Condomless Sex Research Articles

Perceptions, experiences and concerns with sexually transmitted infections among current and former PrEP users: a longitudinal qualitative study of gay, bisexual and queer men in Canada

Background Pre-exposure prophylaxis (PrEP) use has been attributed to heightened rates of sexually transmitted infections (STIs), ostensibly due to increased condomless anal sex (CAS) and greater frequency of STI testing. Few qualitative studies have assessed how gay, bisexual and queer men (GBQM) who use PrEP perceive STIs and how these attitudes have evolved post-PrEP uptake. We investigated the perspectives of current and former PrEP users on STIs. Methods Annual, in-depth longitudinal interviews were conducted with 38 current and former PrEP users in Ontario (n = 18) and British Columbia (n = 20), Canada, as part of a mixed-methods implementation science study (2020–2022). Over 3 years, 109 interviews were conducted. Data analysis included reflexive thematic coding and longitudinal recurrent cross-sectional analysis using NVivo 12. Results Four STI-related themes emerged: (1) lack of STI-related concerns due to treatment and prevention optimism, (2) stigma-related concerns, (3) perceived risk among other PrEP users due to increased CAS, and (4) inconsistent testing concerns among non-PrEP users. Over time, some STI-related anxieties decreased with increased knowledge and reduced stigma. However, concerns persisted for other participants due to perceived risky sexual behaviours among other PrEP users and non-PrEP users. Both current and former PrEP users who expressed STI-related apprehensions consistently indicated adopting risk-reduction strategies, including condom use and having fewer sexual partners throughout the study. Conclusions Findings show how varied STI perceptions and experiences among current and former PrEP users shaped sexual decision-making over time. Providers, public health experts, and policymakers should develop a more comprehensive strategy to address STI concerns among GBQM.

Ehealth interactive intervention in promoting safer sex among men who have sex with men

Men who have sex with men (MSM) who use dating applications (apps) have higher rates of engaging in condomless anal sex than those who do not. Therefore, we conducted a two-arm randomized controlled trial to evaluate the effectiveness of an interactive web-based intervention in promoting safer sex among this population. The intervention was guided by the Theory of Planned Behavior and co-designed by researchers, healthcare providers, and MSM participants. The primary outcome was the frequency of condomless anal sex in past three months. Secondary outcomes included five other behavioral outcomes and two psychological outcomes. This trial was registered on ISRCTN (ISRCTN16681863) on 2020/04/28. A total of 480 MSM were enrolled and randomly assigned to the intervention or control group. Our findings indicate that the intervention significantly reduced condomless anal sex behaviors by enhancing self-efficacy and attitudes toward condom use among MSM dating app users, with the effects sustained at both three and six months.

Pre-exposure prophylaxis implementation gaps among people vulnerable to HIV acquisition: a cross-sectional analysis in two communities in western Kenya, 2021-2023.

Despite theincreasing availability of prevention tools like pre-exposure prophylaxis (PrEP), HIV incidence remains disproportionately high in sub-Saharan Africa. We examined PrEP awareness, uptake and persistence among participants enrolling into an HIV incidence cohort in Kenya. We used cross-sectional enrolment data from the Multinational Observational Cohort of HIV and other Infections (MOCHI) in Homa Bay and Kericho, Kenya. The cohort recruited individuals aged 14-55 years with a recent history of sexually transmitted infection, transactional sex, condomless sex and/or injection drug use. Participants completed questionnaires on PrEP, demographics and sexual behaviours. We used multivariable robust Poisson regression to estimate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) for associations with never hearing of PrEP, never taking PrEP and ever stopping PrEP. Between 12/2021 and 5/2023, 399 participants attempted the PrEP questionnaire, of whom 316 (79.2%) were female and median age was 22 years (interquartile range 19-24); 316 of 390 participants (81.0%) engaged in sex work or transactional sex. Of 396 participants who responded to the question, 120 (30.3%) had never heard of PrEP. Of 275 participants who had heard of PrEP, 206 (74.9%) had never taken it. Of 69 participants who had ever taken PrEP, 50 (72.5%) stopped it at some time prior to enrolment. Participants aged 15-19 years more often reported never taking PrEP compared with those 25-36 years (aPR 1.31, 95% CI: 1.06-1.61). Participants who knew someone who took PrEP less often reported never hearing about PrEP (aPR 0.10, 95% CI: 0.04-0.23) and never taking PrEP (aPR: 0.69, 95% CI: 0.60-0.80). Stopping PrEP was more common among participants with a weekly household income ≤1000 versus >1000 Kenyan shillings (aPR 1.40, 95% CI: 1.02-1.93) and those using alcohol/drugs before sex (aPR 1.53, 95% CI: 1.03-2.26). Stopping PrEP was less common among those engaging in sex work or transactional sex (aPR 0.6, 95% CI: 0.40-0.92). We identified substantial gaps in PrEP awareness, uptake and persistence, which were associated with potential system- and individual-level risk factors. Our analyses also highlight the importance of increasing PrEP engagement among individuals who do not know others taking PrEP.

