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Background Adolescents aged 13–24 years account for 23% of HIV diagnoses in the Atlanta Metropolitan Area, indicating the need for new prevention strategies. Pre-Exposure Prophylaxis (PrEP), recently approved for adolescent use, is effective in HIV prevention and is often marketed to young men who have sex with men (MSM); however, problems with access, scalability and waning adherence have limited its use in this population and more broadly. A 2016 CDC HIV surveillance report showed 19.2% of new HIV diagnoses were attributed to heterosexual transmission in women aged 13–24, relative to 0% in their heterosexual male counterparts, and 5.4% in same-aged MSM. This study assesses parent and female adolescent knowledge on HIV risk and PrEP perception to inform potential implementation strategies. Methods PrEP acceptability and barrier surveys were administered to 102 adolescent-parent dyads attending an adolescent clinic and emergency room in Atlanta, Georgia. Eight female adolescent-parent pairs were randomly selected to participate in in-depth phone interviews. Responses were analyzed using computer-assisted thematic analyses. Results Of the 8 female adolescent participants (mean age = 18.9 years), all were African American, and 1 was sexually active. Of the 8 parent participants (mean age = 44.1 years), all were female and African American. None of the participants had ever used PrEP. Analysis indicated that both parents and adolescent females had poor HIV risk assessment and knowledge, as well as barriers to PrEP usage including concerns about side effects, cost, and desire for alternative PrEP delivery methods and/or schedules. Finally, adolescent females expressed reliance on self-efficacy to be able to discuss HIV protection methods with their partner. Conclusion Female adolescents use unreliable methods to ensure HIV prevention, and with poor HIV knowledge, are at risk of transmission. Thus, PrEP may be a viable option for adolescent females at high risk for infection. PrEP implementation strategies in adolescents needs to consider HIV risk assessment, PrEP education, potential options for alternative dosing and delivery, and continued implementation work, focused beyond just the young MSM community. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background Reduced microbiota diversity (dysbiosis) in people with HIV (PWH) can damage the intestinal barrier and increase microbial translocation, resulting in inflammation, a driver of morbidity and mortality. We hypothesized that fecal microbiota transplants (FMT) would reverse dysbiosis in PWH. Methods We administered 6 weekly oral doses of a novel lyophilized fecal microbiota product from 2 healthy donors to 6 men who have sex with men with HIV on suppressive ART. Shotgun sequencing on stool before, after 6 weekly FMT, and 20 weeks after the last FMT (Weeks 0, 6 and 26), and from donors, was performed to determine bacterial community profiles. Biomarkers were measured by Luminex assays and ELISAs. All comparisons used Wilcoxon matched-pairs signed rank test. Results Median age at Week 0 was 41 years, CD4+ T-cell count 504 cells/mm3, VL < 20 copies/mL. Mean α diversity by observed species index increased from Week 0 to 6 (61.2 to 70.2, P = 0.29; Figure 1) and decreased by Week 26 (70.2 to 52.2, P = 0.33) to be similar to the donors' (63.5, P = 0.86). Microbiome distribution by principal component analysis shifted toward the donors' distribution in most participants at Week 6 but shifted away by Week 26 (Figure 2). Biomarkers did not change significantly during the study. PID3, with HIV > 35 years, had chronic constipation that resolved with FMT with a large shift in distribution but recurred at Week 26. Fusobacterium gonidiaformans , Porphyromonas somerae , and Haemophilus parainfluenzae comprised 27% of his microbiome at Week 0 but 0.73% at Week 6; untyped Bacteroides comprised 35% at Week 6. I-FABP (6,899 to 2,736 pg/mL), sCD14 (1.67 to 1.31 μg/mL), IL-6 (1.51 to 1.13 pg/mL) and sTNFRII (11,659 to 8,300 pg/mL) levels decreased in PID3; Week 0 levels in PID3 were higher than in other recipients. No related serious adverse events occurred. Conclusion Weekly FMT resulted in increased intestinal microbiome α diversity and a shift in microbiome distribution in most participants. These changes did not persist after stopping FMT. PWH with long-term HIV and/or greater inflammation or gut damage may be most likely to benefit from FMT. The effects of recurrent FMT were transient, suggesting longer duration of treatment or intermittent FMT boosting may be required to maintain its benefits. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background Antiretroviral therapy adherence remains a challenge, particularly for young African American men who have sex with men (YAAMSM). We enrolled 40 YAAMSM for 3 months of electronic adherence monitoring (EAM). These data may be useful in developing an antiretroviral EAM intervention that responds to missed doses with real-time text messages. Methods YAAMSM (age 18–34 years) living with HIV and taking ART participated in a quantitative and qualitative study that included ART adherence monitoring with a Wisepill electronic monitoring device for up to 3 months. Interviews were performed during April 2017–April 2019 at baseline and follow-up. Monitoring data were reviewed to determine timing and patterns of missing their first true adjudicated miss for durations of 1 dose, 3 consecutive days, and 7 consecutive days. Follow-up qualitative interviews included exploring acceptability of monitoring. Results The median age was 28 years and median participant observation time was 90 days (interquartile range 88–90 days) (n = 40 participants). Among those with at least 2 weeks follow-up and adjudication (n = 32), 100% missed at least 1 day. Most (82%) of these participants were <80% adherent in at least one of their monitored months. One dose and 3-day misses did not cluster (e.g. no disproportion on weekends). Most (88%) first missed doses occurred during the first 9 days monitored and most (69%) of the 13 who missed 3 consecutive days missed within the first monitored month. Four participants missed 7 consecutive days. Among 31 with a follow-up interview, 28 (90%) felt receiving a text because of device monitoring would affect their medication taking in the future. Illustrative quotes included, "It made me more responsible" and "...it makes you want to do it right." Conclusion Most YAAMSM living with HIV in this study had adherence below the target threshold of > 80%. These data support development of a text message responsive real-time electronic adherence monitoring intervention approach. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background In the DISCOVER PrEP trial, emtricitabine/tenofovir alafenamide (F/TAF) was noninferior to emtricitabine/tenofovir disoproxil fumarate (F/TDF) for HIV prevention. Here, we report on the renal outcomes of F/TAF and F/TDF among all DISCOVER participants and in those on baseline F/TDF PrEP who were randomized to F/TAF. Methods In total, 5387 men who have sex with men (MSM) and transgender women (TGW) at risk for HIV were randomized 1:1 to receive blinded F/TDF or F/TAF taken once daily (full cohort). Of these, 905 were on F/TDF PrEP at enrollment; of whom, 465 were randomized to F/TAF. Renal function and safety assessments included urinalysis (UA), estimated glomerular filtration rate (eGFRCG), urine protein:creatinine (Cr) ratio (UPCR), markers of proximal tubular function (β2-microglobulin:Cr ratio [β2M:Cr] and retinol-binding protein:Cr ratio [RBP:Cr]) and investigator-reported renal adverse events (AEs). Week 48 data are presented. Results In the full cohort, F/TAF was associated with more favorable changes in eGFRCG, β2M:Cr, and RBP:Cr compared with F/TDF (Table 1). Treatment-emergent proteinuria by UA was more common with F/TDF than F/TAF (24.3% vs. 21.3% P = 0.009), as were treatment-emergent elevations in UPCR >200 mg/g (35 [1.5%] vs. 16 [0.7%], P = 0.005). Compared with F/TDF, participants taking F/TAF had numerically fewer study drug-related renal AEs, severe study drug-related renal AEs, and discontinuations due to renal AEs (Table 2). Proximal renal tubulopathy (Fanconi syndrome) was reported in one participant in the F/TDF arm and none in the F/TAF arm. In participants on F/TDF PrEP at enrollment who were randomized to F/TAF, statistically significant increases in eGFRCG were apparent as early as week 4 (Table 1 and Figure 1), as were decreases in tubular proteinuria (Table 1). Renal biomarker changes in PrEP-naïve participants mirrored those in the full cohort. Conclusion Through 48 weeks, MSM and TGW taking F/TAF for PrEP had significantly better measures of renal function and fewer study-drug-related renal AEs compared with those taking F/TDF; switching from F/TDF to F/TAF was associated with improvements in eGFRCG and tubular function biomarkers. F/TAF for PrEP is effective and has a superior renal safety profile compared with F/TDF. Disclosures All Authors: No reported Disclosures. [ABSTRACT FROM AUTHOR]

