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Scholarly Works (8 results)

  • Thesis
  • Peer Reviewed
UC San Francisco Electronic Theses and Dissertations (2018)

Background - Pre-exposure prophylaxis (PrEP) provides protection against HIV transmission but not against other sexually transmitted infections (STIs), which disproportionally affect men who have sex with men (MSM).This dissertation examines the association of PrEP initiation with subsequent patterns of condom use and STIs in MSM. A cohort of 525 MSM, 18 years and older, who self-identified as either high or low risk for HIV acquisition was followed for 13 months after initiating PrEP at a sexual health clinic in San Francisco.

Dissertation Aims - 1) review the literature to examine if PrEP is associated with changes in risk behavior in MSM; 2) determine the reasons why MSM who self-identify as low risk for HIV request PrEP; and 3) determine how PrEP use affects condom use and STIs rates in MSM who self-identify as high risk for HIV.

Methods – A systematic literature review was completed. The cohort was followed over 13 months subsequent to initiating PrEP. Questionnaires were used to examine condom use and biological assays were used to measure the frequency and type of STIs. Frequencies and descriptive analyses were completed, and multilevel logistic regression modeling was used to predict associations of condom use and STIs before and after initiation of PrEP. Framework analysis was used to identify themes and to develop a descriptive understanding of why low-risk MSM initiated and remained on PrEP.

Findings - No conclusive evidence was found that PrEP use leads to increased sexual risk behaviors. Overall, condom use decrease peaked at ~ 6 months and returned to baseline rates at ~12 months. Disparities in condom use and STI rates were observed within sub-populations of MSM, and condom use was found to be influenced by perceived risk. In both the low- and high-risk cohorts, anal GC/CT and syphilis decreased and pharyngeal GC/CT either remained constant or increased. MSM do not use PrEP solely to replace condoms, rather PrEP provides, peace of mind, sexual pleasure and safety and security.

Conclusion - In order to improve sexual health for MSM PrEP, STI screening and condom use education should be tailored to meet differing needs of sub populations. Sexual health discussion should include education on substance use, transmission of pharyngeal GC/CT and how MSM perceive sexual risk. Further research is needed to assess when more intensive counselling regarding condom use would be beneficial, how MSM perceive sexual risk and ways to reduce pharyngeal infections.

