Self-reported Sex Research Articles

Determinants of HIV Transmission Risk Among HIV-Infected Persons Engaged in Care.

People living with HIV (PLWH) engaged in medical care represent an accessible group to focus HIV prevention efforts. In an analysis of 1,883 PLWH from 2007 and 2015, we determined the proportion at risk of HIV transmission and identified factors associated with HIV transmission risk using multivariable mixed effects logistic regression models with random intercepts. HIV transmission risk was defined by an HIV viral load > 1,500 copies/mL and self-reported unprotected sex. We found that 174 (9.2%) individuals were at risk for HIV transmission at least once. Factors associated with HIV transmission risk included younger age (adjusted OR [95% CI] per decade decrease = 2.30 [1.84, 2.89]), illicit drug use (adjusted OR = 5.36 [3.02, 9.56]), depression (adjusted OR = 1.88 [1.10, 3.21]), and education <12th grade (adjusted OR = 2.05 [1.15, 3.67]). Thus, nearly 1 in 10 HIV-infected individuals engaged in care between 2007 and 2015 were potentially at risk of transmitting HIV. Behavioral interventions to decrease HIV transmission should focus on younger, less educated patients who are depressed and actively using illicit drugs.

Hormonal Contraceptive Use Among HIV-Positive Women and HIV Transmission Risk to Male Partners, Zambia, 1994-2012.

Background. Evidence on the association between female-to-male human immunodeficiency virus (HIV) transmission risk and hormonal contraception is sparse and conflicting.Methods. Heterosexual HIV-discordant couples from Lusaka, Zambia, were followed longitudinally at 3 month-intervals from 1994 to 2012. The impact of hormonal contraception on time to HIV transmission from HIV-positive women to their HIV-negative male partners (M−F+) was evaluated.Results. Among 1601 M−F+ couples, 171 genetically linked HIV transmissions occurred in men over 3216 couple-years (5.3 transmissions/100 couple-years; 95% confidence interval [CI], 4.5–6.2). In multivariable Cox models, neither injectable (adjusted hazard ratio [aHR], 0.6; 95% CI, .4–1.2), oral contraceptive pill (aHR, 0.8; 95% CI, .3–2.1), nor implant (aHR, 0.8; 95% CI, .5–1.4) use was associated with HIV transmission, relative to nonhormonal methods, after controlling for the man's age at baseline and time-varying measures of pregnancy, self-reported unprotected sex with the study partner, sperm present on a vaginal swab wet mount, genital inflammation of either partner, genital ulceration of the man, and first follow-up interval. Sensitivity analyses, including marginal structural modeling and controlling for viral load and fertility intentions available in a subset of couples, led to similar conclusions.Conclusions. Our findings suggest null associations between hormonal contraception and risk of female-to-male HIV transmission. We support efforts to increase the contraceptive method mix for all women, regardless of HIV serostatus, along with reinforced condom counseling for HIV-serodiscordant couples.

Estimating self-reported sex practices, drug use, depression, and intimate partner violence among MSM in China: a comparison of three recruitment methods

ABSTRACTMen who have sex with men (MSM) are the group at highest risk for HIV in China. Researchers have used various recruitment methods to reach this population hidden from the hetero-normative culture. To inform future recruitment strategies, we compared estimates of socio-demographic characteristics, HIV risk behaviors, depression, and intimate partner violence (IPV) across three samples of MSM and money boys in Shanghai, China. Data were collected from three community-based samples of MSM and money boys (n = 1352) recruited via respondent-driven sampling (RDS) (n = 404), community popular opinion leaders (CPOL) (n = 385), and Internet and venue-based sampling (VBS) (n = 546). Different recruitment methods generated samples with statistically significant differences among a number of socio-demographic characteristics, sexual behaviors, drug use, depression scores, and exposure to IPV. Specifically, RDS participants had lower education (p = .002), income levels (p < .001), and were more likely to report condomless sex with a woman (p < .001). CPOL participants were younger (p < .001), more likely to report lifetime condomless anal sex (p = .009), more than 10 male partners in the past 30 days (p < .001), and were less likely to experience violence by a male intimate partner (p = .001). VBS participants had lowest depression score (p = .005) and were more likely to report lifetime drug use (p = .003). Our findings reinforce that each recruitment method may reach a sub-group of MSM with a specific risk profile, so multiple methods may be needed to obtain a representative sample of MSM. Interventions may use specific recruitment methods to target certain segments of the MSM population.

