Determinants of Type-Specific Human Papillomavirus Concordance Across Anatomic Sites in Young Men Who Have Sex With Men and Transgender Women, 3 U.S. Cities, 2016-2018.

BACKGROUND: Among men who have sex with men (MSM) and transgender women (TGW), the dynamics of human papillomavirus (HPV) infections at different anatomical sites are not well understood. Information on HPV concordance between anatomic sites can inform the extent of autoinoculation, and susceptibility of different anatomic areas to HPV infection. We described and assessed correlates of HPV concordance across anal, oral, and genital samples. METHODS: We enrolled 1876 MSM and TGW aged 18 to 26 years in 3 US cities. Oral, genital, and anal samples were self-collected for type-specific HPV DNA testing (37 types). Demographics, sexual behaviors, and health history were self-reported. Kappa statistics based on percent positive agreement (kappa+) and generalized estimating equations were used to describe and identify correlates of HPV type-specific concordance between anatomic sample pairs. RESULTS: Any HPV was detected in 69.9%, 48.6%, and 7.4% of anal, genital, and oral samples, respectively. Detection of any HPV (concurrence) was most common in anal-genital pairs (40.9%) and uncommon in oral-genital and oral-anal pairs (3.4% and 6.5% respectively). Type-specific concordance was poor across all sample pairs (kappa+ <0.20). Younger age and older age at first sex were positively associated with type-concordant anal-genital infections. Sexual behaviors were unassociated with concordance. CONCLUSIONS: Poor oral/anogenital concordance suggests the oral mucosa has different susceptibility to HPV infection, differential clearance and/or autoinoculation between oral and anogenital sites is unlikely. There was some observed concurrence and concordance between anal and genital sites, unassociated with sexual behavior, suggesting autoinoculation. Longitudinal studies are necessary to further elucidate mechanisms of multisite infections.

Come back when you're infected: pharmacy access to sterile syringes in an Arizona Secret Shopper Study, 2023.

BACKGROUND: Pharmacies are critical healthcare partners in community efforts to eliminate bloodborne illnesses. Pharmacy sale of sterile syringes is central to this effort. METHODS: A mixed methods "secret shopper" syringe purchase study was conducted in the fall of 2022 with 38 community pharmacies in Maricopa and Pima Counties, Arizona. Pharmacies were geomapped to within 2 miles of areas identified as having a potentially high volume of illicit drug commerce. Daytime venue sampling was used whereby separate investigators with lived/living drug use experience attempted to purchase syringes without a prescription. Investigator response when prompted for purchase rationale was "to protect myself from HIV and hepatitis C." A 24-item instrument measured sales outcome, pharmacy staff interaction (hostile/neutral/friendly), and the buyer's subjective experience. RESULTS: Only 24.6% (n = 28) of 114 purchase attempts across the 38 pharmacies resulted in syringe sale. Less than one quarter (21.1%) of pharmacies always sold, while 44.7% never sold. Independent and food store pharmacies tended not to sell syringes. There emerged distinct pharmacy staff interactions characterized by body language, customer query, normalization or othering response, response to purchase request and closure. Pharmacy discretion and pharmacy policy not to sell syringes without a prescription limited sterile syringe access. Investigators reported frequent and adverse emotional impact due to pharmacy staff negative and stigmatizing interactions. CONCLUSIONS: Pharmacies miss opportunities to advance efforts to eliminate bloodborne infections by stringent no-sale policy and discretion about syringe sale. State regulatory policy facilitating pharmacy syringe sales, limiting pharmacist discretion for syringe sales, and targeting pharmacy-staff level education may help advance the achievement of public health goals to eliminate bloodborne infections in Arizona.

Averting neonatal abstinence syndrome and treating addiction among rural, opioid-using young women.

