Use of Doxycycline to Prevent Sexually Transmitted Infections According to Provider Characteristics.

Use of doxycycline to prevent sexually transmitted infections (STIs) may lead to antimicrobial resistance. We analyzed attitudes toward this practice between US providers who commonly and less commonly treat STIs. Providers who more commonly treat STIs are more likely to prescribe prophylactic doxycycline and believe that benefits outweigh potential for increased antimicrobial resistance.

Online Discussions of Sexually Transmitted Infections During COVID-19: Insights From the Social Media Platform Reddit.

BACKGROUND: With the onset of the COVID-19 pandemic, reported rates of chlamydia and gonorrhea dropped and remained low for several months of 2020 as compared with 2019. Additional data are needed to reveal causes of reported rate changes. Here, we analyze sexually transmitted infection (STI)-related conversations from the online-discussion platform Reddit to gain insight into the role of the pandemic on public experience of STIs in 2020. METHODS: We collected data from Pushshift's and Reddit's application programming interfaces via programs coded in Python. We focused data collection on the "r/STD" subreddit. Collected submissions contained the term(s) "covid" and/or "coronavirus" and were submitted between January 1, 2020, and December 31, 2020. We collected the title and text of each submission. We used a Latent Dirichlet Allocation algorithm to create a topic model of post content and complemented this approach with key term analysis and qualitative hand-coding. RESULTS: Of the 288 posts collected, 148 were complete and included in analyses. Latent Dirichlet Allocation revealed 4 main topics in the collected posts: narration of sexual experiences, STI testing, crowdsourcing of visual STI diagnoses, and descriptions of STI-related pains and treatments. Hand-coding of COVID-19 mentions revealed pandemic-related anxieties about STI care seeking and experienced delays in and changes to quality of STI care received. CONCLUSIONS: References to COVID-19 and associated mitigation efforts were woven into Reddit posts pertaining to several domains of STI care. These data support the notion that Reddit discussions may represent a valuable source of STI information, standing to corroborate and further contextualize STI survey and surveillance work.

The psychosocial impact of prostate cancer screening for BRCA1 and BRCA2 carriers.

OBJECTIVES: To report the long-term outcomes from a longitudinal psychosocial study that forms part of the 'Identification of Men with a genetic predisposition to ProstAte Cancer: Targeted Screening in men at higher genetic risk and controls' (IMPACT) study. The IMPACT study is a multi-national study of targeted prostate cancer (PrCa) screening in individuals with a known germline pathogenic variant (GPV) in either the BReast CAncer gene 1 (BRCA1) or the BReast CAncer gene 2 (BRCA2). SUBJECTS AND METHODS: Participants enrolled in the IMPACT study were invited to complete a psychosocial questionnaire prior to each annual screening visit for a minimum of 5 years. The questionnaire included questions on sociodemographics and the following measures: Hospital Anxiety and Depression Scale, Impact of Event Scale, 36-item Short-Form Health Survey, Memorial Anxiety Scale for PrCa, Cancer Worry Scale, risk perception and knowledge. RESULTS: A total of 760 participants completed questionnaires: 207 participants with GPV in BRCA1, 265 with GPV in BRCA2 and 288 controls (non-carriers from families with a known GPV). We found no evidence of clinically concerning levels of general or cancer-specific distress or poor health-related quality of life in the cohort as a whole. Individuals in the control group had significantly less worry about PrCa compared with the carriers; however, all mean scores were low and within reported general population norms, where available. BRCA2 carriers with previously high prostate-specific antigen (PSA) levels experience a small but significant increase in PrCa anxiety (P = 0.01) and PSA-specific anxiety (P < 0.001). Cancer risk perceptions reflected information provided during genetic counselling and participants had good levels of knowledge, although this declined over time. CONCLUSION: This is the first study to report the longitudinal psychosocial impact of a targeted PrCa screening programme for BRCA1 and BRCA2 carriers. The results reassure that an annual PSA-based screening programme does not have an adverse impact on psychosocial health or health-related quality of life in these higher-risk individuals. These results are important as more PrCa screening is targeted to higher-risk groups.

A Description of Telehealth Use Among Sexually Transmitted Infection Providers in the United States, 2021.

