Search

PURPOSE HIV pre-exposure prophylaxis (PrEP) may increase rates of bacterial sexually transmitted infections (STIs) among gay, bisexual, and other men who have sex with men (GBM) through risk compensation (eg, an increase in condomless sex or number of partners); however, longitudinal studies exploring the time-dependent nature of PrEP uptake and bacterial STIs are limited. We used marginal structural models to estimate the effect of PrEP uptake on STI incidence. METHODS We analyzed data from the iCruise study, an online longitudinal study of 535 Ontarian GBM from July 2017 to April 2018, to estimate the effects of PrEP uptake on incidence of self-reported bacterial STIs (chlamydia, gonorrhea, and syphilis) collected with 12 weekly diaries. The incidence rate was calculated as the number of infections per 100 person-months, with evaluation of the STIs overall and individually. We used marginal structural models to account for time-varying confounding and quantitative bias analysis to evaluate the sensitivity of estimates to nondifferential outcome misclassification. RESULTS Participating GBM were followed up for a total of 1,623.5 person-months. Overall, 70 participants (13.1%) took PrEP during the study period. Relative to no uptake, PrEP uptake was associated with an increased incidence rate of gonorrhea (incidence rate ratio = 4.00; 95% CI, 1.67-9.58), but not of chlamydia or syphilis, and not of any bacterial STI overall. Accounting for misclassification, the median incidence rate ratio for gonorrhea was 2.36 (95% simulation interval, 1.08-5.06). CONCLUSIONS We observed an increased incidence rate of gonorrhea associated with PrEP uptake among Ontarian GBM that was robust to misclassification. Although our findings support current guidelines for integrating gonorrhea screening with PrEP services, additional research should consider the long-term impact of PrEP among this population. Key words: bacterial sexually transmitted infections; STIs; pre-exposure prophylaxis; PrEP; HIV; gay, bisexual, and men who have sex with men; sexual and gender minorities; health risk behaviors; prevention; marginal structural models; quantitative bias analysis; risk compensation; vulnerable populations Submitted September 25, 2023; submitted, revised, June 6, 2024; accepted June 7, 2024., https://doi.org/10.1370/afm.3152 Annals Early Access article INTRODUCTION Bacterial sexually transmitted infections (STIs), including chlamydia, gonorrhea, and syphilis, have increased since 2010, with cases of gonorrhea and syphilis commonly reported among men [...]

Advocates and researchers have made myriad recommendations to guide policy actors in stopping conversion therapy. This commentary extends these recommendations by identifying core challenges that policy actors face with interventions that solely focus on conversion therapy. Conversion therapy exists because of pervasive social values and beliefs that devalue, erase and stigmatize Two-Spirit, lesbian, gay, bisexual, transgender, queer and other sexual and gender minority (2SLGBTQ+) people, in turn, creating a supply and demand market. That is, those who espouse oppressive values enable and supply conversion therapy for the demand of 2SLGBTQ+ people struggling against these values and those who influence their lives (e.g., guardians). The discussion underscores why policy actors must disrupt the cisheteronormative bedrock that sustains conversion therapy. It is imperative for policy actors to expand policies and programming beyond conversion therapy using an intersectional framework that considers colonialism, racism and cisheterosexism. Interventions must encompass all systems (e.g., health, legal, social, economic) that shape 2SLGBTQ+ people's lives to disrupt the market of conversion therapy., (Copyright © 2024 Longwoods Publishing.)