BACKGROUND AND OBJECTIVES: America's opioid epidemic has spawned an epidemic of neonatal abstinence syndrome (NAS). Studies have not tested approaches to promoting contraceptive services for women with opioid use disorder (OUD) along with treatment for this disorder. This pilot study examined the promotion of medication for OUD (MOUD) treatment and contraception use, primarily long-acting reversible contraception (LARC), for women with OUD. METHODS: In Appalachia, a peer-delivered contraception and MOUD promotion intervention was delivered to a sample of 30 women with OUD. Primary outcomes were attendance of initial appointments to receive MOUD and counseling about contraceptive options. Peer recovery coaches also offered to help the women schedule appointments and attend the appointment with them or give them a ride if necessary and requested by the patients. RESULTS: Two-thirds experienced all seven symptoms of opioid dependence. Within 30 days of a brief counseling session, over one-half of the women (56.7%) were referred to MOUD, with all of them initiating treatment within 30 days. Just under one-half of the women (46.7%) were referred to a contraception consultation, with 85.7% of those receiving a LARC implant. DISCUSSIONS AND CONCLUSIONS: Study findings indicate the potential efficacy of a single-session, peer-delivered counseling intervention for linking women with OUD and at high risk of unintended pregnancy to MOUD and to services that provide women with highly reliable contraceptives. SCIENTIFIC SIGNIFICANCE: This study is unique in exploring the efficacy of linking high-risk opioid-using women to contraceptive options and treatment for MOUD to prevent NAS.

Sexual Positioning Practices and Anal Human Papillomavirus Infection Among Young Men Who Have Sex with Men and Transgender Women-Chicago, Illinois, 2016-2018.

BACKGROUND: Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States; men who have sex with men (MSM) have higher prevalence of infection and related disease compared with other men. We assessed whether differences in HPV acquisition exist among MSM according to their sexual positioning practices, as well as self-reported receipt of HPV vaccination. METHODS: We enrolled young MSM and transgender women aged 18 to 26 years in Chicago, IL (N = 666). Participants self-reported their history of HPV vaccination and submitted self-collected anal swab specimens for type-specific HPV detection using an L1-consensus PCR assay. Multivariable logistic regression analyses were used to assess relationships between sexual positioning practices and detection of any HPV or quadrivalent HPV vaccine (4vHPV) types by vaccination status, defined as self-reported receipt of ≥1 HPV vaccine dose versus none. RESULTS: Among 666 participants, 400 (60.1%) had any anal HPV, and 146 (21.9%) had a 4vHPV type. Among vaccinated participants, 18, 36, and 177 reported exclusively insertive, exclusively receptive, or both sexual positioning practices, respectively. Compared with participants reporting exclusively insertive anal sex, odds of any HPV were significantly higher among participants engaging exclusively in receptive anal sex (adjusted odds ratio [aOR], 5.90; 95% confidence interval [CI], 2.52-13.78), as well as those engaging in both (aOR, 3.32; 95% CI, 1.71-6.44). Vaccinated participants, compared with unvaccinated participants, had lower odds of 4vHPV-type HPV regardless of sexual positioning practices (aOR, 0.56; 95% CI, 0.34-0.92). CONCLUSIONS: Adult men and transgender women who practice anal receptive sex have high prevalence of infection with any HPV. Routine vaccination of all adolescents is expected to reduce HPV-related disease incidence among adult MSM and transgender women as vaccinated cohorts age.

Vaccine Effectiveness Against Prevalent Anal and Oral Human Papillomavirus Infection Among Men Who Have Sex With Men-United States, 2016-2018.