BACKGROUND: Telehealth offers one approach to improving access to sexually transmitted infection (STI) prevention and care services. Therefore, we described recent telehealth use among those providing STI-related care and identified opportunities for improving STI service delivery. MATERIALS AND METHODS: Using the DocStyles Web-based, panel survey conducted by Porter Novelli from September 14 to November 10, 2021, 1500 healthcare providers were asked about their current telehealth usage, demographics, and practice characteristics, and compared STI providers (≥10% of time spent on STI care and prevention) to non-STI providers. RESULTS: Among those whose practice consisted of at least 10% STI visits (n = 597), 81.7% used telehealth compared with 75.7% for those whose practice consisted of less than 10% STI visits (n = 903). Among the providers with at least 10% STI visits in their practice, telehealth use was highest among obstetrics and gynecology specialists, those practicing in suburban areas, and those practicing in the South. Among providers whose practice consisted of at least 10% STI visits and who used telehealth (n = 488), the majority were female and obstetrics and gynecology specialists practicing in suburban areas of the South. After controlling for age, gender, provider specialty, and geographic location of their practice, providers whose practice consisted of at least 10% STI visits had increased odds (odds ratio, 1.51; 95% confidence interval, 1.16-1.97) of using telehealth compared with providers whose visits consisted of less than 10% STI visits. CONCLUSIONS: Given the widespread use of telehealth, efforts to optimize delivery of STI care and prevention via telehealth are important to improve access to services and address STIs in the United States.

Changes in Oral and Anal Sex With Opposite-Sex Partners Among Sexually Active Females and Males Aged 15 to 44 Years in the United States: National Survey of Family Growth, 2011-2019.

BACKGROUND: Oral and anal sex with opposite-sex partners is common and associated with sexually transmitted infection (STI) transmission. Trends in these behaviors over the last decade, during which bacterial STI diagnoses have reached historic highs while HIV diagnoses have decreased, are not well understood. We examined recent trends in oral and anal sex and associated condom use with opposite-sex partners among females and males. METHODS: We analyzed data from 16,926 female and 13,533 male respondents aged 15 to 44 years who reported sex with an opposite-sex partner in the past 12 months from the National Survey of Family Growth, 2011-2019. We used survey-weighted linear or logistic regression to evaluate linear temporal trends in oral and anal sex behaviors. RESULTS: From 2011-2013 to 2017-2019, reports of oral sex and number of oral sex partners in the past 12 months increased among females (85.4% in 2011-2013 to 89.4% in 2017-2019; odds ratio [OR], 1.05 [95% confidence interval {CI}, 1.02-1.09], and ß = 0.014 [95% CI, 0.005-0.023]; respectively) but not males (ranges, 87.9%-89.1%; 1.27-1.31). Condom use at last oral sex decreased among both females and males (6.3%-4.3%: OR, 0.93 [95% CI, 0.88-0.99]; 5.9%-4.4%: OR, 0.95 [95% CI, 0.91-1.00]). Anal sex (ranges, 21.0%-23.3% [females] and 23.3%-24.6% [males]), number of anal sex partners (females, 0.22-0.25; males, 0.26-0.30), and condom use at last anal sex (females, 15.3%-18.2%; males, 27.0%-28.7%) remained stable. CONCLUSIONS: The frequency of oral and anal sex with opposite-sex partners among U.S. 15- to 44-year-olds, paired with limited and-for oral sex-decreasing condom use, demonstrates the need to understand the role of these behaviors in increasing STI diagnosis rates and the potential role of extragenital screening and condoms in reducing STI transmission.

Changes in Sexual Behaviors with Opposite-Sex Partners and Sexually Transmitted Infection Outcomes Among Females and Males Ages 15-44 Years in the USA: National Survey of Family Growth, 2008-2019.

Rates of reported gonorrhea and chlamydial infections have increased substantially over the past decade in the USA and disparities persist across age and race/ethnicity. We aimed to understand potential changes in sexual behaviors, sexual network attributes, and sexually transmitted infection (STI) screening that may be contributing to these trends. We analyzed data from 29,423 female and 24,605 male respondents ages 15-44 years from the National Survey of Family Growth, 2008-2019. We used survey-weighted linear or logistic regression to evaluate linear temporal trends in sexual behaviors with opposite-sex partners, network attributes, and STI testing, treatment, and diagnosis. Significant declines were observed in condom use at last vaginal sex, mean number of vaginal sex acts, proportion of condom-protected sex acts in the past 4 weeks, and racial/ethnic homophily with current partners among males and females from 2008-2010 through 2017-2019. Among males, mean number of female partners in the past 12 months and concurrency also declined, while the percent reporting ever having sex with another male increased. Past-year testing for chlamydia and any STI increased among females. Research is needed to understand how these changes interact and potentially contribute to increasing reported gonorrhea and chlamydia diagnoses and identify avenues for future intervention.