Background The incidence of bacterial sexually transmitted infections (STIs) in men who have sex with men (MSM) has increased substantially despite availability of effective antibiotics. The US Centers for Disease Control and Prevention (CDC) recommends annual screening for all sexually active (SA) MSM and more frequent screening for high-risk (HR) MSM. The population-level benefits of improved coverage vs increased frequency of STI screening among SA vs HR MSM are unknown. Methods We used a network transmission model of gonorrhea (NG) and chlamydia (CT) among MSM to simulate the implementation of STI screening across different scenarios, starting with the CDC guidelines at current coverage levels. Counterfactual model scenarios varied screening coverage and frequency for SA MSM and HR MSM (MSM with multiple recent partners). We estimated infections averted and the number needed to screen to prevent 1 new infection. Results Compared with current recommendations, increasing the frequency of screening to biannually for all SA MSM and adding some HR screening could avert 72% of NG and 78% of CT infections over 10 years. Biannual screening of 30% of HR MSM at empirical coverage levels for annual SA screening could avert 76% of NG and 84% of CT infections. Other scenarios, including higher coverage among SA MSM and increasing frequency for HR MSM, averted fewer infections but did so at a lower number needed to screen. Conclusions The optimal screening scenarios in this model to reduce STI incidence among MSM included more frequent screening for all sexually active MSM and higher coverage of screening for HR men with multiple partners. [ABSTRACT FROM AUTHOR]