Initiation and continued use of oral pre-exposure prophylaxis among pregnant and postpartum women in South Africa (PrEP-PP): a demonstration cohort study

When used effectively, oral pre-exposure prophylaxis (PrEP; tenofovir disoproxil fumarate and emtricitabine) prevents maternal HIV acquisition and reduces the risk of vertical transmission. Our study aimed to better understand PrEP initiation, continued use, and adherence in pregnant and postpartum women. The PrEP in Pregnancy and Postpartum (PrEP-PP) study is a demonstration cohort study that enrolled pregnant women aged 16 years and older without HIV attending their first antenatal care visit in Cape Town, South Africa, between Aug 29, 2019, and Oct 10, 2021. Eligible, consenting women were followed up quarterly up to 12 months postpartum with regular HIV testing and offer of PrEP with ongoing adherence counselling. The primary outcome was distribution of women across the PrEP cascade (ie, initiation and continuation up to 12 months postpartum) with crude and adjusted hazard ratios (HRs). We also report on HIV incidence by pregnancy and postpartum status. Overall, 1195 pregnant women were recruited and followed up (median age 26 years, IQR 23-31; median gestational age 21 weeks, IQR 15-31); 1009 (84·4%) started PrEP at enrolment. Among women who initiated PrEP at enrolment, 668 (67·5%) of 990 continued PrEP at the 1-month follow-up, 485 (49·9%) of 972 continued at 3 months, 392 (39·4%) of 994 at 6 months, and 275 (27·4%) of 1005 at 12 months. Of 186 women who did not accept PrEP at enrolment, 70 (37·6%) of 186 subsequently initiated PrEP. Overall, 200 (18·6%) of 1076 women continued PrEP at 12 months postpartum. Of 186 women who did not initiate PrEP at baseline, 70 (37·6%) subsequently initiated PrEP during the study. Factors associated with PrEP discontinuation up to 12 months postpartum included being married or cohabiting (adjusted HR 1·32, 95% CI 1·16-1·50), condomless sex since last visit (1·43, 1·23-1·65), reporting intimate partner violence (2·03, 1·59-2·59), or depression in the past 12 months (1·53, 1·14-2·05). Overall, 16 women seroconverted over 1673·8 woman-years (HIV incidence rate 0·96 per 100 woman-years, 95% CI 0·49-1·42); 14 discontinued PrEP use and two never initiated PrEP. HIV incidence was 0·28 per 100 woman-years during pregnancy (95% CI 0·22-0·33), and the incidence rate ratio was 1·77 per 100 woman-years (0·53-5·90) 0-6 months postpartum and 2·19 per 100 woman-years (0·61-7·83) 6-12 months postpartum compared with pregnant women. There is an urgent need for the integration of PrEP into antenatal and postnatal care and interventions that address barriers to continued use, including targeted counselling during pregnancy and postpartum to reduce PrEP discontinuation. National Institute of Mental Health and Fogarty International, US National Institutes of Health. For the French translation of the abstract see Supplementary Materials section.

Discrimination based on gender identity and decision-making regarding HIV/STI-protected sex, a cross-sectional study among trans and non-binary people in Germany

BackgroundTrans and non-binary people are often discriminated against. Discrimination has a negative impact on health and may affect sexual health and behavior. We explored the relationship between discrimination based on gender identity and the perceived ability to make decisions about their sex life to feel as protected as desired from HIV and sexually transmitted infections (STI) among trans and non-binary people in Germany. Secondarily, we assessed whether feeling unable of making HIV/STI-protected sex decisions was associated with behaviors related to increased HIV/STI risk.MethodsWe conducted a cross-sectional study using data from the Sexual Health and HIV/STI in Trans and Non-Binary Communities (TASG) survey conducted online between March-July 2022 among trans and/or non-binary people aged 18 years and older living in Germany. We described the prevalence of frequent discrimination based on gender identity. We calculated prevalence ratios (PR) with 95% confidence intervals (95% CI) for the associations between frequent experienced discrimination based on gender identity and feeling unable of making HIV/STI-protected sex decisions, and between feeling unable of making HIV/STI-protected sex decisions and behaviors related to increased HIV/STI risk.ResultsAmong 3077 participants, 22% reported frequent discrimination based on gender identity. Participants experiencing such discrimination reported 1.4 times more often to feel unable to make HIV/STI-protected sex decisions (PR 1.4, 95% CI 1.1–1.8). This perceived inability was associated with increased prevalence of sex under drug influence (PR 2.9, 95% CI 2.3–3.7) and condomless penetrative sex with multiple partners without PrEP (PR 2.0, 95% CI 1.4–2.9).ConclusionFeeling unable to make decisions to feel protected from HIV/STI among trans and non-binary people was associated with both frequent discrimination and behaviors that increase the HIV/STI risk. Strategies for empowering trans and non-binary people to assert their sexual decision-making needs should be explored.