    Cover page: Sexual Risk Behavior in Men who have Sex with Men in an Era of Pre Exposure Prophylaxis (PrEP) for HIV Prevention.
    • Article
    • Peer Reviewed
    UC San Francisco Previously Published Works (2020)
    The CDC recommends PrEP for MSM at substantial risk of HIV acquisition, leaving clinicians unsure whether to prescribe PrEP to MSM who do not disclose HIV risk factors. A longitudinal cohort of MSM requesting PrEP despite reporting during a clinical visit either 100% condom use or participation in oral sex only and no other risk factors was followed over 13 months at a community clinic in San Francisco to assess the accuracy of their HIV risk perception. Participants completed a sexual and substance use behavior questionnaire at baseline, outside of the clinical visit and were followed by quarterly HIV/STI testing and condom use change questionnaires. Condomless sex increased from 0% at baseline to 12% at month 1, peaked at 34% at month 7, and then decreased again to 8% at month 13. Rates of pharyngeal GC/CT varied from 7% at baseline to 12% at month 13, while rectal GC/CT decreased from 6% at baseline to 0% at month 13. The rate of syphilis was 1% both at baseline and at month 13, however, 11% and 15% of clients tested positive for syphilis at months 1 and 7 respectively.
      • Article
      • Peer Reviewed
      UC San Francisco Previously Published Works (2020)
      The CDC recommends PrEP for MSM at substantial risk of HIV acquisition, leaving clinicians unsure whether to prescribe PrEP to MSM who do not disclose HIV risk factors. A longitudinal cohort of MSM requesting PrEP despite reporting during a clinical visit either 100% condom use or participation in oral sex only and no other risk factors was followed over 13 months at a community clinic in San Francisco to assess the accuracy of their HIV risk perception. Participants completed a sexual and substance use behavior questionnaire at baseline, outside of the clinical visit and were followed by quarterly HIV/STI testing and condom use change questionnaires. Condomless sex increased from 0% at baseline to 12% at month 1, peaked at 34% at month 7, and then decreased again to 8% at month 13. Rates of pharyngeal GC/CT varied from 7% at baseline to 12% at month 13, while rectal GC/CT decreased from 6% at baseline to 0% at month 13. The rate of syphilis was 1% both at baseline and at month 13, however, 11% and 15% of clients tested positive for syphilis at months 1 and 7 respectively.
        Cover page: Misclassification of sexual health risks in a self-identified low risk cohort of men who have sex with men (MSM) enrolled in a community based PrEP program
        • Article
        • Peer Reviewed
        UC San Francisco Previously Published Works (2018)
        In a community-based clinic serving men who have sex with men in San Francisco, California, this study characterized key steps of the pre-exposure prophylaxis (PrEP) cascade and identified correlates of retention in care. In total, 344 patients were evaluated for PrEP. Three-fourths (78%) of those who sought PrEP services initiated PrEP. The overall cumulative incidence of discontinuing PrEP at 13 months was 38%. Men with a sexually transmitted infection (STI) were 44% less likely to be retained (adjusted hazard ratio [aHR] 0.56, 95% confidence interval [0.33-0.95]). Comprehensive retention efforts for men with STIs are crucial to optimize the benefits of PrEP.
          Cover page: HIV Pre-exposure Prophylaxis (PrEP) Uptake and Retention Among Men Who Have Sex with Men in a Community-Based Sexual Health Clinic.
          • Article
          • Peer Reviewed
          UC San Francisco Previously Published Works (2018)
          In a community-based clinic serving men who have sex with men in San Francisco, California, this study characterized key steps of the pre-exposure prophylaxis (PrEP) cascade and identified correlates of retention in care. In total, 344 patients were evaluated for PrEP. Three-fourths (78%) of those who sought PrEP services initiated PrEP. The overall cumulative incidence of discontinuing PrEP at 13 months was 38%. Men with a sexually transmitted infection (STI) were 44% less likely to be retained (adjusted hazard ratio [aHR] 0.56, 95% confidence interval [0.33-0.95]). Comprehensive retention efforts for men with STIs are crucial to optimize the benefits of PrEP.
            Cover page: HIV Pre-exposure Prophylaxis (PrEP) Uptake and Retention Among Men Who Have Sex with Men in a Community-Based Sexual Health Clinic
            • Article
            • Peer Reviewed
            UC San Francisco Previously Published Works (2017)
            Substance use complicates HIV care and prevention. Primary care clinics are an ideal setting to screen for and offer interventions for unhealthy alcohol and drug use; however, few HIV clinics routinely screen for substance use. We enrolled 208 clinic patients at an urban underserved HIV primary care clinic. We screened the patients for substance use with the Alcohol, Smoking, and Substance Involvement Score Test and measured urine toxicology. Of the 168 participants who completed screening, the majority reported tobacco or nonprescribed substance use in the previous 3 months. More African American participants reported low or no risk amphetamine use compared to Hispanic, White, or Other race participants (p < .001). Implementing standard clinic practice for screening and assessing substance use in HIV primary care clinics is needed.
              Cover page: Prevalence of Substance Use in an HIV Primary Care Safety Net Clinic: A Call for&nbsp;Screening.
              • Article
              • Peer Reviewed
              UC Davis Previously Published Works (2017)
              Substance use complicates HIV care and prevention. Primary care clinics are an ideal setting to screen for and offer interventions for unhealthy alcohol and drug use; however, few HIV clinics routinely screen for substance use. We enrolled 208 clinic patients at an urban underserved HIV primary care clinic. We screened the patients for substance use with the Alcohol, Smoking, and Substance Involvement Score Test and measured urine toxicology. Of the 168 participants who completed screening, the majority reported tobacco or nonprescribed substance use in the previous 3 months. More African American participants reported low or no risk amphetamine use compared to Hispanic, White, or Other race participants (p < .001). Implementing standard clinic practice for screening and assessing substance use in HIV primary care clinics is needed.
                Cover page: Prevalence of Substance Use in an HIV Primary Care Safety Net Clinic: A Call for&nbsp;Screening.
                • Article
                • Peer Reviewed
                UC San Francisco Previously Published Works (2018)
                To meet the goals of the National HIV/AIDS Strategy and the need for a human immunodeficiency virus (HIV)-competent primary care workforce, education and training of nurse practitioners are critical. The University of California, San Francisco School of Nursing developed and implemented an HIV primary care curriculum and evaluated this curriculum for a graduating cohort of 55 students. Results show gains in students’ HIV knowledge and confidence in providing basic HIV care and improvements in attitudes toward people living with HIV. We have been able to show that HIV content can be successfully integrated into a nurse practitioner generalist curriculum.
                  Cover page: HIV Primary Care Curriculum Improves HIV Knowledge, Confidence and Attitudes
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