BACKGROUND: In the United States, human papillomavirus (HPV) vaccination has been recommended for young adult men who have sex with men (MSM) since 2011. METHODS: The Vaccine Impact in Men study surveyed MSM and transgender women aged 18-26 years in 3 US cities during 2016-2018. Self-collected anal swab and oral rinse specimens were assessed for 37 types of HPV. We compared HPV prevalence among vaccinated and unvaccinated participants and determined adjusted prevalence ratios (aPR) and 95% confidence intervals (CI). RESULTS: Among 1767 participants, 704 (39.8%) self-reported receiving HPV vaccine. Median age at vaccination (18.7 years) was older than age at first sex (15.7 years). Quadrivalent vaccine-type HPV was detected in anal or oral specimens from 475 (26.9%) participants. Vaccine-type HPV prevalence was lower among vaccinated (22.9%) compared with unvaccinated (31.6%) participants; aPR for those who initiated vaccination at age ≤18 years was 0.41 (CI, 0.24-0.57) and at age >18 years was 0.82 (CI, 0.67-0.98). Vaccine effectiveness of at least 1 HPV vaccine dose at age ≤18 years or >18 years was 59% and 18%, respectively. CONCLUSIONS: Findings suggest real-world effectiveness of HPV vaccination among young adult MSM. This effect was stronger with younger age at vaccination.

Sexual Mixing Patterns and Anal Human Papillomavirus Among Young Gay, Bisexual, and Other Men Who Have Sex With Men and Transgender Women in 2 Cities in the United States, 2012-2014.

BACKGROUND: Human papillomavirus (HPV) is a common sexually transmitted infection. Men who have sex with men (MSM) and transgender women (TGW) are at high risk for anal HPV infection and subsequent anal cancer. This study assessed the association of partner discordances with prevalent high-risk anal HPV (HRAHPV) among MSM and TGW. METHODS: Participants were enrolled in the cross-sectional young men's HPV study of gay, bisexual, and other MSM, and TGW, aged 18 to 26 years, from 2 cities. Participants completed a confidential standardized computer-assisted interview and provided self-collected anal swabs for type-specific HPV DNA testing. Multivariate analyses were conducted for 3 discordances of interest (i.e., partner age, race/ethnicity, and concurrent partner) to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI). RESULTS: Eight hundred sixty-two participants were included for partner race/ethnicity discordance, 601 for partner age discordance, and 581 for concurrent partner analysis. Most reported being older than 21 years, cisgender male, and gay. Adjusted odds of HRAHPV were not significantly increased among participants reporting partner age discrepancy >10 years (aOR, 0.89; 95% CI, 0.51-1.56), partner race/ethnicity discordance (aOR, 0.88; CI, 0.62-1.24), or partner with concurrent partners (aOR, 0.85; 95% CI, 0.50-1.42), compared with those who did not. CONCLUSIONS: This analysis did not identify any partner discordances associated with HRAHPV. Because HPV infection can persist for years, sexual mixing patterns with early partners might be more relevant than the most recent sex partner. Prevalence of HRAHPV was high and could be preventable by preexposure vaccination, as recommended for everyone through age 26 years including MSM and TGW.

Psychosocial mediators of perceived stigma and suicidal ideation among transgender women.

BACKGROUND: Transgender women (TGW) in the U.S. experience high rates of stigma, depression, and elevated rates of suicide. This study examined correlates of suicidal ideation and estimated the conditional indirect effects of perceived stigma and psychosocial mediators on suicidal ideation. METHODS: Using a cross-sectional study design, TGW (N = 92) were recruited through snowball sampling in Atlanta, Georgia. Structured interviews were conducted. Suicidal ideation was assessed by combining two variables that measured suicidal thoughts. Logistic regression models were performed to identify the potential risk and protective factors for suicidal ideation. We examined hypothesized psychosocial factors, including anxiety, depression, psychosocial impact of gender minority status, and substance use behaviors as potential mediators for the relationship between perceived stigma and suicidal ideation. All models were controlled for age, race, education, and homelessness. RESULTS: Suicidal ideation was reported by 33% (N = 30) of the study participants. In multivariable analysis, suicidal ideation was associated with sexual abuse (AOR = 3.17, 95% CI = 1.10-9.30), anxiety (AOR = 1.74, 95% CI = 1.10-2.73), family verbal abuse (AOR = 2.99, 95% CI = 1.10-8.40), stranger verbal abuse (AOR = 3.21, 95% CI = 1.02-10.08), and psychosocial impact of gender minority status (AOR = 3.42, 95% CI = 1.81-6.46). Partner support was found to be the protective factor for suicidal ideation (AOR = 0.34, 95% CI = 0.13-0.90). In the mediation analysis, the psychosocial impact of gender minority status mediated the relationship between perceived stigma and suicidal ideation. The estimated conditional indirect effect was 0.46, (95% CI = 0.12-1.11). CONCLUSION: Interventions that aim to reduce suicidal behaviors among TGW should address stigma, psychosocial impact of gender minority status, and different forms of violence and abuse.

