Comparing men who have sex with men and inject drugs and people who inject drugs who are men and have sex with men in San Francisco: Implications for HIV and hepatitis C virus prevention

ABSTRACTBackgroundMen who have sex with men (MSM) and people who inject drugs (PWID) carry a disproportionate burden of HIV and hepatitis C virus (HCV) infections. We compared the demographic and risk profiles of MSM who inject drugs (MSM-IDU, i.e., men reached through affiliation with MSM) and PWID who are men and have sex with men (PWID-MSM, i.e., men reached through affiliation with PWID).MethodsWe used data from the most recent waves of the National HIV Behavioural Surveillance among MSM (2017) and PWID (2018) in San Francisco. Participants were recruited through venue-based (MSM) and peer-referral (PWID) sampling and completed standardised questionnaires. We compared the characteristics of MSM-IDU and PWID-MSM using bivariate tests.ResultsOf 504 participants completing the MSM survey, 6.2% reported past-year injection drug use (MSM-IDU). Among 311 male participants completing the PWID survey, 19.0% reported past-year sex with a male (PWID-MSM). Relative to MSM-IDU, more PWID-MSM were older, identified as bisexual, had lower income, a history of incarceration and were homeless. MSM-IDU had more male sexual partners (median: 10 vs 3) and fewer injected daily (29.0% vs 64.4%) than PWID-MSM. While more PWID-MSM sought sterile equipment from a syringe program (86.4% vs 35.5%), fewer reported using PrEP (15.0% vs 42.9%).ConclusionThe sociodemographic, risk behaviour, and prevention access profiles of MSM-IDU and PWID-MSM in San Francisco suggest that they represent distinct populations who may require tailored HIV and HCV prevention strategies. MSM- and PWID-focused prevention programs should provide combined sexual health and harm reduction messages and services.

Human Papillomavirus Prevalence in Urine Samples of Asymptomatic Male Sexual Partners of Women with Sexually Transmitted Diseases

Human papillomavirus (HPV) infection in males is associated with various cancers, including cervical cancer in women and penile and bladder cancers in men. However, there is limited research on the prevalence and prevention of male HPV infection. Moreover, a rapid test that can prevent the increase in HPV infection is needed. In this study, the prevalence of sexually transmitted pathogen (STP) and HPV infection was analyzed using real-time polymerase chain reaction assay in random urine samples collected from asymptomatic male sexual partners of women with sexually transmitted diseases. Among 130 men, 65 (50.0%) had STP and 12 (9.23%) had HPV infection. There was no association between STP and HPV infection. Among 12 cases of HPV infection, three were HPV-16 single infections, six were multiple infections, including HPV-16, and three of other high-risk HPV infections. Our results suggest the need for STP testing, including HPV testing, in sexual partners of high-risk women with sexually transmitted diseases, even in men without clinical symptoms (asymptomatic). Further research should be conducted by diversifying urine samples. We report the most convenient method for HPV detection, and it is expected to be widely applied to prevent sexually transmitted diseases in men and women.

The Case of Linwood Boyette and Transatlantic Imaginaries of AIDS, Race, and Carcerality

In November 1987, Linwood Boyette, an African American man and retired US army sergeant, became one of the first people in West Germany to be jailed for alleged HIV transmission, following charges brought under a legal Maßnahmenkatalog (catalog of measures) in the state of Bavaria. Boyette stood accused of having knowingly exposed three white male sexual partners to HIV and bringing them into “danger of death.” Boyette’s racial and national “otherness” underscored the widespread West German perception of AIDS as a racialized threat linked to the United States. With his example, this article frames early West German criminalization of HIV/AIDS as a transatlantic spectacle of carceral discipline and racialized punishment. The article concludes that the US-inspired Bavarian response mirrors an ongoing carceral racialization of HIV that systemically harms individuals and communities of color in the United States today.