The article informs that according to the annual Sexually Transmitted Disease Surveillance Report issued by the Centers for Disease Control and Prevention (CDC), large number of chlamydia, gonorrhea, and syphilis were reported in the U.S. in 2016, and mentions that majority were cases of chlamydia.

The article focuses on a study regarding the benefits of efforts to increase targeted screening for syphilis on sexual health and human immunodeficiency virus (HIV) care. It mentions that community-supported and adequately resourced campaigns are highly effective at increasing syphilis testing. It also mentions the increase in current epidemiology of syphilis in the U.S.

The article responds to a commentary made on the article "Latent Transition Analyses in Clinical Cohorts" that presented results of latent class and latent transition analysis using sexual behavior surveillance data on gay and bisexual men (GBM) visiting primary-care clinics in Melbourne, Victoria. Topics discussed include the potential dependency between the probability of being observed and the outcome and limitations of prospective surveillance relative to conventional cohort studies.

Linked Article:Siegenbeek van Heukelom et al. Br J Dermatol 2016; 175:735–743. [ABSTRACT FROM AUTHOR]

Background We assessed the prevalence and risk factors of anal and oral high-risk (HR) human papillomavirus (HPV) infection in human immunodeficiency virus–uninfected men who have sex with men (MSM) and take preexposure prophylaxis (PrEP) in France. Methods Anal and oral samples were screened by multiplex real-time polymerase chain reaction (Anyplex II HPV 28; Seegene) for HPV DNA. Results A total of 61 unvaccinated MSM (mean age, 36.1 years) were enrolled. Anal HPV and HR-HPV prevalences were 93.4% and 81.9%, respectively, and oral HPV and HR-HPV prevalences, 33.9% and 19.6%, respectively. HR-HPV type 33 was the most detected genotype, in both anal and oral samples. Among MSM, 68.8% carried ≥1 anal HPV type targeted by the 9-valent Gardasil-9 vaccine; all oral HPV-positive samples carried ≥1 strain included in the vaccine. Condomless receptive anal intercourse and history of anal gonorrhea were the main factors associated with increased risk for anal HPV infection (adjusted odds ratio, 10.4) and anal infection with multiple HR-HPV genotypes (5.77), respectively. Conversely, having had <10 partners in the last 12 months was associated with decreased risk for anal carriage of both multiple HPV (adjusted odds ratio, 0.19) and HR-HPV (0.17) types. Conclusion French MSM using PrEP are at high risk for both anal and oral carriage of HR-HPV that could lead to HPV-related cancers. [ABSTRACT FROM AUTHOR]

The article presents case study of two man, one 64-year-old who had received a heart transplant in 2013 presented in Tours, France, in May 2016 with a 2-week history of fever and night sweats. And other 51-year-old diabetic man presented in Tours with ketoacidosis and septic shock 7 years after he had undergone liver transplantation for which he was still receiving immunosuppressive therapy.

