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Introduction: Disparities in HIV and other sexually transmitted infections (STIs) persist among cisgender sexually minoritized men in the United States, driven in part by sexual behavior stigma, which is a barrier to clinic-based HIV/STI testing. HIV/STI biospecimen self-collection (HSBS) is a novel testing approach that mitigates stigma by allowing for some testing-related procedures to be conducted by oneself in one's home or any private location rather than a facility that requires interpersonal interactions and exposure to other members of the public. HSBS has demonstrated acceptability, feasibility, and effectiveness in testing uptake, but the extent to which stigma persists in HSBS and the quantification of stigma's role in HSBS is limited., Methods: From 2019-2020, a nationwide sample of sexually minoritized men completed an online biobehavioral survey. Those who agreed to be recontacted (N = 4147) were invited to participate in HSBS; consented participants received self-collection kits that were laboratory-tested if completed. Sexual behavior stigma and HSBS associations were assessed with logistic regression., Results: Mean age of participants was 35 years, 58% (2421/4147) were non-Hispanic white, 82% (3391/4147) were gay-identifying, 47% (1967/4147) had at least a college degree, and 56% (2342/4147) earned ≥ $40,000 annually; 27% (1112/4147) expressed HSBS interest, and 67% (689/1034) completed HSBS. HSBS interest and completion were less common among non-Hispanic Black sexually minoritized men and sexually minoritized men of lower socioeconomic status. Stigma from family and friends was significantly, negatively associated with HSBS interest (aOR = 0.72, 95% CI = 0.56, 0.93). Among those who had not tested for HIV/STIs in the past year, anticipated healthcare stigma was marginally, negatively associated with HSBS completion (aOR = 0.40, 95% CI = 0.15, 1.07). Among those who had never previously tested for HIV/STIs, anticipated healthcare stigma was significantly, negatively associated with HSBS interest (aOR = 0.32, 95% CI = 0.14, 0.72)., Conclusions: Sexual behavior stigma persists as an HIV/STI testing barrier, even in the case of HSBS, limiting its utilization. Increasing HSBS among sexually minoritized men in the US necessitates stigma mitigation efforts that directly address equity in implementation., (© 2024. The Author(s).)

