Receptive Anal Intercourse Research Articles

A Sequential Mixed-Methods Study of Factors Associated with Low High-Resolution Anoscopy Completion in Transgender Women with Abnormal Anal Cytology.

In a cohort of transgender women (TGW) with abnormal anal cytology (AAC) in Washington, DC, we determined the rates of and factors associated with completion of high-resolution anoscopy (HRA). This mixed-methods study used a sequential study design. In an academic-community clinic, we recruited TGW who provided blood samples, anal swabs for anal cytology, and completed surveys. For the quantitative phase of this study, we used χ2 test to compare factors associated with HRA completion among TGW with AAC. From that cohort, we used purposive sampling to recruit 16 TGW for qualitative interviews, based on their HRA completion status. We used thematic analysis to analyze the qualitative data. Of 75 TGW, 36 (48%) had AAC, 32 (43%) were referred to HRA, and 15 (20%) completed HRA. HRA completion was associated with being employed (75% vs. 25%; p = 0.01) in the quantitative phase, and low socioeconomic status (SES) was considered a barrier to completing HRA in the qualitative phase. HRA completion was associated with suppressed HIV (67% vs. 18%; p = 0.01) in the quantitative phase. In the qualitative phase, trans-affirming care, receptive anal sex, and engaging in sex work were identified as motivators to completing HRA. In a population of TGW, we found high rates of AAC and low rates of HRA completion. Interventions targeting this gap should address barriers associated with low SES and HIV viremia in TGW. Trans-affirming care and the impact on anal sexual practices should be used as motivators to engage TGW in anal cancer screening.

Rectal Douche as HIV Pre-Exposure Prophylaxis for Receptive Anal Intercourse: An End User Tenofovir Powder Sachet Preparation Feasibility Study (DREAM-04).

Unprotected receptive anal intercourse (RAI) carries the highest sexual HIV transmission risk. The need for diverse pre-exposure prophylaxis (PrEP) options has encouraged the development of on-demand, topical PrEP products for those preferring non-systemic or occasional PrEP. We assessed end-users' proficiency in preparing tenofovir douches from sachets containing two different powder types, lyophilized and spray-dried, and evaluated their experience. Cisgender adult men with a history of RAI-related douching were consented, screened, and randomized 1:1 to the order of the powder type prepared. All participants prepared at least three enema bottles of each powder type. Aliquots from each prepared douche bottle were analyzed for TFV concentration, osmolality, and pH. User experience and likelihood of future product use were assessed by questionnaire. Twenty-one eligible participants were enrolled. Most participants reported both products as easy or very easy to prepare and likely or very likely to be used. Participants preferred the lyophilized product. The lyophilized and spray-dried douche bottles prepared met the osmolality specifications 89% and 61% of the time and TFV content specifications 81% and 29% of the time, respectively. Questionnaires indicated the most common challenges were tearing open the sachets and transferring the spray-dried product. The majority of participants reported the douches were easy to prepare and indicated likely future use. While the lyophilized sachets were prepared sufficiently to establish preparation feasibility, the spray-dried sachets often fell outside specifications. Failure analysis provided insights to guide product modifications to improve the proficiency of douche preparation and future product use.

Infection and Persistent Infection of Human Papillomavirus Among HIV-Negative Men Who Have Sex with Men in Xinjiang, China: A Prospective Cohort Study.

