Characteristics of a cohort of high-risk men who have sex with men on pre-exposure prophylaxis reporting transgender sexual partners.

Transgender people continue to be at high-risk for HIV acquisition, but little is known about the characteristics of their sexual partners. To address this gap, we examined sociodemographic and sexual characteristics of cisgender men who have sex with men (MSM) on pre-exposure prophylaxis (PrEP) reporting transgender sexual partners.A cohort of 392 MSM in southern California in a randomized clinical trial for PrEP adherence were followed from 2013 to 2016. Multivariable generalized estimating equation and logistic models identified characteristics of MSM reporting transgender sexual partners and PrEP adherence.Only 14 (4%) MSM reported having transgender sexual partners. MSM were more likely to report transgender partners if they were African American, had incident chlamydia, reported injection drug-using sexual partners, or received items for sex. Most associations remained significant in the multivariable model: African American (adjusted odds ratio [AOR] 11.20, P = .01), incident chlamydia (AOR 3.71, P = .04), and receiving items for sex (AOR 5.29, P = .04). There were no significant differences in PrEP adherence between MSM reporting transgender partners and their counterpart.MSM who report transgender sexual partners share characteristics associated with individuals with high HIV prevalence. Identifying this group distinct from larger cohorts of MSM could offer new HIV prevention opportunities for this group of MSM and the transgender community

Behavioural surveillance and HIV prevention in men who have sex with men. Reports from Australia, Belgium, Canada, France, Germany, Switzerland, the United Kingdom, and the United States

In 2006 the German Robert Koch Institute conducted the KABaSTI study, a national cross-sectional survey on knowledge, attitudes, and behaviour related to sexually transmitted infections among men who have sex with men (MSM) in Germany. Within the context of the study, a two-day workshop was organized with social scientists and epidemiologists from Australia, Belgium, Canada, France, Germany, Switzerland, the United Kingdom, and the United States to engage in an open dialog about the latest trends in sexual risk behaviour in MSM populations. Participants presented recent data on risk management strategies among MSM beyond consistent condom use, MSM communication of HIV status related to sexual risk taking, the effects of HIV-related serosorting on the incidence of other sexually transmitted infections, trends in HIV testing, the uses of online HIV data in surveillance, and the consequences of early HIV diagnosis and therapy on subsequent sexual risk behaviour. -- Im Jahre 2006 wurde am Robert Koch-Institut im Auftrag des Bundesministeriums für Gesundheit eine große bundesweite Querschnittstudie zu Wissen, Einstellungen und Verhalten bezüglich sexuell übertragbarer Infektionen (STI) bei homo- und bisexuellen Männern durchgeführt (KABaSTI-Studie). Im Rahmen dieser Studie fand in Berlin ein zweitägiges Arbeitstreffen mit Sozialwissenschaftlern und Epidemiologen aus Australien, Belgien, Deutschland, Frankreich, Großbritannien, Kanada, der Schweiz und den Vereinigten Staaten statt, um in einen offenen Dialog über die neuesten Trends im sexuellen Risikoverhalten bei homo- und bisexuellen Männern zu treten. Die teilnehmenden Wissenschaftler präsentierten neueste Daten zu Risikominimierungsstrategien abseits der durchgängigen Kondomverwendung, zum Zusammenhang zwischen Kommunikation über den HIV-Serostatus und dem Eingehen sexueller Risiken, zum Einfluss von HIV-Serosorting auf die Inzidenzen anderer STI, zu Trends im HIV-Testverhalten, zum Beitrag von online erhobenen HIV-Daten für die institutionelle Surveillance und zu den Konsequenzen frühzeitiger HIVDiagnosestellung und -Therapie für sexuelles Verhalten.