Use of pre-exposure prophylaxis increases the odds of condomless anal sex among young men who have sex with men (MSM) of colour.

This study tested the hypothesis that people using pre-exposure prophylaxis (PrEP) would be more likely to report condomless anal sex than those not taking PrEP. Data were from an ongoing study conducted with a cohort of Black and Latino young men who have sex with men (YMSM) recruited in Los Angeles (CA, USA). Of the 399 YMSM in the sample, 14% were currently using PrEP. Using three different measures of condom use, across two different recall periods all except one test result supported an inverse relationship between PrEP and condom use for anal sex. Tests of a risk index provided further significant findings supporting this hypothesis.

Transgender Women Have Higher Human Papillomavirus Prevalence Than Men Who Have Sex With Men-Two U.S. Cities, 2012-2014.

BACKGROUND: Human papillomavirus (HPV) prevalence is high among men who have sex with men (MSM), yet little is known about HPV among transgender women (TGW). We assessed HPV prevalence and knowledge among TGW compared with MSM. METHODS: We enrolled TGW and MSM aged 18 to 26 years from clinics in Chicago and Los Angeles during 2012 to 2014. Participants self-reported gender identity, HIV status, HPV knowledge, and vaccination status. Self-collected anal and oral specimens were tested for HPV DNA (37 types); serum was tested for HPV antibodies (4 vaccine types). Prevalence among unvaccinated TGW and MSM was compared using prevalence ratios (PRs) and 95% confidence intervals (CIs). Participants without DNA or serologic evidence of HPV were considered naïve. RESULTS: Among 1033 participants, 49 were TGW. Among 44 TGW and 855 MSM who were unvaccinated, any HPV DNA was detected in anal specimens from 39 (88.6%) TGW and 606 (70.9%) MSM (PR, 1.3; 95% CI, 1.1-1.4), and oral specimens from 4 (9.1%) TGW and 81 (9.5%) MSM (PR, 1.0; 95% CI, 0.4-2.5). Antibodies were detected among 37 (84.1%) TGW and 467 (54.6%) MSM (PR, 1.5; 95% CI, 1.3-1.8). Most participants were naïve to 1 or more HPV vaccine type/s, including 29 (65.9%) TGW and 775 (90.6%) MSM (PR, 0.7; 95% CI, 0.6-0.9). Most TGW (55.1%) had never heard of HPV vaccine. CONCLUSIONS: Among TGW, HPV prevalence was high and knowledge was low. Most were still naïve to 1 or more HPV vaccine type. Although vaccination ideally occurs prior to exposure, findings support existing national recommendations to vaccinate TGW and MSM, and suggest additional outreach might increase vaccination.

Alcohol exacerbates the association between partner-related issues regarding condom use and condomless anal receptive sex among young Black men who have sex with men.

This study determined associations between a three-item measure of partner-related issues regarding condom use (PRI-CU) and recent condomless anal sex among a sample of young Black men who have sex with men (MSM). Of 172 men indicating an absence of PRI-CU, 10.5% reported recent condomless anal receptive sex (CARS). In contrast, of 122 men indicating recent PRI-CU, 23.8% reported CARS (P = 0.002). Drunkenness during sex exacerbated this association; however, being high during sex conferred a protective value against the association between PRI-CU and CARS. Alcohol use during sex may magnify the potential for PRI-CU to result in CARS among MSM. Conversely, marijuana use may have the opposite effect.