Anal HPV infection is particularly prevalent among men who have sex with men (MSM). The purpose of this study was to understand the status and influencing factors of HPV infection in MSM in Urumqi, Xinjiang, in order to provide suggestions for policy formulation. A prospective cohort study was conducted among HIV-negative MSM in Urumqi Xinjiang between April 2016 and June 2023. 824 MSM were recruited. Data were collected anal swab results from self-administered questionnaires and laboratory tests. A Cox regression model was employed to analyze factors associated with HPV infection. The prevalence rates of high-risk HPV and low-risk HPV were 37.99% and 25.97%. Receptive anal intercourse is a well-established risk factor for both incident and persistent HPV infections among MSM. For new high-risk HPV infections, the adjusted hazard ratio is 1.55 (95% CI: 1.28-1.89), and for persistent high-risk HPV infections, the aHR is 1.95 (95% CI: 1.48-2.57). Similarly, for low-risk HPV, receptive anal intercourse increases the risk of incidence (aHR = 1.34, 95% CI: 1.07-1.67) and persistent infection (aHR = 1.64, 95% CI: 1.18-2.29). Seeking sexual partners in bathhouses raised the risk of low-risk HPV infections (aHR = 1.36, 95% CI: 1.05-1.76). Young MSM may face a higher risk of HPV infection. Implementing targeted HPV vaccination catch-up programs for the MSM population in Urumqi could offer significant societal benefits.

Highly viable gastrointestinal Chlamydia trachomatis in women abstaining from receptive anal intercourse

Chlamydia trachomatis (CT) may employ persistence to evade antimicrobial clearance, possibly residing in the gastrointestinal tract. This study assessed the reliability of droplet digital PCR (ddPCR) in CT detection, its functionality in viability assessment, and predictions on CT transmission dynamics by combining viability PCR (vPCR) and clinical data from 52 infected women. The ddPCR showed 94% positive and 100% negative agreement with Abbott Alinity STI-M for endocervical samples, and 92% positive and 87% negative agreement in rectal samples. Viability was higher in endocervical samples (89.1%) than in rectal samples (69.4%). Samples from participants not engaging in anal intercourse, and with non-concordant multi-locus sequence typing between rectum and endocervix, had on average the highest viability in rectum, indicating a persistent population residing in the gastrointestinal tract. This study demonstrates the effectiveness of ddPCR in detecting CT, especially in samples with high inhibition or low bacterial load, suggesting its superiority over quantitative real-time PCR. These findings support that rectal CT infection can occur independently of anal intercourse, possibly through vaginorectal contamination or oral routes. High rectal CT viability, independent of endocervical infection, indicates potential gastrointestinal establishment. Understanding CT dynamics in various infection sites can provide insights into the epidemiology and pathogenesis of CT.

HIV prevention among adolescents travestis and transgender women in three Brazilian capitals, 2019-2023.

To describe HIV prevention strategies and gender-based discrimination among adolescent travestis and transgender women. This was a cross-sectional study involving 148 adolescent travestis and transgender women aged 15 to 19 years in Salvador, Bahia state, São Paulo, São Paulo state, and Belo Horizonte, Minas Gerais state, conducted between February 2019 and March 2023. Fisher's exact test was performed to assess differences between prevention strategies and gender-based discrimination within healthcare services. 18.9 % reported engaging in receptive anal sex using condom in the past 6 months; 62.2% had undergone HIV test at least once in their lifetime; and 88.5% had started pre-exposure prophylaxis (PrEP) for HIV. Adolescents aged 15 to 17 years with previous experiences of discrimination in healthcare services had undergone fewer HIV tests in their lifetime or had started PrEP less frequently. There is an urgent need for the implementation of public policies that eradicate gender-based discrimination and expand access to HIV prevention.

Hepatitis C Treatment and Behavioral Risk Among Men Who Have Sex With Men With HIV: Comparing Interferon and Direct-Acting Antiviral Eras.

Little is known about the effect of hepatitis C virus (HCV) treatment on sexual risk behavior among men who have sex with men (MSM) with HIV by treatment type (interferon [IFN]-based vs direct-acting antiviral [DAA]-based). MSM with HIV and recently acquired HCV infection enrolled in the MSM Observational Study of Acute Infection with hepatitis C (MOSAIC) cohort. Using data from 2009 to 2018, we evaluated risk behavior through a validated HCV risk score (where ≥2 indicated high risk) and its individual risk behaviors. Levels of risk behavior before, during, and after treatment were modeled for each treatment episode using linear and logistic regression with Generalized Estimating Equations adjusting for DAA availability and number of reinfections. One hundred forty 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 to 2.6), 0.9 (95% CI = 0.8 to 1.0), and 1.7 (95% CI = 1.5 to 1.8), respectively. Before treatment, no differences in mean HCV risk score or proportion of specific behaviors 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 in MSM treated with IFN. MSM treated with DAAs, compared with MSM treated with IFN, had higher levels of HCV-related risk behavior during treatment. The higher risk of HCV reinfection in the DAA-era underscores the need for ongoing HCV testing and behavioral interventions against HCV.