Gay community periodic survey: Melbourne 2015

This study finds that HIV testing by gay and bisexual men in Melbourne continues to increase. Executive summary The Melbourne Gay Community Periodic Survey is a cross-sectional survey of gay and homosexually active men recruited at a range of gay community sites in Melbourne. The major aim of the survey is to provide data on sexual, drug use, and testing practices related to the transmission of HIV and other sexually transmissible infections (STIs) among gay men. The most recent survey, the seventeenth in Melbourne, recruited a total of 3,006 men in January 2015. The majority of these men (n=2,429, 81%) were recruited using face-to-face recruitment by trained staff at gay social venues (e.g. bars and community organisations), sex-on-premises venues, sexual health clinics, and the Midsumma Carnival. The remaining 577 men (19%) participated through an online version of the survey. Online recruitment was conducted for the first time in 2015 through the social networking site Facebook. Men were directed to a website with an online version of the GCPS questionnaire (http://gcpsonline.net). The advertisements were targeted to all men aged 16 and above who were located in Victoria and indicated in their Facebook profile that they were ‘interested’ in men. From its start in 1998, the project has been funded by the Victorian Department of Health and supported by the Victorian AIDS Council and Living Positive Victoria. The Centre for Social Research in Health coordinates the survey, with support from the Kirby Institute. The overall response rate for the 2015 survey was 77%. The data presented in this report are from the period 2011 to 2015. Since 2011, there have been significant decreases in the proportions of men recruited at sexual health clinics, social venues, and the Midsumma Carnival. The proportion of men recruited from sex-on-premises venues has remained stable over time. The online sample was analysed before we incorporated it into the survey database. There were a number of differences between men recruited online and men recruited through venues and events. Men in the online sample were younger and were more likely to be born in Australia. Men in the online sample were also less likely to report testing for HIV in the 12 months prior to the survey and were more likely to report that they were HIV-negative. Compared to men recruited through physical venues, men recruited through online survey were more likely to be in a monogamous relationship and have condomless anal intercourse with their regular partner. They were also more likely to report condomless anal intercourse with casual partners and were less likely to know that PEP was available. The online and offline samples reported similar rates of STI testing and drug use. However, despite these differences, when we merged the online and offline samples, the majority of key indicators did not appear to be affected by the change in sampling methods. We have therefore incorporated the online sample into the combined database and the reporting of trends. We will, however, continue to monitor the impact of online recruitment on the sample over time

Implementation of and Early Outcomes From Anal Cancer Screening at a Community-Engaged Health Care Facility Providing Care to Nigerian Men Who Have Sex With Men.

PurposeAnal cancer risk is substantially higher among HIV-infected men who have sex with men (MSM) as compared with other reproductive-age adults, but screening is rare across sub-Saharan Africa. We report the use of high-resolution anoscopy (HRA) as a first-line screening tool and the resulting early outcomes among MSM in Abuja, Nigeria.MethodsFrom August 2016 to August 2017, 424 MSM enrolled in an anal cancer screening substudy of TRUST/RV368, a combined HIV prevention and treatment cohort. HRA-directed biopsies were diagnosed by histology, and ablative treatment was offered for high-grade squamous intraepithelial lesions (HSIL). HRA proficiency was assessed by evaluating the detection of squamous intraepithelial lesions (SIL) over time and the proportion biopsied. Prevalence estimates of low-grade squamous intraepithelial lesions and HSIL with 95% CIs were calculated. Multinomial logistic regression was used to identify those at the highest risk of SIL.ResultsMedian age was 25 years (interquartile range [IQR], 22-29), median time since sexual debut was 8 years (IQR, 4-12), and 59% (95% CI, 54.2% to 63.6%) were HIV infected. Rate of detection of any SIL stabilized after 200 screenings, and less than 20% had two or more biopsies. Preliminary prevalence estimates of low-grade squamous intraepithelial lesions and HSIL were 50.0% (95% CI, 44.7% to 55.3%) and 6.3% (95% CI, 4.0% to 9.3%). HIV infection, at least 8 years since anal coital debut, concurrency, and external warts were independently statistically associated with SIL.ConclusionProficiency with HRA increased with experience over time. However, HSIL detection rates were low, potentially affected by obstructed views from internal warts and low biopsy rates, highlighting the need for ongoing evaluation and mentoring to validate this finding. HRA is a feasible first-line screening tool at an MSM-friendly health care facility. Years since anal coital debut and external warts could prioritize screening