Background Although men who have sex with men (MSM) are at high risk of hepatitis B virus (HBV) infection, they do not have access to vaccination in West Africa, which is a highly endemic region. We investigated HBV prevalence and associated factors, as well as acceptability and difficulties of vaccination in MSM enrolled in an operational research program in Burkina Faso, Côte d'Ivoire, Mali, and Togo. Methods We followed up 779 MSM in 2015–2018. Participants who were negative for both hepatitis B surface antigen (HBsAg) and antibodies (anti-HBs) at enrollment were offered HBV vaccination. Factors associated with HBV infection were identified using logistic regression models. Results Overall, HBV prevalence was 11.2% (95% confidence interval [CI], 9.0%–13.6%). It was lower in Togo than in Côte d'Ivoire (2.7% vs 17.3%; adjusted odds ratio [aOR], 0.12; 95% CI, 0.02–0.28) and higher in participants with 6+ recent male sexual partners (21.0% vs 9.3%; aOR, 1.48; 95% CI, 1.12–1.97). Of 528 participants eligible for vaccination, 484 (91.7%) were willing to be vaccinated and received at least 1 dose (ranging from 68.2% in Abidjan to 96.4% in Bamako; P <.001). Of the latter, 390 (80.6%) received 3 or 4 doses. The proportion of participants for whom the minimum required time between each dose was respected ranged from 10.9% in Bamako to 88.6% in Lomé (P <.001). Conclusions MSM in West Africa should be targeted more for HBV screening and vaccination. Although vaccination is well accepted by MSM, greater training of health care workers and education of MSM are required. [ABSTRACT FROM AUTHOR]

Indications for human papillomavirus vaccination programs are expanding to boys. However, the rationale behind their inclusion is often not clear. Using a Bayesian synthesis framework and assuming equal vaccine coverage in both sexes, we assessed how the incremental number of cancer cases prevented and life-years gained from boys' vaccination are distributed between women, heterosexual men, and men who have sex with men (MSM). Below 60% coverage, at least 50% of the gains from boys' vaccination was attributable to cervical cancer prevention, whereas at 80% coverage, 50% of the gains was attributable to women, 15% to heterosexual men, and 35% to MSM. Above 90% coverage, 85–100% of the gains from boys' vaccination was attributable to anal and oropharyngeal cancer prevention, mainly in MSM. Sex-neutral vaccination can be advocated on grounds of bolstering herd protection to women and directly protecting men, particularly MSM, with the clinical significance of either argument determined by the coverage. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Social media interventions to promote HIV testing" by J. D. Tucker, B. Cao and H. Li in the previous issue.

A letter to the editor is presented in response to the article "Using social media to increase HIV testing among gay and bisexual men, other men who have sex with men, and transgender persons: outcomes from a randomized community trial" by S. D. Rhodes and colleagues in the previous issue.

A response from the authors of the article "Programmatic Implications of Acute and Early HIV Infection" in the 2015 issue is presented.

The article discusses the significance of the Internet in controlling HIV for men with sexual engagement with other men in China. Topics discussed include the decline of mortality rate with the development of antiretroviral therapy for HIV, research on the spread of HIV epidemic and HIV care in the country, and use of crowdsourcing in improving HIV-testing messaging campaigns and heightened community health engagement.

A letter to the editor is presented in response to the article "Applying a PrEP continuum of care for men who have sex with men in Atlanta, Georgia" by C.F. Kelley and others published in the previous issue of the periodical.

A correction to the article "Design Strategy of the Sabes Study: Diagnosis and Treatment of Early HIV Infection Among Men Who Have Sex With Men and Transgender Women in Lima, Peru, 2013-2017" is presented.