Vaginal Prostate Specific Antigen (PSA) Is a Useful Biomarker of Semen Exposure Among HIV-Infected Ugandan Women.

The practical feasibility of using prostate specific antigen (PSA) as a biomarker of semen exposure was examined among HIV-infected Ugandan women. Vaginal fluids were obtained with self-collected swabs and a qualitative rapid test (ABAcard®p30) was used to detect PSA. Trained laboratory technicians processed samples on-site and positive PSA tests were compared to self-reported unprotected vaginal sex (UVS) in the last 48h. A total of 77 women submitted 126 samples for PSA testing at up to three study visits. Of these samples, 31% (n=39/126) were PSA positive, and 64% (n=25/39) of the positive PSA samples were accompanied by self-report of no UVS at the study visit the PSA was collected. There were no reported difficulties with specimen collection, storage, or processing. These findings provide preliminary data on high levels of misreported UVS among HIV-infected Ugandan women using practically feasible methods for PSA collection and processing.

Sexual activity and dyspareunia the first year postpartum in relation to degree of perineal trauma

Knowledge on sexual complaints and time to sexual resumption after obstetric anal sphincter injury (OASI) is scarce. The aim of the study was to investigate self-reported sexual activity and coital problems 1year postpartum in relation to perineal trauma, in addition to delivery mode. Among 2,846 women recruited during pregnancy, all women who delivered with OASI (n = 42, all third-degree perineal tears), in addition to 20 randomly selected controls per OASI case, a total of 882 women, were sent a self-administered questionnaire addressing time to coital resumption after delivery and potential coital difficulty 1year postpartum. By 8weeks, half of the 561 responders (51.4%) had resumed intercourse, increasing to 75.2% by 12weeks and 94.7% 1year postpartum. In multivariate regression analysis OASI was the strongest predictor for postponed coital onset, defined as after 8weeks (aOR 5.52, CI 1.59-19.16). OASI was also the only significant predictor for dyspareunia 1year after delivery (aOR 3.57, CI 1.39-9.19). Episiotomy was neither a risk factor for postponed coital onset nor for dyspareunia. There were no differences between episiotomy and second-degree laceration injury groups regarding postponed coital onset (p = 0.45) or dyspareunia (p = 0.67) 1year postpartum. Obstetric anal sphincter injury was a strong and independent predictor for both postponed coital resumption after delivery and for dyspareunia 1year postpartum, whereas episiotomy and spontaneous second-degree lacerations were not. Our main finding of affected sexual activity after OASI further supports the need to reduce the rates of this obstetric injury to a minimum.

Cost-Effectiveness of Opt-Out Chlamydia Testing for High-Risk Young Women in the U.S.

