STI prevalence among men living with HIV engaged in safer conception care in rural, southwestern Uganda

Abstract

HIV care provides an opportunity to integrate comprehensive sexual and reproductive healthcare, including sexually transmitted infection (STI) management. We describe STI prevalence and correlates among men living with HIV (MLWH) accessing safer conception care to conceive a child with an HIV-uninfected partner while minimizing HIV transmission risks. This study reflects an ongoing safer conception program embedded within a regional referral hospital HIV clinic in southwestern Uganda. We enrolled MLWH, planning for pregnancy with an HIV-uninfected partner and accessing safer conception care. Participants completed interviewer-administered questionnaires detailing socio-demographics, gender dynamics, and sexual history. Participants also completed STI laboratory screening for syphilis (immunochromatographic testing confirmed by rapid plasma reagin), and chlamydia, gonorrhea, trichomoniasis, and HIV-RNA via GeneXpert nucleic acid amplification testing. Bivariable associations of STI covariates were assessed using Fisher’s exact test. Among the 50 men who completed STI screening, median age was 33 (IQR 31–37) years, 13/50 (26%) had ≥2 sexual partners in the prior three months, and 46/50 (92%) had HIV-RNA <400 copies/mL. Overall, 11/50 (22%) had STIs: 16% active syphilis, 6% chlamydia. All participants initiated STI treatment. STI prevalence was associated with the use of threats/intimidation to coerce partners into sex (27% vs 3%; p = 0.03), although absolute numbers were small. We describe a 22% curable STI prevalence among a priority population at higher risk for transmission to partners and neonates. STI screening and treatment as a part of comprehensive sexual and reproductive healthcare should be integrated into HIV care to maximize the health of men, women, and children.

Sexual and Relationship Benefits of a Safer Conception Intervention Among Men with HIV Who Seek to Have Children with Serodifferent Partners in Uganda

“…MWH and their partners were also offered clinical services, including pregnancy testing, HIV testing, and STI testing and treatment [37]. In addition, participants and partners living with HIV were assessed for HIV-RNA suppression via GeneXpert at enrollment and at 6-months post-enrollment.…”

Sexually transmitted infection (STI) knowledge and perceptions among people in HIV-sero-different partnerships in rural southwestern Uganda

“…We recruited participants using purposive sampling from the Mbarara Regional Referral Hospital's (MRRH) Healthy Families Clinical Program in southwestern, rural Uganda [14] from August 2020 to January 2021 where our team works. This program provides HIV sero-different couples counseling and care regarding HIV prevention and safer conception inclusive of etiologic, laboratory STI testing for patients participating in research studies [7][8][9]. A research assistant screened and PLOS GLOBAL PUBLIC HEALTH recruited participants attending the Healthy Families Clinical Program in person.…”

“…This high STI prevalence is particularly concerning given that Uganda has one of the highest fertility rates in the world, and STIs cause the greatest morbidity and mortality when transmitted vertically to neonates [4][5][6]. In prior work in rural southwestern Uganda, we described an STI prevalence of 24% and a six-month STI incidence of 29.0 per 100 person-years among women without HIV considering pre-exposure prophylaxis (PrEP) with pregnancy plans and an STI prevalence of 22% among men with HIV with partner pregnancy plans [7][8][9].…”

Social and individual vulnerability factors associated with syphilis among populations living on islands in the Brazilian Amazon

“…Identifying and recognizing the differences and specificities of this process becomes essential in the design and implementation of policies aimed at assisting groups most vulnerable to syphilis [ 11 – 13 ]. In rural communities, the prevalence of syphilis in adults ranged from 0.2% among women in rural Nepal [ 5 ] to 16% among men living with HIV in rural Uganda [ 8 ]. Among populations living in seven fishing communities on Lake Victoria, in northwest Tanzania, the prevalence was 15.6% [ 9 ].…”