Background Men who have sex with men (MSM) in the United States experience a disproportionate rate of diagnosis of HIV. Surveillance data demonstrate age-based disparities among MSM, with higher rates of diagnosis among MSM age ≤34 years nationally. Population size estimates within age group at the state level have not been available to determine rates for each state. We estimated the size of the MSM population in 5 age groups in each state and estimated the rate of prevalent HIV diagnoses in 2013 and new HIV diagnoses in 2014. Methods We used data from the General Social Survey, American Community Survey, and previously published estimates from the National Health and Nutrition Examination Survey to estimate the population of MSM in 5 age groups at the state level. We combined these estimates with surveillance data to estimate age-stratified rates of prevalent diagnoses in 2013 and new diagnoses in 2014 in each state. We estimated standardized prevalence and diagnosis ratios comparing the Northeast, South, and West regions with the Midwest. Results Rates of prevalent diagnoses increased with increasing age, and rates of new diagnoses were highest among younger age groups. In the United States, the new diagnosis rate among those age 18–24 years in 2014 was 1.4 per 100 MSM without a diagnosis. The highest diagnosis rates were observed among men age ≤34 years in the South. Conclusions Age-stratified estimates of HIV prevalence and new diagnosis rates at the state level can inform public health prevention strategies and resource allocation. [ABSTRACT FROM AUTHOR]

A correction to the article "Updated data on linkage to HIV care and antiretroviral treatment among men who have sex with men - 20 cities, United States," by B. E. Hoots and colleagues is presented.

The author discusses whether the screening practice of testing Acute Hepatitis C Virus in men having HIV infection who have sex with men (MSM) should be changed. It mentions guidelines that recommends to test human body having positive antibody response to be applied to HCV RNA testing. It highlights a study published in the periodical which reveals that the guidelines were not followed related to HCV screening in HIV patients.

The article discusses research on kaposi sarcoma (KS) in HIV-negative men who have sex with men (MSM). It details the study methodology, which involved HIV-seronegative MSM patients in England, conducted between 1997 and 2011. The researchers theorized that the increased risk of KS is secondary to the increased prevalence of KS-associated herpesvirus (KSHV) within the population cohort.

Background The reasons why bacterial sexually transmitted infections (BSTIs) are increasing in US men who have sex with men (MSM) have not been fully characterized. Methods An open cohort of MSM accessing medical care at a Boston community health center was used to assess secular trends in BSTI diagnoses. Frequency of infection and the estimated population size were used to calculate diagnosis rates. Poisson models were fit for multivariable analyses. Results Between 2005 and 2015, 19 232 men had at least 1 clinic visit. Most (72.4%) were white; 6.0% were black, and 6.1% were Latino. Almost half had documented self-report of identifying as gay (42.6%) or bisexual (3.2%). Most had private health insurance (61.7%); 5.4% had Medicare, 4.6% had Medicaid, and 8.4% reported no insurance. Between 2005 and 2015, BSTI diagnoses increased more than 8-fold. In 2015, of 1319 men who were diagnosed with at least 1 BSTI; 291 were diagnosed with syphilis, 554 with gonorrhea (51.4% rectal, 31.0% urogenital), and 679 with chlamydia (69.1% rectal, 34.3% urogenital). In 2015, 22.7% of BSTIs were diagnosed among HIV-infected patients (15.4% of the clinic population), and 32.8% of BSTIs were diagnosed among HIV-uninfected patients using pre-exposure prophylaxis (PrEP; 10.1% of all men in care). In multivariable analyses, age 18 to 24 years, being HIV-infected, using PrEP, being nonwhite, or reporting Medicaid or not reporting having private insurance or Medicare were independently associated with being diagnosed with a new BSTI. Conclusions Over the past decade, BSTI diagnosis rates increased in HIV-infected and uninfected MSM, with disproportionate increases in PrEP users, racial and ethnic minority MSM, those aged 25 to 34 years, and those without stable health insurance, warranting focused education, screening, and accessible services for these key subpopulations. [ABSTRACT FROM AUTHOR]

The article focuses on a study on reduction in the risk of gonorrhea due to change in behaviors of men who have sex with men. Topics discussed include prevention in growth of gonorrhea in the pharynx due to use of antiseptic alcohol-containing mouthwash, changes in behaviors including not tongue kissing with partners, not having receptive oral sex and using condoms for oral sex, and percentage of participants who showed the will to change behaviors to reduce the risk.

The article discusses the SSSS Members symposium held as of May 2, 2017 featuring studies related to sexual health research on vulnerable populations around the globe. Topics discussed include impact of internalized homonegativity on men who have sex with men (MSM) in Tanzania, effect of attitudes towards the preventive value of antiretroviral therapy on bisexual and gay men's risk behaviors and sexual health issues in Papua New Guinea.

