Changes in reports of sexually transmitted infections

Gonorrhoea incidence has been used as a surrogate marker for unprotected sex by a wide range of researchers. Gonorrhoea incidence is a very responsive marker of changes in sexual behaviour because of the short incubation period of the infection. Active gonorrhoea is also implicated as one of the factors that increase the risk of HIV transmission, so it is reasonable to assume that a fall in gonorrhoea incidence will influence HIV incidence too.

Between 1993 and 1995, the US state of Louisiana1 distributed 21 million free condoms in communities defined as high risk (those with the highest HIV prevalence and gonorrhoea incidence). Gonorrhoea reports declined 22% statewide during the programme, and researchers noted a strong association between the highest density of free condom outlets, numbers of condoms distributed and greatest decline in gonorrhoea reports when they assessed trends on a district-by-district basis. This programme was accompanied by a cohort study which compared changes in self–reported condom use between intervention and non–intervention districts. Condom use rose by 14% in intervention districts and 7% in non–intervention districts. This study offers proof of the concept that social marketing/free distribution of condoms has a significant impact on sexual health which may contribute to HIV prevention.

However, in recent years studies have started to notice a ‘disconnect’ between HIV incidence rates and the rates of STIs, including gonorrhoea. Increases in STIs in gay men, especially syphilis, have not led to a concomitant increase in HIV infections. This has shaken the assumption that increases in STI rates can be used as surrogate markers or predictors of increases in HIV. In the US, for instance, huge increases in syphilis in gay men have not coincided with equally big increases in HIV.2Serosorting may be one reason why an increase in STIs in gay men, especially syphilis, has not led to a concomitant increase in HIV infections. Even in the case of gonorrhoea, an increase in the proportion of cases of gonorrhoea amongst gay men in the UK which are pharyngeal cases, caught orally, has led to a weakening of the association between unprotected anal sex and STIs.3

References

  1. Hegeman R Louisiana Promotes Its Own Condoms. Associated Press, 13 July, 1997
  2. Truong HM et al. HIV serosorting? Increases in sexually transmitted infections and risk behavior without concurrent increase in HIV incidence among men who have sex with men in San Francisco. Sixteenth International AIDS Conference, Toronto, abstract MOAC0105, 2006
  3. Health Protection Agency Testing Times: HIV and other Sexually Transmitted Infections in the United Kingdom: 2007. November, 2007
This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.
Community Consensus Statement on Access to HIV Treatment and its Use for Prevention

Together, we can make it happen

We can end HIV soon if people have equal access to HIV drugs as treatment and as PrEP, and have free choice over whether to take them.

Launched today, the Community Consensus Statement is a basic set of principles aimed at making sure that happens.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap
close

This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.