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Temporal Changes in Sexually Transmitted Infections in a Cohort of Men Who Have Sex with Men Living with HIV: Sex Partner Seeking and Behavioral Correlates

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Abstract

With “undetectable equals untransmittable,” continued engagement in condomless sex has prolonged STI risk in people living with HIV. This study examined the pattern and relationship between STI diagnosis and sex partner-seeking practice over time in a cohort of men who have sex with men (MSM) attending the HIV specialist clinic in Hong Kong. Participants’ STI diagnosis record since HIV diagnosis was retrieved and their frequency of seeking sex partners (A) before, (B) after HIV diagnosis, and (C) following extended period (5–10 years), through eight different settings, was assessed in two rounds of survey, along with their risk behavioral profile. Multivariable regression models were employed to study the factors associated with STI diagnosis and partner-seeking frequency, while their temporal relationships over the three time points (A–C) were examined using cross-lagged panel model. Of 345 subjects recruited, STI incidence dropped from 252 to 187 cases/1000 person-years during 2015–2019. Totally 139/212 MSM (66%) had ≥ 1 episode of STI within the 10-year period after HIV diagnosis, giving an 11–20% annual prevalence. The reduced frequency of seeking sex partner was well preserved following diagnosis with a rebound specifically noted in the use of mobile application, the patrons of which were more likely to be co-infected with STI in 2019. Chemsex, concurrent partnership, and casual sex were risk factors shared between frequent partner-seeking practice and STI diagnosis. A robust autoregressive effect for partner-seeking frequency was also identified, and which significantly predicted STI risk in the long term. To enhance HIV care, the co-administration of STI/behavioral surveillance should be emphasized.

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Acknowledgements

The authors thank Ms. Mandy Li for her assistance in data entry and collation. We appreciate the administrative support provided by the staff of the Integrated Treatment Centre of the Department of Health. Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong is acknowledged for rendering technical assistance throughout the study. This study is supported by grants approved by the Council for the AIDS Trust Fund, the Government of Hong Kong Special Administrative Region (MSS230R & MSS304R).

Funding

This study was supported by the Council for the AIDS Trust Fund, the Government of Hong Kong Special Administrative Region (MSS230R & MSS304R).

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Authors and Affiliations

  1. JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong

    Chin Pok Chan & Ngai Sze Wong

  2. Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong

    Tsz Ho Kwan, Ngai Sze Wong, Chin Man Poon & Shui Shan Lee

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  1. Chin Pok Chan
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  2. Tsz Ho Kwan
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Contributions

CPC and SSL were involved in conceptualization; CPC, NSW, CMP and SSL helped in project administration and methodology; CPC and THK contributed to formal analysis and investigation; CPC was involved in writing—original draft; all authors were involved in writing—review and editing; SSL helped in funding acquisition and supervision; all authors have approved the final article.

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Correspondence to Shui Shan Lee.

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Informed consent was obtained from all participants included in the study.

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Ethical approval was granted by the Joint Chinese University of Hong Kong—New Territories East Cluster Clinical Research Ethics Committee and the Department of Health of the Government of Hong Kong Special Administrative Region.

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Chan, C.P., Kwan, T.H., Wong, N.S. et al. Temporal Changes in Sexually Transmitted Infections in a Cohort of Men Who Have Sex with Men Living with HIV: Sex Partner Seeking and Behavioral Correlates. Arch Sex Behav 52, 2051–2063 (2023). https://doi.org/10.1007/s10508-023-02598-3

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