Impact of six-monthly STD testing and risk-reduction counseling on STD incidence and risky sexual behavior among HIV-infected men who have sex with men (MSM) in care
P. Patel1, T. Bush1, J. Milam2, J. Richardson2, J. Papp1, C. Farshy1, L. Conley1, J. Hammer3, K. Henry4, K. Mayer5, T. Overton6, G. Marks1, J. Brooks1, The SUN Study Investigators
1CDC, Atlanta, United States, 2University of California at San Diego, San Diego, United States, 3Denver Infectious Disease Consultants, Denver, United States, 4University of Minnesota, Minneapolis, United States, 5Brown Medical School/Miriam Hospital, Providence, United States, 6Washington University School of Medicine, St. Louis, United States
Background: We evaluated whether routine biannual sexually transmitted disease (STD) testing coupled with brief risk-reduction counseling reduces STD incidence and high-risk behaviors.
Methods: The Study to Understand the Natural History of HIV and AIDS in the Era of Effective Therapy (SUN) is a prospective observational HIV cohort study conducted in four U.S. cities. At enrollment and every 6 months thereafter, participants completed a behavioral survey and were screened for syphilis, N. gonorrhoeae, and C. trachomatis. All diagnosed STDs were treated per standard of care. Medical providers conducted brief risk-reduction counseling with all patients. Among MSM, we examined trends in STD incidence and rates of self-reported risk behaviors before and after exposure to the risk-reduction intervention. The “pre-intervention” visit was the study visit that was at least 6 months after enrollment STD screening and treatment and at which the participant was first exposed to the intervention. The “post-intervention” visit was 12 months later.
Results: Among 216 MSM with complete STD and behavioral data, median age was 42 years; 22% were non-Hispanic black or Hispanic; 83% were on HAART; 84% had an HIV RNA level < 400 copies/mL and the median CD4 count was 496 cells/mm3. Twelve months after first exposure to the risk-reduction intervention, STD incidence declined from 8.8% to 4.2% (p =0.041). Rates of unprotected receptive or insertive anal intercourse with HIV-positive partners increased (19% to 25%, p=0.024) but with HIV-negative partners or with partners of unknown HIV status did not change (24% to 22%, p=0.590).
Conclusions: STD incidence declined significantly among HIV-infected MSM after implementing frequent, routine STD testing coupled with risk-reduction counseling. Participants may have increasingly engaged in serosorting with HIV-positive partners after the intervention while maintaining stable rates of unprotected sex with at-risk partners. These findings support adoption of routine STD screening and risk-reduction counseling for HIV-infected MSM.