Number Of Condomless Anal Sex Research Articles

Sexual behaviour and incidence of sexually transmitted infections among men who have sex with men (MSM) using daily and event-driven pre-exposure prophylaxis (PrEP): Four-year follow-up of the Amsterdam PrEP (AMPrEP) demonstration project cohort.

An increasing number of countries are currently implementing or scaling-up HIV pre-exposure prophylaxis (PrEP) care. With the introduction of PrEP, there was apprehension that condom use would decline and sexually transmitted infections (STIs) would increase. To inform sexual health counselling and STI screening programmes, we aimed to study sexual behaviour and STI incidence among men who have sex with men (MSM) and transgender women who use long-term daily or event-driven PrEP. The Amsterdam PrEP demonstration project (AMPrEP) was a prospective, closed cohort study, providing oral daily PrEP and event-driven PrEP to MSM and transgender women from 2015 to 2020. Participants could choose their PrEP regimen and could switch at each three-monthly visit. STI testing occurred at and, upon request, in-between 3-monthly study visits. We assessed changes in numbers of sex partners and condomless anal sex (CAS) acts with casual partners over time using negative binomial regression, adjusted for age. We assessed HIV incidence and changes in incidence rates (IRs) of any STI (i.e., chlamydia, gonorrhoea, or infectious syphilis) and individual STIs over time using Poisson regression, adjusted for age and testing frequency. A total of 367 participants (365 MSM) commenced PrEP and were followed for a median 3.9 years (interquartile range [IQR] = 3.4-4.0). Median age was 40 years (IQR = 32-48), 315 participants (85.8%) self-declared ethnicity as white and 280 (76.3%) had a university or university of applied sciences degree. Overall median number of sex partners (past 3 months) was 13 (IQR = 6-26) and decreased per additional year on PrEP (adjusted rate ratio [aRR] = 0.86/year, 95% confidence interval [CI] = 0.83-0.88). Overall median number of CAS acts with casual partners (past 3 months) was 10 (IQR = 3-20.5) and also decreased (aRR = 0.92/year, 95% CI = 0.88-0.97). We diagnosed any STI in 1,092 consultations during 1,258 person years, resulting in an IR of 87/100 person years (95% CI = 82-92). IRs of any STI did not increase over time for daily PrEP or event-driven PrEP users. Two daily PrEP users, and no event-driven PrEP users, were diagnosed with HIV during their first year on PrEP. Study limitations include censoring follow-up due to COVID-19 measures and an underrepresentation of younger, non-white, practically educated, and transgender individuals. In this prospective cohort with a comparatively long follow-up period of 4 years, we observed very low HIV incidence and decreases in the numbers of casual sex partners and CAS acts over time. Although the STI incidence was high, it did not increase over time. The study was registered at the Netherlands Trial Register (NL5413) https://www.onderzoekmetmensen.nl/en/trial/22706.

MHealth-Based Gamification Interventions Among Men Who Have Sex With Men in the HIV Prevention and Care Continuum: Systematic Review and Meta-Analysis.

In the past few years, a burgeoning interest has emerged in applying gamification to promote desired health behaviors. However, little is known about the effectiveness of such applications in the HIV prevention and care continuum among men who have sex with men (MSM). This study aims to summarize and evaluate research on the effectiveness of gamification on the HIV prevention and care continuum, including HIV-testing promotion; condomless anal sex (CAS) reduction; and uptake of and adherence to pre-exposure prophylaxis (PrEP), postexposure prophylaxis (PEP), and antiretroviral therapy (ART). We comprehensively searched PubMed, Embase, the Cochrane Library, Web of Science, Scopus, and the Journal of Medical Internet Research and its sister journals for studies published in English and Chinese from inception to January 2024. Eligible studies were included when they used gamified interventions with an active or inactive control group and assessed at least one of the following outcomes: HIV testing; CAS; and uptake of and adherence to PrEP, PEP, and ART. During the meta-analysis, a random-effects model was applied. Two reviewers independently assessed the quality and risk of bias of each included study. The systematic review identified 26 studies, including 10 randomized controlled trials (RCTs). The results indicated that gamified digital interventions had been applied to various HIV outcomes, such as HIV testing, CAS, PrEP uptake and adherence, PEP uptake, and ART adherence. Most of the studies were conducted in the United States (n=19, 73%). The most frequently used game component was gaining points, followed by challenges. The meta-analysis showed gamification interventions could reduce the number of CAS acts at the 3-month follow-up (n=2 RCTs; incidence rate ratio 0.62, 95% CI 0.44-0.88). The meta-analysis also suggested an effective but nonstatistically significant effect of PrEP adherence at the 3-month follow-up (n=3 RCTs; risk ratio 1.16, 95% CI 0.96-1.38) and 6-month follow-up (n=4 RCTs; risk ratio 1.28, 95% CI 0.89-1.84). Only 1 pilot RCT was designed to evaluate the effectiveness of a gamified app in promoting HIV testing and PrEP uptake. No RCT was conducted to evaluate the effect of the gamified digital intervention on PEP uptake and adherence, and ART initiation among MSM. Our findings suggest the short-term effect of gamified digital interventions on lowering the number of CAS acts in MSM. Further well-powered studies are still needed to evaluate the effect of the gamified digital intervention on HIV testing, PrEP uptake, PEP initiation and adherence, and ART initiation in MSM.