In spite of chlamydia screening recommendations, U.S. testing coverage continues to be low. This study explored the cost-effectiveness of a patient-directed, universal, opportunistic Opt-Out Testing strategy (based on insurance coverage, healthcare utilization, and test acceptance probabilities) for all women aged 15-24 years compared with current Risk-Based Screening (30% coverage) from a societal perspective. Based on insurance coverage (80%); healthcare utilization (83%); and test acceptance (75%), the proposed Opt-Out Testing strategy would have an expected annual testing coverage of approximately 50% for sexually active women aged 15-24 years. A basic compartmental heterosexual transmission model was developed to account for population-level transmission dynamics. Two groups were assumed based on self-reported sexual activity. All model parameters were obtained from the literature. Costs and benefits were tracked over a 50-year period. The relative sensitivity of the estimated incremental cost-effectiveness ratios to the variables/parameters was determined. This study was conducted in 2014-2015. Based on the model, the Opt-Out Testing strategy decreased the overall chlamydia prevalence by >55% (2.7% to 1.2%). The Opt-Out Testing strategy was cost saving compared with the current Risk-Based Screening strategy. The estimated incremental cost-effectiveness ratio was most sensitive to the female pre-opt out prevalence, followed by the probability of female sequelae and discount rate. The proposed Opt-Out Testing strategy was cost saving, improving health outcomes at a lower net cost than current testing. However, testing gaps would remain because many women might not have health insurance coverage, or not utilize health care.

Recent Biomarker-Confirmed Unprotected Vaginal Sex, But Not Self-reported Unprotected Sex, Is Associated With Recurrent Bacterial Vaginosis.

Self-reported unprotected vaginal sex seems to increase risk of bacterial vaginosis (BV). However, the validity of self-reports is questionable, given their inconsistency with more objective measures of recent semen exposure such as detection of prostate-specific antigen (PSA). We examined whether recent unprotected sex, as measured both by PSA detection on vaginal swabs and by self-report, was associated with increased BV recurrence. We analyzed randomized trial data from nonpregnant, BV-positive adult women recruited from a sexually transmitted disease clinic. Participants received BV therapy at enrollment and were scheduled to return after 4, 12, and 24 weeks. Bacterial vaginosis (by Nugent score) and PSA were measured at each visit. We used Cox proportional hazards models to examine the association between PSA positivity and recurrent BV. We also evaluated associations between self-reported unprotected sex (ever/never since the last visit and in the last 48 hours, analyzed separately) and recurrent BV. Prostate-specific antigen and BV results were available for 96 women who contributed 226 follow-up visits. Prostate-specific antigen positivity was associated with increased BV recurrence (adjusted hazard ratio [aHR], 2.32; 95% confidence interval [CI], 1.28-4.21). In contrast, we observed no significant increase in BV recurrence among women self-reporting unprotected sex since the last visit (aHR, 1.63; 95% CI, 0.77-3.43) or in the last 48 hours (aHR, 1.28; 95% CI, 0.70-2.36). Estimates from earlier studies linking self-reported unprotected sex and BV may be biased by misclassification. Biomarkers can improve measurement of unprotected sex, a critical exposure variable in sexual health research.

Unsuspected Herniated Lung Obstructing the Right Internal Jugular Vein and Internal Carotid Artery in a Patient with Thoracic Outlet Syndrome: MRI/MRA and MRV

Knowledge of HIV status is an important step in prevention efforts especially for at risk populations like MSM. CDC recommends that MSM be tested at least annually. There is a limited information on the demographics and risk behaviors of MSM who never tested or test infrequently. This study examined the demographic characteristics, risk behaviors, and HIV status of African American MSM who reported never previously testing for HIV, testing > 12 months prior, or testing within the last 12 months from a testing evaluation study in Washington, D.C.Eligibility requirements were: 18–64 years old; Black/African American; biologically male; and self-reported oral and/or anal sex with a man in the past six months. Descriptive statistics and logistic regression analyses were used.Men who never tested had greater odds of being 25–34 years old, identifying as bisexual or heterosexual and reporting condomless sex with female and male partners. In the multivariate model, men who never tested or tested > 12 months prior to the study had a greater likelihood of having a BS degree, and being age 35 or over. Being newly identified as HIV-positive was associated with never testing and testing > 12 months prior, but was significant in the multivariate model only for never testing.Results suggest prevention strategies should target risk behaviors rather than orientation and engage older men. Future studies should identify factors associated with risky sexual behaviors for men who never test or test infrequently in order to inform prevention interventions.

Transactional Sex among Noninjecting Illicit Drug Users: Implications for HIV Transmission.

