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Individual Oral Paper

LGBTQ+

At the Intersection of HIV and Behavioral Health: Predictors and Outcomes Across the Care Cascade

4 - (IOP 21) HIV Pre-exposure Prophylaxis (PrEP) and HIV Treatment Attitudes Predict Bacterial Sexually Transmitted Infections Among Urban Gay and Bisexual Men (GBM)

Saturday, November 22, 2025
3:45 PM - 4:00 PM CST
Location: Celestin H, Level 3
Keywords: HIV / AIDS, LGBTQ+, Sexuality
Recommended Readings: Hart, T. A., Noor, S. W., Tavangar, F., Zahran, A., Skakoon-Sparling, S., Tan, D. H., ... & Moore, D. M. (2024). Human Immunodeficiency Virus Treatment Attitudes and Bacterial Sexually Transmitted Infections Among Gay and Bisexual Men. Sexually Transmitted Diseases, 51(3), 178-185.,   ,   ,   ,  
Trevor A. Hart*, Yangqing Deng, Paolo Palma, Syed W. Noor, Darrell H.S. Tan, David Moore, Shayna Skakoon-Sparling, Terri Zhang, Daniel Grace, Nathan J. Lachowsky, Joseph Cox, Aki Gormezano, Milada Dvorakova, Allan Lal, & Jody Jollimore for the Engage Study

Author Notes: [*] Presenter

Background: Cross-sectional differences in HIV-treatment attitudes (i.e., beliefs in whether treatment is effective at reducing transmission) and PrEP use are associated with differences in condomless anal sex (CAS) and STI acquisition. It is unclear, however, how these factors change within-persons over time, and whether these drive STI outcomes.

Methods: We analyzed longitudinal data from 2007 sexually-active HIV-negative GBM recruited using respondent-driven sampling from the Engage Cohort study (2017-2022) to examine the direct and indirect effects of PrEP use and HIV-treatment attitudes on CAS and acquisition of any bacterial STI (syphilis, gonorrhea, chlamydia) diagnoses (through self-report and lab-testing) between individuals and within individuals over time, using multilevel mediation.

Results: PrEP use was positively associated with any bacterial STI diagnosis between (β=0.174, p< 0.001) and within (β=0.294, p< 0.001) individuals over time. In contrast, HIV attitudes that were supportive of HIV treatment effectiveness were negatively associated with STIs within individuals (β=-0.256, p=0.001), but positively associated between individuals (β=0.093, p=0.008). CAS only predicted STI outcomes between individuals (β=0.209, p< 0.001). Variation in STI outcomes was slightly more strongly accounted for by within-person rather than between-person effects (ICC=0.406).

Conclusions: Over four years, we found that variation in STI outcomes was accounted for by both within-person changes over time and between-person variance. PrEP use and CAS differences among participants predicted STIs, which underlines the importance of targeted treatment and prevention support for PrEP users. 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.

Learning Objectives:

At the end of this session, the learner will be able to:
  1. Define the between-participant and within-participant effects over a 4-year period of PrEP use and HIV treatment attitudes to CAS and sexually transmitted infections.