Case Investigation and Contact Tracing Efforts From Health Departments in the United States, November 2020 to December 2021.

BACKGROUND: Sixty-four state, local, and territorial health departments (HDs) in the United States report monthly performance metrics on coronavirus disease 2019 (COVID-19) case investigation and contact tracing (CI/CT) activities. We describe national CI/CT efforts from 25 October 2020 through 24 December 2021, which included 3 peaks in COVID-19 case reporting. METHODS: Standardized CI/CT data elements submitted by the 64 HDs were summarized as monthly performance metrics for each HD and the nation. These included measures of CI/CT completeness, timeliness, and workloads. We calculated contact tracing efficacy as the proportion of new cases that occurred in persons identified as contacts within the 14 days before the case was reported. RESULTS: A total of 44 309 796 COVID-19 cases were reported to HDs, with completed HD interviews in 18 153 353 (41%). Less than half of interviews yielded ≥1 contact. A total of 19 939 376 contacts were identified; 11 632 613 were notified (58%), with 3 618 846 undergoing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing within 14 days of notification. Of the total reported cases, 2 559 383 occurred in recently identified contacts. CONCLUSIONS: We document the resource-intense nationwide effort by US HDs to mitigate the impact of COVID-19 through CI/CT before and after vaccines became widely available. These results document the coverage and performance of CI/CT despite case surges and fluctuating workforce and workloads.

Intersection of Syphilis and Human Immunodeficiency Virus (HIV) Networks to Identify Opportunities to Enhance HIV Prevention.

BACKGROUND: Human immunodeficiency virus (HIV) and syphilis infection continue at disproportionate rates among minority men who have sex with men (MSM) in the United States. The integration of HIV genetic clustering with partner services can provide important insight into local epidemic trends to guide interventions and control efforts. METHODS: We evaluated contact networks of index persons defined as minority men and transgender women diagnosed with early syphilis and/or HIV infection between 2018 and 2020 in 2 North Carolina regions. HIV clusters were constructed from pol sequences collected through statewide surveillance. A combined "HIV-risk" network, which included persons with any links (genetic or sexual contact) to HIV-positive persons, was evaluated by component size, demographic factors, and HIV viral suppression. RESULTS: In total, 1289 index persons were identified and 55% named 1153 contacts. Most index persons were Black (88%) and young (median age 30 years); 70% had early syphilis and 43% had prevalent HIV infection. Most people with HIV (65%) appeared in an HIV cluster. The combined HIV-risk network (1590 contact network and 1500 cluster members) included 287 distinct components; however, 1586 (51%) were in a single component. Fifty-five percent of network members with HIV had no evidence of viral suppression. Overall, fewer index persons needed to be interviewed to identify 1 HIV-positive member without viral suppression (1.3 vs 4.0 for contact tracing). CONCLUSIONS: Integration of HIV clusters and viral loads illuminate networks with high HIV prevalence, indicating recent and ongoing transmission. Interventions intensified toward these networks may efficiently reach persons for HIV prevention and care re-engagement.

Sexual Risk Behaviors Among Persons Diagnosed With Primary and Secondary Syphilis Who Reported High-Risk Substance Use: Data From the National Notifiable Diseases Surveillance System, 2018.