Noninjecting illicit drug users (NIDUs) present high risk for HIV infection, due especially to transactional sex. This study aimed to estimate the prevalence and risk factors for transactional sex among NIDUs in the Southwest region of Goiás State, Central Brazil. The prevalence of self-reported transactional sex was 22.8%. Prevalence in women and men was 52.7% and 16.8%, respectively, a significant difference (p < 0.001). Crack use and history of sexually transmitted infections (STI) were risk factors for transactional sex in men. Homelessness, crack use, sex under the influence of drugs, and history of sexual violence were risk factors for transactional sex in women. A high prevalence of transactional sex was observed among NIDUs. This risk behavior may contribute to the high rates of HIV among this population and their social networks and in the general population.

Risk Behaviors and Testing History of African American MSM: Implications for Prevention

ObjectivesKnowledge of HIV status is an important step in prevention efforts especially for at risk populations like MSM. CDC recommends that MSM be tested at least annually. There is a limited information on the demographics and risk behaviors of MSM who never tested or test infrequently. This study examined the demographic characteristics, risk behaviors, and HIV status of African American MSM who reported never previously testing for HIV, testing > 12 months prior, or testing within the last 12 months from a testing evaluation study in Washington, D.C. MethodsEligibility requirements were: 18–64 years old; Black/African American; biologically male; and self-reported oral and/or anal sex with a man in the past six months. Descriptive statistics and logistic regression analyses were used. ResultsMen who never tested had greater odds of being 25–34 years old, identifying as bisexual or heterosexual and reporting condomless sex with female and male partners. In the multivariate model, men who never tested or tested > 12 months prior to the study had a greater likelihood of having a BS degree, and being age 35 or over. Being newly identified as HIV-positive was associated with never testing and testing > 12 months prior, but was significant in the multivariate model only for never testing. ConclusionResults suggest prevention strategies should target risk behaviors rather than orientation and engage older men. Future studies should identify factors associated with risky sexual behaviors for men who never test or test infrequently in order to inform prevention interventions.

Differences in use of contraception by age, sex and HIV status of 10-19-year-old adolescents in Nigeria.

The study tried to identify predictors of good knowledge of contraceptive methods and use of condoms at the last sexual act with a girl/boyfriend by adolescents aged 10-19 years in Nigeria. It also tried to find the association between age, sex and HIV status with the study outcomes. This was a cross sectional study that recruited a geographically representative sample of 749 adolescents living with HIV (ALHIV) and 825 HIV negative/untested adolescents aged 10-19 years in Nigeria. A face to face interviewer-administered questionnaire was used to collect information on their socio-demographic profile, awareness of contraceptive methods, and use of contraceptives. Study participants were recruited from six of the 36 states in Nigeria and the Federal Capital Territory. Chi-square was used to establish association between self-reported HIV status, age and sex, and awareness of contraceptive methods and condom use during last sex act. Significant predictors of 'good knowledge of modern contraceptive' and 'use of condoms by sexually active adolescents at last sex act' were also determined using logistic regression. Being a student significantly reduced the odds of having good knowledge about modern contraceptives (OR: 0.46; CI: 0.32-0.65; p<0.001). Having a tertiary level of education (OR: 1.36; CI: 1.12-1.64; p=0.002) and being HIV negative (OR: 2.92; CI: 1.98-4.32; p<0.001) increased the odds of having good knowledge of modern contraceptives. The only significant predictor for use of condoms at last sexual intercourse with a boy/girlfriend is self-efficacy about being about to negotiate condom use with a boy/girlfriend (OR: 141.01; CI: 14.99-1326.36; p<0.001). The study findings reiterate the need to introduce adolescents in general and ALHIV specifically to condom use in early adolescence prior to commencing sexual activities; and the need to provide adolescent friendly sexual and reproductive health services in Nigeria.

Randomized Controlled Trial of an Internet Application to Reduce HIV Transmission Behavior Among HIV Infected Men Who have Sex with Men.