Effects of HIV Self-Testing on Testing Promotion and Risk Behavior Reduction Among Transgender Women in China: Randomized Controlled Trial.

To date, no randomized controlled trials have specifically addressed behavior changes after HIV self-testing (HIVST) among transgender women. This study aims to evaluate the effects of HIVST on changes in HIV testing behavior, frequency of condomless sex, and partner numbers among transgender women in China. Participants were recruited from 2 Chinese cities using both online and offline methods. Transgender women were randomly assigned to receive an HIVST intervention. Data from the previous 3 months were collected at baseline, 3 months, and 6 months. The primary outcome was the mean change in the number of HIV tests among transgender women during the 6-month follow-up. An intention-to-treat analysis was conducted. The statistical analysis used analysis of covariance and linear mixed-effects models. From February to June 2021, and 255 transgender women were recruited, of which only 36.5% (93/255) had a steady job, and 27.1% (69/255) earned less than US $414.9 of income per month. They were randomly assigned to the intervention (n=127) and control (n=128) groups. At 6 months, the mean number of HIV tests was 2.14 (95% CI 1.80-2.48) in the intervention group and 1.19 (95% CI 0.99-1.40) in the control group (P<.001), with increases of 0.84 (95% CI 0.54-1.14) and 0.11 (95% CI -0.19-0.41) over 6 months, respectively. The net increase was 0.73 (95% CI 0.31-1.15; P<.001), with a similar adjusted result. No significant differences in the frequency of condomless sex or partner numbers were observed between the 2 groups. HIVST is an effective strategy for enhancing regular HIV testing behavior among transgender women in China. This strategy should be combined with measures to address the financial vulnerability of the transgender women community to reduce subsequent risk behaviors, including condomless sex. Chinese Clinical Trial Registry ChiCTR2000039766; https://www.chictr.org.cn/showproj.html?proj=61402.

Hepatitis C treatment and behavioural risk among men who have sex with men with HIV: comparing interferon and direct-acting antiviral eras.

Little is known about the effect of HCV treatment on sexual risk behaviour among men who have sex with men (MSM) with HIV by treatment type (IFN-based vs DAA-based). MSM with HIV and recently acquired HCV infection enrolled in the observational MOSAIC cohort. Using data from 2009-2018, we evaluated risk behaviour through a validated HCV risk score (where ≥2 indicated high risk) and its individual risk behaviours. Levels of risk behaviour before, during and after treatment were modelled for each treatment episode using linear and logistic regression with Generalized Estimating Equations adjusting for DAA availability and number of re-infections. 140 MSM with a median age of 45 years (interquartile range=40-49) yielded 180 treatment episodes (n=131 IFN-based, n=49 DAA-based). Adjusted mean risk score before, during and after treatment was 2.4 (95% confidence interval (CI)=2.1-2.6), 0.9 (95%CI=0.8-1.0) and 1.7 (95%CI=1.5-1.8), respectively. Before treatment, no differences in mean HCV risk score or proportion of specific behaviours were found between the regimen groups. During treatment, MSM treated with DAAs had a higher average risk score and proportion of receptive condomless anal sex, sharing toys and unprotected fisting than those treated with IFN. After treatment, the proportion sharing straws were significantly higher in MSM treated with DAAs than IFN. MSM treated with DAAs, compared to IFN, had higher levels of HCV-related risk behaviour during treatment. The higher risk of HCV re-infection in the DAA-era underscores the need for ongoing HCV testing and behavioural interventions against HCV.

