social media (Facebook and Instagram), dating websites, apps for MSM (Grindr and PlanetRomeo) and gay media.Primary and secondary outcome measuresHIV testing was defined as recent (<1 year), not recent (≥1 year) or never. Using multinominal regression analyses, factors associated with not recent testing and never testing, compared with recent testing, were assessed among MSM living in highly (>2500 residences/km2) or non-highly (≤2500 residences/km2) urbanised areas.ParticipantsThe study sample included 3815 MSM, currently living in the Netherlands. The mean age was 36 years (SD 14.7), and 67.6% were highly educated.ResultsIn highly urbanised areas, 11.8% was never and 19.8% was not recently HIV-tested. In non-highly urbanised areas, this was 25.2% and 19.6%. Among MSM living in highly urbanised areas, independently associated with never and not recent testing were younger age, self-identification as bisexual, fewer sex partners, never notified of HIV and no recent condomless anal intercourse. Among MSM living in non-highly urbanised areas, lower perceived HIV severity, higher perceived HIV risk and a lower proportion gay friends were associated with never and not recent testing. Among never tested MSM, those in non-highly urbanised areas preferred self-sampling/self-testing over facility-based testing; those in highly urbanised areas preferred testing at healthcare facilities.ConclusionsThe proportion of never tested MSM was high (25%) in non-highly urbanised areas in the Netherlands. MSM living in non-highly urbanised areas may possibly be reached with targeted approaches to increase HIV testing uptake such as self-testing/self-sampling strategies.

Geosocial networking app use associated with sexual risk behavior, but also PrEP use, among gay, bisexual, and other men who have sex with men: Cross-sectional web-based survey (Preprint)

BACKGROUND In the United States, geosocial networking (GSN) applications (i.e., mobile dating apps) have become central to dating and sexual interactions in recent years. Among gay, bisexual, and other men who have sex with men (GBM), these apps play an important role in reducing barriers and facilitating partner-seeking. However, despite these benefits, there are concerns that these apps may facilitate risky sexual behavior and transmission of sexually transmitted infections (STIs) among GBM. OBJECTIVE The present study examined the association between GSN app use and sexual risk among a U.S. sample of GBM. METHODS Using a cross-sectional design, respondents (N = 223) completed an online survey assessing their use of GSN apps, sexual risk and protective behaviors, HIV serostatus, and previous STI diagnoses. RESULTS Respondents were ages 21-78 (M = 31.90, SD = 10.06), 69.5% Non-Hispanic White, and from 40 States and the District of Columbia. Nearly half (47%; n = 104) of the sample reported using GSN apps. GSN users were more likely to report past year condomless anal intercourse (p < .001), 3+ sexual partners in the previous year (p < .001), and a previous STI diagnosis (p = .001) relative to non-users, and also reported more frequent use of recreational drugs before sex (p = .001), alcohol use before sex (p < .001), and cannabis use before sex (p = .01). Interestingly, GSN users were also more likely to report having ever received an HIV test (p < .001) and using pre-exposure prophylaxis (PrEP; p = .03). Rates of HIV seropositivity did not significantly differ between GSN users and non-users (p = .53). Among the subset of GSN users, 38 participants reported using only GBM-specific GSN apps (e.g., Grindr), while 27 participants reported using only sexuality nonspecific GSN apps (e.g., Tinder). Exclusive users of sexual minority-specific apps reported more frequent recreational drug use before sex (p = .01) and were also more likely to report past year condomless anal intercourse (p < .001), 3+ sexual partners in the previous year (p = .004), a previous STI diagnosis (p = .002), and HIV testing (p = .003). Alcohol use before sex, cannabis use before sex, PrEP use, and HIV rates were similar between both groups (ps > .11). CONCLUSIONS Findings suggest that GSN apps may be a useful pathway for interventions aimed at reducing STI-risk among GBM. Future, prospective studies should examine how risk levels change after initiation of GSN app use.

Age Is Associated With HIV Sexual Risk Behaviors Among Trans Women in Los Angeles County

Little is known about how HIV risk varies among trans women of different ages. From January 2010 to February 2021, 2,242 trans women were assessed via outreach encounters consisting of health education and risk reduction information, and queries of recent sexual behaviors. Generalized linear models provide adjusted rates of engagement in condomless anal intercourse (CAI), in exchange sex, and CAI with exchange partners in the past 30 days for each year from age 18 to 60. Most participants identified as Hispanic/Latina (52%) and most were HIV negative (80%). Engagement in exchange sex remained prevalent from participants’ early 20s through their mid-40s, though CAI with such partners never exceeded an average estimated prevalence of 15%. Condomless behaviors with non-exchange partners was more common, with at least 20% reporting engagement in non-exchange CAI regardless of age. The need for trans-specific sexual risk reduction interventions that take age into account is underscored.

Acute HIV infection syndrome mimicking COVID-19 vaccination side effects: a case report

Background Symptoms of primary HIV infection, including fever, rash, and headache, are nonspecific and are often described as flu-like. COVID-19 vaccination side effects, such as fever, which occur in up to 10% of people following COVID-19 vaccination, can make the diagnosis of acute HIV infection even more challenging. Case presentation A 26-year-old man presented with fever and headache following COVID-19 vaccination. The symptoms were initially thought to be vaccine side effects. A diagnostic workup was conducted due to persisting fever and headache > 72 h following vaccination, and he was diagnosed with Fiebig stage II acute HIV infection, 3 weeks after having unprotected anal intercourse with another man. Conclusion Thorough anamnesis is key to estimating the individual risk of primary HIV infection, in patients presenting with flu-like symptoms. Early diagnosis and initiation of antiretroviral therapy is associated with better prognosis and limits transmission of the disease.

