AIDS and Behavior

, Volume 17, Issue 4, pp 1406–1414

Syphilis Among Men Who Have Sex With Men (MSM) in Taiwan: Its Association With HIV Prevalence, Awareness of HIV Status, and Use of Antiretroviral Therapy

  • Yen-Fang Huang
  • Kenrad E. Nelson
  • Yu-Ting Lin
  • Chin-Hui Yang
  • Feng-Yee Chang
  • Chih-Yin Lew-Ting
Original Paper

Abstract

To understand how awareness of HIV-positivity and the use of antiretroviral therapy associated with syphilis infection, 361 MSM attending 16 Hong-Pa (drug-and-sex parties) in Taiwan were studied. The syphilis rate of individuals within their first 2 years after HIV diagnosis (awareness) was lower than that in individuals who had not been diagnosed HIV infection prior to Hong-Pa (unawareness) (Adj OR = 0.24, P < 0.05). Notably, there was a decrease in the beneficial effect of HIV-positive status awareness on syphilis prevention with an increase in time since notification. Moreover, antiretroviral therapy was not associated with a lower incidence of syphilis, and syphilis infection peaked during the treatment dropout period. In conclusion, the duration of a protective effect of knowing one’s HIV-positivity against syphilis infection was short, and the highest risk of syphilis infection was observed when patients discontinued antiretroviral therapy. Future research should examine the behavioral mechanisms involved in this prevention failure.

Keywords

Men who have sex with men Awareness Antiretroviral therapy Syphilis HIV 

Resumen

Para conocer la concienciación respecto al VIH positivo y del uso de la terapia antirretroviral asociada con la infección de la sífilis se estudiaron en Taiwán 361 casos de HSH (hombres que tienen sexo con hombres) en 16 “Hong-Pa” (fiestas de droga y sexo).La tasa de sífilis entre los individuos que habían sido diagnosticados como portadores del VIH solo durante los primeros dos años (de ser conscientes de su enfermedad) fue menor que entre los individuos que no habían sido diagnosticados como portadores del VIH antes de asistir a una “Hong-Pa” (desconociendo su enfermedad). (razón de posibilidades ajustada = 0.24, P < 0.05). En particular, hubo un efecto beneficioso desde la notificación de ser portadores del VIH en la disminución de contagios de sífilis pero esta va aumentando según va pasando el tiempo.Por otra parte, la terapia antirretroviral no se asoció con una menor incidencia de la sífilis, y la infección por sífilis alcanzó su punto máximo durante el período del abandono del tratamiento. En conclusión, la duración del efecto protector contra la infección de sífilis por tener consciencia de ser portador del VIH-positivo fue corto, y el mayor riesgo de infección por sífilis se observó cuando los pacientes abandonaron la terapia antirretroviral. En el futuro, las investigaciones deberían examinar los mecanismos de comportamiento involucrados en esta falta de prevención.

Palabras clave

Hombres que tienen sexo con hombres Ser conscientes de su enfermedad Terapia antirretroviral Sífilis VIH 