Friendship, Intimacy, and Love between Men

The men interviewed described four main types of relationships with male sexual partners. First were casual, sex-only relationships that provided comfort, convenience, and security, but no deep or lasting emotional ties. Second were genuine friendships. They involved activities other than sex, including talking about politics over coffee, hunting, camping, and even going on dinner dates together with their wives. The third form was deeply intimate but nonromantic friendships, which were more intimate than most friendships but less involved than romantic connections. These involved extensive time commitments, unprotected sex, or sexual exclusivity as far as sex with men was concerned. The final category was romantic relationships involving love. Regardless of relationship type, all of the men engaged in emotion work to prevent attachments that would have affected other parts of their lives, especially their romantic relationships with women. The few who did experience feelings of love toward men set tight boundaries for those relationships or eventually cut them off. None sought to leave their women partners to romantically partner with a man. By regulating the emotions they felt toward men and channeling romantic sentiments towards women, the men interviewed formed relationships compatible with rural and small-town straight culture.

The Study of Prevalence, Knowledge, Attitude, Beliefs and Practice of Cervical Cancer in HIV Positive Women in Purdah and HIV Positive Women Not in Purdah in Gombe State Nigeria

Introduction: Purdah or pardah is a Persian word which translated loosely to mean ‘curtain’, is a religious and social practice of female seclusion prevalent among some Muslim communities. In stating the reasons for the need of purdah, the Qu’ran declares that “the observance of hijab is so that the (pure and pious women) may be recognized and not be molested” Cervical cancer is a malignant disease of the cervix. The disease has a pre-malignant stage which usually occurs in younger women. Carcinoma of the cervix is associated with the following risk factors; early age at first sexual intercourse, multiple male sexual partners, male sexual partners who have had multiple partners, early age at first birth, multiparty, smoking, long-term use of oral contraceptive pills, immunosuppressed states. Cervical cancer is preventable through vaccination and can be easily diagnosed, but prevention and diagnostic programmes are not widely available in the developing world (Branca et al., 2003). Rates of cervical cancer are four to five times higher among women living with HIV than among HIV negative women, while the overall risk of acquiring HIV among women doubles when women are infected with the human papillomavirus, a cause of cervical cancer. Aim: To study the Prevalence, Knowledge, Attitude, Beliefs and Practice of cervical cancer in HIV positive women in purdah and HIV positive women not in purdah, and relate this to the prevalence of cervical cancer. Methods: The study was a cross-sectional study to determine the prevalence of cervical cancer among HIV positive women in purdah attending the anti retroviral therapy (ART) Clinic of the Federal Teaching Hospital, Gombe. A sample size of 150 each was used for both the subject group and controls. HIV positive women in purdah=150 subjects, HIV positive women not in purdah= 150 subjects and HIV negative women not in purdah =150 subjects. Sample size equals 450 to give room for alteration. Results: Results collected using the questionnaire revealed that only a mean of about 41 (27.3%) HIV positive women in purdah had correct knowledge of Cervical Cancer as compared with HIV positive women not in purdah who had a mean of 129 (86.0%) and 114 (76.7%) for HIV negative women not in purdah. Large percentage of 61.3% of HIV positive women in Purdah, 86.0% of HIV positive women not in purdah and 76.7% of HIV negative women not in purdah, had previous knowledge of Cervical Cancer. The knowledge about the link between early marriages to increased risk of cervical cancer was not low amongst HIV positive women in purdah (34.7%) but this was not the case with their counterparts as 86.0% of HIV positive women not in purdah and 80.7% of HIV negative women in purdah were knowledgeable about the link. Not less than 95% of women in all groups expressed indifference towards the gender of the personnel collecting the Pap smear nevertheless some still showed some reluctance towards having their pap smear collected by personnel of the opposite sex. Women in purdah showed the highest percentage of this reluctance (4.7%). As regards to practices, the women in purdah had a mean positive practice of 63.3% as against 58.7% and 60.8% respectively of the control group (HIV positive women not in purdah and HIV negative women not in purdah). Women in purdah had a higher positive practice in all cases except the issues of husbands deciding the number of children (16.7% -HIV positive women in purdah, 88.0% -HIV positive women not in purdah and 100% -HIV negative women not in purdah) and husbands deciding when to stop having children (35.5% -HIV positive women in purdah, 52.0% -HIV positive women not in purdah and 43.3% -HIV negative women not in purdah). Conclusion: The prevalence of cervical lesions in HIV positive women in purdah (42.0%) is higher than that of HIV negative women not in purdah (16.0%), but lower than that of HIV positive women not in purdah (56.0%).Hiv positive women in purdah had the lowest knowledge of cervical cancer with a mean score of (27.3%) while the control groups had a higher knowledge of 86.0% and 76.7% respectively. This implies that there is need for comprehensive and correct knowledge, positive attitude/ beliefs and positive behavioral practice are important in the control of cervical cancer and diseases in general.

