Preliminary evidence of HIV seroconversion among HIV-negative men who have sex with men taking non-prescribed antiretroviral medication for HIV prevention in Miami, Florida, USA

Sexual Health ◽  
2017 ◽  
Vol 14 (2) ◽  
pp. 193 ◽  
Author(s):  
Mance E. Buttram ◽  
Steven P. Kurtz
Keyword(s):  
Hiv Prevention ◽  
Hiv Transmission ◽  
Qualitative Interviews ◽  
Transmission Risk ◽  
Accurate Information ◽  
Limited Information ◽  
Antiretroviral Medication ◽  
Hiv Seroconversion ◽  
Sex With Men ◽  
Hiv Negative

Background Limited information suggests that men who have sex with men (MSM) are informally obtaining antiretroviral medication (ARVs) and using them for HIV pre-exposure prophylaxis (PrEP). Methods: Data are drawn from an on-going study examining the use of non-prescribed ARVs for PrEP. To date, 24 qualitative interviews have been conducted with HIV-negative, substance-using MSM living in Miami, Florida, USA. Data are presented from two participants who reported HIV seroconversion while using non-prescribed ARVs for PrEP. Results: Preliminary data indicate that some young MSM: (i) lack awareness of and accurate information about the efficacious use of PrEP; (ii) obtain non-prescribed ARVs from HIV-positive sex partners and use these medications for PrEP in a way that does not provide adequate protection against HIV infection or cohere with established guidelines; and (iii) engage in multiple HIV transmission risk behaviours, including condomless anal sex and injection drug use. Conclusions: The informal, non-prescribed and non-medically supervised use of ARVs for HIV prevention has the potential to undermine the protective benefits of PrEP and leave men unprotected against HIV transmission and at risk for ARV resistance.

scholarly journals Longitudinal HIV Transmission Risk Profiles Among Men Who Have Sex With Men Living With HIV in the SUN Study

2018 ◽  
Vol 13 (1) ◽  
pp. 155798831881828
Author(s):  
Jacob J. van den Berg ◽  
Nickolas D. Zaller ◽  
Fizza S. Gillani ◽  
Shira I. Dunsiger ◽  
Brandon D. L. Marshall ◽  
...  
Keyword(s):  
United States ◽  
Hiv Prevention ◽  
Sexual Risk ◽  
Hiv Transmission ◽  
The United States ◽  
Transmission Risk ◽  
Risk Class ◽  
Sex With Men ◽  
Hiv Transmission Risk ◽  
Living With Hiv

Examining how multiple concomitant factors interact to augment HIV transmission risk is needed to inform more effective primary and secondary HIV prevention programs for men who have sex with men (MSM) in the United States. The development of a “taxonomy” of long-term sexual and drug-related risk behavior profiles may have important implications for resource allocation and targeted HIV prevention programming. A secondary data analysis was conducted to explore longitudinal HIV transmission risk profiles among 423 MSM living with HIV enrolled in the Study to Understand the Natural History of HIV and AIDS in the Era of Effective Therapy (SUN Study). Between March 2004 and February 2012, participants completed semiannual, audio computer-assisted self-interviews that included demographics, employment status, medical information, alcohol use, stimulant use, sexual risk, and depression. Latent class analysis was used to identify patterns of risky behavior over time with respect to sexual risk, heavy drinking, and stimulant (i.e., methamphetamine and cocaine) use taken collectively. Three classes were identified: (a) High Sustained Heavy Drinker Class (33%), (b) High Mostly Stable Sexual Risk Class (17%), and (c) Overall Low Risk Class. (50%). Post hoc comparisons between classes revealed that men in Classes 1 ( p = .03) and 2 ( p = .02) were significantly younger than those in Class 3. In comparison to those in Classes 1 and 3, those in Class 2 were less likely to report being a racial/ethnic minority ( p = .04) and had the highest self-reported sexually transmitted infections ( p < .001). Findings indicate the need to better integrate sexual and substance use risk reduction strategies, including brief interventions and engagement in addiction treatment, for MSM living with HIV in the United States.

scholarly journals The Paradoxes of PrEP: Rejection, Reluctancy, and Novel Gay Identities in Biomedical HIV Prevention in Serbia

