{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:09:10Z","timestamp":1787018950931,"version":"build-2736575974"},"reference-count":30,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2020,1,28]],"date-time":"2020-01-28T00:00:00Z","timestamp":1580169600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["2T32HS013852-16"],"award-info":[{"award-number":["2T32HS013852-16"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]},{"name":"University of Alabama Birmingham Walter B. Frommeyer Jr. Fellowship in Investigative Medicine Award"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Int J STD AIDS"],"published-print":{"date-parts":[[2020,2]]},"abstract":"<jats:p>HIV pre-exposure prophylaxis (PrEP) effectively prevents HIV acquisition among men who have sex with men (MSM), but PrEP uptake has been associated with sexually transmitted infections (STIs). The effect of PrEP on STIs in MSM in the Deep South of the United States is unknown. We performed a retrospective analysis of adult MSM at an American Deep South PrEP clinic to calculate the prevalence and incidence rate of bacterial STIs (chlamydia, gonorrhea, and syphilis) and identify associated risk factors by linking incident STI to patient-reported outcomes; 139 MSM accessed the clinic between 2014 and 2018 with baseline bacterial STI prevalence of 11%. Twenty-six of 81 eligible MSM on PrEP had incident STIs with an incidence rate of 33.1 cases per 100 person-years. Significantly higher proportions of high PrEP adherence, multiple sexual partners, and inconsistent condom use were seen in those with incident STI, and we identified MSM with both high PrEP adherence and multiple sexual partners as being at especially high risk for bacterial STIs (hazard ratio: 7.57, 95% confidence interval: 1.75\u201332.74). Bacterial STIs are common after initiating PrEP in this clinic, and MSM reporting high PrEP adherence and multiple sexual partners have a significant risk for incident STI. High-risk sexual behaviors persisted after starting PrEP, highlighting the importance of ongoing, intensive sexual health screening and interventions.<\/jats:p>","DOI":"10.1177\/0956462419886228","type":"journal-article","created":{"date-parts":[[2020,1,29]],"date-time":"2020-01-29T01:51:46Z","timestamp":1580262706000},"page":"127-135","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":12,"title":["Sexually transmitted infections and sexual behaviors of men who have sex with men in an American Deep South PrEP clinic"],"prefix":"10.1177","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1614-758X","authenticated-orcid":false,"given":"Ronnie M","family":"Gravett","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew O","family":"Westfall","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edgar T","family":"Overton","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kachina","family":"Kudroff","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina A","family":"Muzny","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellen F","family":"Eaton","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2020,1,28]]},"reference":[{"key":"bibr1-0956462419886228","volume-title":"Sexually transmitted disease surveillance, 2017","author":"Centers for Disease Control and Prevention.","year":"2018"},{"key":"bibr2-0956462419886228","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-019-02659-6"},{"key":"bibr3-0956462419886228","doi-asserted-by":"publisher","DOI":"10.1097\/OLQ.0000000000000614"},{"key":"bibr4-0956462419886228","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cit437"},{"key":"bibr5-0956462419886228","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1011205"},{"key":"bibr6-0956462419886228","unstructured":"Centers for Disease Control and Prevention. 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Outcomes for PrEP users in the Southern US: Persistence and STIs. In: HIV Research for Prevention 2018, Madrid, Spain, 24 October 2018."},{"key":"bibr22-0956462419886228","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0208107"},{"key":"bibr23-0956462419886228","unstructured":"Butler I, Al-Dahir S, Zeng P, et al. STI and Long Term PrEP at a Federally Qualified Health Center in the American South. Poster #7807 14th International Conference on HIV Treatment and Prevention Adherence, June 17\u201319, 2019."},{"key":"bibr24-0956462419886228","unstructured":"Centers for Disease Control and Prevention. HIV Surveillance Report, 2017; vol. 29. 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