In the United States, a context of multiple marginalization shapes sexual health disparities experienced by transgender women. Using data from 396 transgender women with negative or unknown HIV status, we performed exploratory factor analysis on responses to gender identity and sexual behavior stigma items and regressed sexual health outcomes on extracted factors via modified Poisson regression with robust variance estimation. Overall, 97.2% of participants endorsed ≥ 1 gender identity stigma; 67.2% endorsed ≥ 1 sexual behavior stigma; and 66.9% endorsed ≥ 1 of each. Extracted factors included gender-identity social stigma, reflecting experiences related to family, fearfulness in public, and verbal harassment (α = 0.68); gender-identity institutional stigma/violence, reflecting experiences related to healthcare, police interactions, and interpersonal violence (α = 0.73); and global sexual behavior stigma, reflecting experiences related to family, friends, and healthcare, as well as police interactions, fearfulness in public, verbal harassment, and interpersonal violence (α = 0.83). Gender-identity social stigma was significantly, positively associated with testing for HIV and testing for sexually transmitted infections. Gender-identity institutional stigma/violence and global sexual behavior stigma were both significantly, positively associated with condomless anal sex, sex work, testing for HIV, testing for sexually transmitted infections, and use of HIV pre-exposure prophylaxis. Stigma-mitigation remains critical to improve quality of life and sexual health for transgender women in the United States., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: The speed with which a pathogen circulates in a sexual network is a function of network connectivity. Cross-sectional connectivity is a function of network features like momentary degree and assortative mixing. Temporal connectivity is driven by partner acquisition rates. The forward-reachable path (FRP) has been proposed as a summary measure of these two aspects of transmission potential. We use empirical data from San Francisco and Atlanta to estimate the generative parameters of the FRP and compare results to the HIV/sexually transmitted infection epidemics in each city., Methods: We used temporal exponential random graph models to estimate the generative parameters for each city's dynamic sexual network from survey data. We then simulated stochastic dynamic networks from the fitted models and calculated the FRP for each realization, overall, and stratified by partnership type and demographics., Results: The overall mean and median paths were higher in San Francisco than in Atlanta. The overall paths for each city were greater than the sum of the paths in each individual partnership network. In the casual partnership network, the mean path was highest in the youngest age group and lowest in the oldest age group, despite the fact that the youngest group had the lowest mean momentary degree and past-year partner counts., Conclusions: The FRP by age group revealed the additional utility of the measure beyond the temporal and cross-sectional network connectivity measures. Other nonnetwork factors are still necessary to infer total epidemic potential for any specific pathogen., Competing Interests: The authors report no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Men who have sex with men (MSM) and transgender women (TGW) experience high incidence and prevalence of sexually transmitted infections (STI), and data are needed to understand risk factors for STIs in these populations. The Sibanye Health Project was conducted in Cape Town and Port Elizabeth, South Africa from 2015 to 2016 to develop and test a package of HIV prevention interventions for MSM and TGW. We describe the incidence, prevalence and symptoms of Chlamydia trachomatis (CT), Neisseria gonorrhea (NG) and syphilis observed during the study., Methods: Participants completed HIV testing at baseline. All participants who were HIV negative were followed prospectively. Additionally, a sample of participants identified as living with HIV at baseline was selected to be followed prospectively so that the prospective cohort was approximately 20% HIV positive; the remaining participants identified as HIV positive at baseline were not followed prospectively. Prospective participants were followed for 12 months and returned for clinic-based STI/HIV testing and assessment of STI symptoms at months 6 and 12. Additional HIV/STI testing visits could be scheduled at participant request., Results: Following consent, a total of 292 participants attended a baseline visit (mean age = 26 years), and 201 were enrolled for the 12-month prospective study. Acceptance of screening for syphilis and urethral NG/CT was near universal, though acceptance of screening for rectal NG/CT was lower (194/292; 66%). Prevalence of urethral CT and NG at baseline was 10% (29/289) and 3% (8/288) respectively; incidence of urethral CT and NG was 12.8/100 person-years (PY) and 7.1/100 PY respectively. Prevalence of rectal CT and NG at baseline was 25% (47/189) and 16% (30/189) respectively; incidence of rectal CT and NG was 33.4/100 PY and 26.8/100 PY respectively. Prevalence of syphilis at baseline was 17% (45/258) and incidence was 8.2/100 PY. 91%, 95% and 97% of diagnosed rectal NG/CT, urethral NG/CT and syphilis infections, respectively, were clinically asymptomatic., Conclusions: Prevalence and incidence of urethral and rectal STIs were high among these South African MSM and TGW, and were similar to rates in other settings in the world. Clinical symptoms from these infections were rare, highlighting limitations of syndromic surveillance and suggesting the need for presumptive testing and/or treatment to address the STI epidemic among MSM/TGW in South Africa., (© 2020 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society.)

Background: Adverse Childhood Experiences (ACEs) are associated with a wide range of increased risk behaviors and health consequences, they have not been extensively described in all subpopulations., Objective: The specific objectives of the study were to describe the prevalence of predefined ACEs among a nationwide sample of men who have sex with men (MSM) and determine associated HIV or sexually transmitted infection (STI) related health outcomes, testing practices, and risk behaviors., Participants and Setting: Eligible participants were MSM aged 18 years or older who reported male-male sex in the past 12 months., Methods: Data were obtained from the 2015 cycle of the American Men's Internet Survey, these data were collected between September 2015 and April 2016, and contained questions related to 8 ACE exposure categories. During analyses conducted between September 2017 and April 2018, multiple log-binomial models were fit to assess associations., Results: Among 2590 participants, 79.7 % reported exposure to one or more ACE category. Participants exposed to any ACE were more likely to report STI testing (adjusted prevalence ratio [aPR]: 1.07; 95 % confidence interval [95 %-CI]: 1.00, 1.15), illicit substance use (aPR: 1.23, 95 %-CI: 1.05, 1.46), and condomless anal intercourse with another man (aPR: 1.13, 95 %-CI: 1.03, 1.21)., Conclusions: There is a high overall ACE burden among MSM nationally, with potential influences on key HIV/STI behaviors in later life. ACE exposure should be routinely assessed, prevention is ideal but appropriate measures such as trauma informed care should also be considered for adult MSM accessing HIV and STI-related services., (Published by Elsevier Ltd.)