We conducted a prospective, randomized controlled trial of an internet-based safer-sex intervention to reduce HIV transmission risk behaviors. HIV-infected men who have sex with men (n=179) were randomized to receive a monthly internet survey alone or a monthly survey plus tailored risk reduction messages over 12months. The primary outcome was the cumulative sexually transmitted infection (STI) incidence over 12months. Secondary outcomes included self-reported unprotected sex with an at risk partner and disclosure of HIV status to partners. In a modified intent to treat analysis, there was no difference in 12-month STI incidence between the intervention and control arms (30 vs. 25%, respectively; p=0.5). Unprotected sex decreased and disclosure increased over time in both study arms. These improvements suggest that addition of the risk-reduction messages provided little benefit beyond the self-monitoring of risky behavior via regular self-report risk behavior assessments (as was done in both study arms).

Past 15-year trends in adolescent marijuana use: Differences by race/ethnicity and sex

BackgroundThe potential for increases in adolescent marijuana use is an important concern given recent changes in marijuana policy. The purpose of this study was to estimate trends in marijuana use from 1999 to 2013 among a national sample of US high school students. We examine changes over time by race/ethnicity and sex. MethodsData are from the National Youth Risk Behavior Survey (YRBS), which involves biennial, school-based surveys that generate nationally representative data about 9th–12th grade students in the United States. Students self-reported sex, race/ethnicity, and marijuana use (i.e., lifetime use, past 30-day use, any use before age 13). We generated national estimates of the prevalence of marijuana use for the time period, and also tested for linear and quadratic trends (n=115,379). ResultsThe prevalence of lifetime marijuana use decreased modestly from 1999 to 2009 (44% to 37%), and has increased slightly since 2009 (41%). Other marijuana use variables (e.g., past 30-day use) followed a similar pattern over time. The prevalence of past 30-day use from 1999 to 2013 for all groups and both sexes was 22.5%, and it was lowest among Asians and highest among American Indian/Alaska Natives. Although boys have historically had a higher prevalence of marijuana use, results indicate that male–female differences in marijuana use decreased over time. ConclusionDespite considerable changes in state marijuana policies over the past 15 years, marijuana use among high school students has largely declined. Continued surveillance is needed to assess the impact of policy changes on adolescent marijuana use.

P18.05 Contribution of biomarkers to the validation of self-reported condom use in a treatment as prevention and a pre-exposure prophylaxis demonstration study among female sex workers

Introduction The phenomenon of condom migration remains a major concern whenever a new HIV prevention approach is being considered to strengthen the existing preventive arsenal. We are currently measuring the baseline condom use at the recruitment visit of an on-going demonstration study on pre-exposure prophylaxis (PrEP) and treatment as prevention (TasP), involving female sex workers (FSWs) in Cotonou, Benin, West Africa. Methods During the recruitment visit, data on unprotected sex were collected through face-to-face interviews, from the first 112 FSWs with available biomarker results, recruited as of February 28, 2015. In addition, vaginal samples were tested for prostate-specific antigen (PSA) and Y chromosome DNA (Yc-DNA) PCR tests, to validate the self-reported unprotected sex. Additional biomarkers include gonorrhoea and chlamydia testing using nucleic-acid amplification tests and urine pregnancy tests. Performance parameters of the self-reported unprotected sex were calculated using combined results of all biomarkers as gold standard for recent semen exposure. Results The prevalence of recent self-reported unprotected sex with all types of sexual partners was 31.2% (35/112) vs. 51.8% (58/112) according to the combined biomarkers (p = 0.003, McNemar test). Using the combined biomarkers as gold standard, the sensitivity and specificity of self-reported unprotected sex were 34.5% and 72.2%, respectively. The prevalences of gonorrhoea and chlamydia at the recruitment visit were 8.0% (9/112) and 6.2% (7/112), respectively. Either infection was present in 16 participants (14.3%), out of whom 10 were positive for PSA or Yc-DNA PCR. The pregnancy test was positive for two participants of whom one was positive for both PSA and Yc-DNA PCR. Conclusion These results confirm the questionable validity of self-reported condom use among FSWs. They underscore the need of supplementing self-reported data by biomarkers to improve data reliability. These early results are part of the baseline data that will be subsequently used to look for condom migration. Disclosure of interest statement This study is funded by the Bill and Melinda Gates Foundation, and Truvada® for pre-exposure prophylaxis is provided free of charge by Gilead Sciences, Inc.