Partnership types and coital frequency as predictors of gonorrhea and chlamydia among young MSM and young transgender women.

Sexually transmitted infections pose a major public health challenge in the United States and this burden is especially acute in subpopulations like young men who have sex with men (YMSM) and young transgender women (YTW). Yet, the direct behavioral antecedents of these infections are not well understood making it difficult to identify the cause of recent increases in incidence. This study examines how variations in partnership rates and the number of condomless sex acts are associated with STI infections among YMSM-YTW. This study leveraged 3years of data from a large longitudinal cohort of YMSM-YTW. A series of generalized linear mixed models examined the association between the number of condomless anal sex acts, number of one-time partners, number of casual partners, and number of main partners and chlamydia, gonorrhea, or any STI. Results indicated the number of casual partners was associated with gonorrhea [aOR = 1.17 (95% CI: 1.08, 1.26)], chlamydia [aOR = 1.12 (95% CI: 1.05, 1.20)], and any STI [aOR = 1.14 (95% CI: 1.08, 1.21)] while the number of one-time partners was only associated with gonorrhea [aOR = 1.13 (95% CI: 1.02, 1.26)]. The number of condomless anal sex acts was not associated with any outcome. These findings suggest the number of casual partners is a consistent predictor of STI infection among YMSM-YTW. This may reflect the quick saturation of risk within partnerships making the number of partners, rather than the number of acts, the more relevant factor for STI risk.

Efficacy of MyPEEPS Mobile, an HIV Prevention Intervention Using Mobile Technology, on Reducing Sexual Risk Among Same-Sex Attracted Adolescent Males

HIV transmission rates in the United States have increased among men who have sex with men. However, there are no published randomized trials examining interventions to reduce sexual risk for HIV acquisition in males younger than 18 years. To determine the efficacy of MyPEEPS Mobile, a mobile-delivered HIV prevention intervention, to reduce sexual risk behavior in same-sex attracted young males. This was a national randomized clinical trial of the efficacy MyPEEPS Mobile vs a delayed intervention among males aged 13 to 18 years to prevent or reduce sexual risk for HIV acquisition. Study activities were completed through 4 study sites in Birmingham, Alabama; New York, New York; Seattle, Washington; and Chicago, Illinois. Study staff at each site met with participants in person or via video conferencing. Data were collected from June 1, 2018, to April 7, 2020, and analyzed from July to October 2021. The MyPEEPS Mobile intervention contains 21 online psychoeducational and skill-building modules, which participants completed over a 3-month period. Participants randomized to the intervention group received access to MyPEEPS Mobile for the first 3 months, while those randomized to the delayed intervention group received access at their 9-month visit after data for the primary efficacy analysis had been collected. The self-reported primary outcome was change in the number of condomless anal sex acts between study conditions. Secondary outcomes were change in the number of sex partners, number of condomless anal sex partners, the number of sex acts while under the influence of substances, preexposure prophylactic uptake, nonoccupational postexposure prophylaxis use, and HIV and sexually transmitted infection testing. In the analytic sample of 763 racially and ethnically diverse study participants, the mean (SD) age was 16.2 (1.4) years; 736 participants (97%) were male, 13 (2%) nonbinary; and 6 (1%) genderqueer; 158 (21%) were Black or African American, 311 (41%) were Hispanic or Latino, and 284 (37%) were White. Overall, 382 were randomized to the intervention group and 381 to the delayed intervention group. At 3-month follow-up, there was a significant reduction in the number of condomless anal sex acts in the intervention group compared with the delayed intervention group (incidence rate ratio [IRR], 0.56; 95% CI, 0.32-0.99); however, there was no significant difference between groups at 6 or 9 months. In subgroup analyses, the intervention effect was pronounced among Black non-Hispanic participants at 3-month follow-up (IRR, 0.19; 95% CI, 0.04-0.94) and 6-month follow-up (IRR, 0.15; 95% CI, 0.03-0.78) compared with the delayed intervention group. There were no significant differences in the change in the number of sex partners, number of condomless anal sex partners, the number of sex acts while under the influence of substances, preexposure prophylactic uptake, nonoccupational postexposure prophylaxis use, and HIV and sexually transmitted infection testing between the intervention and delayed intervention groups. In this study, the MyPEEPS Mobile intervention demonstrated a 44% overall reduction in condomless anal sex at 3-month follow-up compared with the delayed intervention group, but not at 6 or 9 months. To our knowledge, MyPEEPS Mobile is the first intervention to demonstrate evidence of short-term efficacy for reducing sexual risk among same-sex attracted young males. ClinicalTrials.gov Identifier: NCT03167606.

