Substance Use and Chemsex in MSM - A Latent Class Analysis

Engagement in “chemsex” among men who have sex with men is associated with higher rates of STIs and HIV seroconversion as well as an increased mental health burden. MSM were recruited for an anonymous online survey. The survey included questions of substance use, consumption motives, sexual risk behavior, HIV serostatus, and psychological characteristics. A latent class analysis was used to identify subgroups based on the consumed substances. 597 MSM answered the questionnaire. The latent class analysis revealed four different clusters. Most men described the use of amyl nitrite and cannabis ( n = 370). One cluster consumed mainly MDMA, cocaine, and amphetamine ( n = 106) and another cluster used mainly chemsex-related drugs ( n = 43). A fourth cluster reported a range of consumed substances ( n = 78). This cluster reported higher rates of suicide attempts, STIs, and risk behaviors. Substances typically related to chemsex were consumed in a sexualized context to a relevant extent.

Impact of recurrent sexually transmitted infections on HIV seroconversion: Results from multi-state frailty models

After several decades of research, South Africa is still considered to be the epicentre of HIV epidemic. The country also has the highest burden of sexually transmitted infections (STIs) which have been frequently linked to increasing rates of HIV transmission due to biological and behavioural associations between these two pathogeneses. We investigated the cumulative impact of recurrent STIs on subsequent HIV seroconversion among a cohort of South African women. We used the ‘ frailty’ models which can account for the heterogeneity due to the recurrent STIs in a longitudinal setting. The lowest HIV incidence rate was 5.0/100 person-year among women who had no baseline STI and remained negative during the follow-up. This estimate was three times higher among those who had recurrent STIs in the follow-up period regardless of their STI status at baseline (15.8 and 14.0/100 person-year for women with and without STI diagnosis at baseline, respectively). Besides younger age and certain partnership characteristics, our data provided compelling evidence for the impact of recurrent STI. diagnoses on increasing rates of HIV. At the population-level, 65% of HIV infections collectively associated with recurrent STIs. These results have significant clinical and epidemiological implications and may play critical role in the trajectory of the infections in the region.

The electronic identification protects privacy and has consistent HIV incidence with the traditional real-name follow-up among Chinese MSM: A 24-month prospective cohort study (Preprint)

BACKGROUND Men who have sex with men (MSM) usually face stigma and discrimination in relation to their sexual orientation and have the fear of identification disclosure, which may prevent them from taking HIV tests and participating in research studies. The traditionally used real-name identification methods might lead to biased estimates in HIV incidence. OBJECTIVE This study evaluated an electronic identification (eID) method in estimating HIV incidence among MSM using a social media application that allowed good protection of privacy than the real-name identification. METHODS From January 2018 to January 2020, a WeChat OpenID identifier was used to generate and assign eID for MSM who attended the First Affiliated Hospital of China Medical University for voluntary counselling and testing (VCT) services. The inclusion criteria were men aged 18 years and older who had consensual anal or oral sex with men in the previous 12 months and agreed to WeChat authorization. The eID group was compared with the real-name identification group (PID) that we acquired through HIV testing information regarding participants’ demographic and behavioral characteristics and HIV incidence. Sensitivity, specificity, positive and negative predictive values, and Kappa statistics were used to compare the consistency of the two groups. Cox regression was used to assess factors that were associated with HIV infection during the follow-up period. RESULTS Of 1499 WeChat OpenID users, 1133 participants were identified and linked to their traditional PID and some participants used multiple OpenIDs. The Kappa consistency between eID and traditional PID method were 0.753. At baseline, 4.2% participants in eID group received an HIV positive testing result, which was comparable to PID group (5.4%, Kappa=0.992). Thirty-five participants infected HIV during the follow-up period. The incidence of HIV infection was 7.3/100 person-years for eID group (95% CI, 5.4-10.1) and 5.8/100 person-years for PID group (95% CI, 4.2-8.0), and the consistency was high (Kappa=0.712, P>.05). The retention rates between eID and PID group were also accordant (Kappa=0.722). Number of sexual partners, recent unprotected anal sex, and recent party drug use were associated with HIV seroconversion. CONCLUSIONS The eID method that allowed anonymous tests and multiple visits had consistent results compared to the traditional real-name PID method. This method can be scaled up in future prevention and testing programs in HIV high risk populations with high privacy and confidentiality demands.