Height and Body Mass on the Mating Market

People with traits that are attractive on the mating market are better able to pursue their preferred mating strategy. Men who are relatively tall may be preferred by women because taller height is a cue to dominance, social status, access to resources, and heritable fitness, leading them to have more mating opportunities and sex partners. We examined height, education, age, ethnicity, and body mass index (BMI) as predictors of sexual history among heterosexual men and women ( N = 60,058). The linear and curvilinear associations between self-reported height and sex partner number were small for men when controlling for education, BMI, and ethnicity (linear β = .05; curvilinear β = −.03). The mean and median number of sex partners for men of different heights were: very short (9.4; 5), short (11.0; 7), average (11.7; 7), tall (12.0; 7), very tall (12.1; 7), and extremely tall (12.3; 7). Men who were “overweight” reported a higher mean and median number of sex partners than men with other body masses. The results for men suggested limited variation in reported sex partner number across most of the height continuum, but that very short men report fewer partners than other men.

Are Sex Drive and Hypersexuality Associated with Pedophilic Interest and Child Sexual Abuse in a Male Community Sample?

Although much is currently known about hypersexuality (in the form of excessive sexual behavior) among sexual offenders, the degree to which hypersexual behavior is linked to paraphilic and especially pedophilic interests in non-forensic populations has not been established. The purpose of the present study was to elucidate the associations between total sexual outlets (TSO) and other sex drive indicators, antisocial behavior, pedophilic interests, and sexual offending behavior in a large population-based community sample of males. The sample included 8,718 German men who participated in an online study. Hypersexual behavior as measured by self-reported TSO, self-reported sex drive, criminal history, and pedophilic interests were assessed. In moderated hierarchical logistic regression analyses self-reported contact sexual offending against children was linked to sexual fantasizing about children and antisociality. There was no association between aggregated sex drive, and sexual abusive behaviour in the multivariate analyses. In contrast, self-reported child pornography consumption was associated with sex drive, sexual fantasies involving children, and antisociality. Nevertheless, in clinical practice an assessment of criminal history and pedophilic interests in hypersexual individuals and vice versa hypersexuality in antisocial or pedophilic men should be considered as particularly antisociality and pedophilic interest are important predictors of sexual offending against prepubescent children.

Understanding sexual activity and Chlamydia testing rate based on linked national survey and Medicaid claims data.

BackgroundMonitoring adherence to national recommendations for annual chlamydia screening of female adolescents and young adult women is important for targeting quality improvement interventions to improve low screening rates. However, accurate measurement of rates may vary depending on the data source used to determine eligible sexually-active women.MethodsThe 2001–2004 NHANES data linked with Medicaid administrative data by respondent’s unique identifier, the 2011–2012 NHANES data, and the 2004 and 2010 Medicaid data were used in this cross-sectional analysis. We defined self-reported sexual activity by self-reported sexual behaviors, claim-identified sexual activity by reproductive-related claims among women who had ≥ one healthcare claim, HEDIS-defined sexual activity by reproductive-related claims among women who were enrolled in Medicaid for ≥330 days and had ≥ one healthcare claim, and chlamydia tests by claims submitted in the 12 months prior to the survey interview.ResultsOf Medicaid women aged 18–25 years, 91.5% self-reported to be sexually-active. Of self-reported sexually-active women aged 18–25 years, 92.0% had ≥ one healthcare claim in the 12 months prior to the survey interview; of this subpopulation, only 58.8% were enrolled in Medicaid for ≥ 330 days in the 12 months prior to the survey interview; of this further subpopulation, 74.1% had healthcare claims identifying them as sexually-active in the 12 months prior to the survey interview. Of HEDIS-defined sexually-active women, 42.4% had chlamydia testing.ConclusionOur study suggests that the number of sexually-active women aged 18–25 years used as the denominator in the chlamydia testing measure could be significantly different, depending upon the definition applied and the data used. Our data highlight the limited representativeness of Medicaid population in the current HEDIS measure on chlamydia testing when a high proportion of women who were enrolled in Medicaid for <330 days had been excluded from the measure. The interventions that can improve the proportion of women who were enrolled in Medicaid for ≥ 330 days among all young Medicaid women are needed not only for improving health care services, but also for measuring quality of healthcare.