Minority Stress, Identity Conflict, and HIV-Related Outcomes Among Men Who Have Sex with Men, Transgender Women, and Gender Nonbinary People of Color.

Purpose: This study investigated conflict between sexual orientation and racial/ethnic identities as a mechanism linking minority stress to HIV-related outcomes among men who have sex with men (MSM), transgender women and gender nonbinary (TGN) people of color (POC). Methods: We tested longitudinal mediation models with sexual orientation microaggressions, internalized heterosexism (IH), and sexual orientation concealment at Time 1, and pre-exposure prophylaxis (PrEP) use and number of condomless anal sex (CAS) partners at Time 3, mediated by identity conflict at Time 2. Participants were 337 MSM and TGN POC. Data were collected in Chicago, Illinois, from September 2018 to February 2021. Results: Indirect associations of IH and sexual orientation concealment, respectively, at Time 1 with CAS partners at Time 3 through identity conflict at Time 2 were significant. Mediation models with sexual orientation microaggressions as the predictor and PrEP use as the outcome were not significant. Conclusion: Minority stress may contribute to identity conflict and increase CAS by isolating MSM and TGN POC from sexual and gender minority communities, thus restricting access to safer sex resources, and by increasing psychological distress and decreasing self-care (e.g., condom use).

Strengthening resilience to reduce HIV risk in Indian MSM: a multicity, randomised, clinical efficacy trial

SummaryBackgroundMen who have sex with men (MSM) in India are extremely marginalised and stigmatised, and therefore experience immense psychosocial stress. As current HIV prevention interventions in India do not address mental health or resilience to these stressors, we aimed to evaluate a resilience-based psychosocial intervention in the context of HIV and sexually transmitted infection (STI) prevention.MethodsWe did a multicity, randomised, clinical efficacy trial in Chennai (governmental tuberculosis research institute) and Mumbai (non-governmental organisation for MSM), India. Inclusion criteria were MSM, aged 18 years or older, who were at risk of HIV acquisition or transmission, defined as having any of the following in the 4 months before screening: anal sex with four or more male partners (protected or unprotected), diagnosis of an STI, history of transactional sex activity, or condomless anal sex with a man who was of unknown HIV status or serodiscordant. Participants were required to speak English, Tamil (in Chennai), or Hindi (in Mumbai) fluently. Eligible individuals were randomly assigned (1:1) to either a resilience-based psychosocial HIV prevention intervention, consisting of group (four sessions) and individual (six sessions) counselling alongside HIV and STI voluntary counselling and testing, or a standard-of-care control comprising voluntary counselling and testing alone. The primary outcomes were number of condomless anal sex acts with male partners during the past month (at baseline and 4 months, 8 months, and 12 months after randomisation), and incident bacterial STIs (at 12 months after randomisation). Resilience-related mediators included self-esteem, self-acceptance, and depression. Recruitment is now closed. This trial is registered with ClinicalTrials.gov, NCT02556294.FindingsBetween Sept 4, 2015, and June 28, 2018, we enrolled 608 participants; 305 (50%) were assigned to the psychosocial intervention condition and 303 (50%) were assigned to the control condition. 510 (84%) of 608 men completed an assessment at 4 months after randomisation, 483 (79%) at 8 months, and 515 (85%) at 12 months. 512 (99%) of 515 men had STI data from the 12-month assessment. The intervention condition had a 56% larger reduction in condomless anal sex acts (95% CI 35–71; p<0.0001) from baseline to 4-month follow-up, 72% larger reduction (56–82; p<0.0001) from baseline to 8-month follow-up, and 72% larger reduction (53–83; p<0.0001) from baseline to 12-month follow-up, compared with the standard-of-care control condition (condition by time interaction; χ2=40.29, 3 df; p<0.0001). Improvements in self-esteem and depressive symptoms both mediated 9% of the intervention effect on condomless anal sex acts. Bacterial STI incidence did not differ between study conditions at 12-month follow-up.InterpretationA resilience-based psychosocial intervention for MSM at risk of HIV acquisition or transmission in India was efficacious in reducing condomless anal sex acts, with evidence for mediation effects in two key target resilience variables. HIV prevention programmes for MSM in India should address mental health resilience to augment reductions in the risk of sexually transmitted HIV.FundingNational Institute of Mental Health.