BACKGROUND: Recent increases in high-risk substance use (HRSU; i.e., injection drug use, heroin, methamphetamine, crack/cocaine) have coincided with rising primary and secondary (P&S) syphilis rates. To further understand these trends, we examined sexual risk behaviors among women, men who have sex with women only (MSW), and men who have sex with men (MSM) who were diagnosed with P&S syphilis in 2018 and reported HRSU. METHODS: Data on HRSU and sexual risk behaviors among persons with P&S syphilis were drawn from syphilis case reports in 2018 from the National Notifiable Diseases Surveillance System. Persons with P&S syphilis were asked about sexual risk behaviors in the past 12 months including exchange sex for drugs/money, sex while intoxicated and/or high on drugs, sex with a person who injects drugs (PWID), sex with an anonymous partner, and number of sex partners. We describe percentages and adjusted prevalence ratios (aPRs) for women, MSW, and MSM reporting these behaviors by age, race/Hispanic ethnicity, type of drug used, and incarceration history (both in the past 12 months). RESULTS: Among 19,634 persons diagnosed with P&S syphilis in 2018 with information on HRSU, 29.3% of women, 22.7% of MSW, and 12.4% of MSM reported HRSU. Among those reporting HRSU, percentages reporting exchange sex ranged from 17% to 35% (highest for women), whereas reports of anonymous sex ranged from 44% to 71% (highest for MSM). In this population, sexual risk behaviors were more commonly reported among those with a recent incarceration history than those without such history. Among those reporting injection drug use or heroin use, percentages reporting sex with a PWID ranged from 51% to 77%. In adjusted models, HRSU was significantly associated with one or more sexual risk behaviors for women (aPR, 2.63 [95% confidence interval {CI}, 2.39-2.90]; MSW: aPR, 1.38 [95% CI, 1.31-1.46]; and MSM: aPR, 1.30 [95% CI, 1.26-1.34]). CONCLUSIONS: Collaborative partnerships across the US public health system could help address barriers to timely clinical care among persons diagnosed with P&S syphilis who report HRSU.

Beyond Disease Intervention: Exploring an Expanded Role for Partner Services in the MATRix-NC Demonstration Project.

BACKGROUND: Disease intervention specialists (DIS) provide partner services for sexually transmitted infections (STIs). We assessed an expansion of DIS services for clients with HIV and/or syphilis, and contacts within their social and sexual networks. METHODS: Black and Latinx cisgender men and transgender women who have sex with men diagnosed with HIV and/or syphilis in 4 urban North Carolina counties were referred to designated DIS, who were trained to recruit clients as "seeds" for chain-referral sampling of sociosexual network "peers." All received HIV/STI testing and care; referrals for preexposure prophylaxis (PrEP) and social, behavioral, and non-STI medical services were offered. Participants completed baseline, 1-month, and 3-month computerized surveys. RESULTS: Of 213 cases referred to DIS from May 2018 to February 2020, 42 seeds (25 with syphilis, 17 with HIV) and 50 peers participated. Median age was 27 years; 93% were Black and 86% were cisgender men. Most peers came from seeds' social networks: 66% were friends, 20% were relatives, and 38% were cisgender women. Incomes were low, 41% were uninsured, and 10% experienced recent homelessness. More seeds than peers had baseline PrEP awareness; attitudes were favorable, but utilization was poor. Thirty-seven participants were referred for PrEP 50 times; 17 (46%) accessed PrEP by month 3. Thirty-nine participants received 129 non-PrEP referrals, most commonly for housing assistance, primary care, Medicaid navigation, and food insecurity. CONCLUSIONS: Chain-referral sampling from partner services clients allowed DIS to access persons with significant medical and social service needs, demonstrating that DIS can support marginalized communities beyond STI intervention.

The BARCODE1 Pilot: a feasibility study of using germline single nucleotide polymorphisms to target prostate cancer screening.