A seroprevalence study indicates a high proportion of clinically undiagnosed MPXV infections in men who have sex with men in Berlin, Germany

IntroductionDuring the mpox outbreak in 2022, the highest number of cases in Germany were registered in Berlin, almost all of them in men who have sex with men (MSM). However, the frequency of clinically undiagnosed infections is unknown.MethodsA cross-sectional study was conducted among MSM in Berlin, Germany. Participants were recruited from private practices and community-based checkpoints specialised in HIV and STI care for MSM. They were asked to complete an online questionnaire on socio-demographic data, mpox diagnosis, vaccination history and sexual behaviour, and to provide a blood sample for serological analysis. The samples were tested for antibodies against a range of antigens to distinguish between antibodies induced by mpox infection and MVA vaccination, with pre-immune sera from childhood smallpox vaccination as a confounding factor. Associations of behavioural variables with reported and suspected mpox diagnosis as the outcome were tested using univariable and multivariable logistic regression models.ResultsBetween the 11th April and 1st July 2023, 1,119 participants were recruited in eight private practices and two community-based checkpoints in Berlin. All participants provided a blood sample for serological testing. Information for the online questionnaire was provided by 728 participants; core data on age and mpox history for participants who did not provide questionnaire data were provided by the practices for an additional 218 participants. A previous diagnosis of mpox was reported for/by 70 participants (7.4%). Using a conservative and strict case definition, we serologically identified an additional 91 individuals with suspected undiagnosed mpox infection. Individuals with reported or suspected mpox infections reported more condomless anal sex partners in the past 3 months (OR = 5.93; 95% CI 2.10-18.35 for 5–10 partners; OR = 9.53; 95% CI 2.72–37.54 for > 10 partners) and were more likely to report sexual contact with partners diagnosed with mpox (OR = 2.87; 95% CI 1.39–5.84).ConclusionA substantial proportion of mpox infections were clinically undiagnosed. The number of condomless anal sex partners was strongly associated with both confirmed and suspected undiagnosed mpox infection. Therefore, mpox control measures based on clinical diagnosis of mpox are likely to have limited effectiveness in preventing mpox transmission in outbreak situations because many infections remain unrecognised and undiagnosed.

Examining concordance of sexual-related factors and PrEP eligibility with HIV risk perception among adolescent girls and young women: cross-sectional insights from DREAMS sites in Kenya, Malawi, and Zambia

BackgroundHIV risk perception is an important cognition for prevention, theoretically engendering service-seeking and risk-reduction behaviors, but its composition remains poorly understood. We examined country-specific correlates of self-appraised HIV exposure risk among sexually active adolescent girls and young women (AGYW, aged 15–24 years) without HIV in Kenya, Malawi, and Zambia. We also explored overlaps between self-appraised HIV exposure risk and pre-exposure prophylaxis (PrEP) eligibility to identify engagement opportunities.MethodsWe analyzed cross-sectional data (2016/2017) to estimate sexual-related correlates of self-appraised HIV exposure risk (likely vs. not, temporally framed as “ever”) using log-Poisson models with robust standard errors. For sexual-related factors with an unadjusted p ≤ 0.10, individual adjusted models were fitted, controlling for sociodemographic and cognitive factors with an unadjusted p ≤ 0.10. PrEP eligibility was defined using national guidelines; since conditional criteria are in Malawi’s (age-disparate sex + ever-pregnant) and Zambia’s (multiple partners + condomless sex) guidelines, we also assessed PrEP eligibility after decoupling these factors.ResultsFew AGYW reported likely HIV exposures (Kenya [N = 746]: 15.7%, Malawi [N = 1348]: 46.2%, Zambia [N = 349]: 9.5%) despite ubiquitous HIV risk (98.7%, 99.8%, and 98.9% of Kenyan, Malawian, and Zambian AGYW reported ≥ 1 sexual-related factor). However, the adjusted models found some actual-perceived risk concordance. Positive correlates of self-appraised likely HIV exposures included partner(s)’ likely HIV exposure (all countries); partner(s)’ unknown HIV status and other partners (Kenya, Malawi); STI symptoms and partner(s) living outside the community (Kenya); non-partner sexual violence (Zambia); and transactional sex, multiple partners, pre-coital alcohol use, and physical/sexual intimate partner violence (Malawi). Per national guidelines, PrEP eligibility criteria differentially identified HIV risk (Kenya: 93.6%, Malawi: 53.3%, Zambia: 44.6%), and self-appraised likely HIV exposures were low among PrEP-eligible AGYW (Kenya: 16.5%, Malawi: 48.5%, Zambia: 18.8%). Decoupling Malawi’s and Zambia’s conditional PrEP criteria could increase risk identification to > 85% and potential engagement by ~ 70% and ~ 30%, respectively.ConclusionsAGYW's HIV risk perceptions were mostly influenced by factors beyond their locus of control. Conditional PrEP eligibility criteria may inhibit AGYW’s access and uptake in some settings: countries should consider decoupling these factors to minimize barriers. Intersections between autonomy, behaviors, and perceptions among AGYW in gender-inequitable settings warrants further investigation.