Understanding pre-exposure prophylaxis (PrEP) regimen use: Switching and discontinuing daily and event-driven PrEP among men who have sex with men.

BackgroundOptimising HIV pre-exposure prophylaxis (PrEP) provision requires insight into preferences of PrEP regimens and PrEP discontinuation. We assessed regimen switching and discontinuation and their determinants among men who have sex with men (MSM) participating in the Amsterdam PrEP demonstration project.MethodsBetween 3-August-2015 and 31-May-2016, we enrolled MSM (n = 374) and TGP (n = 2) in a prospective, longitudinal study. Participants could choose between daily or event-driven PrEP regimens at enrolment and every 3 months. We assessed transition intensities (TI) and determinants of switching (i) between regimens, and (ii) from either regimen to discontinuing PrEP using a multi-state Markov model. PrEP discontinuation was defined as formally stopping study participation or having no study visit for ≥6 months.FindingsOf 367 analysed participants, 73·3% chose daily and 26·7% event-driven PrEP at enrolment. Median follow-up was 3·1 years (IQR 2·9–3·2). 121 participants switched their PrEP regimen at least once (cumulative probability 34·2%, 95% CI 29·4–39·6), with 90 switches from event-driven to daily PrEP (TI 0·35/PY, 95% CI 0·29–0·44) and 113 switches from daily to event-driven PrEP (TI 0·16/PY, 95% CI 0·13–0·20). Switching from event-driven to daily PrEP was associated with younger age, not reporting sex with HIV-positive partners, chemsex, and sexual compulsivity. Switching from daily to event-driven PrEP were associated with younger age and lower sexual satisfaction. 67 participants discontinued PrEP (cumulative probability 17·7%, 95% CI 14·1–22·2), with no difference between regimens: event-driven (n = 23, TI 0·08/PY, 95% CI 0·05–0·13) and daily PrEP (n = 44, TI 0·06/PY, 95% CI 0·04–0·08). Discontinuing daily PrEP was associated with younger age, fewer casual partners, and higher number of condomless anal sex acts with casual partners.InterpretationSwitching between PrEP regimens was common, while going from event-driven to daily PrEP use was associated with certain sexual-related determinants (i.e. chemsex, sexual compulsivity, no known HIV-positive partners). PrEP discontinuation rates were low and independent of regimens. PrEP care should consider the reasons for choice and switch of regimen and involve education on safely switching or discontinuing PrEP, especially among younger MSM. FundingZonMw, H-TEAM, RIVM, GGD research funds, Aidsfonds, Amsterdam Diner Foundation, Gilead Sciences, Gilead Sciences Europe Ltd, Janssen Pharmaceuticals, MAC AIDS Fund, ViiV Healthcare.

Network-Level Correlates of Sexual Risk Among Male Sex Workers in the United States: A Dyadic Analysis.