Relative Safety 2: Risk and unprotected anal intercourse among gay men diagnosed with HIV

In 1999 Sigma Research published Relative safety: an investigation of risk and unprotected anal intercourse among gay men diagnosed with HIV (Keogh et al. 1999). This study explored the social, psychological and cultural meanings associated with unprotected anal intercourse (UAI) among men with diagnosed HIV. It highlighted both the complexity of sexual interaction for men with diagnosed HIV, and the many potential costs and benefits perceived by them. Now, with more than 24,000 homosexually active men diagnosed with HIV in the UK (Health Protection Agency 2008), a figure that is set to increase in years to come, it is vital that agencies involved in HIV prevention interrogate their own beliefs about UAI and ensure that their interventions meet the needs of men with diagnosed HIV. . . . . The following chapter explains how the study was undertaken, outlines the broad topic areas addressed during the interviews, and describes the sample of men who took part. Chapter 3 outlines the range of harms that men with HIV perceive when engaging in UAI. Chapters 4 and 5 explore the ways in which men responded to these perceived harms, firstly those relating to the risk of onward HIV infection, or superinfection, and latterly those concerning the potential for harms to their personal and social identities. Chapter 6 considers the implications of these findings for health promotion interventions targeting men with HIV, and with homosexually active men more broadly

Complex Agent Networks explaining the HIV epidemic among homosexual men in Amsterdam

Simulating the evolution of the Human Immunodeficiency Virus (HIV) epidemic requires a detailed description of the population network, especially for small populations in which individuals can be represented in detail and accuracy. In this paper, we introduce the concept of a Complex Agent Network(CAN) to model the HIV epidemics by combining agent-based modelling and complex networks, in which agents represent individuals that have sexual interactions. The applicability of CANs is demonstrated by constructing and executing a detailed HIV epidemic model for men who have sex with men (MSM) in Amsterdam, including a distinction between steady and casual relationships. We focus on MSM contacts because they play an important role in HIV epidemics and have been tracked in Amsterdam for a long time. Our experiments show good correspondence between the historical data of the Amsterdam cohort and the simulation results.Comment: 21 pages, 4 figures, Mathematics and Computers in Simulation, added reference

Evaluating the impact of policies recommending PrEP to subpopulations of men and transgender women who have sex with men based on demographic and behavioral risk factors.

IntroductionDeveloping guidelines to inform the use of antiretroviral pre-exposure prophylaxis (PrEP) for HIV prevention in resource-limited settings must necessarily be informed by considering the resources and infrastructure needed for PrEP delivery. We describe an approach that identifies subpopulations of cisgender men who have sex with men (MSM) and transgender women (TGW) to prioritize for the rollout of PrEP in resource-limited settings.MethodsWe use data from the iPrEx study, a multi-national phase III study of PrEP for HIV prevention in MSM/TGW, to build statistical models that identify subpopulations at high risk of HIV acquisition without PrEP, and with high expected PrEP benefit. We then evaluate empirically the population impact of policies recommending PrEP to these subpopulations, and contrast these with existing policies.ResultsA policy recommending PrEP to a high risk subpopulation of MSM/TGW reporting condomless receptive anal intercourse over the last 3 months (estimated 3.3% 1-year HIV incidence) yields an estimated 1.95% absolute reduction in 1-year HIV incidence at the population level, and 3.83% reduction over 2 years. Importantly, such a policy requires rolling PrEP out to just 59.7% of MSM/TGW in the iPrEx population. We find that this policy is identical to that which prioritizes MSM/TGW with high expected PrEP benefit. It is estimated to achieve nearly the same reduction in HIV incidence as the PrEP guideline put forth by the US Centers for Disease Control, which relies on the measurement of more behavioral risk factors and which would recommend PrEP to a larger subset of the MSM/TGW population (86% vs. 60%).ConclusionsThese findings may be used to focus future mathematical modelling studies of PrEP in resource-limited settings on prioritizing PrEP for high-risk subpopulations of MSM/TGW. The statistical approach we took could be employed to develop PrEP policies for other at-risk populations and resource-limited settings