2022 ◽  
pp. 34-51
Author(s):  
Zoran Milosavljević
Keyword(s):  
Hiv Prevention ◽  
Gay Men ◽  
Hiv Transmission ◽  
Gay Identity ◽  
Hiv Status ◽  
Social Significance ◽  
Gay Communities ◽  
Hiv Status Disclosure ◽  
Status Disclosure ◽  
Hiv Negative

This article explores the different ways in which gay men in Serbia perceive PrEP as a novel method of HIV prevention. In the article, I draw on data from my research on PrEP use among thirty gay men in Belgrade. The use of PrEP is still very low amongst gay communities in Serbia due to their rejection of PrEP and due to the stigma around PrEP use. In Serbia, the social significance of PrEP relates to HIV status disclosure on gay social/dating media. Paradoxically, on gay dating sites, the signifier "PrEP" blurs the line between HIV positive gay men – who have achieved undetectable HIV status through a potent ARV therapy – and those HIV negative gay men who use PrEP as a preventative tool against HIV transmission. In the article, I will argue that a new form of gay identity has emerged on gay dating apps in Serbia – "undetectable, on PrEP." This new identity emerges from confusion in HIV risk assessment. The use of PrEP has been seen as a marker to denote someone’s HIV negative status and to protect them from HIV transmission. However, some gay men with an undetectable HIV status would like to be regarded as HIV negative even though they are not, and thus they use the signifier "on PrEP" to highlight their desire to claim an HIV negative status. PrEP has many symbolic valences: from HIV status disclosure to assumed promiscuity. As I will argue, while the health paradigm is of utmost importance for Serbian gay men, internalized stigma additionally drives the low uptake of PrEP amongst gay communities in Serbia, thus contributing to the confusion regarding PrEP use and the overall approach to HIV prevention. This article finds that those respondents who accept PrEP without stigma or confusion regarding their HIV status are also more willing and ready to recommend using PrEP to other gay men.

scholarly journals Southern African guidelines for the safe use of pre-exposure prophylaxis in men who have sex with men who are at risk for HIV infection

2012 ◽  
Vol 13 (2) ◽  
Author(s):  
Southern African HIV Clinicians Society Consensus Committee
Keyword(s):  
At Risk ◽  
Renal Function ◽  
Hiv Prevention ◽  
Hepatitis B ◽  
Hiv Infection ◽  
Creatinine Clearance ◽  
Fixed Dose ◽  
Sex With Men ◽  
Exposure Prophylaxis ◽  
Hiv Negative

Background. The use of oral antiretrovirals to prevent HIV infection among HIV-negative men who have sex with men (MSM) has been shown to be safe and efficacious. A large, randomised, placebo-controlled trial showed a 44% reduction in the incidence of HIV infection among MSM receiving a daily oral fixed-dose combination of tenofovir disoproxil fumarate and emtricitabine (Truvada) in combination with an HIV prevention package. Improved protection was seen with higher levels of adherence. Aim. The purpose of this guideline is to: (i) explain what pre-exposure prophylaxis (PrEP) is; (ii) outline current indications for its use; (iii) outline steps for appropriate client selection; and (iv) provide guidance for monitoring and maintaining clients on PrEP. Method. PrEP is indicated for HIV-negative MSM who are assessed to be at high risk for HIV acquisition and who are willing and motivated to use PrEP as part of a package of HIV prevention services (including condoms, lubrication, sexually transmitted infection (STI) management and risk reduction counselling). Recommendations. HIV testing, estimation of creatinine clearance and STI and hepatitis B screening are recommended as baseline investigations. Daily oral Truvada, along with adherence support, can then be prescribed for eligible MSM. PrEP should not be given to MSM with abnormal renal function, nor to clients who are unmotivated to use PrEP as part of an HIV prevention package; nor should it be commenced during an acute viral illness. Three-monthly follow-up visits to assess tolerance, renal function, adherence and ongoing eligibility is recommended. Six-monthly STI screens and annual creatinine levels to estimate creatinine clearance are recommended. Hepatitis B vaccination should be provided to susceptible clients. Gastro-intestinal symptoms and weight loss are common side-effects, mostly experienced for the first 4 - 8 weeks after initiating PrEP. There is a risk of the development of antiretroviral resistance among those with undiagnosed acute HIV infection during PrEP initiation and among those with sub-optimal adherence who become HIV infected while on PrEP. Risk compensation (increasing sexual behaviours that can result in exposure to HIV) while on PrEP may become a concern, and clinicians should continue to support MSM clients to continue to use condoms, condom-compatible lubrication and practice safer sex. Research is ongoing to assess optimum dosing regimens, potential long-term effects and alternative PrEP medications. Recommendations for the use of PrEP among other at-risk individuals, and the components of these recommendations, will be informed by future evidence. S Afr J HIV Med 2012;13(2):40-55.

