Alcohol and drug use, partner PrEP use and STI prevalence among people with HIV

Abstract

ObjectivesPeople with HIV (PWH) have a high burden of bacterial sexually transmitted infections (STIs). We examined the relationship of alcohol and drug use and partner pre-exposure prophylaxis (PrEP) use to STI prevalence in a cohort of PWH with a history of unhealthy alcohol use.MethodsWe analysed data from a primary care-based alcohol intervention study at Kaiser Permanente Northern California (KPNC). Participants were recruited between April 2013 and May 2015 and were followed for up to 24 months. We linked participant responses to questions from the 24 month follow-up interview, including alcohol and drug use and partner PrEP use, with STI test results (ie, syphilis, chlamydia, gonorrhoea) in the KPNC electronic health record. Prevalence ratios (PR) were estimated using Poisson models fitted with robust variance estimators to evaluate the association of substance use and partner use of PrEP with STIs.ResultsIn the analytic sample (n=465), the median age was 52 years (IQR 45–59); 67% were white; 95% were men who have sex with men. Thirty-two per cent of participants had HIV-positive partners only; 31% had HIV-negative partners with at least one on PrEP in the previous year and 37% had HIV-negative partners without any on PrEP. Twenty-three per cent reported alcohol and drug use prior to sex in the last 6 months. Eight per cent of participants had an STI. Partner PrEP use (adjusted PR (aPR) 2.99 (95% CI 1.11 to 8.08)) was independently associated with higher STI prevalence. Participants who reported use of alcohol (aPR 1.53 (0.61 to 3.83)), drugs (aPR 1.97 (0.71 to 5.51)) or both (aPR 1.93 (0.75 to 4.97)) prior to sex had a higher STI prevalence.ConclusionsThe higher prevalence of STIs among PWH with unhealthy alcohol use who have partners on PrEP suggests that this subgroup may be a high-yield focus for targeted outreach, STI screening and sexual health counselling.

Factors associated with sexually transmitted infections in sugarcane cutters: subsidies to caring for*

“…One finding that drawn attention was the high frequency of alcohol and illicit drug consumption, and as observed in other studies (37)(38) , these variables are positively associated with STIs. Almost all cane cutters reported consumption of alcohol and 13.4% of illicit drugs in their lives.…”

Syphilis among men who have sex with men attending a large HIV clinic in Trinidad

“…6,9–11 The resurgence in syphilis in MSM is thought to be due to changes in sexual behavior and risk perception due to the availability of effective antiretroviral therapy 11 which suppresses the HIV viral load thereby reducing HIV transmission. Substance abuse, 23 HIV serosorting, 24 HIV pre-exposure prophylaxis, 25 and the ease of finding sexual partners due to internet and mobile dating applications 26 may also contribute to the resurgence of syphilis among MSM; however, these data were not available as our study involved retrospective data collection.…”

Alcohol use as a risk factor for sexually transmitted infections: A systematic review and conclusions for prevention

“…In total, 11 publications satisfied the inclusion criteria. As there are countless articles (mostly cross-sectional studies, not included in our review) on associations between alcohol use and STIs (for a random selection, see Connor et al, 2015;Herrera et al, 2016;Hojilla et al, 2020;Liu et al, 2016;Soe et al, 2018), we based our review solely on cohort and case control studies.…”