Male sex workers (MSWs) are at increased risk of HIV infection in the United States. Research is limited on sexual and drug use network characteristics of MSWs. Community-based organization and health center in 2 US Northeast cities. One hundred MSWs completed a behavioral assessment and sexual and drug network inventory. Using dyadic analyses, we assessed whether network characteristics, including sex worker-male client age, race, and HIV status homophily and risk multiplexity (ie, overlap in drug-use and sex networks), were associated with condom use. MSW participants' mean age was 33.6. Two-thirds identified as Black or Latino, 12% identified as heterosexual, and 90% reported recent drug use. Participants reported an average of 5.3 male clients in the past month (SD = 3.4), and having anal sex with 74% of these clients, at a rate of 2.2 times per month (SD = 4.6). Participants reported inconsistent condom use during anal sex with 53% of clients. In multivariable models, inconsistent condom use was more common in relationships with presumed HIV status homophily [odds ratio (OR): 1.25; 95% confidence interval (CI): 1.07 to 1.46] and sexual and drug network multiplexity (OR: 1.19; 95% CI: 1.09 to 1.30); and less common within relationships where the client is older than the MSW participant (OR: 0.83; 95% CI: 0.74 to 0.93). Number of multiplex relationships was positively associated with number of condomless anal sex acts with male clients (incidence rate ratio: 1.35; 95% CI: 1.19 to 1.54). Network characteristics may contribute to disproportionate HIV risk among MSWs. Modeling studies should include network characteristics when simulating HIV transmission, and future HIV interventions should address the role of networks.

Social Capital Moderates the Relationship Between Stigma and Sexual Risk Among Male Sex Workers in the US Northeast.

Stigma contributes to elevated HIV incidence among male sex workers (MSW). Social capital (i.e., resources accessed through one's social relationships) may act as a buffer between stigma and sexual risk behaviors and HIV acquisition. Using negative binomial regression, we examined the association between both sex work-related stigma and social capital with respect to number of condomless sex acts among 98 MSW living in the US Northeast. In models adjusted for sociodemographic characteristics, sex work-related stigma was associated with number of condomless sex acts with any non-paying partner (i.e., male and female) (aIRR = 1.25, p < 0.001) and male non-paying partners (aIRR = 1.27, p = 0.09) among individuals with low social capital, not among those with high social capital. Sex work-related stigma was not associated with number of condomless anal sex acts with male paying clients at any level of social capital. Future HIV prevention interventions should consider promoting social capital among MSW.

Sexual behaviour and incidence of HIV and sexually transmitted infections among men who have sex with men using daily and event-driven pre-exposure prophylaxis in AMPrEP: 2 year results from a demonstration study

Pre-exposure prophylaxis (PrEP) for HIV might induce risk compensation, defined as increased sexual risk behaviour leading to increased incidence of bacterial sexually transmitted infections (STIs). We examined the incidence of HIV, STIs, and sexual behaviour after initiating daily and event-driven PrEP. AMPrEP is a demonstration study that assessed the incidence of HIV and bacterial STIs and sexual behaviour among PrEP users at the STI clinic of the Public Health Service of Amsterdam (Amsterdam, the Netherlands). Eligible adults (aged ≥18 years) were HIV-negative men who have sex with men (MSM) and transgender people who had reported one or more of the following in the previous 6 months: condomless anal sex with casual partners, at least one bacterial STI, use of post-exposure prophylaxis after a sexual risk incident, or an HIV-positive sexual partner with detectable viral load. Participants were given a choice of daily PrEP or event-driven PrEP regimens. Participants were seen every 3 months for HIV and STI testing. Participants also completed self-administered questionnaires about sexual behaviour at each visit. Over the first 2 years, we assessed the number and incidence rate of HIV and chlamydia, gonorrhoea, and syphilis, including STIs diagnosed in between study visits and assessed changes in incidence over time using piecewise exponential survival models. The number of sexual acts and sexual partners were also analysed and changes over time were assessed using negative binomial regression models. This study is ongoing; the data cutoff for this analysis was June 30, 2018. Between Aug 3, 2015, and May 31, 2016, 376 participants were recruited, of whom nine participants were lost to follow-up, thus 367 participants were included in the analysis. Overall, 365 MSM and two transgender women were included, contributing 681·7 person-years of follow-up. At enrolment, 269 (73%) of 367 participants chose daily PrEP and 98 (27%) participants chose event-driven PrEP. Two individuals in the daily PrEP group became HIV-positive; overall HIV incidence rate was 0·30 per 100 person-years (95% CI 0·07-1·19). 253 participants were diagnosed with one or more STI during the first 2 years (incidence rate 90·4 per 100 person-years). STI incidence did not change over time (adjusted incidence rate ratio [aIRR] 1·00 per 3 month follow-up, 95% CI 0·93-1·07). More than a quarter of all STIs were diagnosed from tests done in between study visits. STI incidence was lower in the event-driven PrEP group than the daily PrEP group (aIRR 0·59, 95% CI 0·46-0·75). The number of condomless anal sex acts with casual partners per 3 months increased, but the number of partners and sex acts remained stable. Although the overall incidence of STIs did not change during 2 years of PrEP use, the incidence of STIs was higher among participants using daily PrEP than those using event-driven PrEP, which is likely a result of differences in sexual behaviour. This finding suggests the need to tailor STI prevention interventions according to behavioural profiles. ZonMw, H-TEAM, Internal GGD research funds, Aidsfonds, Stichting AmsterdamDiner Foundation, Gilead Sciences, Janssen Pharmaceutica, M A C AIDS Fund, and ViiV Healthcare.

