Men who have sex with men (MSM) are more likely to receive the recommended sexually transmitted infection (STI) testing and prevention services at Ryan White HIV/AIDS Program-funded facilities, according to results of a study published in the Annals of Internal Medicine.
Over the past 10 years, cases of bacterial STIs have steadily increased, with a disproportionate increase among MSM, especially those infected with HIV. STIs can potentially facilitate the transmission of HIV by increasing genital HIV shedding. This challenges efforts to end the HIV epidemic. Therefore, this study determined the prevalence of STI transmission risk behaviors and receipt of recommended prevention services and annual STI testing among MSM receiving care for HIV infection.
In total, 1269 men who reported anal intercourse with men in the last 12 months and had medical records available for review were included in this analysis set. These men were included from the Medical Monitoring Project, which was an annual, 2-stage, complex sample survey to produce national estimates of behavioral and clinical characteristics of adults in the United States diagnosed with HIV. All included men reported whether the HIV care facilities they utilized received any Ryan White HIV/AIDS Program funding, because this program is federally funded and facilities not funded by this program have significantly different service delivery. Medical records were used to assess self-reported risk behaviors for STI transmission, testing for STIs and hepatitis C during the past 12 months, and all tests documented in the primary HIV medical record. The prevalence of all measures among patients at funded vs non-funded facilities were also analyzed.
Condomless anal intercourse in the past 12 months was reported by an estimated 64.5% of MSM. Furthermore, before or after sex, 46.9% of MSM reported drinking alcohol, 35.8% of MSM reported using noninjection drugs, and 3.7% of MSM reported using injection drugs. Of the included men, 61.1% received care at Ryan White HIV/AIDS Program-funded facilities, and 37.9% received care at facilities not funded by the Ryan White HIV/AIDS Program. There were no observed differences in risk behaviors by facility funding status.
Compared with patients at Ryan White HIV/AIDS Program-funded facilities, a lower percentage of patients at non-funded facilities received all assessed prevention services in the past 12 months. Roughly 55% of patients who received care at a Ryan White HIV/AIDS Program funded facility, compared with roughly 35% at non-funded facility, were tested for gonorrhea of chlamydia using samples from any anatomic site (urine, or swabs of the urethra, anorectum, or pharynx)—this trend was similar, though less significant for site-specific samples. For hepatitis C, approximately 30% of patients at non-funded sites received screening compared with approximately 40% at Ryan White HIV/AIDS Program-funded sites. In addition, the prevalence of STI testing was lower among patients at facilities not funded by Ryan White HIV/AIDS Program during the past 12 months.
Overall, the study authors concluded that, “Meeting public health goals for preventing [STIs], and in turn ending the HIV epidemic, may require closer adherence to guidelines for delivering prevention services and [STI] testing to HIV-positive MSM, especially those receiving care at non-[Ryan White HIV/AIDS Program]-funded facilities.”
Disclaimer: This study was funded by the Centers for Disease Control and Prevention.
Weiser J, Tie Y, Pearson WS, Shouse RL. Receipt of prevention services and testing for sexually transmitted disease among HIV-positive men who have sex with men, United States. Ann of Intern Med. doi:10.7326/M19-4051