bims-hivpec 2018-09-02 papers

Issue of 2018‒09‒02
two papers selected by
Matthew Quaife, London School of Hygiene and Tropical Medicine

AIDS Behav. 2018 Aug 25.

Prevalence and Correlates of Unhealthy Alcohol and Drug Use Among Men Who Have Sex with Men Prescribed HIV Pre-exposure Prophylaxis in Real-World Clinical Settings.

Onyema Ogbuagu, Brandon D L Marshall, Perry Tiberio, Adedotun Ogunbajo, Lydia Barakat, Madeline Montgomery, Alexi Almonte, Tyler Wray, Emily C Williams, E Jennifer Edelman, Philip A Chan.

Pre-exposure prophylaxis (PrEP) is effective in preventing HIV acquisition among men who have sex with men (MSM). However, little is known about unhealthy substance use among MSM initiating PrEP in real-world settings. Unhealthy substance use is a risk factor for HIV acquisition and non-adherence to treatment, and may also impact PrEP use. MSM who were prescribed PrEP from 2015 to 2017 at clinics in Providence, Rhode Island and New Haven, Connecticut were recruited to participate in a prospective observational study. Structured clinical assessments were used to assess demographics, HIV risk behaviors, and unhealthy alcohol (alcohol use disorders identification test [AUDIT]-C scores ≥ 4) and drug use (use of any drugs in the past 3 months). Bivariate and multivariate analyses were performed to determine demographics and behaviors associated with unhealthy alcohol and drug use. Among 172 MSM initiating PrEP, 64% were white and 40% were 25-34 years old. Participants reported a median of 3 (IQR 2-7) sexual partners in the last 3 months; 20% reported an HIV positive partner. Unhealthy alcohol and any drug use were reported by 54 and 57%, respectively, and 76% reported at least one of the two. The majority of drug use reported was marijuana and poppers (41 and 26% of participants, respectively). Relative to those without unhealthy alcohol use, unhealthy alcohol use was independently associated with any drug use (adjusted odds ratio [AOR] = 2.57, 95% CI 1.32-5.01). Frequent drug use was associated with younger age (< 25 years, AOR 4.27, 95% CI 1.51-12.09). Unhealthy alcohol use is common among MSM taking PrEP. Drug use other than marijuana and poppers was uncommon among our cohort. Further efforts may be needed to understand the influence of unhealthy alcohol and other substance use on PrEP outcomes and to engage MSM who use drugs for PrEP.

Keywords: Alcohol; HIV; Implementation; Men who have sex with men; Pre-exposure prophylaxis

DOI: https://doi.org/10.1007/s10461-018-2260-9

Am J Obstet Gynecol. 2018 Aug 22. pii: S0002-9378(18)30685-9. [Epub ahead of print]

Low HIV testing rates among U.S. women who report anal sex and other HIV sexual risk behaviors, 2011-2015.

Mary E Evans, Guoyu Tao, Sarah E Porter, Simone C Gray, Ya-Lin A Huang, Karen W Hoover.

OBJECTIVE: In 2016, 19% of HIV diagnoses were in women. About 40% of HIV infections in women aged 18-34 years have been attributed to anal sex, suggesting that women who report high risk behaviors such as anal sex might benefit from HIV testing and prevention with pre-exposure prophylaxis (PrEP). In this analysis, we estimated HIV testing rates among women who reported anal sex.METHODS: We analyzed data from the 2011-2015 National Survey of Family Growth to estimate the proportion of sexually active, nonpregnant U.S. women aged 15-44 years who had an HIV test within the past year, stratified by those who reported anal sex and other risk factors, including ≥2 sexual partners, condomless sex with a new partner or multiple partners, gonorrhea in the past year, or any history of syphilis.
RESULTS: Overall, 7.9 million (18.7%) of 42.4 million sexually active, nonpregnant U.S. women reported an HIV test within the past year. Among 42.4 million sexually active women, 9.0 million (20.1%) reported they had anal sex in the past year. Among these 9.0 million women, 19.2% reported that their providers asked about their type of intercourse and 20.1% reported an HIV test within the past year. Overall, HIV testing was higher among women who reported anal sex and reported that their providers asked about type of sex than those whose provider did not ask (37.8% vs. 15.9%; p-value<0.001). HIV testing in the past year was higher for women with other risk behaviors compared to anal sex, ranging from 35.8% to 47.2%.
CONCLUSIONS: Overall, HIV testing rates within the past year were low among women with sexual behaviors that increase their risk of acquiring HIV, and especially low among those who reported anal sex. Early detection and treatment of HIV, and HIV prevention with PrEP, are effective health services that protect women's health and well-being, but that can only be offered based on HIV testing results. Women's healthcare providers are uniquely poised to assess risk for acquiring HIV, including taking a sexual history that asks about anal sex, and performing HIV testing to identify women who need HIV treatment or might benefit from PrEP.

Keywords: HIV; HIV testing; PrEP; anal intercourse; anal sex; women

DOI: https://doi.org/10.1016/j.ajog.2018.08.026