Implementing Assisted Partner Services to HIV Test and Treat Men and their Female Sexual Partners: A Study Protocol (Preprint)

BACKGROUND Despite the effective scale-up of HIV testing and treatment programs worldwide, only 75% of persons living with HIV (PLWH) globally know their status, with lower rates among men. This highlights the importance of implementing HIV testing and linkage interventions with high uptake in this population group. In a cluster randomized controlled trial conducted between 2013 and 2015, our team found that assisted partner services (APS) for HIV-exposed partners of newly diagnosed PLWH, safely reached more at-risk individuals to conduct testing compared to client referral alone. However, more data is needed to assess APS implementation in a real-world setting. OBJECTIVE This study evaluates the effectiveness, acceptability, fidelity, and cost of APS when integrated into existing HIV testing services (HTS) in Western Kenya. METHODS In a collaboration between the University of Washington and PATH, we are integrating APS into 31 health facilities in Western Kenya and enrolling female index clients newly diagnosed with HIV who receive APS, their male sexual partners, and female sexual partners of the male sexual partners who test HIV positive. Female index clients and all sexual partners testing HIV-positive will be followed up at 6 weeks, 6 months, and 12 months to assess linkage to care, antiretroviral therapy (ART) initiation, and HIV viral load suppression. We will evaluate acceptability, fidelity and cost of real-world implementation of APS via in-depth interviews conducted with national, county, and sub-county level policymakers responsible for HIV testing services. Facility health staff providing HIV testing services and APS, in addition to staff working with the study project team will also be interviewed. We will also conduct direct observations of facility infrastructure and clinic procedures, and extract data from facility and county/national databases. RESULTS As of March 2020, we have recruited 1724 index clients, 3201 male partners, and 1585 female partners. We have completed all recruitment for this study and have completed all 6-week (99%), 6-month (97%) and 12-month (91%) follow-up visits. Preliminary analyses demonstrate that through scaling-up APS, facilities are able to identify 12-18 new HIV-positive males for every 100 men contacted and tested. We are now in the process of completing the remaining follow-up interviews and building a self-testing component of the study as an adaptation to the COVID-19 pandemic. CONCLUSIONS Results will be used to bridge the gap between clinical research findings and everyday practice, and provide guidance on optimal strategies for APS integration into HIV service delivery. CLINICALTRIAL N/A

Treatment of Male Sexual Partners of Women with Bacterial Vaginosis (BV); A Randomized, Double-Blind, Placebo-Controlled Trial

Objective We aimed to determine if treatment of male sexual partners of women with recurrent BV with oral metronidazole twice daily for 7 days (i.e. multi-dose metronidazole) significantly decreased BV recurrence rates in the female. Methods This was a multi-center, two-arm, double-blinded, placebo-controlled study. Women with recurrent BV and a current diagnosis of BV by Amsel and Nugent were enrolled. Multi-dose metronidazole for 7 days was dispensed to women. Male partners were randomized to placebo versus multi-dose metronidazole for 7 days and asked to refrain from unprotected sex for 14 days. Female follow-up visits were conducted at day 21 and 8 and 16 weeks. Male follow-up visits occurred at days 14-21. BV cure was defined as 0-2 Amsel criteria and Nugent score 0-6 in the female partner with the primary endpoint at 16 weeks. Results Two-hundred fourteen couples were enrolled. In the intent-to-treat population, there was no significant difference between treatment arms for the primary outcome. BV treatment failure occurred in 81% and 80% of women in the metronidazole and placebo arms through the third follow-up visit, respectively (p>0.999). However, women whose male partners were adherent to study medication were less likely to fail treatment (adjusted relative risk (ARR)=0.85; 95% CI 0.73-0.99; p=0.035). This finding persisted in post-hoc comparisons in the metronidazole arm. Conclusion Overall, this study did not find that male partner treatment with multi-dose metronidazole significantly reduces BV recurrence in female partners although women whose partners were adherent to multi-dose metronidazole were less likely to fail treatment.