Outcomes of A Community-Led Web-Based HIV Self-Testing Demonstration Among Cisgender Men Who have Sex with Men and Transgender Women in the Philippines During the COVID-19 Pandemic: A Retrospective Cohort Study

Introduction: The Philippines, experiencing the fastest rising HIV epidemic globally, has limited options of HIV testing that its uptake remains low among cisgender men who have sex with men (cis-MSM) and transgender women (TGW), especially amid the COVID-19 pandemic. As HIV self-testing (HIVST) and web-based approaches could synergize efforts to expand its uptake, we aimed to evaluate the outcomes of a community-led web-based HIVST demonstration and to explore factors associated with HIVST-related behaviours and outcomes. Methods We did a secondary data analysis of routinely collected data in a community-led web-based HIVST demonstration among cis-MSM and TGW in Western Visayas, Philippines. We reviewed data on demographics, sexuality-, and context-related variables and explored associations with opting directly-assisted HIVST (DAH) and willingness to distribute, using multivariable logistic regression. Results HIVST kits were distributed to 706 individuals (648 cis-MSM, 58 TGW), 52.1% were first-time testers, 12.5% opted DAH, and 48.2% were willing to distribute. Reporting rate was high (97.5%) with 8.4% reactivity rate. While linkage to prevention (100%) and care (87.9%) were high, pre-exposure prophylaxis (PrEP) (0.3%) and antiretroviral therapy (ART) (60.4%) initiation were limited. There were no reports of adverse events. Those who opted for DAH, not willing to distribute, employed, and those who recently had anal intercourse had significantly higher proportions of testing reactive. Those who opted web-based approaches (adjusted odds ratio, aOR=0.28 [confidence interval, CI 0.14-0.57]) were less likely to opt DAH. Those living in urban areas (aOR=1.60 [CI 1.13-2.26]) and with no history of HIV test (aOR=0.45 [CI 0.32-0.61]) were associated with lower likelihood of secondary distribution than their counterparts. Maximal quarantine restrictions were associated with higher likelihood of DAH (aOR = 4.07 [CI 2.42-6.90]) and willingness to distribute (aOR=3.51 [CI 2.45-5.07]) relative to minimal restrictions. Conclusions HIVST could reach those who were never tested for HIV. While there is demand in accessing unassisted and web-based approaches, DAH should still be offered. Uptake of PrEP and same-day ART should be upscaled by decentralizing these services to community-based organizations. Differentiated service delivery is key to respond to preferences and values of key populations amid the dynamic geographical and sociocultural contexts they are in.

Characteristics and Longitudinal Patterns of Erectile Dysfunction Drug Use Among Men Who Have Sex with Men in the U.S.

We investigated the longitudinal relationship between erectile dysfunction (ED) drug use with behavioral factors, including substance use and sexual activities in men who have sex with men from the Multicenter AIDS Cohort Study during 1998–2016 (n = 1636). We used a bivariate random-intercept model to evaluate ED drug use along with other behavioral factors to assess relationships between the two outcomes over time on a population level and also at the individual level. Average ED drug use among men who have sex with men (MSM) with HIV was positively correlated with average use of marijuana (r = .19), poppers (r = .27), and stimulants (r = .25). In this group, testosterone use (r = .32), multiple partners (r = .41), insertive anal intercourse with condom (r = .40), and insertive anal intercourse without condom (r = .43) all showed moderate correlations over time with average ED use (p < .001). Associations among MSM without HIV were similar, with average marijuana use (r = .19) and stimulant use (r = .22) being positively correlated with average ED drug use, and were also correlated with having multiple partners (r = .36), insertive anal intercourse with condom (r = .22), and insertive anal intercourse without condom (r = .18) over time. Positive within-individual associations between ED drug use and multiple partners and insertive anal intercourse with and without condom were observed regardless of HIV serostatus. This study showed that MSM who reported use of ED drugs were also, on average, more likely to use recreational drugs and engage in sexual activities, such as having multiple partners and insertive anal intercourse. Within individuals, average ED drug use was also positively correlated with sexual behaviors.

High prevalence of rectal chlamydia among pregnant adolescents in La Romana, Dominican Republic warrants extragenital STI testing

To our knowledge, there are no studies estimating the prevalence of extragenital sexually transmitted infections (STIs) among pregnant adolescents in the Caribbean. This study sought to fill this gap by assessing the prevalence and correlates of oral, genital, and rectal chlamydia (CT) among a sample of pregnant adolescents in La Romana, Dominican Republic. Two hundred pregnant youths, aged 15–24 years, were recruited by systematic sampling during their first prenatal visit to a maternal care unit. A sociodemographic and behavioral questionnaire was administered and urine and oral/anal swabs were collected and tested for CT. Descriptive analyses and Fisher’s exact tests were performed. The prevalence of oral, genital, and rectal CT was 6%, 15%, and 23%, respectively, although less than 5% of participants reported ever engaging in receptive anal intercourse. This discrepancy could be explained by autoinoculation, concurrent transmission during sex, undertreatment of rectal CT, or underreporting of anal sex. Almost half of CT infections would have been missed if only genital samples were collected, as current protocol dictates. More research is needed to understand sexual behaviors and rectal STI risk factors among heterosexual adolescent women. STI screening procedures for pregnant and sexually active adolescents should include routine testing of extragenital sites.