STI Testing and Prevention Services Trends Among Men

Men who have sex with men (MSM) are more likely to receive
the recommended sexually transmitted infection (STI) testing and prevention
services at Ryan White HIV/AIDS Program-funded facilities, according to results
of a study published in the Annals of
Internal Medicine.

Over the past 10 years, cases of bacterial STIs have steadily increased, with a disproportionate increase among MSM, especially those infected with HIV. STIs can potentially facilitate the transmission of HIV by increasing genital HIV shedding. This challenges efforts to end the HIV epidemic. Therefore, this study determined the prevalence of STI transmission risk behaviors and receipt of recommended prevention services and annual STI testing among MSM receiving care for HIV infection.

In total, 1269 men who reported anal intercourse with men in
the last 12 months and had medical records available for review were included
in this analysis set. These men were included from the Medical Monitoring
Project, which was an annual, 2-stage, complex sample survey to produce
national estimates of behavioral and clinical characteristics of adults in the
United States  diagnosed with HIV. All
included men reported whether the HIV care facilities they utilized received
any Ryan White HIV/AIDS Program funding, because this program is federally
funded and facilities not funded by this program have significantly different
service delivery. Medical records were used to assess self-reported risk
behaviors for STI transmission, testing for STIs and hepatitis C during the
past 12 months, and all tests documented in the primary HIV medical record. The
prevalence of all measures among patients at funded vs non-funded facilities
were also analyzed.

Condomless anal intercourse in the past 12 months was
reported by an estimated 64.5% of MSM. Furthermore, before or after sex, 46.9%
of MSM reported drinking alcohol, 35.8% of MSM reported using noninjection
drugs, and 3.7% of MSM reported using injection drugs. Of the included men,
61.1% received care at Ryan White HIV/AIDS Program-funded facilities, and 37.9%
received care at facilities not funded by the Ryan White HIV/AIDS Program.
There were no observed differences in risk behaviors by facility funding

Compared with patients at Ryan White HIV/AIDS Program-funded
facilities, a lower percentage of patients at non-funded facilities received
all assessed prevention services in the past 12 months. Roughly 55% of patients
who received care at a Ryan White HIV/AIDS Program funded facility, compared
with roughly 35% at non-funded facility, were tested for gonorrhea of chlamydia
using samples from any anatomic site (urine, or swabs of the urethra,
anorectum, or pharynx)—this trend was similar, though less significant for
site-specific samples. For hepatitis C, approximately 30% of patients at
non-funded sites received screening compared with approximately 40% at Ryan
White HIV/AIDS Program-funded sites. In addition, the prevalence of STI testing
was lower among patients at  facilities
not funded by Ryan White HIV/AIDS Program during the past 12 months.

Overall, the study authors concluded that, “Meeting public
health goals for preventing [STIs], and in turn ending the HIV epidemic, may
require closer adherence to guidelines for delivering prevention services and [STI] testing to HIV-positive MSM, especially those receiving care at non-[Ryan White
HIV/AIDS Program]-funded facilities.”

This study was funded by the Centers for Disease Control and Prevention.


Weiser J, Tie Y, Pearson WS, Shouse RL. Receipt of prevention services and testing for sexually transmitted disease among HIV-positive men who have sex with men, United States. Ann of Intern Med. doi:10.7326/M19-4051


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