References

  1. 1.
    Sullivan PS, Hamouda O, Delpech V, et al. Reemergence of the HIV epidemic among men who have sex with men in North America, Western Europe, and Australia, 1996–2005. Ann Epidemiol. 2009;19(6):423–31.PubMedCrossRefGoogle Scholar
  2. 2.
    van Griensven F, de Lind van Wijngaarden JW, Baral S, Grulich A. The global epidemic of HIV infection among men who have sex with men. Curr Opin HIV AIDS. 2009;4(4):300–7.PubMedCrossRefGoogle Scholar
  3. 3.
    Simms I, Fenton KA, Ashton M, et al. The re-emergence of syphilis in the United Kingdom: the new epidemic phases. Sex Transm Dis. 2005;32(4):220–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Marcus U, Kollan C, Bremer V, Hamouda O. Relation between the HIV and the re-emerging syphilis epidemic among MSM in Germany: an analysis based on anonymous surveillance data. Sex Transm Infect. 2005;81(6):456–7.PubMedCrossRefGoogle Scholar
  5. 5.
    Hopkins S, Lyons F, Coleman C, Courtney G, Bergin C, Mulcahy F. Resurgence in infectious syphilis in Ireland—an epidemiological study. Sex Transm Dis. 2004;31(5):317–21.PubMedCrossRefGoogle Scholar
  6. 6.
    Dougan S, Evans BG, Elford J. Sexually transmitted infections in Western Europe among HIV-positive men who have sex with men. Sex Transm Dis. 2007;34(10):783–90.PubMedGoogle Scholar
  7. 7.
    Macdonald N, Dougan S, McGarrigle CA, et al. Recent trends in diagnoses of HIV and other sexually transmitted infections in England and Wales among men who have sex with men. Sex Transm Infect. 2004;80(6):492–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Auerbach JD. Principles of positive prevention. J Acquir Immune Defic Syndr. 2004;37(Suppl 2):S122–5.PubMedCrossRefGoogle Scholar
  9. 9.
    Bunnell R, Mermin J, De Cock KM. HIV prevention for a threatened continent: implementing positive prevention in Africa. JAMA. 2006;296(7):855–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Marks G, Crepaz N, Senterfitt JW, Janssen RS. Meta-analysis of high-risk sexual behavior in persons aware and unaware they are infected with HIV in the United States—implications for HIV prevention programs. J Acquir Immune Defic Syndr. 2005;39(4):446–53.PubMedCrossRefGoogle Scholar
  11. 11.
    McCusker J, Stoddard AM, Mayer KH, Zapka J, Morrison C, Salzman SP. Effects of HIV antibody test knowledge on subsequent sexual behaviors in a cohort of homosexually active men. Am J Public Health. 1988;78(4):462–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Valleroy LA, MacKellar DA, Karon JM, et al. HIV prevalence and associated risks in young men who have sex with men. JAMA. 2000;284(2):198–204.PubMedCrossRefGoogle Scholar
  13. 13.
    Buehler JW, Diaz T, Hersh BS, Chu SY. The supplement to HIV-AIDS surveillance project: an approach for monitoring HIV risk behaviors. Public Health Rep. 1996;111(suppl 1):133–7.PubMedGoogle Scholar
  14. 14.
    Nakashima AK, Campsmith ML, Wolfe MI, Nakamura G. Late versus early testing of HIV-16 sites, United States, 2000–2003. MMWR Morb Mortal Wkly Rep. 2003;52(25):581–6.Google Scholar
  15. 15.
    Cleary PD, Devanter NV, Rogers TF, et al. Behavior changes after notification of HIV infection. Am J Public Health. 1991;81(12):1586–90.PubMedCrossRefGoogle Scholar
  16. 16.
    Smith D, Warren D, Vlahov D, et al. Design and baseline participant characteristics of the human immunodeficiency virus epidemiology research (HER) study: a prospective cohort study of human immunodeficiency virus infection in US women. Am J Epidemiol. 1997;146(6):459–69.PubMedCrossRefGoogle Scholar
  17. 17.
    Saah AJ, Hoover DR, Weng S, et al. Association of HLA profiles with early plasma viral load, CD4 + cell count and rate of progression to AIDS following acute HIV-1 infection. Multicenter AIDS Cohort Study. AIDS. 1998;12(16):2107–13.PubMedCrossRefGoogle Scholar
  18. 18.
    Colfax GN, Buchbinder SP, Cornelisse PGA, Vittinghoff E, Mayer K, Celum C. Sexual risk behaviors and implications for secondary HIV transmission during and after HIV seroconversion. AIDS. 2002;16(11):1529–35.PubMedCrossRefGoogle Scholar
  19. 19.
    Camoni L, Dal Conte I, Regine V, et al. Sexual behaviour reported by a sample of Italian MSM before and after HIV diagnosis. Ann Ist Super Sanita. 2011;47(2):214–9.PubMedGoogle Scholar
  20. 20.
    Crepaz N, Marks G, Liau A, et al. Prevalence of unprotected anal intercourse among HIV-diagnosed MSM in the United States: a meta-analysis. AIDS. 2009;23(13):1617–29.PubMedCrossRefGoogle Scholar
  21. 21.
    Crepaz N, Hart TA, Marks G. Highly active antiretroviral therapy and sexual risk behavior: a meta-analytic review. JAMA. 2004;292(2):224–36.PubMedCrossRefGoogle Scholar
  22. 22.
    Scheer S, Chu PL, Klausner JD, Katz MH, Schwarcz SK. Effect of highly active antiretroviral therapy on diagnoses of sexually transmitted diseases in people with AIDS. Lancet. 2001;357(9254):432–5.PubMedCrossRefGoogle Scholar
  23. 23.