The article discusses a study related to examination of gender expression (GE) heterogeneity in South African men who have sex with men (MSM) and relationship to sexual health outcomes. Topics discussed include difference in GE between bisexual MSM (GBMSM) by sexual, socio-demographics and dating experiences, highlighting of heterogeneity of gender among MSM and importance of diverse gender politics.

The article discusses a study related to examination of associations between sexual well-being outcomes in sex with men (MSM) self-reporting anal pain during receptive penetration and anal penetration cognitions. Topics include association of greater control cognitions with greater distress and severity of anal pain, association of higher positive cognitions with greater sexual satisfaction and importance of penetration cognitions for sexual well-being of men experiencing anal pain .

The article presents study on men who have sex with men (MSM) who attended the Melbourne Sexual Health Centre (MSM) in Australia for their first visit in 2016. It mentions use of Chi-squared test to examine the differences in sexual behaviours between vaccinated and unvaccinated MSM. It reveals vaccinating against Human Papillomavirus (HPV) is not associated with increased sexual activity and condomless anal sex practice among MSM.

The article focuses on a presentation presented at the 23rd Congress of the World Association for Sexual Health which examines the levels of subjective well-being and and clinical symptomatology. It mentions data obtained are compared to those from a group of Men who have Sex with Men (MSM) with transwomen. It also need to develop intervention strategies to acknowledge the unique reality of MTF transgender individuals and those with non-normative gender identities.

The article looks at a study which aims to explore men who have sex with men (MSM) partner notification (PN) experiences following a recent HIV diagnosis. It mentions men reported high risk sexual behaviour particularly with casual partners, who they predominantly met online, via smartphone apps and partner perceived at risk or responsible for transmission. It concludes MSM feel morally obliged to notify their partners following a HIV diagnosis.

The article discusses a study related to hypersexuality in men who have sex with men (MSM) including effects of negative mood on arousal, impact of acute alcohol intake on genital response and association between sexual response and porn use.

The article discusses a study related to understanding of kissing pattern amongst men who have sex with men (MSM) by different sources for meeting partners. Topics discussed include difference in kissing practices among men with respect to meeting partners at different locations, kissing as important contributor to gonorrhoea transmission and penile-anal sex as major mode of gonorrhoea transmission among men who met partners at sex on premises venues (SOPV).

The article focuses on an article in "Morbidity and Mortality Weekly Report" as of August 2016 regarding Shigella sonnei infection in men. Topics include recognizing Shigella infections among men who had sex with men (MSM) and homeless person with a specific pulsed-field gel electrophoresis (PFGE) pattern linked to outbreak; cases of shigellosis in the U.S. and increase in risk of infection; and identification of Shigella outbreak strain in women who reported homelessnes in Portland, Oregon.

A letter to the editor is presented in response to the article "Test-and-Treat in Los Angeles: A Mathematical Model of the Effects of Test-and Treat for the men who have sex with men Population in Los Angeles County" by N Sood and his colleagues in the 2013 issue.

A reprint of the article "Mainstreaming HIV Services for Men Who Have Sex With Men: The Role of General Practitioners," which appeared in the 2012 issue of "Sexually Transmitted Infections" is presented. It discusses the strong potential of general practitioners (GPs) and other primary care doctors for providing human immunodeficiency virus (HIV) services. It also cites several challenges to providing high-quality HIV clinical services.

The author offers a commentary on the study "Understanding the Personality and Behavioral Mechanisms Defining Hypersexuality in Men Who Have Sex With Men" by Miner and colleagues. Topics include the issue of whether hypersexuality is a clinical problem, research targets considered in the study, and findings on the association of sexually specific factors and negative emotionality and the experience of out-of-control sexual behavior.

The article reports the increasing rates of shigellosis among adult males, specifically men who have sex with men (MSM) in the U.S. , Canada and Europe as of August 2015. It mentions the increased risk for infection with shigellae that are not susceptible to ciprofloxacin or azithromycin drugs. It also discusses the use of Azithromycin as antimicrobial treatment for shigellosis among children.