Bacterial sexually transmitted infections among HIV-infected patients in the United States: estimates from the Medical Monitoring Project.

Bacterial sexually transmitted infections may facilitate HIV transmission. Bacterial sexually transmitted infection testing is recommended for sexually active HIV-infected patients annually and more frequently for those at elevated sexual risk. We estimated percentages of HIV-infected patients in the United States receiving at least one syphilis, gonorrhea, or chlamydia test, and repeat (≥2 tests, ≥3 months apart) tests for any of these sexually transmitted infections from mid-2008 through mid-2010. The Medical Monitoring Project collects behavioral and clinical characteristics of HIV-infected adults receiving medical care in the United States using nationally representative sampling. Sexual activity included self-reported oral, vaginal, or anal sex in the past 12 months. Participants reporting more than 1 sexual partner or illicit drug use before/during sex in the past year were classified as having elevated sexual risk. Among participants with only 1 sex partner and no drug use before/during sex, those reporting consistent condom use were classified as low risk; those reporting sex without a condom (or for whom this was unknown) were classified as at elevated sexual risk only if they considered their sex partner to be a casual partner, or if their partner was HIV-negative or partner HIV status was unknown. Bacterial sexually transmitted infection testing was ascertained through medical record abstraction. Among sexually active patients, 55% were tested at least once in 12 months for syphilis, whereas 23% and 24% received at least one gonorrhea and chlamydia test, respectively. Syphilis testing did not vary by sex/sexual orientation. Receipt of at least 3 CD4+ T-lymphocyte cell counts and/or HIV viral load tests in 12 months was associated with syphilis testing in men who have sex with men (MSM), men who have sex with women only, and women. Chlamydia testing was significantly higher in sexually active women (30%) compared with men who have sex with women only (19%), but not compared with MSM (22%). Forty-six percent of MSM were at elevated sexual risk; 26% of these MSM received repeat syphilis testing, whereas repeat testing for gonorrhea and chlamydia was only 7% for each infection. Bacterial sexually transmitted infection testing among sexually active HIV-infected patients was low, particularly for those at elevated sexual risk. Patient encounters in which CD4+ T-lymphocyte cell counts and/or HIV viral load testing occurs present opportunities for increased bacterial sexually transmitted infection testing.

Abstract P285: Frequency of Sexual Activity the Year before Myocardial Infarction and Risk for Subsequent Cardiovascular Adverse Events: Results of a Long-Term Follow-Up Study

