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. 2024 Mar 1;51(3):178-185.
doi: 10.1097/OLQ.0000000000001915. Epub 2023 Dec 28.

Human Immunodeficiency Virus Treatment Attitudes and Bacterial Sexually Transmitted Infections Among Gay and Bisexual Men

Trevor A Hart, Syed W Noor, Farideh Tavangar, Adhm Zahran  1 , Shayna Skakoon-Sparling, Darrell H S Tan, Gilles Lambert, Daniel Grace  2 , Nathan Lachowsky, Jordan M Sang  3 , Paolo A Palma  1 , Terri Zhang  1 , Milada Dvorakova  4 , Joseph Cox, David M Moore; Engage Study
Affiliations

Human Immunodeficiency Virus Treatment Attitudes and Bacterial Sexually Transmitted Infections Among Gay and Bisexual Men

Trevor A Hart et al. Sex Transm Dis. .

Abstract

Backgrounds: Positive attitudes toward human immunodeficiency virus (HIV) treatment, such as reduced concern about HIV transmissibility, are associated with sexual behaviors that may increase the risk of bacterial sexually transmitted infections (STIs) among gay, bisexual, and other men who have sex with men (GBM). We examined associations between HIV treatment attitudes and bacterial STI diagnoses among GBM in Canada's three largest cities.

Methods: We fit a structural equation model between HIV treatment attitudes and bacterial STI diagnoses via sexual behaviors in the Engage study's baseline data. We estimated direct and indirect paths between scores on HIV treatment attitudes and STIs via number of male anal sex partners, condomless anal sex, and oral sex. We conducted sub-analyses with participants stratified by HIV serostatus.

Results: Among 2449 GBM recruited in 2017 to 2019, there was a direct association between HIV treatment attitudes and current STI diagnoses (β = 0.13; 95% CI, 0.07-0.19; P < 0.001). The mediated model revealed a positive total indirect effect through 2 pathways: (1) engaging in condomless anal sex and (2) number of male anal sex partners and condomless anal sex. These 2 indirect pathways remained in the stratified mediation models for both HIV negative GBM and for GBM living with HIV.

Conclusions: The association between HIV treatment attitudes and diagnosed STIs is mediated through a higher number of male anal sex partners and condomless anal sex. The results highlight the importance of providers educating patients when providing effective STI counseling, testing, and prevention for GBM about how accurate HIV treatment attitudes may inadvertently be associated with the bacterial STI epidemic.

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Conflict of interest statement

Conflict of Interest and Sources of Funding: The Engage Cohort Study is led by Principal Investigators in Toronto by T.A.H. and D.G., in Montreal by J.C. and G.L., and in Vancouver by Jody Jollimore, Nathan Lachowsky, and David Moore. The authors would like to thank the Engage/Momentum II study participants, office staff, and community engagement committee members, as well as our community partner agencies. Engage/Momentum II is funded by the Canadian Institutes for Health Research (CIHR, TE2-138299; FDN=143342; PJT-153139), the Canadian Foundation for AIDS Research (CANFAR), the Ontario HIV Treatment Network (OHTN, 1051), the Public Health Agency of Canada (4500345082), and Toronto Metropolitan University. T.A.H. was supported by an Endgame Leader Chair Award in Gay and Bisexual Men's Health from the Ontario HIV Treatment Network. D.M.M. and N.J.L. are supported by Scholar Awards from the Michael Smith Foundation for Health Research (5209, 16863). S.S.-S. is supported by a CIHR postdoctoral fellowship award. D.G. is supported by a Canada Research Chair in Sexual and Gender Minority Health. D.H.S.T. is supported by a Tier 2 Canada Research Chair in HIV Prevention and STI Research. J.M.S. was supported by a CTN postdoctoral fellowship award. The authors would like to thank the participants and staff of the Engage Cohort Study and our community engagement committees and community partner organizations.

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