Compared to a control behavioral intervention, Contingency Management, an escalating voucher-based incentive system to reinforce stimulant abstinence, better supported MSM stimulant users in PEP course completion, decreased stimulant use, and a trend toward fewer condomless sexual acts.Background. Stimulant-using men who have sex with men (MSM) are at high risk of human immunodeficiency virus (HIV) acquisition. Contingency Management (CM) is a robust substance abuse intervention that provides voucher-based incentives for stimulant-use abstinence.Methods. We conducted a randomized controlled trial of CM with postexposure prophylaxis (PEP) among stimulant-using MSM. Participants were randomized to CM or a noncontingent “yoked” control (NCYC) intervention and observed prospectively. Generalized linear models were used to estimate the effect of CM on PEP course completion, medication adherence, stimulant use, and sexual risk behaviors.Results. At a single site in Los Angeles, 140 MSM were randomized to CM (n = 70) or NCYC (n = 70). Participants were 37% Caucasian, 37% African American, and 18% Latino. Mean age was 36.8 (standard deviation = 10.2) years. Forty participants (29%) initiated PEP after a high-risk sexual exposure, with a mean exposure-to-PEP time of 32.9 hours. PEP course completion was greater in the CM group vs the NCYC group (adjusted odds ratio [AOR] 7.2; 95% confidence interval {CI}, 1.1–47.9), with a trend towards improved medication adherence in the CM group (AOR, 4.3; 95% CI, 0.9–21.9).Conclusions. CM facilitated reduced stimulant use and increased rates of PEP course completion, and we observed a trend toward improved adherence. Participants in the CM group reported greater reductions in stimulant use and fewer acts of condomless anal intercourse than the control group. This novel application of CM indicated the usefulness of combining a CM intervention with PEP to produce a synergistic HIV prevention strategy that may reduce substance use and sexual risk behaviors while improving PEP parameters. [ABSTRACT FROM PUBLISHER]

In the United Kingdom, human immunodeficiency virus (HIV) transmission among men who have sex with men (MSM) is not under control, despite readily available treatment, highlighting the need to design a cost-effective combination prevention package. MSM report significantly reduced transmission risk behavior following HIV diagnosis. To assess the effectiveness of HIV diagnosis in averting transmission during highly infectious primary HIV infection (PHI), we developed a stochastic individual-based model to calculate the number of HIV-transmission events expected to occur from a cohort of recently infected MSM with and those without the behavior changes reported after diagnosis. The model incorporates different types of sex acts, incorporates condom use, and distinguishes between regular and casual sex partners. The impact on transmission in the 3 months after infection depends on PHI duration and testing frequency. If PHI lasts for 3 months and testing is performed monthly, then behavior changes after diagnosis would have reduced estimated transmission events by 49%–52%, from 31–45 to 15–23 events; a shorter duration of PHI and/or a lower testing frequency reduces the number of infections averted. Diagnosing HIV during PHI can markedly reduce transmission by changing transmission-risk behavior. Because of the high infectivity but short duration of PHI, even short-term behavior change can significantly reduce transmission. Our quantification of the number of infections averted is an essential component of assessment of the cost-effectiveness of strategies to increase detection and diagnoses of PHI. [ABSTRACT FROM AUTHOR]

Background. Seroadaptive behaviors are strategies employed by men who have sex with men (MSM) to reduce the transmission risk for human immunodeficiency virus (HIV). It has been suggested that they contribute to the increasing diagnoses of sexually transmitted infections in HIV-diagnosed MSM. To understand the context in which the reemerging sexually transmitted infections appear, we developed a social epidemiological model incorporating the multiple factors influencing seroadaptive behaviors.Methods. A literature review of seroadaptive behaviors in HIV-diagnosed MSM was conducted. The literature was synthesized using a social epidemiological perspective.Results. Seroadaptive behaviors are adopted by MSM in high-income countries and are a way for HIV-diagnosed men to manage and enjoy their sexual lives. Influences are apparent at structural, community, interpersonal, and intrapersonal levels. There is little evidence of whether and when the behavior forms part of a premeditated strategy; it seems dependent on the social context and on time since HIV diagnosis. Social rules of HIV disclosure and perception of risk depend on the setting where partners are encountered.Conclusions. Seroadaptive behaviors are strongly context dependent and can reduce or increase transmission risk for different infectious diseases. Further data collection and mathematical modeling can help us explore the specific conditions in more detail. [ABSTRACT FROM AUTHOR]