JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
Arch Sex Behav. 2023 Jul;52(5):2051-2063. doi: 10.1007/s10508-023-02598-3. Epub 2023 Apr 26.
With "undetectable equals untransmittable," continued engagement in condomless sex has prolonged STI risk in people living with HIV. This study examined the pattern and relationship between STI diagnosis and sex partner-seeking practice over time in a cohort of men who have sex with men (MSM) attending the HIV specialist clinic in Hong Kong. Participants' STI diagnosis record since HIV diagnosis was retrieved and their frequency of seeking sex partners (A) before, (B) after HIV diagnosis, and (C) following extended period (5-10 years), through eight different settings, was assessed in two rounds of survey, along with their risk behavioral profile. Multivariable regression models were employed to study the factors associated with STI diagnosis and partner-seeking frequency, while their temporal relationships over the three time points (A-C) were examined using cross-lagged panel model. Of 345 subjects recruited, STI incidence dropped from 252 to 187 cases/1000 person-years during 2015-2019. Totally 139/212 MSM (66%) had ≥ 1 episode of STI within the 10-year period after HIV diagnosis, giving an 11-20% annual prevalence. The reduced frequency of seeking sex partner was well preserved following diagnosis with a rebound specifically noted in the use of mobile application, the patrons of which were more likely to be co-infected with STI in 2019. Chemsex, concurrent partnership, and casual sex were risk factors shared between frequent partner-seeking practice and STI diagnosis. A robust autoregressive effect for partner-seeking frequency was also identified, and which significantly predicted STI risk in the long term. To enhance HIV care, the co-administration of STI/behavioral surveillance should be emphasized.
随着“检测不到等于不传播”的理念，持续进行无保护性行为会延长 HIV 感染者的性传播感染（STI）风险。本研究通过对在香港 HIV 专科诊所就诊的男男性接触者（MSM）队列进行了分析，调查了他们自 HIV 确诊以来的性传播感染诊断模式和性伴侣寻求行为的时间变化关系。通过两轮调查，评估了参与者 HIV 确诊以来的性传播感染诊断记录，以及在 HIV 确诊前（A）、后（B）和（C）长时间（5-10 年）后的性伴侣寻求频率，在 8 种不同环境下进行了评估，并结合他们的风险行为特征。采用多变量回归模型研究了与性传播感染诊断和性伴侣寻求频率相关的因素，同时使用交叉滞后面板模型检验了这三个时间点（A-C）之间的时间关系。在招募的 345 名参与者中，2015-2019 年期间，性传播感染的发病率从 252 例/1000 人年降至 187 例/1000 人年。在 HIV 确诊后的 10 年内，总共有 139/212 名 MSM（66%）发生了 1 次或以上的性传播感染，年患病率为 11-20%。确诊后，寻求性伴侣的频率明显减少，但在 2019 年，使用移动应用程序的人数出现反弹，而这些应用程序的使用者更有可能同时感染性传播感染。性滥交、同时存在多个性伴侣和随意性行为是频繁寻求性伴侣行为和性传播感染诊断之间的共同危险因素。性伴侣寻求频率的稳健自回归效应也得到了确认，并且长期来看，它显著预测了性传播感染的风险。为了加强 HIV 护理，应强调同时进行性传播感染/行为监测。