scholarly journals HIV prevention strategies and risk of infection: a model-based analysis

2018 ◽  
Vol 146 (8) ◽  
pp. 1015-1025 ◽  
Author(s):  
A. Hahn ◽  
R. Hinz ◽  
T. Meyer ◽  
U. Loderstädt ◽  
O. Herchenröder ◽  
...  
Keyword(s):  
Hiv Prevention ◽  
Condom Use ◽  
Hiv Transmission ◽  
Hiv Infections ◽  
Risk Groups ◽  
Unprotected Sex ◽  
Transmission Risk ◽  
Prevention Strategies ◽  
Hiv Prevention Strategies ◽  
Hiv Transmission Risk

AbstractRisk populations for HIV infections tend to neglect condom use, making alternative preventive approaches necessary. Accordingly, we modelled the risk of sexual HIV transmission for condom usevs.use of rapid diagnostic test (RDT) systems with subsequent exclusion of potential sexual partners with a correctly or falsely positive test from unprotected sex with and without the use of HIV pre-exposure prophylaxis (PrEP) in a bio-statistical approach. We combined a previously described model of transmission risk for HIV-exposed individuals with a newly suggested model of risk of HIV exposure for sexually active HIV-negative individuals. The model was adapted for several stages of infection and different strategies of HIV infection prevention.HIV prevention with RDTs can reduce the transmission risk by up to 97% compared with having sex without any prevention and up to 80% compared with condom use. Nevertheless, RDT-based prevention strategies demonstrate a lack of protection in several stages of infection; in particular, RNA-based RDT systems may fail under treatment. RDT-based pre-screening of potential sex partners prior to unprotected sexual contacts substantially reduces HIV transmission risk. Combination of different prevention strategies is advisable for high-risk groups.

scholarly journals 1281. Awareness of U=U Among Gay and Bisexual Men Who Have Sex with Men

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S461-S461
Author(s):  
Meredith E Clement ◽  
Rick Zimmerman ◽  
Josh Grimm ◽  
Joseph Schwartz
Keyword(s):  
Hiv Transmission ◽  
Gay And Bisexual Men ◽  
Bisexual Men ◽  
Hiv Status ◽  
Anal Sex ◽  
And Bisexual ◽  
Sex With Men ◽  
Living With Hiv ◽  
Hiv Negative ◽  
Strong Agreement

Abstract Background The “Undetectable = Untransmittable” (“U=U”) campaign is gaining traction, but prior studies from 2012–2017 have shown that the proportion of gay and bisexual men who have sex with men (GBMSM) who are aware of or have perceived accuracy of U=U is low. We report findings from a survey administered to GBMSM in 2018 to understand whether the landscape is changing with respect to U=U message dissemination. Methods GBMSM were recruited on gay dating apps to complete a 96 question survey. Survey data were collected in April-August of 2018. Collected data elements included demographic information, HIV status, ART and PrEP use, and beliefs and opinions regarding HIV transmission. Results 969 GBMSM completed the survey; of whom, 678 had analyzable data (241 had never had anal sex with a man and 54 were missing ≥1 of the variables used in the analysis). Average age was 43 years, 65% were white, 15% black, 15% white, and 15% were HIV-infected (of whom 92% were on anti-retrovirals). Of the 85% who were HIV-uninfected, 39% were on PrEP. In response to the statement that a person with an undetectable viral load cannot transmit HIV to an HIV-uninfected person, 24% strongly agreed. Among HIV-negative GBMSM, 33% of those on PrEP agreed and 12% of those not on PrEP agreed. Among those living with HIV, 42% agreed. A multivariable logistic regression was run to explain correlates of strong agreement with U=U, using the following variables: age, education, being Black, being Hispanic, relationship status, number of lifetime male sexual partners, condom use with most recent anal sex, HIV status, PrEP use, and attitudes about living with HIV. Variables associated with strong agreement with U=U were living with HIV (AOR = 1.63, P < 0.001), taking PrEP (AOR = 2.85, P < 0.001), most recent encounter’s condom use (AOR = 2.22, P = 0.003), and having positive attitudes about living with HIV (AOR= 1.93, P < 0.001). Table 1 shows percentages for each of these variables (bivariate relationships) strongly agreeing with U=U. Conclusion Now that U=U has been scientifically proven, the challenge is public awareness. U=U awareness seems to be improving among GBMSM, with HIV-negative GBMSM making the greatest strides. Education around U=U and PrEP efficacy may help reduce guilt around HIV transmission and alleviate HIV stigma. Disclosures All authors: No reported disclosures.