Risk of Clade II Mpox Associated with Intimate and Nonintimate Close Contact Among Men Who Have Sex with Men and Transgender Adults - United States, August 2022-July 2023.

A global outbreak of clade II mpox associated with sexual contact, disproportionately affecting gay, bisexual, and other men who have sex with men (MSM), has been ongoing since May 2022. Information on types of contact most associated with transmission is limited. This report used data from a multijurisdictional vaccine effectiveness case-control study of sexually active persons aged 18-49 years who identified as MSM or transgender, collected during August 2022-July 2023. Odds of mpox associated with selected types of intimate and nonintimate close contact with a person with mpox were estimated. Among 457 case-patients and 1,030 control patients who met minimum data requirements, 150 (32.8%) case-patients and 57 (5.5%) control patients reported close contact with a person with mpox and were included in this analysis. Adjusted odds of mpox were 5.4 times as high among those who reported having condomless receptive anal sex with a person with mpox, compared with participants who reported close contact with a person with mpox and no condomless receptive anal sex with that person (OR = 5.4; p = 0.031). Although the mpox vaccine is highly effective, vaccination coverage remains low; a multifaceted approach to prevention remains important and should include vaccination promotion, safer sex practices, and increasing awareness that mpox continues to circulate.

Gaps in HIV Pre-exposure Prophylaxis Acceptance: Findings from an Outpatient HIV Testing Service in Italy

Background: The aim of this study is to assess the acceptability of HIV pre-exposure prophylaxis (PrEP) among individuals eligible for prophylaxis. Setting: Retrospective study of individuals receiving their first HIV test at the Infectious Diseases Unit of IRCCS San Raffaele Scientific Institute, Milan, Italy. Methods: People i) who received their first HIV test (baseline date) between January 2018 (availability of PrEP in Italy) and December 2023 (data lock), ii) with an indication for PrEP based on condomless sex were included; those already on PrEP were excluded. Individuals with a negative HIV test result were offered PrEP counselling and prescription according to guidelines. Characteristics of people who accepted or declined HIV PrEP were compared using Mann-Whitney or Chi-square tests, as appropriate. Results: A total of 2627 people were tested for HIV: 175 (6.6%) were diagnosed with HIV. Of the 2452 people with negative HIV test results, 2165 (88.3%) were men; median age was 34.3 years (interquartile range, IQR=28.7-42.4). Sexually transmitted infections (STIs) were detected in 478/2452 (19.5%), most commonly gonorrhoea (206/2452, 8.4%). Overall, 982/2452 (40.0%) people accepted PrEP, including only three women. Non-acceptance was higher among women (p&lt;0.001) and non-Caucasians (p&lt;0.001). Of those who did not accept PrEP, 260 (17.7%) were diagnosed with at least one STI at the time of HIV testing. Conclusion: Low PrEP acceptance was observed, particularly among women and people of non-Caucasian origin. Non-acceptance of PrEP was also observed among individuals diagnosed with an STI.

Impact of doxycycline post-exposure prophylaxis for sexually transmitted infections on the gut microbiome and antimicrobial resistome.