OBJECTIVES: To assess the feasibility and uptake of a community-based prostate cancer (PCa) screening programme selecting men according to their genetic risk of PCa. To assess the uptake of PCa screening investigations by men invited for screening. The uptake of the pilot study would guide the opening of the larger BARCODE1 study recruiting 5000 men. SUBJECTS AND METHODS: Healthy males aged 55-69 years were invited to participate via their general practitioners (GPs). Saliva samples were collected via mailed collection kits. After DNA extraction, genotyping was conducted using a study specific assay. Genetic risk was based on genotyping 130 germline PCa risk single nucleotide polymorphisms (SNPs). A polygenic risk score (PRS) was calculated for each participant using the sum of weighted alleles for 130 SNPs. Study participants with a PRS lying above the 90th centile value were invited for PCa screening by prostate magnetic resonance imaging (MRI) and biopsy. RESULTS: Invitation letters were sent to 1434 men. The overall study uptake was 26% (375/1436) and 87% of responders were eligible for study entry. DNA genotyping data were available for 297 men and 25 were invited for screening. After exclusions due to medical comorbidity/invitations declined, 18 of 25 men (72%) underwent MRI and biopsy of the prostate. There were seven diagnoses of PCa (38.9%). All cancers were low-risk and were managed with active surveillance. CONCLUSION: The BARCODE1 Pilot has shown this community study in the UK to be feasible, with an overall uptake of 26%. The main BARCODE1 study is now open and will recruit 5000 men. The results of BARCODE1 will be important in defining the role of genetic profiling in targeted PCa population screening. Patient Summary What is the paper about? Very few prostate cancer screening programmes currently exist anywhere in the world. Our pilot study investigated if men in the UK would find it acceptable to have a genetic test based on a saliva sample to examine their risk of prostate cancer development. This test would guide whether men are offered prostate cancer screening tests. What does it mean for patients? We found that the study design was acceptable: 26% of men invited to take part agreed to have the test. The majority of men who were found to have an increased genetic risk of prostate cancer underwent further tests offered (prostate MRI scan and biopsy). We have now expanded the study to enrol 5000 men. The BARCODE1 study will be important in examining whether this approach could be used for large-scale population prostate cancer screening.

Improving Sexual Health in U.S. Rural Communities: Reducing the Impact of Stigma.

Sexually transmitted infections (STI), including HIV, are among the most reported diseases in the U.S. and represent some of America's most significant health disparities. The growing scarcity of health care services in rural settings limits STI prevention and treatment for rural Americans. Local health departments are the primary source for STI care in rural communities; however, these providers experience two main challenges, also known as a double disparity: (1) inadequate capacity and (2) poor health in rural populations. Moreover, in rural communities the interaction of rural status and key determinants of health increase STI disparities. These key determinants can include structural, behavioral, and interpersonal factors, one of which is stigma. Engaging the expertise and involvement of affected community members in decisions regarding the needs, barriers, and opportunities for better sexual health is an asset and offers a gateway to sustainable, successful, and non-stigmatizing STI prevention programs.

RESUMEN: Las infecciones de transmisión sexual (ITS), incluyendo al VIH, se encuentran entre las enfermedades más diagnosticadas en los Estados Unidos y representan algunas de las disparidades de salud más significativas. La creciente escasez de servicios de atención médica en entornos rurales limita la prevención y el tratamiento de las ITS para los estadounidenses de zonas rurales. Los departamentos locales de salud son las fuentes principales para el cuidado de las ITS en las comunidades rurales, pero estos proveedores confrontan dos desafíos principales, o una doble disparidad: (1) capacidad inadecuada y (2) malas condiciones de salud entre las poblaciones rurales. Además, en las comunidades rurales la interacción entre el estatus rural y determinantes claves de la salud aumentan las disparidades asociadas a las ITS. Estos determinantes clave pueden incluir factores estructurales, de comportamiento y interpersonales, como el estigma. El involucrar la experiencia y la participación de los miembros de la comunidad afectados en las decisiones sobre las necesidades, barreras y oportunidades para una mejor salud sexual es beneficioso y ofrece una puerta de entrada a programas de prevención de ITS sostenibles, exitosos y no estigmatizantes.

Reddit on PrEP: Posts About Pre-exposure Prophylaxis for HIV from Reddit Users, 2014-2019.

Social media forums provide a window into how gay, bisexual, and other men who have sex with men talk about pre-exposure prophylaxis for HIV prevention (PrEP) outside of research contexts. To examine information exchange about this important pillar of HIV prevention, discussions around PrEP were collected from the r/askgaybros subreddit of the social media site Reddit (2014-2019). Post titles and asks were qualitatively coded to identify themes describing the primary purpose of the post. In all, 1163 PrEP posts were identified, and a 23.3-fold increase in post volume was seen from 2014 (n = 20) to 2019 (n = 466). The most common post type was a mention of PrEP in a post primarily discussing: an assessment of risk after a sexual encounter (19.2%); a sexual or romantic relationship (6.0%); or other (29.3%). Access challenges (19.1%), information seeking (17.5%), and the cultural effects of PrEP on the gay community (16.3%) were other common themes. Posts regarding the initiation of PrEP (11.8%) and PrEP side-effects (9.4%) were moderately represented. Posts addressing promotion, shade, stigma, and usage were infrequent (≤ 5.5% of posts, respectively). Over time, discussion of PrEP has increased exponentially on r/askgaybros, which may reflect the normalization of PrEP. Qualitative analysis of these posts can be a rich source of data for scientists, practitioners, and healthcare providers interested in increasing uptake of PrEP and decreasing barriers to its use.