Stability of condomless anal sex behaviours of young Black men who have sex with men: implications for HIV prevention, including pre-exposure prophylaxis.

Background Among a sample of young Black men who have sex with men (YBMSM), this study evaluated the stability of annually assessing condomless anal receptive sex (CARS) as an indication for pre-exposure prophylaxis (PrEP) use. Further, the study determined the proportion of YBMSM engaging in CARS rarely (defined as twice or less per year) who may thus may be more efficiently protected by condom use rather than PrEP. METHODS: This is a secondary analysis of data collected as part of a randomised control trial that recruited 600 YBMSM from a sexually transmissible infection (STI) clinic located in the southern US. Of these, 144 met the inclusion criteria for the present study. Only HIV-uninfected men assigned to the control condition, who completed the 12-month period of observation, were included. RESULTS: Correlation coefficients between the baseline level of CARS were 0.16 at the first quarter and 0.09, 0.10, and 0.03 at each successive quarter. Discriminant function analysis indicated similarly weak predictive ability of the baseline measure (r = 0.215; P = 0.16). Of 106 reporting no CARS at baseline, 73 (68.9%) had summed scores of zero (no CARS) over the four follow-up assessments. Of 38 reporting any CARS at baseline, 14 (36.8%) had a summed score of zero for the observation period. Of these same 38, 27 (71.0%) had summed scores of two or fewer events of CARS for the observation period. CONCLUSION: Among YBMSM, CARS in not a stable behaviour over 12 months. Many YBMSM indicated for PrEP may benefit from be a program concurrently promoting condom use.

Randomised controlled trial of a brief, clinic-based intervention to promote safer sex among young Black men who have sex with men: implications for pre-exposure prophylaxis-related counselling.

Background The aim of this study was to determine the 3-month efficacy of a single-session, clinic-based intervention promoting condom use for anal and oral sex among HIV-uninfected Black young men who have sex with men (YBMSM). METHODS: A pre-post test randomised controlled trial (RCT) was conducted from 2012 to 2015 using a 3-month period of observation. Recruitment and assessment occurred in sexually transmissible infection (STI) clinics. Men were randomised to either the intervention condition (n=142) or a standard-of-care control condition (n=135). The experimental condition comprised a single session of a one-to-one program designed for use in STI clinics. YBMSM completed both baseline and 3-month follow-up assessments. Outcomes measures were condomless anal insertive sex, condomless anal receptive sex and condomless oral sex. RESULTS: Among men receiving the intervention, 11.2% (n=15) reported any condomless anal insertive sex at follow-up, compared with 20.6% (n=27) among controls (rate ratio=0.54, P=0.04). In addition, 12.0% (n=17) of men receiving the intervention reported any condomless anal receptive sex at follow-up, compared with 21.6% (n=29) among controls (rate ratio=0.55, P=0.03). When combining insertive and receptive anal sex, 18.3% (n=26) of men receiving the intervention reported any condomless sex, compared with 31.1% (n=42) among controls (rate ratio=0.59, P=0.01). Furthermore, 45.8% (n=33) of men receiving the intervention reported any condomless oral sex at follow-up, compared with 63.2% (n=48) among controls (rate ratio=0.72, P=0.03). CONCLUSIONS: This analysis of data from a Phase 3 RCT suggests that a single session of a clinic-based behavioural intervention may effectively promote the consistent use of condoms for anal and oral sex among HIV-uninfected YBMSM. The single-session program may be a valuable counselling tool for use in conjunction with recommended quarterly clinic appointments for YBMSM using pre-exposure prophylaxis.

Corrigendum to: Decision making over condom use during menses to avert sexually transmissible infections.

