STD Testing Rates, Service Receipt Among HIV-Positive MSM Remain Low

The CDC recommends regular testing for bacterial sexually transmitted diseases (STDs) among all sexually active gay, bisexual, and other men who have sex with men (MSM) because they have a higher risk of infection. Chief among these STDs are gonorrhea, chlamydia, syphilis, and hepatitis C virus (HCV). Those most at risk also should be receiving recommended STD counseling services.

“Having an STD (like gonorrhea) makes it easier to get HIV or give it to others, so it’s important that you get tested to protect your health and the health of your partner,” states the CDC.

Despite these guidelines, there has been a constant uptick in STDs over the past decade, particularly among HIV-positive MSM, even though they are receiving care for their HIV, according to the authors who investigated the receipt of STD testing and associated services among these individuals and published their results online today in Annals of Internal Medicine.

The primary outcome of their study was to determine both deficiencies in bacterial STD testing and what risky behaviors result in these deficiencies among HIV-positive MSM—especially because having an STD increases the risk of transmitting HIV.

Data were gleaned from the Medical Monitoring Project (MMP), an annual 2-stage sample survey of HIV-positive US adults’ clinical and behavioral characteristics, comparing receipt of STD services between healthcare facilities that were and were not funded by the Ryan White HIV/AIDS Program (RWHAP), “a federally funded program providing a comprehensive system of HIV primary medical care, essential support services, and medications for low-income persons with HIV who are uninsured and underserved.” (Ryan White contracted HIV through a blood transfusion while receiving treatment for hemophilia.)

The patient population consisted of 1269 HIV-positive MSM who self-reported on the following risk behaviors as they pertained to transmission of gonorrhea, chlamydia, syphilis, and HCV:

• Sexual behaviors
• Drug and alcohol use before or during sex
• HIV or STD prevention services

Between June 2017 and May 2018, the most recent period for which data are available, 100% of states but only 45% of eligible individuals responded to the MMP. For receipt of informational materials and free condoms, conversations with prevention or healthcare workers, and small-group sessions, respectively, rates of patients who received STD testing and care at RWHAP-funded facilities (62.6%, 69.1%, 39.5%, 62.3%, 15.1%) far outpaced the overall rates (58.7%, 62.0%, 32.9%, 56.7%, 11.8) and those of non—RWHAP-funded facilities (52.5%, 50.5%, 22.0%, 47.6%, 6.6%).

Broken down by STD, however, the numbers were worse, except for syphilis:

• Gonorrhea: Overall: 49.7% Non—RWHAP-funded facilities: 37.2% RWHAP-funded facilities: 57.4%
• Chlamydia: Overall: 49.4% Non—RWHAP-funded facilities: 36.7% RWHAP-funded facilities: 57.2%
• HCV: Overall: 34.5% Non—RWHAP-funded facilities: 26.8% RWHAP-funded facilities: 39.2%
• Syphilis: Overall: 68.3% Non—RWHAP-funded facilities: 58.4% RWHAP-funded facilities: 74.5%

The results on patients’ risky behaviors were alarming, too. Close to 64.5% (95% CI, 60.3%-68.6%) had condomless anal sex in the past year; 46.9% (95% CI, 43.0%-50.8%) reported they drank alcohol before or during sex; 35.8% (95% CI, 32.2%-39.4%) used noninjection drugs before or during sex; and 3.7% (95% CI, 2.2%-5.2%) used injectable drugs before or during sex.

All sets of results leave much room for improvement, because they show that many of the survey respondents still “did not receive recommended prevention services and STD testing, particularly testing for extragenital gonorrhea and chlamydia, which is essential for reducing STDs in this population,” the authors noted. “Meeting public health goals for preventing STDs, and in turn ending the HIV epidemic, may require closer adherence to guidelines for delivering prevention services and STD testing to HIV-positive MSM.”

To help adhere to the guidelines, they reiterate the importance of evidence-based strategies that include nurse-led programs, self-swabbing for gonorrhea and chlamydia, and monitoring provider performance.

Reference

Weiser J, Tie Y, Beer L, Pearson WS, Shouse RL. Receipt of prevention services and testing for sexually transmitted diseases among HIV-positive men who have sex with men, United States [published online May 4, 2020]. Ann Intern Med. doi: 10.7326/M19-4051.