Factors Associated With Online Sex Partners Among Gay, Bisexual and Other Men Who Have Sex With Men: Results From a National Survey.

BACKGROUND: Associations between online sex seeking and increased risk for sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) among men who have sex with men (MSM) typically rely on convenience samples. We examined Internet and mobile app use for finding sex partners among a nationally representative sample of MSM. METHODS: We analyzed 2011 to 2017 data from the National Survey of Family Growth, a nationally representative sample of the civilian, non-institutionalized US population (15-44 years). The analytic sample was comprised of men who reported 1 or more same-sex partners in the past year. We also assessed associations between online sex-seeking and STI risk, sexual health care behaviors, and condom use. RESULTS: Of 13,320 male respondents, 442 (3.0%) reported sex with a man in the past year, of whom 215 (46.3%) had met a partner online. Between MSM who met partners online and those who did not, we found no differences by age, education, race/ethnicity or socioeconomic status. Men who have sex with men with online partners were more likely to identify as gay (68.4% vs 49.5%, P = 0.0124). They also reported more sex partners overall (M = 3.04 vs 1.60, P < 0.0001), and multiple insertive (46.3% vs 8.5%, P < 0.0001) and receptive (33.2% vs 15.4%, P = 0.0055) anal sex partners, in the past year. They were also more likely to receive sexual risk assessments (56.0% vs 40.4%, P = 0.0129), STI testing (57.4% vs 35.3%, P = 0.0002), and STI treatment (17.8% vs 8.7%, P = 0.0152) in the past year. We found no differences in condom use. CONCLUSIONS: Men who have sex with men who report using online sources to find sex partners are more likely than other MSM to report behaviors that increase risk for STI/HIV but are also more likely to engage in behaviors that may mitigate further transmission, such as STI testing.

Health Care Access and Service Use Among Behavioral Risk Factor Surveillance System Respondents Engaging in High-Risk Sexual Behaviors, 2016.

INTRODUCTION: Access to health care services such as screening, testing, and treatment of sexually transmitted diseases is vital for those who engage in high-risk behaviors. Studies examining the relationship between high-risk behaviors and health care access and utilization are crucial for determining whether persons at risk are receiving appropriate health services. METHODS: We examined 2016 data from the Behavioral Risk Factor Surveillance System. Our study population included persons aged 18 to 65 years. χ and logistic regression analyses were used to examine relationships between high-risk behaviors including drug use and high-risk sexual behaviors, and access to and utilization of health care services. RESULTS: Among our study population, 6.2% engaged in a high-risk behavior in the past year. Those engaging in high-risk behaviors were more likely to have no health insurance coverage (odds ratio [OR], 1.23; 95% confidence interval [CI], 1.13-1.34), have no personal health care provider (OR, 1.14; 95% CI, 1.06-1.21), have foregone care because of cost (OR 1.54; 95% CI, 1.42-1.65), or have had no routine check-up in the past 2 years (OR 1.16; 95% CI, 1.09-1.25). CONCLUSIONS: Those who engaged in high-risk behaviors had poorer health care access and utilization outcomes. Future studies should incorporate the relationships between changes in behaviors, health care access and utilization, and resulting sexually transmitted disease morbidity.

Social and behavioural research prospects for sexually transmissible infection prevention in the era of advances in biomedical approaches.

In the past two decades, major advances in biomedical intervention approaches to prevent HIV and many sexually transmissible infections (STIs) have shown great promise. However, challenges to prevention remain in the area of achieving population-level impact for biomedical prevention approaches. In this paper we address what social and behavioural research approaches can contribute beyond well-known behaviour change and counselling interventions. We organise work into five areas. Adherence and disinhibition research is primarily into individual-level constructs pertaining to maximising intervention effectiveness. Coverage research represents a population-level construct germane to maximising efficient prioritisation for prevention. Research covering social determinants, a second population-level construct, contributes to both prioritisation and effectiveness. Finally, disparities and social inequities need to be incorporated into prevention, given the pervasive and persistent disparities found in rates of HIV and STIs and in their antecedents.

