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

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.

High risk sexual behaviours associated with traditional beliefs about gender roles among men interested in medical male circumcision in South Africa

Background Beliefs about gender roles and high-risk sexual behaviours underlie the human immunodeficiency virus (HIV) epidemic in South Africa. Yet, there is limited information on the relationships between beliefs about gender roles and risky sexual behaviours. Few studies have explored the association between beliefs about gender roles, high risk sexual behaviour, and health-seeking behaviour among men. Methods We investigated associations between gender beliefs (dichotomised as traditional or progressive) and high-risk sexual behaviour among South African men presenting for medical male circumcision (Apr 2014 to Nov 2015). Results Of 2792 enrolled men, 47.4% reported traditional gender beliefs. Participant ages ranged between 18–46 years (median age 26 years; interquartile range, 21–31 years). Most participants had at least one sex partner over the last 12 months (68.2%). Younger men (18–24 years old vs. 25–46 years old) (odds ratio [OR], 1.5 [95% confidence interval (CI) 1.0–2.0]), those with multiple partners ([OR], 1.5 (CI) 1.3–1.8]) and participants unsure of their last partner’s HIV status (OR, 1.4 [95% CI 1.1–1.7]) were more likely to have traditional beliefs on gender roles. Conclusion Young men with traditional beliefs on gender roles may be more likely to engage in high-risk sexual behaviour and could be good candidates for HIV prevention programmes. N = 206 (max 350) Trial registration Name of registry: Clinicaltrials.gov; Trial registration number: NCT02352961; Date of registration: 30 January 2015 “Retrospectively registered”; URL of trial registry record: https://www.clinicaltrials.gov/

Impact of victimization during youth on adult high-risk sexual behaviour among gay and bisexual men

Based on the minority stress model, this study examines the impact of general and gay-specific childhood teasing on adult high-risk sexual behaviour among gay and bisexual men, mediated by depression and social anxiety. High-risk sexual behaviour was operationalized as the number of acts of unprotected anal intercourse with a partner of opposite or unknown HIV status, and also as the number of partners of opposite or unknown HIV status with whom an individual engaged in unprotected anal intercourse. Depression, social anxiety, and retrospective self-report of childhood teasing were measured at baseline, and sexual behaviour was measured at 6-month follow-up. Results indicate that gay-specific teasing, but not general teasing, was indirectly associated with number of high-risk sex acts via depression. Additionally, both types of teasing were directly associated with number of high-risk sex partners after accounting for depression and social anxiety.

Impact of victimization during youth on adult high-risk sexual behaviour among gay and bisexual men

Based on the minority stress model, this study examines the impact of general and gay-specific childhood teasing on adult high-risk sexual behaviour among gay and bisexual men, mediated by depression and social anxiety. High-risk sexual behaviour was operationalized as the number of acts of unprotected anal intercourse with a partner of opposite or unknown HIV status, and also as the number of partners of opposite or unknown HIV status with whom an individual engaged in unprotected anal intercourse. Depression, social anxiety, and retrospective self-report of childhood teasing were measured at baseline, and sexual behaviour was measured at 6-month follow-up. Results indicate that gay-specific teasing, but not general teasing, was indirectly associated with number of high-risk sex acts via depression. Additionally, both types of teasing were directly associated with number of high-risk sex partners after accounting for depression and social anxiety.

Moth-Eaten Essential Syphilitic Alopecia in Human Immunodeficiency Virus-Positive Patient: A Case Report

Hair loss is rare to be reported as sole manifestation of secondary syphilis. Syphilitic alopecia consists of symptomatic syphilitic alopecia that presents with other secondary syphilis manifestation, and essential syphilitic alopecia which can be patchy ("moth-eaten" type), diffuse, or combination without other manifestations of secondary syphilis. Here we report a case of secondary syphilis in patient with Human Immunodeficiency Virus (HIV) that present with moth-eaten alopecia as a sole manifestation. A 35-year-old male with HIV complained hair loss on his scalp and eyebrows. Physical examination showed non scarring moth-eaten alopecia on his scalp and lossof lateral third of his eyebrows without other lesions. Serological test for syphilis was positive. He was treated with 2.4 millions unit of benzathine penicillin G (BPG), single dose intramuscular injection. Six months after injection, patient showed clinical and serological improvement. Syphilitic alopecia cannot be ruled out in patients with non scarring hair loss with unclear etiology. Serological tests are recommended especially for patients with history of high risk sexual behaviour.