Sexually Explicit Media and Condomless Anal Sex Among Gay and Bisexual Men.

Gay and bisexual men (GBM) have reported viewing significantly more sexually explicit media (SEM) than heterosexual men. There is some evidence that SEM depicting bareback anal sex may be linked to engagement in condomless anal sex (CAS) and thus HIV/STI transmission among GBM. A nationwide sample of HIV-negative GBM in the U.S. completed an online survey that included measures on SEM consumption (both overall frequency and percentage viewed depicting bareback sex) and reported on CAS in the past 3months. Data showed that there was no main effect for the frequency of SEM watched in association on either the number of CAS acts with casual partners or the probability of engaging in CAS during a casual sex event. However, there was an interaction between amount of SEM consumed and percentage of bareback SEM consumed on both outcomes, such that men who reported both a high frequency of SEM consumption and a high percentage of their SEM being bareback reported the highest levels of risk behavior. These findings highlight the role that barebacking depicted in SEM may play in the normalization of sexual risk behaviors for GBM. Interventions looking to target the role SEM may play in the lives of GBM should examine what variables may help to mediate associations between viewing SEM and engaging in risk behavior.

Recent HIV Risk Behavior and Partnership Type Predict PrEP Adherence in Men Who Have Sex with Men

BackgroundIndividuals engaging in higher risk behavior are often more adherent to PrEP but it is unclear if partnership type itself affects PrEP adherence. We examined the effect of recent HIV risk behaviors and partnership type on PrEP adherence in men who have sex with men (MSM) taking PrEP.MethodsCCTG 595 is a 48-week PrEP demonstration study of 398 HIV− at-risk MSM. At baseline and week 48, HIV risk score was estimated as the probability of seroconversion over the next year based on number of condomless anal sex acts with HIV+/unknown partners in the last month and any STI diagnosed at study visit. HIV risk score was categorized as low (<0.12), moderate (0.12−0.59) and high (>0.59) risk based on population seroconversion probabilities. Partnership type was assigned as no/single HIV− partner, single HIV+ partner, or multiple partners of any serostatus in the past 3 months. PrEP adherence was estimated by intracellular tenofovir-diphosphate (TFV-DP) levels as a continuous variable at week 48. Statistical methods included McNemar’s test, Wilcoxon rank-sum test, and linear regression model where appropriate.ResultsOf 313 MSM who completed week 48, there was no significant change in HIV risk category from baseline to week 48 (low: 44 to 42%; moderate: 27 to 24%; high: 28 to 34%; P = 0.25). There was a significant change in partnership type, with the proportion of those with no or single HIV− partnerships increasing (1 to 9%, P < 0.001). In univariate analysis, moderate and high-risk groups had higher TFV-DP levels than the low-risk group at week 48 (P = 0.018). Participants with no/single HIV− partner had significantly lower TFV-DP levels than those with one HIV+ partner or multiple partners (P = 0.007). In a multivariable linear regression model, only low-risk partnerships remained significant where no/single HIV− partnerships were associated with lower TFV-DP levels (mean difference = −344fmol/punch [−617, −71], P = 0.014).ConclusionAlthough there was a shift in partnership type towards lower risk partnerships, objective HIV risk behavior remained stable over time. Individuals with higher HIV risk behaviors and risk partnerships had higher TFV-DP levels suggesting maintained strong motivation for PrEP adherence. Thus, recent sexual risk behavior and partnership type may be important predictors of PrEP adherence in MSM.Disclosures All authors: No reported disclosures.

