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      Sexually transmitted infections and sexual behaviors of men who have sex with men in an American Deep South PrEP clinic

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          Abstract

          HIV pre-exposure prophylaxis (PrEP) effectively prevents HIV acquisition among men who have sex with men (MSM), but PrEP uptake has been associated with sexually transmitted infections (STIs). The effect of PrEP on STIs in MSM in the Deep South of the United States is unknown. We performed a retrospective analysis of adult MSM at an American Deep South PrEP clinic to calculate the prevalence and incidence rate of bacterial STIs (chlamydia, gonorrhea, and syphilis) and identify associated risk factors by linking incident STI to patient-reported outcomes; 139 MSM accessed the clinic between 2014 and 2018 with baseline bacterial STI prevalence of 11%. Twenty-six of 81 eligible MSM on PrEP had incident STIs with an incidence rate of 33.1 cases per 100 person-years. Significantly higher proportions of high PrEP adherence, multiple sexual partners, and inconsistent condom use were seen in those with incident STI, and we identified MSM with both high PrEP adherence and multiple sexual partners as being at especially high risk for bacterial STIs (hazard ratio: 7.57, 95% confidence interval: 1.75–32.74). Bacterial STIs are common after initiating PrEP in this clinic, and MSM reporting high PrEP adherence and multiple sexual partners have a significant risk for incident STI. Highrisk sexual behaviors persisted after starting PrEP, highlighting the importance of ongoing, intensive sexual health screening and interventions.

          Short Summary

          HIV and bacterial sexually transmitted infections (STIs) disproportionately affect men who have sex with men (MSM) in the American Deep South. We found a high incidence among MSM after starting PrEP and identified MSM with high PrEP adherence and multiple sexual partners as highest risk for STI. Our findings signal a need for intensive, targeted sexual health counseling and intervention to curb the rise in STIs.

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          Author and article information

          Journal
          9007917
          1045
          Int J STD AIDS
          Int J STD AIDS
          International journal of STD & AIDS
          0956-4624
          1758-1052
          17 May 2020
          28 January 2020
          February 2020
          06 June 2020
          : 31
          : 2
          : 127-135
          Affiliations
          [1 ]Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
          [2 ]Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
          Author notes

          Authors’ contributions

          RMG, CAM, and EFE designed the study. AOW assisted with data analysis and interpretation. KK and ETO assisted with data collection and oversight. RMG, CAM, and EFE wrote and revised the manuscript. All authors reviewed the manuscript and approved prior to submission.

          Corresponding author: Ronnie M Gravett, 1900 University Blvd, THT 229, Birmingham, AL 35229, USA. rgravett@ 123456uabmc.edu
          Author information
          http://orcid.org/0000-0002-1614-758X
          Article
          PMC7275373 PMC7275373 7275373 hhspa1556126
          10.1177/0956462419886228
          7275373
          31992145
          740a5991-d9a9-4f7e-a5c1-ccd609c683b6
          History
          Categories
          Article

          HIV prevention,condoms,medication adherence,sexually transmitted infections,health risk behaviors,Pre-exposure prophylaxis

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