Doxycycline post-exposure prophylaxis (doxy-PEP) reduces bacterial sexually transmitted infections among men who have sex with men and transgender women. Although poised for widespread clinical implementation, the impact of doxy-PEP on antimicrobial resistance remains a primary concern as its effects on the gut microbiome and resistome, or the antimicrobial resistance genes (ARGs) present in the gut microbiome, are unknown. To investigate these effects, we studied participants from the DoxyPEP trial, a randomized clinical trial comparing doxy-PEP use, a one-time doxycycline 200-mg dose taken after condomless sex (DP arm, n = 100), to standard of care (SOC arm, n = 50) among men who have sex with men and transgender women. From self-collected rectal swabs at enrollment (day-0) and after 6 months (month-6), we performed metagenomic DNA sequencing (DNA-seq) or metatranscriptomic RNA sequencing (RNA-seq). DNA-seq data were analyzable from 127 samples derived from 89 participants, and RNA-seq data were analyzable from 86 samples derived from 70 participants. We compared the bacterial microbiome and resistome between the two study arms and over time. The median number of doxycycline doses taken since enrollment by participants with DNA-seq data was zero (interquartile range (IQR): 0-7 doses) for the SOC arm and 42 (IQR: 27-64 doses) for the DP arm. Tetracycline ARGs were detected in all day-0 DNA-seq samples and in 85% of day-0 RNA-seq samples. The proportional mass of tetracycline ARGs in the resistome increased between day-0 and month-6 in DP participants from 46% to 51% in the metagenome (P = 2.3 × 10-2) and from 4% to 15% in the metatranscriptome (P = 4.5 × 10-6), but no statistically significant increases in other ARG classes were observed. Exposure to a higher number of doxycycline doses correlated with proportional enrichment of tetracycline ARGs in the metagenome (Spearman's ρ = 0.23, P = 9.0 × 10-3) and metatranscriptome (Spearman's ρ = 0.55, P = 3.7 × 10-8). Bacterial microbiome alpha diversity, beta diversity and total bacterial mass did not differ between day-0 and month-6 samples from DP participants when assessed by either DNA-seq or RNA-seq. In an abundance-based correlation analysis, we observed an increase over time in the strength of the correlation between tetracycline ARGs and specific bacterial taxa, including some common human pathogens. In sum, doxy-PEP use over a 6-month period was associated with an increase in the proportion of tetracycline ARGs comprising the gut resistome and an increase in the expression of tetracycline ARGs. At 6 months of doxy-PEP use, no residual differences were observed in alpha and beta diversity or taxonomic composition of the gut microbiome. As doxy-PEP is implemented as a public health strategy, further studies and population-level surveillance of doxycycline-resistant pathogens are needed to understand the implications of these findings. ClinicalTrials.gov registration number: NCT03980223 .

Transactional sex and its associated factors among gay, bisexual and other men who have sex with men in Nepal.

Background Transactional sex, which involves the exchange of sex for money, goods or other items of value, has been associated with adverse health outcomes, such as HIV and other sexually transmitted infections, mental health challenges, and substance use. Although transactional sex has been extensively studied globally among cisgender and transgender women, there is a lack of comprehensive understanding regarding its prevalence and correlates among gay, bisexual and other men who have sex with men (GBMSM), particularly in Nepal. Thus, this study aimed to examine the prevalence of transactional sex and its associated factors among GBMSM in Nepal. Methods A cross-sectional survey was conducted among GBMSM in Kathmandu Valley, Nepal, between October and December 2022 (N =250). We collected information on participants' sociodemographic characteristics, sexual and other behavioural characteristics, and their engagement in transactional sex. Bivariate and multivariate logistic regression analyses were performed to determine the factors associated with transactional sex. Results The average age of participants was 27.5years (s.d. 8.9). Overall, 16.4% reported engaging in transactional sex within the past 6months. Participants with more financial dependants (aOR: 1.2, 95% CI: 1.0-1.5) and those who had experienced police detention (aOR: 4.8, 95% CI: 1.1-19.6) were more likely to engage in transactional sex. In contrast, GBMSM who reported engaging in condomless sex were less likely to engage in transactional sex (aOR: 0.02, 95% CI: 0.06-0.1). Conclusions The study findings underscore a noteworthy prevalence of transactional sex and associated socioeconomic and behavioural factors among GBMSM in Nepal. These results underscore the need for targeted interventions addressing both economic vulnerabilities and legal interactions to reduce transactional sex and its associated risks in this high-risk group.

Impact of Awareness of Sexual Partners' HIV Serostatus on the HIV Acquisition among Men Who Have Sex with Men in Guangzhou, China: A Nested Case-Control Study.

This study aimed to investigate the impact of sexual partners' HIV serostatus awareness on theHIV acquisition among men who have sex with men (MSM) in Guangzhou, China. A nested case-control study was conducted based on a prospective cohort of MSM in Guangzhou. Within the cohort, individuals who underwent HIV seroconversion were identified as the case group, and each case was matched with four controls from the non-seroconverted participants. Information regarding the awareness of sexual partners' HIV serostatus over the preceding 6months was gathered. Of the 161 participants, 36.0% were aware of the HIV serostatus of all their sexual partners. The practice of engaging in condomless anal sex with partners of unknown HIV serostatus and being aware of the HIV serostatus of only some casual partners were positively correlated with an elevated risk of acquiring HIV. Conversely, being fully aware of the HIV serostatus of all sexual partners, including regular ones, was associated with a diminished risk of HIV incidence.Regular communication with sexual partners regarding HIV testing outcomes, honest disclosure of one's own HIV serostatus, and refusal of sexual contact with partners of unknown HIV serostatus can potentially mitigate the risk of acquiring HIV among MSM.

"It's Almost Like Playing 'The Price is Right'": Factors Considered by Online Male Sex Workers When Setting the Price for Their Services.