Rectal mucosal inflammation, microbiome, and wound healing in men who have sex with men who engage in receptive anal intercourse

Abstract Mucosal injury is common during consensual intercourse and induces an inflammatory response that could contribute to pathogen transmission including HIV. Here, we compared mucosal immune and microbiome responses to experimentally induced mucosal injury between men who have sex with men engaging in receptive anal intercourse (MSM-RAI) and men who do not engage in RAI (controls), all without HIV. Rectal mucosal secretions were collected from adult MSM-RAI (n = 19) and controls (n = 6) via anoscopy before and up to eight days after experimentally induced injury. Mucosal healing was evaluated by repeated injury surface area measurements with digital imaging. MSM-RAI demonstrated overall significantly higher concentrations of pro-inflammatory cytokines and a distinct rectal microbiome compared with controls. Wound healing was numerically faster in MSM-RAI but did not meet statistical significance (p = 0.09). Different cytokine injury response patterns were observed between MSM-RAI and controls; however, IL-6 and IP-10 were important mediators in both groups. Microbial guilds, particularly from the Lachnospiraceae and Prevotellaceae families, were associated with rectal mucosal inflammation. This work is the first experimental study of rectal mucosal injury and the immune environment in healthy humans and provides a more nuanced understanding of rectal mucosal inflammation after injury, which can inform our understanding of HIV transmission.

The rectal microbiome: understanding its role in HIV transmission.

Condomless receptive anal intercourse stands out as the sexual practice with highest risk of HIV-1 infection. Recent studies have suggested that the gut microbiome influences susceptibility to HIV transmission. This review explores recent research on host risk factors, the rectal microbiome composition, local inflammation, and bacteria-derived mediators that may affect HIV transmission. Constitutive host factors such as rectal mucosal structure and immune cell populations in the rectum contribute to increased susceptibility. Changes in the composition of the rectal microbiota, influenced by sexual practices and HIV infection modulate immune activation and inflammation, impacting HIV susceptibility. Bacteria-derived mediators may further influence immune responses and HIV replication in the rectal mucosa. Understanding the role of the rectal microbiome in HIV transmission has important clinical implications. Targeted interventions that modulate the microbiome may reduce susceptibility to HIV transmission by regulating immune responses and inflammation. Further research into the host-microbiome interactions could lead to novel preventive and therapeutic strategies to mitigate HIV transmission.

Receptive Anal Intercourse: Impact on Colorectal and Urologic Diagnoses.

Purpose: We evaluated the relationship between lifetime receptive anal intercourse (RAI) and the risk of common colorectal and urologic diagnoses. Methods: We conducted an internet-based survey on sensations during RAI between July 2022 and March 2023. We used multivariable logistic regression to assess the independent impact of lifetime RAI exposure on the diagnosis of common urologic and colorectal conditions. Participants completed a main survey and were invited to complete randomly assigned patient-reported outcome measures (PROMs), which measured pelvic symptoms, mental health symptoms, and sexual satisfaction. Results: In total, 1100 participants completed the main survey and 416 completed the PROMs. Participants of the main survey ranged from 18 to 78 years old and the median age of the sample was 32 years. There was no significant association between lifetime RAI exposure and any medical diagnosis, except for anal fissures, which increased linearly with additional RAI exposure. Both sexual satisfaction and mental health symptoms improved with RAI exposure. Conclusions: RAI was not associated with most of the colorectal and urologic diagnoses tested and was associated with fewer mental symptoms and increased sexual satisfaction. Development of anal fissures may be directly related to trauma of the anal canal from penetration.