A Pilot Randomized Controlled Trial of an Integrated In-person and Mobile Phone Delivered Counseling and Text Messaging Intervention to Reduce HIV Transmission Risk among Male Sex Workers in Chennai, India.

Men who have sex with men (MSM) are at increased risk for HIV infection in India, particularly those who engage in transactional sex with other men (i.e., male sex workers; MSW). Despite the need, HIV prevention efforts for Indian MSW are lacking. As in other settings, MSW in India increasingly rely on the use of mobile phones for sex work solicitation. Integrating mobile phone technology into an HIV prevention intervention for Indian MSW may mitigate some of the challenges associated with face-to face approaches, such as implementation, lack of anonymity, and time consumption, while at the same time proving to be both feasible and useful. This is a pilot randomized controlled trial to examine participant acceptability, feasibility of study procedures, and preliminary efficacy for reducing sexual risk for HIV. MSW (N=100) were equally randomized to: (1) a behavioral HIV prevention intervention integrating in-person and mobile phone delivered HIV risk reduction counseling, and daily, personalized text or voice messages as motivating "cognitive restructuring" cues for reducing condomless anal sex (CAS); or (2) a standard of care (SOC) comparison condition. Both groups received HIV counseling and testing at baseline and 6-months, and completed ACASI-based, behavioral and psychosocial assessments at baseline, 3, and 6months. Mixed-effects regression procedures specifying a Poisson distribution and log link with a random intercept and slope for month of follow-up was estimated to assess the intervention effect on the primary outcomes: (1) CAS acts with male clients who paid them for sex, and (2) CAS acts with male non-paying sexual partners-both outcomes assessed over the past month. The intervention was both feasible (98% retention at 6-months) and acceptable (>96% of all intervention sessions attended); all intervention participants rated the intervention as "acceptable" or "very acceptable." A reduction in the reported number of CAS acts with male clients who paid them for sex in the past month was seen in both study conditions. MSW in the intervention condition reported a faster rate of decline in the number of CAS acts with male clients in the past month from the baseline to both the 3-month (B=-1.20; 95% CI -1.68, -0.73; p<0.0001) and 6-month (B=-2.44; 95% CI -3.35, -1.53; p<0.00001) assessment visits compared to the SOC condition. Post-hoc contrasts indicated that, at 3months, participants in the intervention condition reported 1.43 (SD=0.29) CAS acts with male clients in the past month compared to 4.85 (SD=0.87) in the control condition (p=0.0003). Furthermore, at 6months, the intervention condition participants reported 0.24 (SD=0.09) CAS acts with male clients in the past month compared to 2.79 (SD=0.79) in the control condition (p<0.0001). Findings are encouraging and provide evidence of feasibility and acceptability, and demonstrate initial efficacy (for reducing sexual risk for HIV) of a behavioral HIV prevention intervention for Indian MSW that combines daily, personalized text or voice messages with mobile phone-delivered sexual risk reduction counseling and skills building. Future testing of the intervention in a fully powered randomized controlled efficacy trial is warranted.

Using Online Settings to Identify Gay and Bisexual Men Willing to Take or With Experience Taking PrEP: Implications for Researchers and Providers.

Given the ongoing HIV epidemic, it is essential to identify gay and bisexual men who are interested in starting PrEP as well as active PrEP users. We report on online survey data gathered over a 17-month period in 2014-2015 from gay and bisexual men identified through six sources of recruitment (n = 2903): Facebook, a hookup website, two geosocial-sexual networking apps (herein "App 1: Pop-up ads" and "App 2: Banner ads"), and two types of listservs (one focused on general gay nightlife, and one focused on gay sex parties). Willingness to take PrEP were as follows: sex party listservs (71.3%), both apps (69.8%), Facebook (67.6%), hookup website (65.2%), and nightlife listservs (50.5%). Experience having taken PrEP was as follows: sex party listservs (23.4%), App 2: Banner ads (22.5%), nightlife listservs (17.1) Facebook (14.2%), App 1: Pop-up ads (12.4%), and hookup website (2.1%). In multivariable modeling, willingness to go on PrEP was independently associated with being younger, single, a person of color, and having been tested for HIV in the past 12 months. Source of recruitment was largely unassociated with willingness to start PrEP. Number of recent male partners, number of recent condomless anal sex (CAS) events, and when data were collected (i.e., time in months) were not significantly associated with willingness to start PrEP. In multivariable models, experience having taken PrEP was positively associated with sexual identity as gay, number of recent male sex partners, number of recent CAS acts, being tested for HIV in the past 12 months, and time (in months). Experience taking PrEP varied greatly by recruitment source, suggesting both researchers and providers might be well served to utilize digital mediums to effectively identify these individuals; however, should do so with caution as not all digital options may prove fruitful.