Some men who have sex with men (MSM) engage in the exchange of sexual services for money, drugs, shelter or something else of value. There has been limited research examining the factors that influence how male sex workers (MSWs) determine their fees for their services. To learn more about this, qualitative interview data were analyzed from 180 MSM from 8 US cities who had recently engaged in exchange sex with clients they had primarily met through dating/hookup websites and apps. The primary factor that affected participants' fees was the type of services provided, with a higher price generally charged for anal sex than for oral sex, mutual masturbation or massage. Condomless anal sex, in particular, commanded a higher fee. Additionally, participants required more money for special kinks or fetishes or any services that they considered to be risky, demanding or physically or emotionally uncomfortable. Other factors that affected how much participants charged for a given encounter included the duration of the meeting, the level of client appeal, the perceived wealth of the client, and the participant's current financial situation. Participants varied in their approaches to fee setting, in terms of both their degree of flexibility when negotiating a price and whether they preferred to suggest a fee or have the client first state an amount they were willing to pay. Information about MSWs' approaches to fee setting provides greater understanding of their lived experiences and the risks they may accept for higher fees.

Outcomes of a policy to prioritize populations with expected healthcare barriers for subsidized PrEP care in Amsterdam, the Netherlands: a cross-sectional study.

The Dutch HIV pre-exposure prophylaxis (PrEP) pilot provided subsidized PrEP care to maximum 2,900 individuals at a time in Amsterdam. Populations with expected barriers to accessing PrEP elsewhere were prioritized for program inclusion. We evaluated their prior sexual health service engagement and PrEP need. Cross-sectional analysis using enrolment data. We included individuals ever enrolled in the PrEP program at the Center for Sexual Health (CSH) Amsterdam between 2019-2023. We calculated the proportion belonging to higher-priority groups (i.e.,<25 years old, transgender, sex worker, uninsured or migrant). We defined classes of sexual health service engagement in the 12 months preceding enrolment using latent class analysis (LCA). We compared engagement classes, sexual behavior and positivity of HIV and sexually transmitted infections (STI) between higher- and lower-priority groups. 2,004/4,075 (49%) individuals enrolled belonged to higher-priority groups. LCA showed three classes of prior engagement: "Newly engaged" (14%,n = 551) were new to the CSH-Amsterdam; "PrEP initiators" (40%,n = 1,642) previously visited the CSH-Amsterdam but had not used PrEP; "PrEP experienced" individuals (46%,n = 1,882) previously accessed PrEP. Higher-priority groups were more often "newly engaged" or "PrEP-initiators" than "PrEP-experienced". Higher-priority groups less often had condomless anal sex with casual partners or chemsex in the prior six months. Positivity of bacterial STI was similar between higher-priority (n = 300/2,004, 15.0%) and lower-priority (n = 315/2,071, 15.2%) groups. 13/14 HIV diagnoses at enrolment were in higher-priority groups. Higher-priority populations had less often previously used sexual health services and accounted for most new HIV diagnoses at enrolment. Engaging these populations in sexual healthcare, including PrEP, should be stressed.

Condomless anal intercourse among HIV-positive and HIV-negative men who have sex with men in Zimbabwe.

Men who have sex with men (MSM) are disproportionately impacted by HIV in sub-Saharan Africa (SSA), where condomless anal intercourse (CAI) is a major driver of HIV transmission among this hidden subpopulation. To determine CAI drivers and prevalence among HIV-positive and HIV-negative MSM. Data from 1538 MSM who participated in a biobehavioural survey in Zimbabwe were used. Secondary statistical data analysis methods were used to determine prevalences and drivers of CAI. A high prevalence of CAI, of at least 30%, among HIV-positive and HIV-negative MSM was found. Factors that led to a statistically significant higher CAI among HIV-positives compared to HIV-negatives included drunkenness (35% vs. 25%, P = 0.01), fear of partner (13% vs. 9%, P = 0.017), trusting the partner (10% vs. 6%, P = 0.008), and being offered more money (10% vs. 6%, P = 0.003). Our findings indicate that economic, socio-behavioural and perceptual dimensions increase men's likelihood to engage in risky sexual behaviour, suggesting the need for HIV prevention efforts that provide tailored education regarding HIV risk among MSM in SSA. This is the first large biobehavioural survey that generated valuable information useful for analysing condomless anal sex among MSM in Zimbabwe.