Understanding the sources of efficacy dilution in a trial of a monthly dapivirine vaginal ring for HIV-1 prevention.

Women-initiated HIV - 1 prevention products are key to reducing women's HIV-1 risk. Clinical trials of vaginal microbicides have shown limited to no efficacy in intention-to-treat (ITT) analyses. It is hypothesized that these negative results are partly due to efficacy dilution. We developed a microsimulation model of MTN-020/ASPIRE, a phase 3 trial that evaluated monthly use of a dapivirine vaginal ring for HIV-1 prevention. We evaluated four sources of efficacy dilution: trial-level factors: (i) an imbalance in the number of monthly sex acts between study arms and (ii) heterogeneity in risk emergent over time; and individual-level factors: (iii) product non-adherence and (iv) receptive anal intercourse. Assuming 70% per-vaginal exposure efficacy (consistent with the ITT estimate of 27%), heterogeneity in risk accounted for the largest proportion of efficacy dilution, at 42% (90% CrI: 38, 45), followed by non-adherence (33%; 90% CrI: 27, 39), an imbalance in arms (18%; 90% CrI: 16, 21) and lastly, anal intercourse with less than 10% of efficacy dilution. Our results suggest that heterogeneity in risk was the most important source of efficacy dilution in the ASPIRE trial. Future trials of HIV-1 prevention products for women should consider alternative trial designs and analytic approaches that minimize bias introduced by heterogeneity in risk.

Duration of kissing in different intimate positions among men who have sex with men: A cross-sectional study.

Despite mounting evidence showing that kissing (tongue-kissing) may transmit gonorrhoea between men who have sex with men (MSM), little data exists on factors influencing the duration of kissing while they are above and/or lying underneath a partner for this population group. Between May 2019 and March 2020, we invited MSM aged ≥18years who attended the Melbourne Sexual Health Centre (MSHC) to participate in a survey about the duration of their kissing (minutes) and intimate position while kissing (i.e., kissing while above, or while lying underneath) their most recent partner. Univariable and multivariable negative binomial regressions were performed to examine the associations between the duration of kissing in different intimate positions, and demographic and behavioural characteristics (including age, region of birth, HIV status or PrEP use, and role in anal sex). Of the 965 men with a recent male kissing partner, 89.0% (n = 859) also had sex with that partner. Of the 166 men with a recent female kissing partner, 71.7% (n = 119) also had sex with that partner. Our adjusted analyses showed that, on average, men born in Asia (mean 8.52 vs 11.69min, p < .001) and South America or the Caribbean (mean 8.61 vs 11.69min, p = .022) spent less time kissing compared to men born in Oceania, and the same was also observed for kissing while above or lying underneath. Men who had only receptive anal sex spent less time kissing while above than those who only had insertive anal sex (mean 3.04 vs 5.86min, p < .001). Our study is the first to examine factors that influence duration of kissing in different intimate positions. These factors could be associated with oropharyngeal gonorrhoea if saliva transmitted gonorrhoea and if gravity played a role.

Prospective longitudinal study of men who have sex with men and transgender women to determine HIV incidence in two provinces in Thailand.

