title: The Effect of High Rates of Bacterial Sexually Transmitted Infections on HIV Incidence in a Cohort of Black and White Men Who Have Sex with Men in Atlanta, Georgia.
abstract: Data reporting sexually transmitted infection (STI) incidence rates among HIV-negative U.S. men who have sex with men (MSM) are lacking. In addition, it is difficult to analyze the effect of STI on HIV acquisition given that sexual risk behaviors confound the relationship between bacterial STIs and incident HIV. The InvolveMENt study was a longitudinal cohort of black and white HIV-negative, sexually active MSM in Atlanta who underwent routine screening for STI and HIV and completed behavioral questionnaires. Age-adjusted incidence rates were calculated for urethral and rectal Chlamydia (CT), gonorrhea (GC), and syphilis, stratified by race. Propensity-score-weighted Cox proportional hazards models were used to estimate the effect of STI on HIV incidence and calculate the population attributable fraction (PAF) for STI. We included 562 HIV-negative MSM with 843 person-years of follow-up in this analysis. High incidence rates were documented for all STIs, particularly among black MSM. Having a rectal STI was significantly associated with subsequent HIV incidence in adjusted analyses (aHR 2.7; 95% CI 1.2, 6.4) that controlled for behavioral risk factors associated with STI and HIV using propensity score weights. The PAF for rectal STI was 14.6 (95% CI 6.8, 31.4). The high incidence of STIs among Atlanta MSM and the association of rectal STI with HIV acquisition after controlling for behavioral risk underscore the importance of routine screening and treatment for STIs among sexually active MSM. Our data support targeting intensive HIV prevention interventions, such as preexposure chemoprophylaxis (PrEP), for Atlanta MSM diagnosed with rectal STIs.
authors.affiliation: 1Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.|2Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.
authors.forename: Colleen F
authors.initials: CF
authors.lastname: Kelley
authors.affiliation: 2Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.
authors.forename: Adam S
authors.initials: AS
authors.lastname: Vaughan
authors.affiliation: 2Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.
authors.forename: Nicole
authors.initials: N
authors.lastname: Luisi
authors.affiliation: 2Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.
authors.forename: Travis H
authors.initials: TH
authors.lastname: Sanchez
authors.affiliation: 3Division of Health Promotion and Behavior, School of Public Health, Georgia State University, Atlanta, Georgia.
authors.forename: Laura F
authors.initials: LF
authors.lastname: Salazar
authors.affiliation: 1Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.|4Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia.
authors.forename: Paula M
authors.initials: PM
authors.lastname: Frew
authors.affiliation: 4Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia.
authors.forename: Hannah L F
authors.initials: HL
authors.lastname: Cooper
authors.affiliation: 4Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia.
authors.forename: Ralph
authors.initials: R
authors.lastname: Diclemente
authors.affiliation: 1Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.|5Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia.
authors.forename: Carlos
authors.initials: C
authors.lastname: del Rio
authors.affiliation: 2Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Sullivan
authors.affiliation: 2Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.
authors.forename: Eli S
authors.initials: ES
authors.lastname: Rosenberg
mesh_terms: D000328:Adult; D044383:Black People; D002690:Chlamydia Infections / Q000150:complications*; D005845:Georgia / Q000453:epidemiology; D006069:Gonorrhea / Q000150:complications*; D015658:HIV Infections / Q000453:epidemiology*; D018451:Homosexuality, Male; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D013587:Syphilis / Q000150:complications*; D044465:White People; D055815:Young Adult; D001741:Black or African American