Characterizing syndemic HIV risk profiles and mHealth intervention acceptability among patients in the emergency department

ABSTRACT Syndemic theory proposes that co-occurring, mutually reinforcing psychosocial challenges (mental health, substance use, minority stress [discrimination/stigma], abuse, unmet basic needs) drive HIV risk behavior and create barriers to care for marginalized populations. It is thus necessary to address this holistic, complex picture in HIV prevention. Emergency department (ED) visits are a prime opportunity to engage key risk groups, given their low engagement in regular clinic-based care and high utilization of drop-in care via EDs. Yet, EDs are overburdened and under-resourced; mHealth may be a vehicle for intervention delivery in this context. This study aimed to 1) characterize demographics, syndemic profiles, and HIV risk behavior among ED patients and 2) assess the acceptability of addressing syndemic issues, particularly via an mHealth approach, in the ED. A sample of N = 198 ED patients with an indication of HIV risk completed a cross-sectional psychosocial assessment. Descriptive statistics and bivariate correlations between syndemic issues were examined. Patients presenting to the ED reported marginalized identities and complex syndemic profiles including mental health issues (77%), at risk substance use (30%), childhood abuse (35%), adult abuse (31%), minority stress (63%), and unmet basic needs (37%). Over half the sample reported at least three syndemic issues (54%). All syndemic issues were significantly correlated with each other, supporting a synergistic nature. The sample reported indicators of HIV risk including lack of PrEP awareness (33%)/uptake (94%), condomless sex (37%), and not testing for HIV (41%). Majority reported syndemic profiles have never been addressed in the ED (71%), think it would be helpful (88%), and willing to utilize mHealth during an ED visit (76%). The current study provides information to guide next steps for ED-based point-of-care HIV prevention, and more broadly, working towards equitable HIV prevention services reaching those missed by existing interventions.

A Systematic Review and Narrative Synthesis of Factors Affecting Pre-exposure Prophylaxis Willingness Among Black Women for HIV Prevention.

Pre-exposure prophylaxis (PrEP) can significantly reduce human immunodeficiency virus (HIV) transmission among Black women in the United States (U.S.), a group disproportionately affected by HIV. However, PrEP uptake in this HIV-vulnerable population is low. This review analyzes the factors influencing Black women's PrEP willingness using the Behavioral Model for Vulnerable Populations (BMVP). Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Population, Intervention, Comparison, Outcome, Study Design (PICOS) framework, we conducted a systematic literature search and selected 24 peer-reviewed studies on PrEP willingness. Narrative synthesis revealed a heterogeneous landscape of the determinants affecting PrEP willingness among Black women, categorized into three main domains. Predisposing demographic and social factors included younger age, unmarried status, higher education, sexual or gender minority identity, trust in healthcare providers, and perceived HIV risk. Predisposing behavioral factors included condomless sex, multiple partners, and engagement in sex work. Socioeconomic status, health insurance, healthcare access, support systems, and structural challenges were identified as enabling factors influencing Black women's PrEP willingness. Finally, the perceived need domain and health-related factors influencing the perceived need for PrEP included a history of sexually transmitted infections (STI), intimate partner violence (IPV), and birth control interference. This study emphasizes the complexity of the barriers and facilitators of PrEP uptake and, thus, the need for tailored interventions and health strategies to promote its use. Addressing the interconnected individual, interpersonal, and structural determinants of PrEP access is crucial for improving PrEP willingness and thereby advancing health equity in this population.

Familias con Orgullo: Pilot Study of a Family Intervention for Latinx Sexual Minority Youth to Prevent Drug Use, Sexual Risk Behavior, and Depressive Symptoms.

Families are key in the healthy development of Latinx sexual minority youth (Latinx SMY), a group that experiences behavioral, mental, and sexual health disparities. Despite this, there are no family-based interventions for Latinx SMY and their families to prevent drug use, sexual risk behaviors, and depressive symptoms. The purpose of this pilot study was to evaluate the preliminary impact (i.e., estimated effect sizes) of Familias con Orgullo (FcO) and examine its feasibility and acceptability among 30 Latinx SMY and their parents. Parents and adolescents were randomized to FcO or a control condition and assessed pre/post-intervention. Feasibility was measured based on session completion and effect sizes. Focus groups were conducted to evaluate intervention acceptability. Findings showed promising effects favoring FcO on parent-adolescent communication (d = 0.46) and parental involvement (d = 0.34). There were also promising effects favoring FcO on suicidal thoughts (OR = 0.75) and depression symptoms (OR = 0.69). Finally, 100% of the adolescents in FcO either continued to remain drug-free or transitioned from current use to no use (from baseline to post-intervention) compared to 74% in the control. Effect sizes for condomless sex, parental monitoring, and positive parenting were small. Session completion (above 80%) and focus group findings indicated strong feasibility and acceptability. FcO holds promise for reducing drug use and depressive symptoms and improving family functioning among Latinx SMY.