HIV and sexually transmitted infections: responding to the “newest normal”

Abstract

Although the first case reports of AIDS were in men who had sex with men (MSM) [1] and HIV is most commonly spread heterosexually [2], the epidemic has usually been addressed differently than other sexually transmitted infections (STI). Initially, this was because it emerged as a lethal, untreatable, rapidly spreading epidemic. Focused AIDS research, palliative patient care programmes, and community activism evolved to deal with the mounting morbidity, and to speed the development of highly active antiretroviral therapy (HAART). In contrast, "classical" STI care and research were already embedded in well-established settings. Thus, from the beginning, HIV and STI were often addressed through separate programmes.However, subsequent research demonstrated STI and HIV synergism [3]. The co-occurence of STI, particularly genital herpes, was shown to facilitate the spread of HIV [4]. Because of the effects of STI in potentiating HIV acquisition and transmission, several randomized controlled trials were undertaken to determine whether STI treatment and/or prophylaxis could decrease HIV incidence [5][6][7]. Only the Mwanza trial that treated symptomatic STI demonstrated a modest impact of STI treatment in HIV incidence [5]. The other studies did not find that mass treatment and/or syndromic management were sufficient to arrest HIV spread. STI management as a primary HIV prevention strategy was superseded once safe and effective HAART became widely accessible, since it was shown that suppressive treatment significantly decreased HIV transmission [8,9].The proof that HAART could decrease HIV transmission [10,11], and that pre-exposure prophylaxis (PrEP) could decrease HIV acquisition [12], uncoupled epidemiologic synergy between STI and HIV [13]. HIV-infected individuals who adhered to their medication, whose virus was suppressed, would not transmit HIV to partners [14], and PrEP adherence provided substantial protection against HIV acquisition for high risk uninfected people [15]. Although condoms remain highly effective in preventing STI transmission [16], their decreased use in this era of antiretroviral optimism has been associated with bacterial STI increasing globally. At present, there are more than 1 million new curable STI occurring daily globally [17], and although HIV incidence is slowly declining in several settings, there still are close to 2 million new HIV infections annually, and nearly 40 million people living with the virus [18].The "new normal" of HIV and STI spread becoming unlinked offers unique opportunities to control both epidemics [19], particularly in the light of increasing sophistication in understanding mucosal biology, as well as the behavioural and sociological factors potentiating HIV and STI spread [20]. At the 22nd International AIDS Conference in Amsterdam in July 2018, for the first time, there will be a two-day pre-conference focusing exclusively on HIV and STIs: "STI 2018: Understanding and Addressing the HIV and STI Syndemics. " This meeting is designed to review the contemporary ep...

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“…A further evaluation of the transmission dynamics of HIV in bar setting in slums would better characterise the HIV risk among individuals www.nature.com/scientificreports/ found at bars. Additionally, an evaluation of the prevalence of other sexually transmitted diseases (STDs) among individuals at bars in slums would be desirable since STDs increase the risk of HIV infection 49 . Studies that have evaluated the prevalence of TB in bar settings have been contact investigations of an index case and their findings may not compare to our cross sectional evaluation of the TB prevalence.…”

Association between knowledge, risk behaviours, and testing for sexually transmitted infections among men who have sex with men: findings from a large online survey in the United Kingdom

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