Rates of New Human Immunodeficiency Virus (HIV) Diagnoses After Reported Sexually Transmitted Infection in Women in Louisiana, 2000–2015: Implications for HIV Prevention

Abstract

Background Human immunodeficiency virus (HIV) prevention interventions for prevention interventions for women include screening, partner notification, promoting condoms, and preexposure prophylaxis (PrEP). Women’s risk of acquiring HIV can help guide recommendations. Methods We used data from Louisiana’s sexually transmitted infection (STI) and HIV registries to study 13- to 59-year-old women following first diagnosis of syphilis, gonorrhea, or chlamydia during 2000–2015. We measured HIV rates reported subsequent to STI (through 2016). Rates for women without STI were estimated by subtracting women with STI from reported cases and from Census estimates for the population. PrEP cost was estimated as $11 000 per year, and effectiveness estimated as 100%. Results STIs were syphilis (6574), gonorrhea (64 995), or chlamydia (140 034). These 211 603 women had 1 865 488 person-years of follow-up and 969 HIV diagnoses. Women with no STI had 5186 HIV diagnoses over 24 359 397 person-years. HIV rates diagnosis (per 100 000 person-years) were higher for women after syphilis (177.3), gonorrhea (73.2), or chlamydia (35.4) compared to women with no STI (22.4). Providing PrEP to all women diagnosed with syphilis or gonorrhea would cost $7 371 111 000 and could have prevented 546 HIV diagnoses. Limiting PrEP to 1 year after syphilis or gonorrhea diagnosis would cost $963 847 334, but only 143 HIV diagnoses were within 2 years after a syphilis or gonorrhea diagnosis. Conclusions Rates of HIV diagnosis were high after women had STI, but not high enough to make PrEP cost-effective for them. Most women diagnosed with HIV did not have previously reported STI.

Systematic Literature Review and Quantitative Analysis of Health Problems Associated with Sexually Transmitted Neisseria gonorrhoeae Infection

“…Gonorrhoea infection in women was associated with a significantly increased risk of HIV seroconversion. Three studies were included [ 40 , 51 , 52 ], one in sex workers [ 40 ], and all three reported an increased risk. Data from the two large studies using a general-population sample were pooled.…”

Factors Associated with HIV Seroconversion Among Women Attending an Urban Health Clinic in the South: A Matched Case–Control Study

“…There are dire consequences to this lack of awareness; other studies are beginning to quantify the number of new HIV diagnoses that could be prevented among women had they only been provided with PrEP at the time key risk factors (such as STI diagnoses) were realized. 23 Efforts to promote PrEP to women are needed, especially in Fulton County, so the results of this study not only get us closer to identifying women at greatest risk of HIV but also quantify that increased risk. This quantification would allow clinicians to tell female patients how much more likely they are to acquire HIV because of certain risk factors.…”

“…19,21,22 For example, a study conducted in Louisiana found that women with an STI were diagnosed with HIV at a rate 2.3 times that of women without an STI. 23 While risk factors for HIV among men who have sex with men (MSM) have been well-characterized in various settings and locations across the United States, less is known about the impact these factors have for HIV acquisition among women specifically in urban, low-income Southern US settings. 8 Despite the high HIV burden among minority women, very few epidemiologic studies have assessed risk factors for HIV among black women in the United States, and more specifically among black women within HIV ''hotspots'' in the South.…”

How perceived Australian sexual norms shape sexual practices of East Asian and sub-Saharan African international students in Sydney

“…Therefore, casual sex may be one of the notable perceived Australian sexual scripts that may have serious implications for HIV and STI transmission. Though the risk of HIV transmission may be low in Australia, STI prevalence is relatively high and also on the increase [ 41 , 42 ] and infection with an STI can increase the risk of HIV [ 43 ]. According to the study findings, participants believe that premarital sex in Australia is mostly casual, compared to their home countries; where it is supposed to occur in a romantic relationship that may lead to marriage.…”