Mapping virtual platforms to estimate the population size of men who have sex with men (MSM) who use internet to find sexual partners: implications to enhance HIV prevention among MSM in Kenya

Introduction: Men who have sex with men (MSM) in Kenya face a disproportionate HIV disease burden. Over the last few years, the use of virtual platforms and internet sites to seek male sexual partners has increased manyfold in Kenya. New approaches are required to map, estimate and profile MSM who operate through virtual platforms to design interventions for them. Methods: This study was conducted in three counties in Kenya: Kiambu, Kisumu and Mombasa with MSM who use virtual platforms such as geosocial networking (GSN) and social networking applications to find and connect with male sex partners. The platforms were profiled through a multi-stage approach and the number of MSM associated with these platforms were estimated. In the final stage, 435 respondents randomly selected from the virtual platforms were interviewed in a secure location after informed consent. Data analysis focused on calculating an estimate of MSM for each virtual platform in each site, adjusting for duplicate profiles and multiple registrations. Results: We identified 24 GSN apps, 18 Facebook accounts/pages and 18 WhatsApp groups across the three counties, with Facebook being the preferred platform. Kiambu had the highest number of estimated MSM at 3,635 (95%CI = 3,335 to 3,990) followed by Kisumu at 1,567 (95%CI = 1,480 to 1,665) and Mombasa at 1,469 (95%CI = 1,335 to 1,604) who used virtual platforms to find other male sexual partners. On average, each MSM had 3.7 profiles on multiple platforms, with an average of 2.1 profiles used in the past month. Conclusions: The use of conventional population size estimation approaches that focus on physical sites alone may underestimate the total number of MSM in a geography. Virtual mapping should be used in conjunction with conventional hot spot based size estimation methodologies to estimate numbers of MSM to set programmatic targets.

Changes in sexual behavior, PrEP adherence, and access to sexual health services due to the COVID-19 pandemic among a cohort of PrEP-using MSM in the South

BackgroundThe COVID-19 pandemic has had unforeseen consequences on the delivery of HIV and STD prevention services. However, little is known about how the pandemic has impacted PrEP-using men who have sex with men (MSM).MethodsData come from an online cohort of PrEP-using MSM in the Southern United States from October 2019 to July 2020. Participants were administered ten surveys in total, including one ad hoc survey specifically on COVID-19. We conducted a cross-sectional analysis of this ad hoc survey (n=56) and present changes in sexual behaviors and utilization of and access to sexual health services. Using linear mixed-effects regression models, we also analyzed data from the larger cohort (n=78) and document how sexual behaviors and PrEP use varied longitudinally focusing on three months: February (pre-pandemic), April (early pandemic), and June (later in the pandemic).ResultsA fifth of participants discontinued or changed how often they take PrEP because of COVID-19. A quarter of the cohort documented challenges when attempting to access PrEP, HIV testing, or STD testing. For all sexual behaviors examined longitudinally—number of male sexual partners, anal sex acts, condomless anal sex, oral sex (all measured in the past 2 weeks)—there was a significant decrease from February to April followed by a significant increase from April to June.DiscussionOur findings suggest reduced access to and utilization of STD and HIV services coupled with a continuation of behaviors which confer STD/HIV risk. Ensuring appropriate delivery of STD/HIV prevention services during this pandemic is imperative.