Rising Incidence of Syphilis Among Rural HIV+ Men Despite Systematic, Point of Care Prevention Counseling
Methods: We performed a retrospective cohort study to identify risk factors associated with incident syphilis diagnoses in a cohort of HIV+ men mostly living in rural south central Pennsylvania from 2008 to mid-2013. During this same time period we introduced a succinct, formalized risk behavior screening protocol tied to transmission reduction education delivered at the point of care. Patients’ demographic, clinical, psychosocial and risk behavioral characteristics were examined. A multivariate logistic regression model was performed to identify factors associated with syphilis.
Results: Between 2003 and 2007 we diagnosed a total of 15 syphilis cases, all men. Without significant changes in our population or syphilis screening practice, a total of 51 new syphilis infections were diagnosed among 702 HIV+ men during the study period (5 patients were diagnosed with 2 or more episodes). The number of syphilis cases paradoxically increased from 5 cases in 2008 to 17 cases in 2012 in the face of our ongoing prevention counseling. Younger age (<35 years) (adjusted odds ratio [aOR]=2.99), a higher educational attainment (aOR=4.30), and perception that partner may have sex with other people (aOR=2.85) were significantly associated with syphilis. Additionally, non-injection drug use was related to syphilis diagnosis in HIV+ men who have sex with men (aOR=2.61).
Conclusion: Some HIV+ men, especially younger, well-educated men or those who perceived that their partners may have sex with other people, continue to have high-risk behaviors that may facilitate HIV transmission and increase their own risks of acquiring new STDs. Routine clinic-based risk-reduction counseling may not have long-term effects in reducing high-risk behaviors. New approaches are needed to prevent safer sex fatigue in HIV+ men.
P. Albright, None
T. Crook, None
C. Whitener, None
P. Du, None
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