Regarding number of partners, we first examined absence of any male anal sex partners compared with presence of any, and then created a high-risk group using scores greater than the median (Mdn=1) as compared with a low-risk group (ie, 1 or below).
Regarding associations between STI diagnosis and HIV, rectal STI lab diagnosis of chlamydia and/or gonorrhoea was positively associated with testing positive for HIV antibodies, X 2(1) =19.63, p 0.05). All participants included in this study completed the STI/HIV testing and were provided their testing results-men who received positive results were actively linked to local STI no-cost or low-cost clinics.ĭespite the entire sample self-reporting as HIV-negative or unknown status, 31 of 331 (9.4%) participants tested HIV antibody positive of these, 12 of 31 (39%) also tested positive for a rectal STI. Lab tests to diagnose rectal and urethral chlamydia and gonorrhoea (nucleic acid amplification testing), as well as antibody testing for HIV (OraQuick ADVANCE Rapid HIV 1/2), were self-administered by the participant during a telehealth counselling session. 8īGBMSM reported on the number of CAI acts and number of male partners in the past 3 months, sexual identity disclosure and self-reported STI diagnosis history. All participants were 18 years of age or older, assigned male sex at birth, identified as Black/African American, reported CAI in the past year, and self-reported an HIV-negative or unknown status.
Written informed consent was provided by participants. Participants were recruited from a larger longitudinal study, primarily through social media advertisements (ie, Facebook, Reddit, Snapchat, Twitter), word of mouth and geospatial networking apps (ie, Grindr, Scruff). We analysed data from 331 BGBMSM from Atlanta, Georgia collected in 2017–2019. We tested whether behavioural risk factors were positively associated with rectal STI and HIV diagnoses to determine whether these are adequate markers to guide testing needs in the clinical setting. To illustrate a potential gap in the STI continuum of care, we explored data from a behavioural and testing study of BGBMSM. Given that presence of an STI is one of the most robust predictors of HIV seroconversion among MSM, 2 stakeholders need to test the assumption that these behavioural risk factors are adequate markers of the need for rectal and urethral STI screening among BGBMSM. Healthcare providers typically use patient-reported behaviours for determining STI testing needs, such as recent acts of condomless anal intercourse (CAI) and number of sex partners. In particular, determining who is ‘at risk’ can be difficult for healthcare providers to assess. Though the CDC recommends testing every 3–6 months for ‘at-risk’ MSM, reliance on this directive for determining testing may also contribute to testing disparities. 4 Moreover, efforts to address the need for rectal STI testing have not been prioritised, 5 with the first Food and Drug Administration-approved rectal STI diagnostic test not appearing until 2019. 4 In prior research, providers ranged from two (18.3% urethral vs 8.5% rectal) to six times (13.8% urethral vs 2.3% rectal) more likely to perform urethral chlamydia and gonorrhoea screening as compared with rectal screening. However, rectal STI screening is less frequently performed than urethral screening among MSM in community-based sexual health clinics (for both individuals living and not living with HIV in the USA).
2 As such, the Centers for Disease Control and Prevention (CDC) recommends 3 routine testing for STIs at each site of sexual contact every 3–6 months for sexually active MSM. 1 STIs remain a strong predictor of HIV seroconversion. Without changes in current HIV incidence rates, it is estimated that 60% of BGBMSM will be living with HIV by the age of 40 years. Despite advancements in HIV prevention, Black gay, bisexual and other men who have sex with men (BGBMSM) continue to experience a high burden of HIV in the USA.