title: Which HIV-infected men who have sex with men in care are engaging in risky sex and acquiring sexually transmitted infections: findings from a Boston community health centre.
abstract: OBJECTIVE
  The primary objective was to determine the prevalence of sexually transmitted infections (STI) in a cohort of HIV-infected men who have sex with men (MSM) in their primary care setting, and to identify the demographic and behavioural characteristics of those infected with STI and the correlates of sexual transmission risk behaviour.
  
  
  METHODS
  At study entry, participants (n = 398) were tested for STI and their medical charts were reviewed for STI results in the previous year. Data on demographics, substance use, sexual behaviour and HIV disease characteristics were collected through a computer-assisted self-assessment and medical record extraction. Logistic regression analyses assessed characteristics of those with recent STI and recent transmission risk behaviour.
  
  
  RESULTS
  The sample was predominantly white (74.6%) and college educated (51.7%). On average, participants were 41.5 years old (SD 8.4) and had been HIV infected for 8.6 years (SD 6.7); 9% of the sample had an STI, with 6.4% testing positive for syphilis, 3.1% for gonorrhoea and 0.25% for chlamydia. Age and years since HIV diagnosis were significantly associated with testing positive for an STI, as was engaging in transmission risk behaviour and using methamphetamine, ketamine and inhalants. Substance use, particularly methamphetamine use, and being more recently diagnosed with HIV were each uniquely associated with transmission risk behaviour in a multivariable model.
  
  
  CONCLUSIONS
  These results underscore the need to develop more effective secondary prevention interventions for HIV-infected MSM, tailored to more recently diagnosed patients, particularly those who are younger and substance users.
authors.affiliation: The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, USA. Kenneth_Mayer@brown.edu
authors.forename: K H
authors.initials: KH
authors.lastname: Mayer
authors.forename: C
authors.initials: C
authors.lastname: O'Cleirigh
authors.forename: M
authors.initials: M
authors.lastname: Skeer
authors.forename: C
authors.initials: C
authors.lastname: Covahey
authors.forename: E
authors.initials: E
authors.lastname: Leidolf
authors.forename: R
authors.initials: R
authors.lastname: Vanderwarker
authors.forename: S A
authors.initials: SA
authors.lastname: Safren
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D004812:Epidemiologic Methods; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology / Q000635:transmission; D018451:Homosexuality, Male / Q000523:psychology / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D011320:Primary Health Care; D012309:Risk-Taking; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000453:epidemiology* / Q000523:psychology / Q000635:transmission; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology; D013997:Time Factors; D047568:Unsafe Sex / Q000706:statistics & numerical data*; D055815:Young Adult