Erratum to: The Role of Structural Barriers in Risky Sexual Behavior, Victimization and Readiness to Change HIV/STI-Related Risk Behavior Among Transgender Women

This study examines the role of structural barriers experienced by a community-based sample of 63 HIV-positive and negative transgender women that may elevate HIV infection and transmission risks. Separate hierarchical linear multiple regression analyses tested the association between structural barriers (e.g., unemployment, lack of food, shelter) and condomless anal sex acts, abuse, and readiness to change risk behavior, while controlling for other related factors. Among this primarily Hispanic and African-American sample, HIV-positive and negative transgender women experienced a similar number of structural barriers and experiencing structural barriers was significantly associated with an increased number of condomless anal sex acts (p = .002), victimization (p = .000) and a decreased readiness to change HIV-related risk behavior (p = .014). Structural-level interventions are needed to address this elevated risk among this underserved and hard-to-reach population.

The Role of Structural Barriers in Risky Sexual Behavior, Victimization and Readiness to Change HIV/STI-Related Risk Behavior Among Transgender Women.

This study examines the role of structural barriers experienced by a community-based sample of 63 HIV-positive and negative transgender women that may elevate HIV infection and transmission risks. Separate hierarchical linear multiple regression analyses tested the association between structural barriers (e.g., unemployment, lack of food, shelter) and condomless anal sex acts, abuse, and readiness to change risk behavior, while controlling for other related factors. Among this primarily Hispanic and African-American sample, HIV-positive and negative transgender women experienced a similar number of structural barriers and experiencing structural barriers was significantly associated with an increased number of condomless anal sex acts (p=.002), victimization (p=.000) and a decreased readiness to change HIV-related risk behavior (p=.014). Structural-level interventions are needed to address this elevated risk among this underserved and hard-to-reach population.

A Group-Based Sexual Risk Reduction Intervention for Men Who Have Sex With Men in Ho Chi Minh City, Vietnam: Feasibility, Acceptability, and Preliminary Efficacy

An emerging HIV epidemic can be seen among men who have sex with men (MSM) in Vietnam. There are currently no evidence-based behavioral sexual risk reduction interventions for MSM in this setting. Between October 2012 and June 2013, 100 high-risk MSM from Ho Chi Minh City were enrolled in an open pilot trial to assess feasibility and acceptability of a group-based, manualized sexual risk reduction intervention, and to preliminarily examine changes in primary and secondary outcomes. Participants completed a behavioral assessment battery and HIV testing at baseline, 3, and 6 months post-baseline. Over 80.0% of the sample was <25years old and 77.0% identified as Bong kin ("hidden," masculine-appearing). Feasibility and acceptability of the program was evidenced by 87.0% retention for the intervention sessions, 78.0% completion of the 6 month assessment, and positive responses on evaluation forms and qualitative exit interviews. There was a decline in the number of condomless anal sex acts from baseline (6.32) to 3 month (2.06) and 6 month (2.49) follow-up (p<.0001). These data support the need for further testing of this group-based, behavioral HIV prevention intervention to reduce sexual risk behavior among MSM in Vietnam in a randomized controlled efficacy trial.

Gay-Related Rejection Sensitivity as a Risk Factor for Condomless Sex.

Gay-related rejection sensitivity has been linked to numerous adverse health outcomes, but its relationship to condomless sex remains unexamined. The present study investigated the role of gay-related rejection sensitivity as a predictor of condomless sex. Gay and bisexual men completed questionnaires measuring rejection sensitivity and condom use self-efficacy as well as a timeline followback interview regarding past 90-day sexual behaviors. Gay-related rejection sensitivity was positively associated with the number of condomless anal sex acts with casual partners, and condom use self-efficacy mediated this association. These findings have important implications for effective HIV prevention efforts among this at-risk population.