    Elford J, Bolding G, Sherr L. High-risk sexual behaviour increases among London gay men between 1998 and 2001: What is the role of HIV optimism? AIDS. 2002;16(11):1537–44.PubMedCrossRefGoogle Scholar
  24. 24.
    Dukers NH, Goudsmit J, de Wit JB, Prins M, Weverling GJ, Coutinho RA. Sexual risk behaviour relates to the virological and immunological improvements during highly active antiretroviral therapy in HIV-1 infection. AIDS. 2001;15(3):369–78.PubMedCrossRefGoogle Scholar
  25. 25.
    Stolte IG, Dukers NH, Geskus RB, Coutinho RA, de Wit JB. Homosexual men change to risky sex when perceiving less threat of HIV/AIDS since availability of highly active antiretroviral therapy: a longitudinal study. AIDS. 2004;18(2):303–9.PubMedCrossRefGoogle Scholar
  26. 26.
    Huebner DM, Rebchook GM, Kegeles SM. A longitudinal study of the association between treatment optimism and sexual risk behavior in young adult gay and bisexual men. J Acquir Immune Defic Syndr. 2004;37(4):1514–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Van de Ven P, Kippax S, Knox S, Prestage G, Crawford J. HIV treatments optimism and sexual behaviour among gay men in Sydney and Melbourne. AIDS. 1999;13(16):2289–94.PubMedCrossRefGoogle Scholar
  28. 28.
    Stephenson JM, Imrie J, Davis MM, et al. Is use of antiretroviral therapy among homosexual men associated with increased risk of transmission of HIV infection? Sex Transm Infect. 2003;79(1):7–10.PubMedCrossRefGoogle Scholar
  29. 29.
    Centers for Diseases Control, Taiwan, ROC. The HIV/AIDS monthly report (in Chinese). Available at: http://www2.cdc.gov.tw/np.asp?ctNode=2694&mp=220. Accessed 20 Jan 2012.
  30. 30.
    Fang CT, Hsu HM, Twu SJ, et al. Decreased HIV transmission after a policy of providing free access to highly active antiretroviral therapy in Taiwan. J Infect Dis. 2004;190(5):879–85.PubMedCrossRefGoogle Scholar
  31. 31.
    Yang CH, Huang YF, Lai AC, et al. Analyzing data of HIV/AIDS related database—5 years project (in Chinese). Available at: http://www.cdc.gov.tw/professional/programresult.aspx?treeid=9068ACD483C71FC1&nowtreeid=3B791EACC1B5C579&year=&number=&subject=%E4%BA%94%E5%B9%B4%E8%A8%88%E7%95%AB&key. Accessed 31 July 2012.
  32. 32.
    Yoshioka MR, Schustack A. Disclosure of HIV status: cultural issues of Asian patients. AIDS Patient Care STDS. 2001;15(2):77–82.PubMedCrossRefGoogle Scholar
  33. 33.
    Ministry of Justice, Taiwan, ROC. Civil code of the Republic of China. Available at: http://law.moj.gov.tw/Eng/LawClass/LawContent.aspx?PCODE=B0000001. Accessed 31 July 2012.
  34. 34.
    van Griensven F, de Lind van Wijngaarden JW. A review of the epidemiology of HIV infection and prevention responses among MSM in Asia. AIDS. 2010;24(Suppl 3):S30–40.PubMedCrossRefGoogle Scholar
  35. 35.
    Ko NY, Lee HC, Hung CC, et al. Trends of HIV and sexually transmitted infections, estimated HIV incidence, and risky sexual behaviors among gay bathhouse attendees in Taiwan: 2004–2008. AIDS Behav. 2011;15:292–7.PubMedCrossRefGoogle Scholar
  36. 36.
    Wang SF, Liu SC, Lin SF, Lin TL, Wang SH, Huang YF. Analysis and testing for AIDS in 92 homosexuals at a private party. Epidemiol Bull. 2004;20:105–22.Google Scholar
  37. 37.
    Suissa S. Immortal time bias in pharmacoepidemiology. Am J Epidemiol. 2008;167(4):492–9.PubMedCrossRefGoogle Scholar
  38. 38.
    Heijman RLJ, Geskus RB, Davidovich U, Coutinho RA, Prins M, Stolte IG. Changes in sexual behaviour after HIV diagnosis among MSM who seroconverted before and after the introduction of ART. 18th Conference on Retroviruses and Opportunistic Infections, Boston, 2011 [paper # 1034].Google Scholar
  39. 39.
    Politch JA, Mayer KH, Welles SL, et al. Highly active antiretroviral therapy does not completely suppress HIV in semen of sexually active HIV-infected men who have sex with men. AIDS. 2012;26(12):1535–43.PubMedCrossRefGoogle Scholar
  40. 40.
    Stolte IG, Dukers NHTM, Geskus RB, Coutinbo RA, Wit JB. Homosexual men change to risky sex when perceiving less HIV/AIDS threat since availability of highly active antiretroviral therapy: a longitudinal study. AIDS. 2004;18(2):303–9.PubMedCrossRefGoogle Scholar
  41. 41.
    Vanable PA, Ostrow DG, Mckiman DJ, et al. Impact of combination therapies on HIV risk perceptions and sexual risk among HIV-positive and HIV-negative gay and bisexual men. Health Psychol. 2000;19(2):134–45.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Yen-Fang Huang
    • 1
    • 2
  • Kenrad E. Nelson
    • 3
  • Yu-Ting Lin
    • 1
  • Chin-Hui Yang
    • 1
  • Feng-Yee Chang
    • 1
  • Chih-Yin Lew-Ting
    • 2
    • 4
  1. 1.Department of HealthCenters for Disease ControlTaipeiTaiwan
  2. 2.Institute of Health Policy and ManagementCollege of Public Health, National Taiwan UniversityTaipeiTaiwan
  3. 3.Department of EpidemiologyBloomberg School of Public Health, Johns Hopkins UniversityBaltimoreUSA
  4. 4.Department of Public HealthNational Taiwan UniversityTaipeiTaiwan

Personalised recommendations