Female Genital Schistosomiasis and HIV-1 incidence in Zambian women: a retrospective cohort study

Background Female genital schistosomiasis (FGS) has been associated with prevalent HIV-1. We estimated the incidence of HIV-1 infection in Zambian women with and without FGS. Methods Women (aged 18-31, non-pregnant, sexually active) were invited to participate in this study in January-August 2018 at final follow-up of the HPTN 071 (PopART) Population Cohort. HIV-1 negative participants at enrolment (n=492) were included in this analysis with testing to confirm incident HIV-1 performed in HPTN 071 (PopART). Association of incident HIV-1 infection with FGS (Schistosoma DNA detected by PCR in any genital specimen) was assessed with exact Poisson regression. Results Incident HIV-1 infections were observed in 4.1% (20/492) participants. Women with FGS were twice as likely to seroconvert as women without FGS but with no statistical evidence for a difference (aRR 2.16, 95%CI[0.21–12.30], p=0.33). Exploratory analysis suggested an association with HIV-1 acquisition among women with ≥2 positive genital PCR specimens (RR 6.02, [0.58–34.96]), p=0.13). Conclusions Despite higher HIV seroconversion rates in women with FGS, there was no statistical evidence of association, possibly due to low power. Further longitudinal studies should investigate this association in a setting with higher schistosomiasis endemicity.

Ongoing HIV transmission following a large outbreak among people with long term injecting drug use in Athens, Greece (2014-2020)

Background The HIV outbreak among People Who Inject Drugs (PWID) in Athens, Greece in 2011-2013 was the largest recent epidemic in Europe and North America. We aim to provide updated estimates of HIV prevalence and incidence. Methods Two community-based HIV/hepatitis C programs on active PWID were implemented in 2012-2013 (ARISTOTLE, N=3,320) and 2018-2020 (ARISTOTLE HCV-HIV, N=1,635) through consecutive respondent-driven sampling recruitment rounds. PWID were uniquely identified across rounds/programs. We evaluated trends in HIV prevalence, socioeconomic characteristics, and injection practices in PWID participating in both periods and estimated HIV incidence in a cohort of seronegative PWID. Molecular sequencing and phylogenetic analysis were performed in HIV seroconverters. Results HIV prevalence (95% CI) increased from 14.2% (11.7%-17.1%) in 2012-2013 to 22.0% (19.0%-25.3%) in 2018-2020 (p<0.001). There was a deterioration of socioeconomic characteristics such as homelessness (from 16.2% to 25.6%, p<0.001), a shift in the use of cocaine (from 16.6% to 28.1%, p<0.001), reduced access to free syringes (past 12 months: 51.8% and 45.1%, p=0.005) and to HIV testing (past 12 months: 50.9% and 49.4%). HIV incidence (95% CI) in 2014-2015, 2016-2017 and 2018-February 2020 was 2.10 (1.41-3.14), 2.04 (1.34-3.10) and 1.52 (0.84-2.75) new cases/100 person-years, respectively. Younger age, lower educational level, larger injection network and daily injecting were risk factors for HIV seroconversion. Almost 9% of HIV seroconversions occurred within a newly expanding phylogenetic cluster. Conclusion The ongoing HIV transmission among PWID in Athens provides empirical evidence that the current levels of prevention and treatment are inadequate to control the epidemic, leading to expansion of the pool of infected PWID and a rise in HIV prevalence. Re-evaluation of prevention and treatment programs is urgently needed.

Phylogenetic evidence of HIV-1 transmission linkage between two men who have sex with men

Background In China, an HIV-infected man (complainant; P2) alleged that another man (defendant; P1) had unlawfully infected him with HIV through unprotected homosexual contact in 2018. Methods We employed epidemiological, serological and phylogenetic analyses to investigate the transmission linkage between two men who have sex with men (MSM). Partial segments of three HIV-1 gene regions (gag, pol, and env) were amplified and sequenced by cloning. Maximum-likelihood (ML) and Bayesian methods were used to determine the direction and estimate the timing of transmission. Local control sequences and database control sequences were also used in the phylogenetic analysis. Results It indicated that P2 underwent HIV seroconversion after P1 was diagnosed as HIV positive. The time to the most recent common ancestor (tMRCA) estimates consistently showed that P1 most likely became HIV-1 infected at an earlier date than P2. P1 and P2 were infected with the same HIV-1 CRF01_AE subtype according to segments of all three gene regions (gag, pol, and env). All three genetic regions of P1 have been subject to more potential selective forces than those of P2, indicating a longer evolutionary history. Bayesian and ML trees showed similar paraphyletic-monophyletic topologies of gag and env, with the virus from P1 located at the root, which supported a P1-to-P2 transmission direction. Conclusions Phylogenetic investigations can elucidate HIV transmission linkage and might empower its use in the opposition of the intentional transmission of HIV-1 as a forensic tool.