Departments of Epidemiology; and.
Medicine, University of Washington, Seattle, WA; and.
J Acquir Immune Defic Syndr. 2021 Aug 1;87(4):1032-1039. doi: 10.1097/QAI.0000000000002686.
The extent to which uptake of biomedical HIV prevention strategies have affected population-level sexual behavior and sexually transmitted infections (STIs) among men who have sex with men (MSM) is not well understood.
We collected data as part of routine care from MSM attending the municipal STI clinic in Seattle, Washington, 2002-2018. MSM were asked about condom use in the previous 12 months. We classified behaviors into 4 mutually exclusive categories: no anal sex; consistent condom use for anal sex; serosorting [condomless anal sex (CAS) only with HIV-concordant partners]; and CAS with serodiscordant/unknown-status partners. STI/HIV testing was performed per routine clinic protocol.
There were 45,656 and 6987 visits by MSM without HIV and MSM with HIV, respectively. The use of antiretroviral therapy and preexposure prophylaxis increased substantially during the study period to 94% and 50%, respectively, by 2018. CAS with serodiscordant/unknown-status partners decreased through 2013 but increased thereafter (to 40% among MSM without HIV; 68% among MSM with HIV). Serosorting increased among MSM without HIV but declined after 2013 among MSM with HIV. Consistent condom use declined for all MSM (from 35% to 11% among MSM without HIV; from 20% to 5% among MSM with HIV). HIV test positivity declined substantially (3.5%-0.5%), whereas STI test positivity increased over time.
Since 2013, CAS with HIV-discordant/unknown-status partners increased substantially concurrent with declining HIV test positivity and increasing STI test positivity. This highlights the success of biomedical HIV prevention strategies to reduce HIV incidence while affirming the need for new approaches to STI prevention.
人们对生物医学艾滋病毒预防策略的接受程度在多大程度上影响了男男性行为者（MSM）的人群性行为和性传播感染（STI）尚不清楚。
我们从 2002 年至 2018 年期间在华盛顿州西雅图市的市 STI 诊所接受常规护理的 MSM 中收集数据。MSM 被问及过去 12 个月的 condom 使用情况。我们将行为分为 4 个相互排斥的类别：没有肛交；始终使用 condom 进行肛交；血清分类[仅与 HIV 一致的伴侣进行无 condom 的肛交（CAS）]；与血清不一致/未知状态的伴侣进行 CAS。按照常规诊所方案进行 STI/HIV 检测。
分别有 45656 次和 6987 次 MSM 无 HIV 和 MSM 有 HIV 的就诊。在研究期间，抗逆转录病毒治疗和暴露前预防的使用大幅增加，到 2018 年分别达到 94%和 50%。与血清不一致/未知状态的伴侣进行 CAS 的情况在 2013 年之前下降，但此后又有所增加（在无 HIV 的 MSM 中占 40%；在有 HIV 的 MSM 中占 68%）。血清分类在无 HIV 的 MSM 中增加，但在有 HIV 的 MSM 中在 2013 年之后下降。所有 MSM 的 condom 使用均下降（在无 HIV 的 MSM 中从 35%降至 11%；在有 HIV 的 MSM 中从 20%降至 5%）。HIV 检测阳性率大幅下降（从 3.5%降至 0.5%），而 STI 检测阳性率随着时间的推移而增加。
自 2013 年以来，与 HIV 不一致/未知状态的伴侣进行 CAS 的情况大幅增加，同时 HIV 检测阳性率下降，STI 检测阳性率上升。这突出了生物医学艾滋病毒预防策略在降低 HIV 发病率方面的成功，同时也肯定了需要采取新的方法来预防 STI。
