P156 High Rates of Sexually Transmitted Infections (STIs) Among a Sample of Methamphetamine-Using MSM Seeking Post-Exposure Prophylaxis (PEP) for HIV in Los Angeles County (LAC)

Wednesday, March 10, 2010
Pre-Function Lobby & Grand Ballroom D2/E (M4) (Omni Hotel)
Raphael Landovitz, MD1, Galina Inzhakova, MPH2, Paymon Ebrahimzadeh, MPH2 and Cathy J. Reback, PhD2, 1Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA, 2Friends Research Institute, Los Angeles, CA

Background: The majority of HIV infections in LAC are among MSM. Methamphetamine use is a major factor driving new infections, primarily as a result of concurrent high-risk sexual behaviors. HIV prevention strategies directed at this population requires addressing both methamphetamine use and HIV exposure. Post-exposure prophylaxis (PEP) for HIV is recommended for sexual and injection drug exposures, and consists of 28 days of antiretroviral therapy administered within 72-hours of exposure. Contingency Management (CM) provides incentives for documented abstinence from methamphetamine use. This study combines PEP after high-risk exposure to HIV with CM.

Objectives: To assess prevalence rates of STIs and sexual risk-taking behavior among methamphetamine-using MSM enrolled in a pilot HIV prevention study.

Methods: Interim baseline data was used to estimate point-prevalence of STIs and sexual risk-taking behavior.

Results: Nineteen participants enrolled between March 2009 and September 2009. Data was frozen on 9/4/2009 for this analysis. Mean age of participants was 35.5(SD 7.3) years, and mean duration of self-reported heavy methamphetamine use was 5.0(SD 5.6) years. Prior Chlamydial infection was reported by 8/19(42%), prior genital or rectal gonorrheal infection by 7/19(37%), and prior syphilis by 4/19(21%). Prevalent STIs diagnosed at baseline testing included 2 cases of chronic hepatitis B(10.5%), 1 syphilis(5.3%), 2 dual-site rectal and pharyngeal gonorrhea(10.5%), and 1 urethral Chlamydia(5.3%). Participants reported a mean of 6.0(SD 4.3) and 24.0(SD 29.1) sexual partners in the previous 30 days and 6 months, respectively. Eleven of 19(57.9%) participants initiated PEP.

Conclusions: Historical and prevalent STI rates were high in this interim analysis of HIV-uninfected, methamphetamine-using MSM enrolling in a biobehavioral risk-reduction intervention.

Implications for Programs, Policy, and/or Research: Despite high STI rates, this population remains HIV-uninfected. Future studies will examine the potential biological basis for this observation and the role of behavioral economics in implementing biomedical HIV prevention strategies among methamphetamine-using MSM.

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