In Thailand, HIV transmission is well characterized in large urban centers such as Bangkok and Chiang Mai but less so outside of these areas. The main purpose of this study was to assess HIV incidence and associated risk factors in Nakhon Ratchasima and Ratchaburi. Participants assigned male sex at birth were enrolled in this prospective observational cohort study between November 2017 and July 2018. HIV and syphilis testing and sociobehavioral questionnaires were administered over 18 months. HIV incidence rates and 95% confidence intervals (CIs) were estimated using a Poisson distribution. Cox proportional hazards models were used to estimate unadjusted and adjusted hazard ratios (aHRs) and 95% CIs for associations between potential risk factors and HIV seroconversion. A total of 1003 participants were enrolled. Overall HIV incidence was 1.56 per 100 person-years (95% CI:1.02-2.44) and similar at both sites. In the fully adjusted model, sex with a sex worker in the past six months was associated with reduced risk of seroconversion (aHR:0.10, 95% CI:0.01-0.77). In the reduced adjusted model, receptive anal sex (aHR:3.40, 95% CI:1.32-8.74) and STI diagnosis in the past six months (aHR:3.58, 95% CI:1.19-10.76) were associated with seroconversion, while sex with a sex worker in the past six months was associated with reduced risk of seroconversion (aHR:0.11, 95% CI:0.02-0.67). Additionally, 56% reported interest in taking PrEP and 82% reported willingness to participate in a hypothetical future vaccine trial. Recent receptive anal sex practices were associated with HIV acquisition in these populations, highlighting the continued need for interventions encouraging safer anal sex practices to reduce HIV incidence.

“I Feel More Masculine Having Sex with a Woman Than Being Fucked by a Man”: Masculinity and Bisexual Men's Experiences of Sex with Women and Men

ABSTRACT Prior research with heterosexual and gay men suggests that heteronormative, hegemonic masculine norms influence sexual behaviors, including in relation to sexual health, and in sex between men, positioning in anal intercourse. This qualitative study offers an in-depth account of how bisexual men’s beliefs about masculinity and about the gendered nature of certain sexual behaviors may influence their experiences of sex with women and men, and the sexual practices they engage in. Twenty-two bisexual men participated in one-to-one, semi-structured interviews, where they were asked about their experiences of sex with women and men in relation to their beliefs about masculinity. A reflexive thematic analysis identified the influence of prevailing discourses of heteronormativity and hegemonic masculinity on sexual experiences and behaviors. Participants’ beliefs about masculinity and the gendered nature of certain aspects of sex influenced experiences relating to sexual performance, sexual assertiveness, positions adopted, practices engaged in, and how gender was enacted in sexual encounters. Sex with women was experienced as more masculine than sex with men: Participants described feeling more sexually assertive than their sexual partners, in control of the encounter, and responsible for facilitating their partners’ sexual pleasure. Sex with men was experienced as more egalitarian and provided favorable opportunities to relinquish sexual control and responsibilities around facilitating pleasure, and to feel less masculine, including by engaging in receptive anal intercourse. Findings therefore indicate that, for some bisexual men, masculinity is highly salient, influencing a range of sexual behaviors and experiences in sex with women and with men.

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.

The Impact of Pleasure and Pain on Frequent Substance Use During Receptive Anal Intercourse

ABSTRACT Sexualized drug use (SDU) describes use of any psychoactive substance before or during planned sexual activity to facilitate, intensify, or prolong intercourse. The impact of pain, pleasure, and other mediators on SDU is not well characterized. This study aimed to distinguish the motivations behind different classes and frequencies of substance use during receptive anal intercourse (RAI). Data were from an internet-based survey conducted between July 2022-January 2023. We measured the frequency of SDU for five substances: poppers, alcohol, marijuana, methamphetamine, and nicotine. Satisfaction with pleasurable sensations during RAI and any type of pain bother during RAI were assessed on a 5-point scale. Multivariable logistic regression was performed for 1,119 respondents. Our results showed a strong association between bothersome pain during RAI and frequent alcohol (aOR 2.1), marijuana (aOR 2.4), nicotine (aOR 3.1), and meth (aOR 5.9) use. None of the five substance classes studied was correlated with dissatisfaction with pleasure during RAI. Frequent popper use was associated with increasing lifetime RAI experience and number of sexual partners. The mechanism behind SDU during RAI is substance-specific and multifactorial. Bothersome pain during RAI is highly associated with frequent SDU. Inquiring about pain during RAI may offer avenues for intervention.