Superimposing incident sexually transmitted infections on HIV phylogram to investigate possible misclassification of men who have sex with men as heterosexuals in a cohort in Antwerp, Belgium

2019 ◽  
Vol 30 (5) ◽  
pp. 486-495
Author(s):  
Kara K Osbak ◽  
Conor J Meehan ◽  
Sergio G Ribas ◽  
Leo Heyndrickx ◽  
Kevin K Ariën ◽  
...  
Keyword(s):  
Sexually Transmitted Infections ◽  
Sexual Behaviour ◽  
Hiv Transmission ◽  
Phylogenetic Analyses ◽  
Laboratory Data ◽  
Risk Groups ◽  
Transmission Risk ◽  
Sexually Transmitted ◽  
Sex With Men ◽  
Hiv Transmission Risk

In this study, we assessed if the superimposition of incident sexually transmitted infections (STIs) on HIV phylogenetic analyses could reveal possible sexual behaviour misclassifications in our HIV-infected population. HIV-1 sequences collected between 1997 and 2014 from 1169 individuals attending a HIV clinic in Antwerp, Belgium were analysed to infer a partial HIV transmission network. Individual demographic, clinical and laboratory data collected during routine HIV follow-up were used to compare clustered and non-clustered individuals using logistic regression analyses. In total, 438 (37.5%) individuals were identified in 136 clusters, including 76 transmission pairs and 60 clusters consisting of three or more individuals. Individuals in a cluster were more likely to have a history of syphilis, Chlamydia and/or gonorrhoea (P < 0.05); however, when analyses were stratified by HIV transmission risk groups (heterosexual and men who have sex with men [MSM]), this association only remained significant for heterosexuals with syphilis (P = 0.001). Under closer scrutiny, this association was driven by six heterosexual men who were located in six almost exclusively MSM clusters. A parsimonious conclusion is that these six individuals were potentially misclassified as heterosexual. Improving the accuracy of sexual behaviour reporting could improve care.

scholarly journals Modeling an Integrated HIV Prevention and Care Continuum to Achieve the Ending the HIV Epidemic Goals

2020 ◽  
Author(s):  
Samuel M. Jenness ◽  
Jordan A. Johnson ◽  
Karen W. Hoover ◽  
Dawn K. Smith ◽  
Kevin P. Delaney
Keyword(s):  
Hiv Prevention ◽  
Hiv Transmission ◽  
Relative Increase ◽  
Retention Rates ◽  
Hiv Care ◽  
Transmission Model ◽  
Hiv Screening ◽  
Substantial Impact ◽  
Hiv Epidemic ◽  
Sex With Men