Purpose: The purpose of this study was to present perceptions about using patient portals to manage HIV and sexually transmitted infection (STI) test results and to communicate with sexual partners among a 2018 nationwide sample of adolescent and young sexual minority men (YSMM) aged 15-25 years., Methods: Univariate and bivariate analyses were conducted on cross-sectional online survey data., Results: Participants gave high or moderate value to portals that provide tips for sexual health (95.1% [1,168/1,228]), ability to locate HIV/STI testing centers (96.9% [1,190/1,228]), and ability to order home-based HIV/STI testing (96% [1,179/1,228]). Perceived health engagement and dyadic communication benefits of use were sustained at or above 94%. YSMM with a history of HIV/STI diagnosis were less willing to share online results with main (93% vs. 97%; Χ 2  = 5.13; p = .02) and nonmain (70% vs. 77%; Χ 2  = 5.17; p = .02) sexual partners., Conclusions: Patient portals represent highly acceptable spaces to deliver comprehensive sexual health services and could support communication on HIV/STI testing with sex partners among YSMM., (Copyright © 2020 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Introduction: Men who have sex with men (MSM) and transgender women (TGW) are at increased risk for acquiring HIV, but there are limited HIV incidence data for these key populations in Africa. Understanding HIV prevalence and incidence provides important context for designing HIV prevention strategies, including pre‐exposure prophylaxis (PrEP) programmes. We describe HIV prevalence, awareness of HIV infection, HIV incidence and associated factors for a cohort of MSM and TGW in Cape Town and Port Elizabeth, South Africa. Methods: From 2015 to 2016, MSM and TGW in Cape Town and Port Elizabeth were enrolled and prospectively followed for 12 months, receiving a comprehensive package of HIV prevention services. HIV testing was conducted at baseline and at follow‐up visits (targeted for three, six and twelve months). All HIV‐negative PrEP‐eligible participants were offered PrEP enrolment during the first four months of study participation. We determined HIV prevalence among participants at baseline, and incidence by repeat screening of initially HIV‐negative participants with HIV tests at three, six and twelve months. Results: Among 292 participants enrolled, HIV prevalence was high (43%; 95% CI: 38 to 49) and awareness of HIV status was low (50%). The 167 HIV‐negative participants who were followed prospectively for 144.7 person‐years; nine incident HIV infections were documented. Overall annual incidence was 6.2% (CI: 2.8 to 11.8) and did not differ by city. Annual HIV incidence was significantly higher for younger (18 to 19 years) MSM and TGW (MSM: 21.8% (CI: 1.2 to 100); TGW: 31.0 (CI: 3.7, 111.2)). About half of participants started PrEP during the study; the annual incidence of HIV among 82 (49%) PrEP starters was 3.6% (CI: 0.4, 13.1) and among those who did not start PrEP was 7.8% (CI: 3.1, 16.1). Conclusions: HIV incidence was high among MSM and TGW in the context of receiving a comprehensive package of prevention interventions and offering of PrEP. PrEP uptake was high; the observed incidence of HIV in those who started PrEP was about half the incidence of HIV in those who did not. Future implementation‐oriented studies should focus on decisions to start and continue PrEP for those at highest risk, including young MSM. [ABSTRACT FROM AUTHOR]

Background Human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) has great potential to reduce HIV incidence among young black men who have sex with men (YBMSM); however, initiation and persistence for this group remain low. We sought to understand the patterns and predictors of PrEP uptake and discontinuation among YBMSM in Atlanta, Georgia. Methods PrEP was offered to all participants in a prospective cohort of YBMSM aged 18–29 years not living with HIV. Time to PrEP uptake, first discontinuation, and final discontinuation were assessed using the Kaplan-Meier method. Cox proportional hazard models were used to identify predictors of uptake and discontinuation. Results After 440 person-years of follow-up, 44% of YBMSM initiated PrEP through the study after a median of 122 days. Of PrEP initiators, 69% had a first discontinuation and 40% had a final discontinuation during the study period. The median time to first PrEP discontinuation was 159 days. Factors associated with PrEP uptake included higher self-efficacy, sexually transmitted infection (STI), and condomless anal intercourse. Factors associated with discontinuation included younger age, cannabis use, STI, and fewer sex partners. HIV incidence was 5.23/100 person-years (95% confidence interval [CI], 3.40–7.23), with a lower rate among those who started PrEP (incidence rate ratio, 0.39; 95% CI,.16–.92). Conclusions Persistent PrEP coverage in this cohort of YBMSM was suboptimal, and discontinuations were common despite additional support services available through the study. Interventions to support PrEP uptake and persistence, especially for younger and substance-using YBMSM, are necessary to achieve full PrEP effectiveness. Clinical Trials Registration NCT02503618. [ABSTRACT FROM AUTHOR]