Introduction: Sexual activity (SA) is an important component of quality of life and of concern for many patients with myocardial infarction (MI). Available data showed that the frequency of SA decreased one year after an MI, however, the general patterns were relatively stable overall. Although SA may be a trigger of an MI in very few cases, the association between SA before MI and the onset of a subsequent adverse cardiovascular disease event (CVD-event) has not been evaluated so far. Hypothesis: Frequency of SA during the 12-months prior to an MI is not associated with risk of subsequent adverse CVD-event. Methods: Prospective cohort study in CHD patients aged 30-70 years undergoing an in-patient rehabilitation program after an incident MI due to CHD. SA frequency (including masturbation) during the 12-months prior to the MI was evaluated by means of a standardized questionnaire. A Cox-proportional hazards model was used to determine the association of frequency of SA on subsequent adverse CVD-events (nonfatal and fatal MI, stroke, cardiovascular death) during ten-year follow-up after adjustment for age, gender, school education, rehabilitation clinic, smoking status, history of diabetes mellitus, left-ventricular function HDL-cholesterol. Results and Conclusions: The mean age of the included 536 patients with an incident MI was 57.1 years (SD 8.6) at baseline, 85.8% were men. Self-reported SA in the 12-months before the MI was none for n=80, less than 1 time per month for n=25 (both grouped in one category), less than 1 time per week for n=136, and one or more times per week for n=295. Sexual more active patients were on average younger, more often men, had less often diabetes and a less severe coronary vessel disease. They were also more often physical active in leisure time compared to others. During ten-year follow up (median 9.97 years) n=100 adverse CVD-events occurred (overall 23.9 events per 1000 patient years). When compared to patients with less than one time SA per week (reference group) patients with at least one SA per week had a Hazard ratio (HR) of 0.49 (95% confidence interval (CI) 0.31-0.77) in the multivariable analysis; adding leisure time physical activity practiced 12-months prior to the MI into this final model did not change the results. Additional adjustment for Nt-proBNP level at baseline did not alter the result. In conclusion, a weekly SA activity pattern in the year prior to an acute MI is not associated with a higher risk for subsequent adverse cardiovascular events.

Hormonal contraception does not increase women’s HIV acquisition risk in Zambian discordant couples, 1994–2012

ObjectiveTo determine the impact of hormonal contraceptive methods on risk of HIV acquisition among HIV-negative women cohabiting with HIV-positive male partners. Study designFrom 1994–2012, HIV discordant couples recruited from a couples' voluntary HIV counseling and testing center in Lusaka, Zambia were followed longitudinally. HIV-negative partners were tested quarterly. This analysis is restricted to couples in which the man was HIV-positive and the woman was HIV-negative at enrollment and the man was not on antiretroviral treatment. Multivariate Cox models evaluated associations between time-varying contraceptive methods and HIV acquisition among women. Sensitivity analyses explored exposure misclassification and time-varying confounder mediation. ResultsAmong 1393 couples, 252 incident infections occurred in women over 2842 couple-years (8.9 infections per 100 couple-years; 95% CI, 7.8–10.0). Multivariate Cox models indicated that neither injectable [adjusted hazard ratio (aHR)=1.2; 95% CI, 0.8–1.7], oral contraceptive pill (OCP, aHR=1.3; 95% CI, 0.9–1.8), or implant (aHR=1.1; 95% CI, 0.5–2.2) use was significantly associated with HIV acquisition relative to non-hormonal contraception controlling for woman's age, literacy and time-varying measures of genital ulceration/inflammation. This remained true when only looking at the subset of infections acquired from the spouse (82% of infections) and additionally controlling for baseline HIV viral load of the male partner, pregnancy status, and time-varying measures of sperm on a vaginal swab wet prep and self-reported unprotected sex. OCP and injectable users reported more unprotected sex (p<.001), and OCP users were more likely to have sperm on vaginal swab (p=.1) than nonhormonal method users. ConclusionsWe found no association between hormonal contraception and HIV acquisition risk in women. Condom use and reinforced condom counseling should always be recommended for HIV discordant couples. HIV testing of sex partners together is critical to establish HIV risk, ascertain couple fertility intentions and counsel appropriately. ImplicationsThese findings add to a controversial literature and uniquely address several common design and analytic challenges faced by previous studies. After controlling for confounders, we found no association between hormonal contraception and HIV acquisition risk in women. We support promoting condoms for HIV prevention and increasing the contraceptive method mix to decrease unintended pregnancy.