ABSTRACTObjectiveWe sought to evaluate which combinations of HIV prevention and care activities would have the greatest impact towards reaching the US Ending the HIV Epidemic (EHE) plan goals of reducing HIV incidence at least 75% by 2025 and 90% by 2030.DesignA stochastic HIV transmission model for men who have sex with men (MSM), calibrated to local surveillance estimates in the Atlanta area, a focal EHE target jurisdiction.MethodsModel scenarios varied HIV screening rates relative to current levels, under different assumptions of how HIV-negative MSM would be linked to PrEP initiation, and also considered improvements to HIV care linkage and retention for those screening positive.ResultsA 10-fold relative increase in HIV screening rates (to approximately biannual screening for black and Hispanic MSM and quarterly for white MSM) would lead to 43% of infections averted if integrated with PrEP initiation. Improvements to HIV care retention would avert 41% of infections if retention rates were improved 10-fold. If both screening and retention were jointly improved 10-fold, up to 74% of cumulative infections would be averted. Under this scenario, it would take 4 years to meet the 75% EHE goal and 12 years to meet the 90% goal for MSM in Atlanta.ConclusionsInterventions to improve HIV screening linked with PrEP for those screening negative, and HIV care retention would have a substantial impact on HIV prevention. However, additional interventions may be necessary to reach the EHE goal of a 90% reduction in incidence for Atlanta MSM by 2030.

scholarly journals A Web-Based Study of HIV Prevention in the Era of Pre-Exposure Prophylaxis Among Vulnerable HIV-Negative Gay and Bisexual Men, Transmen, and Transwomen Who Have Sex With Men: Protocol for an Observational Cohort Study (Preprint)

2019 ◽  
Author(s):  
Denis Nash ◽  
Matthew Stief ◽  
Caitlin MacCrate ◽  
Chloe Mirzayi ◽  
Viraj V Patel ◽  
...  
Keyword(s):  
High Risk ◽  
Hiv Prevention ◽  
Hiv Testing ◽  
The United States ◽  
Racially Diverse ◽  
Web Based ◽  
Sex With Men ◽  
Hiv Acquisition ◽  
Exposure Prophylaxis ◽  
Hiv Negative

BACKGROUND Gay, bisexual, and other men who have sex with men continue to bear a large burden of the HIV epidemic in the United States and are among the only populations with increasing incidence in recent years. OBJECTIVE The Together 5000 (T5K) Study aimed to enroll a US-based, racially diverse sample of HIV-negative men, transmen, and transwomen who are not on pre-exposure prophylaxis (PrEP) into an observational cohort to inform the design, implementation, scale-up, and evaluation of HIV prevention programs. METHODS We used internet-based strategies to enroll a large, racially diverse national sample of HIV-negative men, transmen, and transwomen aged 16 to 49 years at high risk of HIV acquisition via sexual networking apps. Study participants are contacted every 6 months (in between annual surveys) for a brief survey on HIV testing, HIV diagnosis, and PrEP use (ie, attempts to access, PrEP initiation, and PrEP discontinuation). Participants complete annual self-administered at-home HIV testing and Web-based surveys. Using baseline serologic data and self-reported HIV testing history, we reconstructed a cohort of persons who were HIV negative at 12 months before baseline to estimate HIV incidence leading up to cohort enrollment. RESULTS The study sample included 8777 participants from all 50 US states, Puerto Rico, and Guam; 50.91% (4468/8777) were persons of color and 25.30% (2221/8777) were young individuals aged 16 to 24 years. Per eligibility criteria, all T5K participants reported having sex with >2 male partners in the 90 days before enrollment, self-reported not having been diagnosed with HIV, and were not actively taking PrEP. In addition, 79.39% (6968/8777) reported >2 insertive condomless anal sex (CAS) acts, 61.02% (5356/8777) reported >1 receptive CAS acts in the past 90 days. Furthermore, most (7525/8777, 85.74%) reported never having taken PrEP. In total, 70.25% (6166/8777) were sent a self-administered at-home HIV test kit and 82.29% (5074/6166) of those sent a kit returned a sample for testing. The HIV incidence rate during the 12-month period leading up to enrollment was estimated to be 2.41 (95% CI 2.02-2.90) per 100 person-years. CONCLUSIONS A large, national, and racially diverse fully Web-based cohort of HIV-negative men, transmen, and transwomen at high risk for HIV seroconversion has successfully been recruited into longitudinal follow-up. This cohort is at high risk for HIV acquisition and can provide important insights related to the real-world uptake, impact, and equity of HIV prevention interventions in the United States. Participants can be invited to participate in trials aimed at testing strategies to improve the uptake of and engagement in these interventions. INTERNATIONAL REGISTERED REPORT RR1-10.2196/13715

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