Background:The aim of this study was to test the hypothesis that receptive partners in penile-vaginal intercourse (PVI) who exercise independent decision making over condom use during menses do so to avert sexually transmissible infection (STI) transmission or acquisition. Methods: Data were collected through a partnership with Clue, the industry-leading female health app. A brief web-based questionnaire was developed, translated into 10 languages, and made accessible via a URL link sent to Clue users and posted on social media. Inclusion criteria were: age ≥14 years, not being currently pregnant and engaging in PVI and condom use during menses in the past 3 months. The analytical subsample comprised 12889 respondents residing in 146 countries. Results: Twenty per cent indicated independent decision making about condom use during menses. Independent decision making was associated with lower odds of reporting that condoms were used for contraception (adjusted odds ratio (aOR) 0.65; 99% confidence interval (CI) 0.57-0.73) and higher odds that they were used for the prevention of STIs (aOR 1.44; 99% CI 1.28-1.61). A third significant finding pertained to always using condoms during menses; this was less likely among those indicating independent (female only) decision making (aOR 0.69; 99% CI 0.62-0.78). Non-significant associations with another two outcomes were found: protecting the partner against menstrual blood and protecting themselves against semen. Conclusions: Findings from people in 146 countries strongly support the hypothesis that those exercising independent decision making over condom use during menses do so to avert STI transmission or acquisition. That only one-fifth of this global sample reported this type of independent decision making suggests that empowerment-oriented (structural-level) interventions may be advantageous for individuals who are the receptive partner in PVI that occurs during menses.

Decision making over condom use during menses to avert sexually transmissible infections.

Background The aim of this study was to test the hypothesis that receptive partners in penile-vaginal intercourse (PVI) who exercise independent decision making over condom use during menses do so to avert sexually transmissible infection (STI) transmission or acquisition. METHODS: Data were collected through a partnership with Clue, the industry-leading female health app. A brief web-based questionnaire was developed, translated into 10 languages, and made accessible via a URL link sent to Clue users and posted on social media. Inclusion criteria were: age ≥14 years, not being currently pregnant and engaging in PVI and condom use during menses in the past 3 months. The analytical subsample comprised 12889 respondents residing in 146 countries. RESULTS: Twenty per cent indicated independent decision making about condom use during menses. Independent decision making was associated with lower odds of reporting that condoms were used for contraception (adjusted odds ratio (aOR) 0.65; 99% confidence interval (CI) 0.57-0.73) and higher odds that they were used for the prevention of STIs (aOR 1.44; 99% CI 1.28-1.61). A third significant finding pertained to always using condoms during menses; this was less likely among those indicating independent (female only) decision making (aOR 0.69; 99% CI 0.62-0.78). Non-significant associations with another two outcomes were found: protecting the partner against menstrual blood and protecting themselves against semen. CONCLUSIONS: Findings from people in 146 countries strongly support the hypothesis that those exercising independent decision making over condom use during menses do so to avert STI transmission or acquisition. That only one-fifth of this global sample reported this type of independent decision making suggests that empowerment-oriented (structural-level) interventions may be advantageous for individuals who are the receptive partner in PVI that occurs during menses.

Extragenital Chlamydia and Gonorrhea in Young Black Men Who Have Sex With Men: Missed Treatment Opportunities for Human Immunodeficiency Virus-Infected Men Who Have Sex With Men?

OBJECTIVES: This study of young black men who have sex with men (YBMSM) assessed the prevalence of extragenital chlamydia and gonorrhea among those testing negative for urethral infections, and compared prevalence of both by human immunodeficiency virus (HIV) status. METHODS: A convenience sample of 609 YBMSM was recruited for a cross-sectional study from 2 sexual health clinics located in Jackson, MS. To detect Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG), nucleic acid amplification testing was performed on urine, rectal swabs, and oral swabs. OraSure was used to detect HIV. RESULTS: Seventy-three percent of all chlamydia infections and 77% of gonorrhea infections were found from anal and oral swabs in the absence of urethral positivity. Compared with HIV-uninfected men, HIV-infected men were significantly more likely to have pharyngeal chlamydia (P = 0.03), multiple CT infections (P = 0.02), rectal NG (P < 0.001), multiple NG infections (P = 0.04), both CT/NG rectal infections (P = 0.001). CONCLUSIONS: As much as three quarters of all chlamydia and gonorrhea infections may be missed when only urine-based nucleic acid amplification testing is used to screen YBMSM for bacterial sexually transmitted infections. These missed opportunities for diagnosis may be particularly likely among HIV-infected YBMSM.

