Background Geosocial networking applications (GSN apps) used to meet sexual partners have become increasingly popular with men who have sex with men (MSM) since 2009. The current study aimed to determine if self-identified HIV negative, MSM clinic attendees who used GSN apps have an increased incidence of sexually transmitted infections (STIs) compared to self-identified HIV negative, MSM attendees who met sexual partners via in-person venues such as bars or clubs or through MSM-specific hook-up websites. Methods Data were collected between August 2011 and January 2013 on all self-identified HIV-negative, MSM clients visiting the L.A. Gay & Lesbian Center for STI screening. A total of 7,184 individuals tested for STIs and self-reported behaviours on drug use and social networking methods to meet sexual partners. Multivariate logistic regression models were used to analyze the results. Results Individuals who used GSN apps to meet sexual partners had greater odds of testing positive for gonorrhoea (OR: 1.25; 95% CI: 1.06–1.48) and for chlamydia (OR: 1.37; 95% CI: 1.13–1.65) compared to individuals who met partners through in-person methods only. There were no significant differences in syphilis and HIV incidence between those who met partners via in-person venues only, on the internet or through GSN apps. Conclusions The present study concludes that sexual health clinic MSM attendees who are meeting on GSN apps are at greater risk for gonorrhoea and chlamydia than MSM attendees who meet in-person or on the internet. Future interventions should explore the use of these novel technologies for testing promotion, prevention and education.

Background Incident syphilis infections continue to be especially prevalent among a core group of HIV-infected men who have sex with men (MSM). Because of synergy between syphilis and HIV infections, innovative means for controlling incident syphilis infections are needed. Methods Thirty MSM who had syphilis twice or more since their HIV diagnosis were randomized to receive either daily doxycycline prophylaxis or contingency management (CM) with incentive payments for remaining free of sexually transmitted diseases (STDs). Subjects were tested for the bacterial STDs gonorrhea (NG), chlamydia (CT) and syphilis at Weeks 12, 24, 36 and 48 and completed a behavioral risk questionnaire during each visit to assess number of partners, condom use and drug use since the last visit. Generalized linear mixed models were used to analyze differences between arms in STD incidence and risk behaviors at follow-up. Results Doxycycline arm subjects were significantly less likely to test positive for any selected bacterial STD during 48 weeks of follow-up (OR: 0.27; CI: 0.09-0.83) compared to CM arm subjects (p = 0.02).There were no significant self-reported risk behavior differences between the Doxycycline and CM arms at follow-up. Conclusions Daily doxycycline taken prophylactically was associated with a decreased incidence of NG, CT, or syphilis incident infections among a core group of HIV-infected MSM at high risk for these infections. Safe and effective biomedical tools should be included in the efforts to control transmission of syphilis, especially in this population. A randomized clinical trial should be conducted to confirm and extend these findings.

There were significant increases in rectal chlamydia and syphilis diagnoses when comparing the periods directly before and after PrEP initiation. However, only 28% of individuals had an increase in STIs between periods. Although risk compensation appears to be present for a segment of PrEP users, the majority of individuals either maintain or decrease their sexual risk following PrEP initiation.

BACKGROUND TDF/FTC PrEP is effective against rectal HIV acquisition when taken as prescribed. Strategies that identify and intervene with those challenged by adherence to daily medication are needed. SETTING PATH-PrEP was an open-label single arm interventional cohort study conducted at 2 community-based clinical sites in Los Angeles, California. METHODS We enrolled self-identified MSM and TGW ≥18 years of age at elevated risk of HIV acquisition. Participants received a PEP or PrEP-based HIV prevention package for at least 48 weeks. Plasma TFV levels from each PrEP visit assessed as below the limit of quantiatation (<10 ng/mL) triggered increased adherence support. RESULTS 301 participants enrolled. Forty-eight-week retention in the PrEP cohort was 75.1%. Biomarker evidence of PrEP adherence consistent with ≥4 doses per week at weeks 4, 12, 24, 36, and 48 were found in 83.1%, 83.4%, 75.7%, 71.6%, and 65.5% of participants; younger and African-American participants were less likely to have protective drug levels. Most of those with suboptimal adherence had adherence improvement after brief intervention. One seroconversion occurred in a participant who discontinued PrEP. Nearly half (46.4%) of participants were diagnosed with at least one incident STI during 48 weeks of study follow-up. CONCLUSIONS AND RELEVANCE PrEP was acceptable and well tolerated in a diverse population of MSM in Los Angeles. A brief intervention triggered from biomarkers of poor adherence was associated with improved adherence. Drug level monitoring has the potential to allow targeting of additional adherence support to those struggling with daily tablet adherence.

People living with HIV/AIDS (PLWHA) have a growing life expectancy in the US due to early provision of effective antiretroviral treatment. This has resulted in increasing exposure to age-related chronic illness that may be exacerbated by HIV/AIDS or antiretroviral treatment. Prior work has suggested that PLWHA may be subject to accelerated aging, with earlier onset and higher risk of acquiring many chronic illnesses. However, the magnitude of these effects, controlling for chronic co-morbidities, has not been fully quantified. We evaluate the magnitude of association of HIV infection on developing chronic conditions while controlling for demographics, behavioral risk factors, and chronic comorbidities. We compare chronic disease risks of diabetes, hypertension, stroke, cancers, lung diseases, cardiovascular diseases, and cognitive impairment between PLWHA and HIV- individuals in a large, de-identified private insurance claims dataset (~24,000 PLWHA) using logistic regressions. HIV status is statistically significantly associated with higher levels for all chronic illnesses examined, a result which is robust to multiple model specifications and duration of analysis (2, 5, and 10 years from enrollment). Our results suggest that PLWHA may be at elevated risk for a wide variety of chronic illnesses and may require additional care as the aging PLWHA population grows.