Rural men who have sex with men (MSM) are heavily affected by HIV, and many lack culturally competent HIV prevention resources. Rural MSM may find sexual partners on the internet, which may also be a way to deliver prevention services to them. To understand the differences between rural and urban MSM with respect to HIV risk factors and behaviors and the utilization of online HIV prevention services, we used data from the 2012 Web-Based HIV Behavioral Survey (WHBS). Using WHBS data collected between June and August 2012, we compared the characteristics of MSM with positive or unknown HIV infection status who had sex with a male in the past 12 months, from rural vs urban areas using Chi square tests and median tests. We used logistic regression and calculated adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) to compare self-reported HIV risk behaviors, HIV/STI testing behaviors, use of prevention services, and perceived discrimination. Of the 8166 MSM included in our analysis, 3583 (44%) were from rural areas, and 4583 (56%) were from urban areas. Compared to urban MSM, rural MSM were less likely to ever test for HIV (aPR = 0.94, CI 0.92-0.95), to be tested for HIV in the last year (aPR = 0.83, CI 0.79-0.87), or to receive free condoms (aPR = 0.83, CI 0.79-0.86) or individual prevention counseling in the past year (aPR = 0.86, CI 0.78-0.95). Rural MSM were less likely to have been tested in the last year for syphilis, gonorrhea, or chlamydia (aPR = 0.70, CI 0.62-0.78; aPR = 0.72, CI 0.64-0.81; aPR = 0.75, CI 0.67-0.85, respectively). Rural MSM also reported perceiving less tolerance of gays and bisexuals within their community (aPR = 0.80, CI 0.77-0.84). HIV prevalence is lower among MSM in rural areas compared to MSM in urban areas, but rural MSM report that they are more likely to face intolerance and are less likely to use basic HIV prevention services compared to urban MSM. Therefore, this hard-to-reach population could benefit from prevention services offered through the internet. [ABSTRACT FROM AUTHOR]

Background: The reasons for black/white disparities in HIV epidemics among men who have sex with men have puzzled researchers for decades. Understanding reasons for these disparities requires looking beyond individual-level behavioral risk to a more comprehensive framework. Methods and Findings: From July 2010-Decemeber 2012, 803 men (454 black, 349 white) were recruited through venue-based and online sampling; consenting men were provided HIV and STI testing, completed a behavioral survey and a sex partner inventory, and provided place of residence for geocoding. HIV prevalence was higher among black (43%) versus white (13% MSM (prevalence ratio (PR) 3.3, 95% confidence interval (CI): 2.5–4.4). Among HIV-positive men, the median CD4 count was significantly lower for black (490 cells/µL) than white (577 cells/µL) MSM; there was no difference in the HIV RNA viral load by race. Black men were younger, more likely to be bisexual and unemployed, had less educational attainment, and reported fewer male sex partners, fewer unprotected anal sex partners, and less non-injection drug use. Black MSM were significantly more likely than white MSM to have rectal chlamydia and gonorrhea, were more likely to have racially concordant partnerships, more likely to have casual (one-time) partners, and less likely to discuss serostatus with partners. The census tracts where black MSM lived had higher rates of poverty and unemployment, and lower median income. They also had lower proportions of male-male households, lower male to female sex ratios, and lower HIV diagnosis rates. Conclusions: Among black and white MSM in Atlanta, disparities in HIV and STI prevalence by race are comparable to those observed nationally. We identified differences between black and white MSM at the individual, dyadic/sexual network, and community levels. The reasons for black/white disparities in HIV prevalence in Atlanta are complex, and will likely require a multilevel framework to understand comprehensively. [ABSTRACT FROM AUTHOR]

Men who have sex with men (MSM) and are engaged in transactional sex (MSM-TS) experience complex social and structural vulnerabilities that increase their HIV risk. This study aimed to estimate the prevalence of TS and associations between TS and sexually transmitted infection (STI) outcomes among cisgender MSM in the U.S. Using 2017–2021 data from an online survey of U.S. MSM, characteristics of MSM-TS were summarized, and adjusted prevalence ratios (aPRs) calculated for the associations between past-year TS and bacterial STI diagnosis, HIV status, and either antiretroviral or pre-exposure prophylaxis use. Analyses were conducted in 2023. TS prevalence was 3.7% (n =1,848/49,539). Compared to other MSM, MSM-TS more commonly reported homelessness, being uninsured, condomless anal sex with partners of any HIV status and condomless anal sex with serodifferent partners, and illicit drug use. TS was associated with increased HIV (aPR 1.44, 95% CI 1.25–1.66) and bacterial STI prevalence (aPR 2.40, 95% CI=2.09–2.52) and lower antiretroviral therapy use (among MSM living with HIV; PR 0.92, 95% CI=0.87–0.97). Structural and behavioral risks converged among U.S. MSM engaging in TS leading to greater HIV and bacterial STI prevalence in this group. HIV interventions for U.S. MSM-TS should address individual as well as structural risks, including poverty and housing instability. [ABSTRACT FROM AUTHOR]