Disclosure of Sexual Behavior Is Significantly Associated With Receiving a Panel of Health Care Services Recommended for Men Who Have Sex With Men.

BACKGROUND: Men who have sex with men (MSM) are at high risk for sexually transmitted infections (STIs). National guidelines recommend that MSM receive HIV, syphilis, gonorrhea, and chlamydia screening at least annually, and hepatitis A and B and human papillomavirus vaccinations. We investigated associations between disclosure of male-male sexual orientation/behavior and receipt of this panel of services. METHODS: Gay, bisexual, and other MSM aged 18 through 26 years were enrolled from health clinics serving lesbian, gay, bisexual, and transgender communities in Los Angeles and Chicago during 2012 to 2014. Participants completed a computer-assisted self-interview regarding health care services, disclosure of sexual orientation/behavior, and recent HIV test results. Proportions receiving recommended care, prevalence ratios (PRs), and 95% confidence intervals (CIs) were calculated using SAS 9.4. RESULTS: Overall, 817 participants visited a provider within the past year. Of these, 525 (64.3%) had disclosed, and 749 (91.7%) felt they could disclose if important to health. In total, 548 (67.1%) received all STI screenings, and 74 (9.1%) received all vaccinations. Only 105 (12.9%) received any human papillomavirus vaccination. More disclosing participants received all recommended screenings (adjusted PR [aPR],1.4; 95% CI, 1.3-1.6) and all recommended care components (aPR, 2.2; 95% CI, 1.4-4.3) than nondisclosing participants. CONCLUSIONS: Despite national recommendations, receipt of a complete panel of STI care services was low among young MSM. Vaccine uptake was lower than STI screening. However, most participants visited a health care provider in the past year and most disclosed, suggesting opportunities to improve services. Providers might encourage disclosure by improving sexual history taking and education, which could increase opportunities for MSM to receive recommended care.

Efficacy of a Clinic-Based Safer Sex Program for Human Immunodeficiency Virus-Uninfected and Human Immunodeficiency Virus-Infected Young Black Men Who Have Sex With Men: A Randomized Controlled Trial.

OBJECTIVE: To test the efficacy of a single-session, clinic-based intervention designed to promote condom use among young black men who have sex with men (YBMSM). METHODS: Six hundred YBMSM were enrolled in a randomized controlled trial, using a 12-month observation period. An intent-to-treat analysis was performed, with multiple imputation for missing data. RESULTS: Compared with the reference group, human immunodeficiency virus (HIV)-infected men in the intervention group had 64% greater odds of reporting consistent condom use for anal receptive sex over 12 months (estimated odds ratio, 1.64; 95% confidence interval, 1.23-2.17, P = 0.001). Also, compared with the reference group, HIV-uninfected men in the intervention group had more than twice the odds of reporting consistent condom use for anal receptive sex over 12 months (estimated odds ratio, 2.14; 95% confidence interval, 1.74-2.63, P < 0.001). Significant intervention effects relative to incident sexually transmitted diseases were not observed. CONCLUSIONS: A single-session, clinic-based, intervention may help protect HIV-uninfected YBMSM against HIV acquisition and HIV-infected YBMSM from transmitting the virus to insertive partners.

Risk Factors for Oral Human Papillomavirus Infection Among Young Men Who Have Sex With Men-2 Cities, United States, 2012-2014.