Demographic, Behavioural, and Biological Factors Seen in Men Who Have Sex with Men with Salmonella spp.: A Systematic Review

Background: The sexual transmissibility of enteric pathogens, including Salmonella spp., has been described in men who have sex with men (MSM). However, the factors seen in MSM with Salmonella spp. are poorly understood. Method: We aimed to systematically review the literature to explore any factors seen in MSM with Salmonella spp. (MSM). We searched six databases—Medline, PubMed, CINAHL, Embase, Emcare, and Global Health—in April 2024 for manuscripts which contained primary peer-reviewed data in English and the measurement of any risk factors observed in MSM with Salmonella spp. This review was registered on PROSPERO (CRD42023472864). Results: Eleven manuscripts were included in the final review and highlighted demographic (living with HIV), behavioural (oral–anal sex, receptive and penetrative anal sex, hand licking to stimulate their partner, group sex, non-condom use), and biological (co-infection with CMV, Mycobacterium avium complex, Strongyloides stercoralis, Blastocystis hominis, Klebsiella spp. Herpes simplex virus, Cytomegalovirus, Cryptosporidium, Histoplasmosis, Shigella spp.; previous infection with Treponema pallidum, Neisseria gonorhoeae, Chlamydia trachomatis and hepatitis B; and antimicrobial treatment failure) factors seen in MSM with Salmonella spp. Conclusion: Despite a limited number of manuscripts and individuals, this review highlighted some potential demographic, behavioural, and biological factors implicated in the transmission of Salmonella spp. in MSM. These data will provide insights for future guidelines, public health control strategies, and research.

HIV epidemic among key populations in Nigeria: results of the integrated biological and behavioural surveillance survey (IBBSS), 2020–2021

IntroductionNigeria has the fastest-growing HIV epidemic in West and Central Africa and key populations (KPs) bear a higher burden of HIV. This integrated biological and behavioural surveillance survey was conducted...

Hotspots of Anal Cancer Screening in a High-risk Population: A Clinical Study on Free Provision, Best Method, Self-sampling, and Independent Risk Factors.

As of 2024, anal cancer (AC) has been steadily increasing worldwide but, due to insufficient evidence, anal cancer screening (ACS) has yet to be standardized. Furthermore, most high-risk people in the world have no help paying for it. Therefore, our primary endpoint was to assess the best screening method for these subjects through a provision that was free of charge (all costs were covered by the Italian public health service). Awareness-raising campaign, determination of risk factors, education on anal self-examination, and sampling (ASS) were secondary objectives. Screening was on a voluntary basis. Engaging in receptive anal intercourse and having a history of cervical dysplasia were the main inclusion criteria. Level 1 ACS tools included digital ano-rectal examination, anoscopy, anal Pap, and anal human papillomavirus (HPV) DNA test (both through self- and proctologist- sampling); high-resolution anoscopy (HRA) with (HRAB) or without biopsy comprised level 2 screening. High-risk people were enrolled until the available funds were exhausted. Fifty high-risk people (40 men who had sex with men -MSM-, 9 women, and 1 heterosexual man) were enrolled. AC was found in one HIV-seropositive MSM, high-grade squamous intraepithelial lesion in 10 (20%) MSM, low-grade squamous intraepithelial lesion LSIL in 13 cases (12 MSM and 1 woman). The combination of HRAB and Pap smear screening achieved the highest values for sensitivity, specificity, and accuracy. ASS HPV DNA test provided excellent results comparable to clinician retrieval. Overweight and college education were identified as independent factors for the risk of and prevention of AC, respectively. A free ACS not only appears justified but also recommended to people screened for AC. Excess weight represents a further risk for this population.

Syphilis among HIV-positive men who have sex with men in Ghana: The 2023 biobehavioral survey.