Availability of Injectable Antimicrobial Drugs for Gonorrhea and Syphilis, United States, 2016.

We estimated the availability of the injectable antimicrobial drugs recommended for point-of-care treatment of gonorrhea and syphilis among US physicians who evaluated patients with sexually transmitted infections in 2016. Most physicians did not have these drugs available on-site. Further research is needed to determine the reasons for the unavailability of these drugs.

Sexually Transmitted Disease, Human Immunodeficiency Virus, and Pregnancy Testing Behaviors Among Internet and Mobile Dating Application Users and Nonusers, 2016.

We examined 2016 United States market research to understand the demographics and sexual health testing behaviors of dating app users. Internet/app users were more likely to be young adults, male, nonwhite, of Hispanic ethnicity, and unmarried. Users also reported greater testing for sexually transmitted disease, human immunodeficiency virus, and pregnancy.

Sexual risk behaviors and STDs among persons who inject drugs: A national study.

Opioid use and the rising case reports of STDs represent co-occurring epidemics; research indicates that persons who inject drugs (PWID) may be at increased risk for acquiring STDs. We use the National Survey of Family Growth (NSFG, 2011-2015) to examine the prevalence of risky sexual behaviors and STD diagnoses among PWID. We describe demographic characteristics, sexual behaviors, and self-reported STD diagnoses of sexually active women and men, separately, by whether they had ever engaged in injection-related behaviors (age 15-44; N = 9006 women, N = 7210 men). Results indicate that in 2011-15, 1.4% of women and 2.6% of men reported ever engaging in injection-related behaviors. Examining the full logistic regression models indicate that for women, sex with a PWID in the past 12 months (AOR = 5.8, 95% CI: 2.9, 11.7), exchanging money/drugs for sex in the past 12 months (AOR = 3.6, 95% CI: 1.2, 10.9), chlamydia and/or gonorrhea diagnosis in the past 12 months (AOR = 2.6, 95% CI: 1.2, 5.3), ever having a syphilis diagnosis (AOR = 8.5, 95% CI: 3.1, 23.4), and ever having a herpes diagnosis (AOR = 3.3, 95% CI: 1.0, 10.3) were associated with increased odds of engaging in injection-related behaviors. For men, sex with a PWID in the past 12 months (AOR = 10.9, 95% CI: 4.3, 27.7), ever being diagnosed with syphilis (AOR = 5.8, 95% CI: 1.8, 18.0), and ever being diagnosed with herpes (AOR = 2.7, 95% CI: 1.0, 7.1) were significantly associated with increased odds of engaging in injection-related behaviors. Future research may examine critical intervention points, including co-occurring factors in both STD acquisition and injection drug use.

Developing a Motion Comic for HIV/STD Prevention for Young People Ages 15-24, Part 2: Evaluation of a Pilot Intervention.

In the United States, young people (ages 15-24 years) are disproportionately affected by human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs), due at least in part to inadequate or incorrect HIV/STD-related knowledge, attitudes, beliefs, and behavioral intentions (KABI). Comic book narratives are a proven method of HIV/STD prevention communication to strengthen KABI for HIV/STD prevention. Motion comics, a new type of comic media, are an engaging and low-cost means of narrative storytelling. The objective of this study was to quantitatively evaluate the effectiveness of a pilot six-episode HIV/STD-focused motion comic series to improve HIV/STD-related KABI among young people. We assessed change in HIV/STD knowledge, HIV stigma, condom attitudes, HIV/STD testing attitudes, and behavioral intentions among 138 participants in 15 focus groups immediately before and after viewing the motion comic series. We used paired t-tests and indicators of overall improvement to assess differences between surveys. We found a significant decrease in HIV stigma (p < .001) and increases in both HIV knowledge (p = .002) and behavioral intentions to engage in safe sex (p < .001). In summary, this motion comic intervention improved HIV/STD-related KABI of young adult viewers by reducing HIV stigma and increasing behavioral intentions to engage in safer sex. Our results demonstrate the promise of this novel intervention and support its use to deliver health messages to young people.