BACKGROUND: Men who have sex with men (MSM) are at risk for cancers attributable to human papillomavirus (HPV), including oropharyngeal cancer. Human papillomavirus vaccination is recommended for US MSM through age 26 years. Oral HPV infection is associated with oropharyngeal cancer. We determined oral HPV prevalence and risk factors among young MSM. METHODS: The Young Men's HPV study enrolled MSM aged 18 through 26 years from clinics in Chicago and Los Angeles during 2012 to 2014. Participants self-reported demographics, sexual behaviors, vaccination and human immunodeficiency virus (HIV) status. Self-collected oral rinse specimens were tested for HPV DNA (37 types) by L1-consensus PCR. We calculated adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) for risk factors associated with oral HPV among participants not previously vaccinated. RESULTS: Oral HPV was detected in 87 (9.4%) of 922; 9-valent vaccine types were detected in 37 (4.0%) of 922. Among HIV-positive participants, 17 (19.3%) of 88 had oral HPV detected. Oral HPV was more prevalent among those reporting first sex at 18 years of age or younger (aPR, 2.44; 95% CI, 1.16-5.12); HIV infection (aPR, 1.99; 95% CI, 1.14-3.48); greater than 5 sex partners within the past month (aPR, 1.93; 95% CI, 1.13-3.31); performing oral sex on greater than 5 partners within the last 3 months (aPR, 1.87; 95% CI, 1.12-3.13); and having greater than 5 male sex partners within the last 3 months (aPR, 1.76; 95% CI, 1.08-2.87). Only 454 (49.2%) of 922 were aware that HPV can cause oropharyngeal cancers. CONCLUSIONS: Many oral HPV infections were with types targeted by vaccination. Oral HPV infections were significantly associated with HIV and sexual behaviors. Fewer than half of participants were aware that HPV could cause oropharyngeal cancer.

Promoting positive condom use experiences among young black MSM: a randomized controlled trial of a brief, clinic-based intervention.

The aim of this study is to determine, among young Black men who have sex with men (YBMSM), the 12-month efficacy of a single-session, clinic-based intervention promoting condom use to enhance sexual pleasure (purpose 1) and the use of condoms from the start-to-finish of anal sex (purpose 2). A pre-test, post-test randomized controlled trial was conducted, using a 12-month period of follow-up observation, in STI clinics. Data from 394 YBMSM completing baseline and 12-month follow-up assessments were analyzed. The experimental condition comprised a one-to-one, interactive program (Focus on the Future) designed for tailored delivery. Regarding study purpose 1, in an age-adjusted linear regression model for 277 HIV-uninfected men, there was a significant effect of the intervention (Beta=0.13, P =0.036) relative to more favorable sexual experiences when using condoms. Regarding study purpose 2, in an adjusted logistic regression model, for HIV-uninfected men, there was a significant effect of the intervention (AOR=0.54, P =0.048) relative to using condoms from start-to-finish of anal sex. Significant effects for HIV-infected men were not observed. A small, but non-significant, effect was observed relative to men's self-report of always using condoms. This single-session program may be a valuable counseling tool for use in conjunction with pre-exposure prophylaxis-related care for HIV-uninfected YBMSM.

Relationship power and HIV risk among young Black men who have sex with men in the Southern United States.

Background The purpose of this study was to examine the impact of relationship power on HIV risk behaviour among young Black men who have sex with men (MSM) in the Southern US. METHODS: Data from 425 Black/African American males aged 18-29 years who reported recent anal intercourse with a male partner were analysed. Five selected measures of relationship power were tested for correlation and association with protected receptive anal intercourse using contingency tables and logistic regression analysis. RESULTS: Acts of 100% protected receptive anal intercourse were common (n=277, 65.2%). Men who reported low barriers to condom negotiation were significantly more likely to report protected acts (P<0.001). Men who reported 100% protected acts were less likely to report financial dependence on male sexual partners and serosorting behaviour (12.0% vs 20.7%, P=0.02; 31.5% vs 49.8%, P<0.001 respectively). CONCLUSION: Future efforts should further examine the role of relationship power in HIV risk among young Black MSM, including the intersection of individual, dyadic and social-structure risks.