{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T13:14:29Z","timestamp":1779196469129,"version":"3.51.4"},"reference-count":31,"publisher":"BMJ","issue":"4","funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["R01AI164947"],"award-info":[{"award-number":["R01AI164947"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000016","name":"U.S. Department of Health and Human Services","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000016","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Sex Transm Infect"],"accepted":{"date-parts":[[2025,9,8]]},"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall, 17.22% of PWH exhibited increasing or persistently high patterns of STI infection. Young adults (18\u201329) 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/sextrans-2025-056628","type":"journal-article","created":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T09:25:25Z","timestamp":1762507525000},"page":"225-231","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["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"],"prefix":"10.1136","volume":"102","author":[{"given":"Bankole","family":"Olatosi","sequence":"first","affiliation":[{"name":"Department of Health Services Policy and Management, University of South Carolina, Columbia, South Carolina, USA"},{"name":"University of South Carolina, Columbia, South Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2569-1373","authenticated-orcid":false,"given":"Salome-Joelle","family":"Gass","sequence":"additional","affiliation":[{"name":"Department of Health Services Policy and Management, University of South Carolina, Columbia, South Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shujie","family":"Chen","sequence":"additional","affiliation":[{"name":"University of South Carolina, Columbia, South Carolina, USA"},{"name":"Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xueying","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Health Promotion Education and Behavior, University of South Carolina, Columbia, South Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiajia","family":"Zhang","sequence":"additional","affiliation":[{"name":"University of South Carolina, Columbia, South Carolina, USA"},{"name":"Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,11,7]]},"reference":[{"key":"2026051905450670000_102.4.225.1","unstructured":"CDC . About ending the HIV epidemic in the US. n.d. Available: https:\/\/www.cdc.gov\/ehe\/php\/about\/index.html"},{"key":"2026051905450670000_102.4.225.2","doi-asserted-by":"crossref","DOI":"10.1093\/ofid\/ofac298","article-title":"Anatomic Site-Specific Gonorrhea and Chlamydia Testing and Incidence Among People With HIV Engaged in Care at 4 US Clinical Centers, 2014-2018","volume":"9","author":"Menza","year":"2022","journal-title":"Open Forum Infect Dis"},{"key":"2026051905450670000_102.4.225.3","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2019-054216"},{"key":"2026051905450670000_102.4.225.4","doi-asserted-by":"crossref","DOI":"10.1002\/jia2.26226","article-title":"Sexual behaviour and STIs among MSM living with HIV in the PrEP era: the French ANRS PRIMO cohort study","volume":"27","author":"Baltes","year":"2024","journal-title":"J Int AIDS Soc"},{"key":"2026051905450670000_102.4.225.5","unstructured":"CDC . Sexually transmitted infections surveillance, 2022. 2024. Available: https:\/\/www.cdc.gov\/std\/statistics\/2022\/default.htm"},{"key":"2026051905450670000_102.4.225.6","doi-asserted-by":"publisher","DOI":"10.1136\/sti.2010.047514"},{"key":"2026051905450670000_102.4.225.7","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1097\/OLQ.0000000000000147","article-title":"Incident sexually transmitted infection as a biomarker for high-risk sexual behavior after diagnosis of acute HIV","volume":"41","author":"Cope","year":"2014","journal-title":"Sex Transm Dis"},{"key":"2026051905450670000_102.4.225.8","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.94.7.1141"},{"key":"2026051905450670000_102.4.225.9","doi-asserted-by":"crossref","first-page":"2051","DOI":"10.1007\/s10508-023-02598-3","article-title":"Temporal Changes in Sexually Transmitted Infections in a Cohort of Men Who Have Sex with Men Living with HIV: Sex Partner Seeking and Behavioral Correlates","volume":"52","author":"Chan","year":"2023","journal-title":"Arch Sex Behav"},{"key":"2026051905450670000_102.4.225.10","doi-asserted-by":"publisher","DOI":"10.1097\/OLQ.0b013e3182753327"},{"key":"2026051905450670000_102.4.225.11","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1293.2009.00708.x"},{"key":"2026051905450670000_102.4.225.12","unstructured":"CDC . CDC publishes new HIV surveillance reports. n.d. Available: https:\/\/www.cdc.gov\/nchhstp\/director-letters\/cdc-publishes-new-hiv-surveillance-reports.html"},{"key":"2026051905450670000_102.4.225.13","doi-asserted-by":"crossref","first-page":"e440","DOI":"10.1016\/S2352-3018(25)00036-0","article-title":"Association of state-level PrEP coverage and new HIV diagnoses in the USA from 2012 to 2022: an ecological analysis of the population impact of PrEP","volume":"12","author":"Sullivan","year":"2025","journal-title":"Lancet