Apart from HIV acquisition, men who have sex with men are at a higher risk of sexually transmitted infections, especially syphilis. Although the intersection between syphilis and HIV poses a formidable challenge among key populations who are known to be vulnerable to many health threats, there is little known about syphilis infection among MSM living with HIV in Ghana. This study seeks to investigate the burden of syphilis and address the existing knowledge gap by exploring behavioral, healthcare access, and structural factors influencing the syphilis burden within the HIV-positive MSM population. This study was conducted in 2023 as part of the bio-behavioral survey (BBS) among men who have sex with men (MSM) in Ghana. A cross-sectional survey that used a respondent-driven sampling (RDS) approach was conducted in the old ten regions of Ghana. Data was collected on 3,420 participants, however, 857 HIV-positive MSM were included in this study since it focused on syphilis among HIV-positive MSM in Ghana. The study estimated the prevalence of syphilis among MSM living with HIV and provided a 95% confidence interval across different categories of explanatory variables. Bivariate and multivariable logistic regression models were used to identify factors associated with overall syphilis prevalence. All other analyses were weighted due to the complex design of the study. The overall prevalence of syphilis was 23.83% (95% CI: 20.44, 27.58). HIV-positive men who only had sex with men had a 29.77% (95% CI: 23.90, 36.40) prevalence of syphilis compared to a prevalence of 9.50% (95% CI: 2.56, 29.53) recorded by HIV-positive MSM who were attracted to mostly females. Participants who ever had receptive anal sex recorded a higher prevalence 26.79% (95% CI: 22.78, 31.23) than those who never had receptive anal sex 12.86% (95% CI: 8.02, 19.99). The odds of syphilis among HIV-positive MSM who never used condoms with regular sex partners in the last 6 months were 41.08 (aOR: 41.08 at 95% CI 1.24-136.42; p = 0.038). There is a high prevalence of syphilis among HIV-positive men who have sex with men in Ghana, especially among those who engage in unprotected anal sex and have multiple sexual partners. Our findings underscore the dire need for targeted interventions to address the dual brunt of HIV and syphilis among the MSM population in Ghana.

Knowledge of Sexually Transmitted Infections and Its Association With Condom Use Self-Efficacy (CUSES) Among People Living With HIV (PLHIV) in Public Health Clinics in Selangor, Malaysia.

Background Condom use self-efficacy is critical in preventing the spread of HIV among people living with HIV (PLHIV). Knowledge of sexually transmitted infections (STIs) is a crucial factor in promoting safer sexual behaviors. However, there is scarce data on its association with condom use self-efficacy, particularly among PLHIV. Objectives This study aims to determine the association between knowledge of STIs and other demographic and behavioral factors with condom use self-efficacy among PLHIV in public health clinics at Hulu Langat, Selangor. Methods A cross-sectional study involved PLHIV attending public health clinics in Selangor, Malaysia. Participants were recruited using convenience sampling. Eligibility criteria included being 18 years or older, able to read and comprehend the Malay language, and having not been diagnosed with psychiatric illness or learning difficulties that may impede their ability to answer the questionnaire. Data were collected from December 2023 to March 2024 through self-administered questionnaires assessing demographic characteristics, sexual practice, clinical factors, knowledge of STIs, and condom use self-efficacy. Multiple linear regressions were performed to identify factors associated with condom use self-efficacy. Results The mean score for condom use self-efficacywas 77.72 ± 12.88, and the mean score for knowledge of STIs was 30.87 ± 5.50. The higher STI knowledge score was associated with higher condom use self-efficacy (B = 0.73, p < 0.001). Other significant factors were higher household income (B = 9.27, p < 0.001), recent sexual activity within the last three months (B = -4.34, p < 0.001), engaging in receptive anal sex (B = 7.06, p < 0.001), and not using a condom during the last sexual intercourse (B = -4.43, p < 0.001) wereassociated with condom use self-efficacy. Conclusion The study confirms that good STI knowledge increases condom use self-efficacy among PLHIV, therefore highlighting the need to educate those at risk with better knowledge of STIs. It also highlights the importance of conducting interventions for those at higher risk due to lower condom use self-efficacy and exploring their barriers towards the use of condoms.