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ObjectiveThe aim of this report is to investigate the nature of the relationship between depression and condomless sex (CLS) among gay, bisexual and other men who have sex with men (GBMSM).MethodsData are from the Antiretrovirals, Sexual Transmission Risk and Attitude (ASTRA) study of people living with HIV and attending one of eight HIV outpatient clinics in England (2011–2012) and the Attitudes to and Understanding of Risk of Acquisition of HIV (AURAH) study of HIV-negative/unknown status individuals attending one of 20 genitourinary medicine clinics in England (2013–2014). This analysis included GBMSM only. For each study, the prevalence of depressive symptoms (Patient Health Questionnaire-9 score ≥10) was presented according to three categories of sex in the past 3 months (considering anal/vaginal sex with men/women and anal sex with men in separate definitions): (1) no sex, (2) condom-protected sex only and (3) CLS. Multinomial logistic regression with ‘condom-protected sex only’ as the reference group was used to adjust for age and (for ASTRA participants) time since HIV diagnosis.ResultsThere were opposing associations of depression with recent sexual behaviour: the prevalence of depression was higher among those who reported no sex and those who reported CLS, compared with those who reported condom-protected sex only. Among the 2170 HIV-positive GBMSM in ASTRA, considering anal/vaginal sex with men/women, the prevalence of depressive symptoms was 32%, 20% and 28%, respectively, among men reporting no sex (n=783), condom-protected sex only (n=551) and CLS (n=836) (global pConclusionsDepression may be linked both to lack of sexual activity and to sexual risk taking. When investigating associations between depression and CLS, it is important to separate out individuals reporting condom-protected sex only from those reporting no sex.

The National Health Service in England is currently discussing whether to fund a Pre-exposure Prophylaxis (PrEP) Programme. The number of eligible individuals expected to come forward is a key consideration. The British HIV Association/BASHH position statement supports access to PrEP for men who have sex with men (MSM) if they have a confirmed HIV-negative status, report condomless anal sex (CLS) with a man in the past 3 months and report CLS is likely to occur again in the next 3 months.1 We aimed to investigate what proportion of MSM attending genitourinary medicine (GUM) services could be eligible for PrEP in England, using data from the AURAH (Attitudes to and Understanding of Risk of Acquisition of HIV) study,2 which recruited in English GUM services (2013–2014). A total of 4380 patients were approached over the study period and …

Background/introduction In the UK, HIV transmission remains ongoing among men who have sex with men (MSM). Data on mental health and sexual behaviour is limited among MSM whose HIV-status is negative/unknown. Aim(s)/objectives To describe the association of depressive symptoms with measures of condomless sex (CLS). Methods AURAH (Attitudes to, and Understanding of, Risk of Acquisition of HIV) is a cross-sectional questionnaire study in 20 UK STI clinics. We included MSM recruited from May 2013–January 2014 who reported anal sex in the past three months. Depressive symptoms were defined as a PHQ-9 score ≥10. We examined the association of depressive symptoms with: CLS in the past three months with (i) ≥2 partners (ii) discordant status partner(s) (unknown/HIV-positive) and self-reported STI diagnosis in the past year, using logistic regression. Results Of 457 MSM included (20% non-white, mean[IQR] age 33[13]), 130 (29%), 167 (37%) and 184 (40%) reported ≥2 CLS partners, discordant CLS and diagnosed STI respectively. Fifty-nine men (13%) had depressive symptoms; 78% of whom were not receiving treatment for depression. Adjusting for age, non-white ethnicity, university education, having a stable partner and recruitment region, depressive symptoms were associated with ≥2 CLS partners [adjusted OR (95% CI): 1.83 (1.01, 3.31), p = 0.048], discordant CLS [2.67 (1.49, 4.77), p = 0.001] and diagnosed STI [2.03 (1.13, 3.63), p = 0.017]. Discussion/conclusion Depressive symptoms are associated with CLS and recent STI among MSM. Management of mental health may play a role in HIV/STI prevention, although causality cannot be inferred and other factors may influence both sexual behaviour and depression.

Background It is unclear whether L1-VLP-based human papillomavirus (HPV) vaccines are efficacious in preventing anogenital pre-cancer in women with prior vaccine-type HPV exposure. Participants in the phase III efficacy trials were not excluded if infected at baseline (HPV-DNA and serology were performed in retrospect); the efficacy in this sub-group of vaccinees can be derived from published reports. Methods A systematic review and meta-analysis was conducted to compare the efficacy of L1-VLP-based HPV vaccines with control (hepatitis A or placebo). Randomized-controlled trials (including post-RCT follow-on cohort studies) were identified from MEDLINE, Embase, Web of Science SM , PubMed, Cochrane (and quoted references). Three vaccines were evaluated: Cervarix ™ containing HPV-16/18 VLPs (GSK), Gardasil ® containing HPV-6/11/16/18 VLPs (Merck), and an HPV-16 monovalent vaccine (Merck Research Laboratories). Results Three RCT reports and one post-RCT follow-on study met the eligibility criteria, comprising data from 13,339 women who were included in the vaccine studies but had evidence of HPV infection at baseline. Efficacy data were synthesised using a DerSimonian and Laird weighted random-effect model. The mean odds ratio (OR) and 95% confidence interval (CI) for the association between Cervarix ™, Gardasil ® and HPV-16 monovalent vaccine and HPV-associated cervical intraepithelial neoplasia grade 3 or worse (CIN3+) was 0·90 (CI: 0·56, 1·44) and for the association between Gardasil ® and HPV-associated vulval/vaginal intraepithelial neoplasia grades 2–3 (VIN2–3/VaIN2–3) OR 1·20 (CI: 0·07, 20·40). Conclusion There was no evidence that the HPV vaccines are effective in preventing vaccine-type HPV-associated pre-cancer in women with evidence of prior HPV exposure in this analysis. However, these studies were not designed to investigate the efficacy in this group, so statistical power (sample size, follow-up period and event rate) was insufficient to detect a small effect size. Longer follow-up is also needed to detect possible prevention of re-infection.