Erectile Dysfunction Medication Prescription and Condomless Intercourse in HIV-Infected Men Who have Sex with Men in the United States

Abstract

Using nationally representative data, we assessed the prevalence of erectile dysfunction medication (EDM) prescription, and its association with insertive condomless anal intercourse (CAI) with an HIV-serodiscordant partner among sexually-active HIV-infected men who have sex with men (MSM) receiving medical care in the United States. Overall, 14% (95% CI 12–16) were prescribed EDM and 21% (95% CI 19–23) engaged in serodiscordant CAI. MSM who were prescribed EDM were more likely to engage in insertive CAI with a serodiscordant casual partner than those not prescribed EDM after adjusting for illicit drug use before or during sex (adjusted prevalence ratio=1.38; 95% CI 1.01–1.88). We found no association with main partners. Only 40% (95% CI 36–44) of MSM prescribed EDM received risk-reduction counseling from healthcare professionals. Risk-reduction counseling should be provided at least annually to all HIV-infected persons as recommended, especially at the time of EDM prescription.

Erectile Dysfunction Medication Prescription: STI and Risk Behavior in Men with HIV

“…[36,37] This study does not confirm findings from 2005 and 2016 showing that HIV-infected MSM are more likely to engage in unprotected sex after EDM prescription. [11,13] This deviation from the literature may be due to a benefit of EDM prescription within a community care clinic that focuses on HIV treatment and prevention. This study did not measure the use of prescribed EDM in a "party" context.…”

“…This ran counter to our study hypothesis and similar studies in high-risk populations. [7,11,13,31,32] In terms of STI screening rates, scant literature exists on the impact of EDM prescription on STI screening practices. One VA-based study documented minimal STI testing in the period after EDM prescription.…”

“…The PRO questionnaire is a well-validated method of collecting private information on a frequent and longitudinal basis compared to other studies using national sampling, anonymous questionnaires or telephone surveys. [9,11,32,41,42] Our study population was also unique since it was performed in the Southeastern portion of the US, which may have led to some of the differences noted. [9,[41][42][43] Data collection from the 6 months before and after EDM prescription may have led to a difference in results compared to other studies using a larger window or a longitudinal design.…”

“…[6] Limited data suggests that erectile dysfunction medication (EDM) use is correlated with risky sexual behavior, particularly among men-who-have-sex-with-men (MSM), although few studies focus on men living with HIV. [7][8][9][10][11][12][13] In general, US providers fail to ask patients routinely about sexual behaviors or screen for sexually transmitted infection (STI) in clinic; this extends to men prescribed EDM. [14][15][16] HIV/STI coinfection is particularly important among men with HIV since the probability of HIV transmission to a sexual partner increases by 2-4 fold in the presence of STI coinfection.…”

Longitudinal Event-Level Analysis of Gay and Bisexual Men’s Anal Sex Versatility: Behavior, Roles, and Substance Use

“…Previous studies using individual-level data identified substances associated with specific anal sex behavior, e.g. erectile dysfunction drugs (EDD) and crystal methamphetamine with insertive anal sex (Mansergh et al, 2006;Lin, Mattson, Freedman, & Skarbinski, 2017) and poppers (amyl nitrites) with receptive anal sex (Drumright, Gorbach, Little, & Strathdee, 2009). However, event-level analyses on substance use and ELV remain rare (Rich et al, 2016), even though the majority of GBM self-identify as versatile (Hart et al, 2003).…”