Access to Contraception amongst Female Adolescents: Rivers State Study

Introduction: The importance of contraception amongst adolescents cannot be over-emphasized especially as it concerns reproductive health. Globally, these group of persons are vulnerable and engage in high risk sexual behaviour with little or no access to contraception particularly in the developing countries of the world. Aim: To determine the access to contraception amongst female adolescents in Rivers State. Methods: It was a cross sectional study of female adolescents attending holiday camp in Port Harcourt, Rivers State. Questionnaires were distributed and information coded and analysed using SPSS version 22. Results: One hundred questionnaires were distributed and 89 retrieved. The mean age was 16 ± 2 years. Fifty seven (64.0%) were in secondary school while 32(36.0%) of the adolescents were undergraduates. Twelve (13.5%) were sexually active compared to 69 (77.5%) who were not sexually active, 8 (9%) were non respondents to this question. One (1.1%) of the adolescents had access to contraception while 85 (95.5%) had no access to contraception, 3 (3.3%) did not give any response as regards to access to contraception or not. The media was the most common means of information 25 (28%) on contraception. Conclusion: The study revealed that access to contraception amongst female adolescents in Port Harcourt was poor. Enlightenment programme is highly recommended to prevent unwanted pregnancies, sexually transmitted infections and other adverse effects on reproductive health.

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

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.

Social Media use and Sexual Behaviour of Undergraduate Students in a Nigerian University

While studies have generally explored the implication of social media on education, crime, and communication, there is a paucity of studies exploring the influence of social media on sexual behaviour. Thus, this study aims to investigate the role of social media on sexual behaviour among 195 undergraduate students in the Niger Delta University, Bayelsa, Nigeria. This cross-sectional study was anchored on the uses and gratification theory (UGT). Data for this study were generated through the use of a structured questionnaire, while data analysis was done at the univariate, bivariate and multivariate levels. Findings shows that the average age of students was 22.72. Also, the study found out that the use of WhatsApp (OR = 15.349, p<0.05), Instagram (OR = 0.254, p<0.05), time spent on the social media (OR = 0.123, p<0.05) were significantly associated with high-risk sexual behaviour in model I. While relationship status (OR = 24.289, p<0.01) was associated with high-risk sexual behaviour in model II. The study, therefore, concluded that the use of social media influences the sexual behaviour of undergraduate. Hence, the study recommended sex education to help expose undergraduate students to the dangers involved in spending excessive time on social media.

Transitions in Adolescent Boys and Young Men’s High-Risk Sexual Behaviour in India

Background: The sexual behaviour of adolescents is of importance due to the engagement in risky sexual activity at a too early age, which may be associated with the adverse outcomes. The study aims to understand the transitions in adolescent boys and young men’s high-risk sexual behaviour in India using two rounds of Indian demographic health survey, NFHS-3 (2005-06) and NFHS-4 (2015-16). Methods: A total of 25,538 in NFHS-3 (2005-06) and 35,112 in NFHS-4 (2015-16) men were considered for the analysis. Men have been divided into two age groups as 15-19 years (adolescent) and 20-24 (young men) for comparison purposes. Descriptive and multivariate statistics have been used. Results: Overall, high-risk sexual behaviour has increased among adolescent boys (64% to 70%) and young men (18% to 27%) from 2005-06 to 2015-16. The trend of live-in relationship has increased among adolescent boys of rural areas (0.6% to 6.0%) as well as in urban areas (3.1% to 10.9%) over the last ten years. Adolescent boys having 10 th and above years of schooling (AOR=1.98; p<0.01), residing in urban areas (AOR=2.23; p<0.01), and belonging to the affluent class of households (AOR=1.41; p<0.05) were more likely to engage in high-risk sexual activity than the young men in India. The odds of high-risk sexual behaviour was higher among alcohol-using adolescent boys (AOR= 1.82; p<0.01) and young men (AOR=2.38; p<0.01) in 2015-16. Conclusions: The study concludes that early sexual debut, lower prevalence of condom use at first sexual experience, tendency of live-in-relationship, and alcohol consumption indicate the hazardous interconnection between such behaviours among adolescent boys over the last decade which put them at higher-risky sexual behaviour as compared to young men. Adolescent’ sexual behaviours have both short-term and long-term consequences, and interventions that focus on multiple domains of risk may be the most effective in helping to promote broad reproductive health among young adults.