Are we there yet? A roadmap from a statewide population-based analysis of STI patterns among people with HIV, with implications for morbidity, transmission and ending the HIV epidemic.

BACKGROUND

Ongoing sexually transmitted infection (STI) transmission reflects inequitable access to sexual healthcare services. STI reinfection pre-HIV and post-HIV infection is a proxy measure of sexual behaviour for people with HIV (PWH). Surveillance data show that recommended screenings are not occurring, leading to missed opportunities. Gaps exist about the true picture of STI infection and reinfection among PWH from pre-HIV to post-HIV diagnosis. To end the HIV epidemic and achieve national HIV goals of preventing new infections, synergistic STI/HIV screening is important to limit coinfection and co-transmission of other STIs and HIV.

METHODS

We describe changes in STI patterns of infection among a statewide cohort of PWH (n=6896) in South Carolina pre-HIV and post-HIV diagnosis using linked HIV and STI surveillance data. We used multinomial logistic regression to examine and compare differences in pre- and post-HIV diagnosis for three STIs, namely chlamydia (CT), gonorrhoea (GC) and syphilis.

RESULTS

Overall, 17.22% of PWH exhibited increasing or persistently high patterns of STI infection. Young adults (18-29) represented the largest proportion of PWH experiencing increasing (66.78%) and persistently high (80.00%) STI infection. Racial and gender minorities were disproportionately affected, with males and black individuals comprising the majority of those with increasing (males: 90.03%, black: 77.30%) and persistently high (males: 83.51%, black: 79.65%) STI infections. Post-diagnosis, syphilis remained the most prevalent STI (35.56%), chlamydia increased to 32.84% from 28.11% prediagnosis, and triple STI infection nearly doubled to 4.19%, corresponding to an approximate 200% increase relative to pre-HIV diagnosis.

DISCUSSION: The persistent patterns of STIs among PWH call for a renewed focus on STI treatment and prevention as a central component for ending the HIV epidemic at the state and national levels.