HIV"},{"key":"2026051905450670000_102.4.225.14","doi-asserted-by":"crossref","first-page":"S134","DOI":"10.1086\/652395","article-title":"Risk of sequelae after Chlamydia trachomatis genital infection in women","volume":"201 Suppl 2","author":"Haggerty","year":"2010","journal-title":"J Infect Dis"},{"key":"2026051905450670000_102.4.225.15","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2014-051786"},{"key":"2026051905450670000_102.4.225.16","doi-asserted-by":"crossref","first-page":"2851","DOI":"10.2147\/IDR.S320648","article-title":"Consequences of HIV\/Syphilis Co-Infection on HIV Viral Load and Immune Response to Antiretroviral Therapy","volume":"14","author":"Fan","year":"2021","journal-title":"Infect Drug Resist"},{"key":"2026051905450670000_102.4.225.17","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000000308"},{"key":"2026051905450670000_102.4.225.18","doi-asserted-by":"crossref","first-page":"677","DOI":"10.15585\/mmwr.mm6724a2","article-title":"Interval Since Last HIV Test for Men and Women with Recent Risk for HIV Infection - United States, 2006-2016","volume":"67","author":"Pitasi","year":"2018","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2026051905450670000_102.4.225.19","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2021-055365"},{"key":"2026051905450670000_102.4.225.20","doi-asserted-by":"crossref","first-page":"1","DOI":"10.14423\/SMJ.0000000000000389","article-title":"High Rates of STIs in HIV-Infected Patients Attending an STI Clinic","volume":"109","author":"Castro","year":"2016","journal-title":"South Med J"},{"key":"2026051905450670000_102.4.225.21","unstructured":"HIV.gov . National HIV\/AIDS strategy 2022-2025. 2023."},{"key":"2026051905450670000_102.4.225.22","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-023-15563-5","article-title":"Achieving the \u201cEnding the HIV Epidemic in the U.S.\u201d incidence reduction goals among at-risk populations in the South","volume":"23","author":"Hamilton","year":"2023","journal-title":"BMC Public Health"},{"key":"2026051905450670000_102.4.225.23","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2018-027245","article-title":"Sexually transmitted infections in young people and factors associated with HIV coinfection: an observational study in a large city","volume":"9","author":"Sent\u00eds","year":"2019","journal-title":"BMJ Open"},{"key":"2026051905450670000_102.4.225.24","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.jana.2015.11.005","article-title":"HIV Risk Behaviors, Perceptions, and Testing and Preexposure Prophylaxis (PrEP) Awareness\/Use in Grindr-Using Men Who Have Sex With Men in Atlanta, Georgia","volume":"27","author":"Goedel","year":"2016","journal-title":"J Assoc Nurses AIDS Care"},{"key":"2026051905450670000_102.4.225.25","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.epidem.2015.02.003","article-title":"The racial disparities in STI in the U.S.: Concurrency, STI prevalence, and heterogeneity in partner selection","volume":"11","author":"Hamilton","year":"2015","journal-title":"Epidemics"},{"key":"2026051905450670000_102.4.225.26","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0090514","article-title":"Understanding racial HIV\/STI disparities in black and white men who have sex with men: a multilevel approach","volume":"9","author":"Sullivan","year":"2014","journal-title":"PLoS One"},{"key":"2026051905450670000_102.4.225.27","doi-asserted-by":"publisher","DOI":"10.1016\/j.annepidem.2013.08.002"},{"key":"2026051905450670000_102.4.225.28","doi-asserted-by":"crossref","DOI":"10.1093\/ofid\/ofac592","article-title":"Risk Factors and Incidence of Sexually Transmitted Infections in the Swiss HIV Cohort Study","volume":"9","author":"Bosetti","year":"2022","journal-title":"Open Forum Infect Dis"},{"key":"2026051905450670000_102.4.225.29","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1177\/1545109711418120","article-title":"The Achilles\u2019 Heel of HIV Treatment for Prevention: History of Sexually Transmitted Coinfections among People Living with HIV\/AIDS Receiving Antiretroviral Therapies","volume":"10","author":"Kalichman","year":"2011","journal-title":"J Int Assoc Physicians AIDS Care"},{"key":"2026051905450670000_102.4.225.30","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-018-2252-9"},{"key":"2026051905450670000_102.4.225.31","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.08.059212"}],"container-title":["Sexually Transmitted Infections"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/sextrans-2025-056628","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T12:45:38Z","timestamp":1779194738000},"score":1,"resource":{"primary":{"URL":"https:\/\/sti.bmj.com\/lookup\/doi\/10.1136\/sextrans-2025-056628"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,7]]},"references-count":31,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,5,19]]},"published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1136\/sextrans-2025-056628"],"URL":"https:\/\/doi.org\/10.1136\/sextrans-2025-056628","relation":{},"ISSN":["1368-4973","1472-3263"],"issn-type":[{"value":"1368-4973","type":"print"},{"value":"1472-3263","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,7]]}}}