CROI 2016 Abstract eBook

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Poster Abstracts

Methods: TRUST/RV368 is a cohort of MSM recruited in Abuja and Lagos, Nigeria, using respondent-driven sampling. Participants are screened for HIV and other STIs and undergo a structured interview to collect detailed data on behaviors, experiences, healthcare engagement and other factors. For this analysis, participants are categorized based on self- report of having received goods or money in exchange for sex with other men in the preceding year. Comparisons are made using Pearson’s chi-squared test, t-test, and logistic regression. Results: FromMarch 2013-August 2015, 1374 men (908 in Abuja; 430 in Lagos) answered baseline questionnaires about transactional sex and 660 (48.0%) reported selling sex in the preceding year with a median of 3 (range 1-350) paying partners. Compared to men who had not sold sex, men who sold sex tended to be younger (median 22.7 vs. 25.3 years, p <0.001), more likely to self-identify as gay/homosexual (42.9% vs. 30.4%, p <0.001), and less likely to have progressed beyond secondary education (19.2% vs. 38.5%, p<0.001). Men who sold sex were more likely to have avoided healthcare (p=0.007), felt afraid in public (p=0.040), been verbally harassed (p<0.001), and been forced to have sex (p<0.001, Figure). No differences were noted in rates of disclosing MSM status to family (p=0.270) or healthcare providers (p=0.690). Among 937 men with HIV test results, 455 (48.6%) were positive, including 45.8% of men who sold sex and 51.3% of men who had not sold sex (p=0.096). The age-adjusted odds ratio of HIV infection among men who sold sex compared to men who had not sold sex was 0.91 (95% confidence interval 0.70-1.18). No differences were observed in the prevalence or age-adjusted odds of chlamydia or gonorrhea. Conclusions: There appears to be intersectional stigma related to both the selling of sex and same-sex practices among these MSS that may compound the effects of stigma and limit uptake of health care as compared to other MSM. Given that these men appear to be distinct from other MSM, specific interventions may be needed to improve access to HIV treatment and retention in care among this key population in Nigeria.

923 Incidence of STIs Among MSM Engaged in Treatment as Prevention in Nigeria Rebecca G. Nowak 1 ;Trevor A. Crowell 2 ; Stefan Baral 3 ;Teclaire Ndomb 4 ; Babjide Keshinro 5 ; Sheila Peel 2 ; Charlotte Gaydos 6 ; Julie Ake 2 ;William A. Blattner 1 ; Manhattan E. Charurat 1 1 Inst of Human Virology, Baltimore, MD, USA; 2 US Military HIV Rsr Prog, Walter Reed Army Inst of Rsr, Silver Spring, MD, USA; 3 Johns Hopkins Bloomberg Sch of PH, Baltimore, MD, USA; 4 Inst of Human Virology, Abuja, Nigeria; 5 Walter Reed Prog - Nigeria, Abuja, Nigeria; 6 Johns Hopkins Univ Sch of Med, Baltimore, MD, USA Background: Concurrent sexually transmitted infections (STIs) diminish the effectiveness of the preventative effects of antiretroviral therapy (ART). In a Nigeria-based men who have sex with men (MSM) cohort (TRUST/RV368) we investigated whether clients who achieved effective HIV viral control also demonstrate parallel adherence to beneficial behavior change and whether this change impacts STI incidence. Methods: MSMwere recruited in Abuja and Lagos, Nigeria by respondent driven sampling. ART use, viral loads, STIs, and condom use were assessed at enrollment and every 3 months. HIV + clients were categorized into three groups: 1) <200 copies/ml; ART<200), 2) >200 copies/ml; ART>200) and 3) non-ART. Condom use, prevalence and incidence of rectal and urethral chlamydia (CT) and gonorrhea (GC) were analyzed by treatment group using chi-squared statistics and Poisson regression models. Results: FromMarch 2013-August 2015, HIV-infected individuals (135 ART <200; 80 ART >200, 30 non-ART) contributed 245 baseline and 758 follow-up visits. Condom use during receptive sex increased during follow-up (FU) for ART users [(ART <200 (baseline, FU: 3.6, 4.3; p<0.01) (ART >200 (3.4, 4.2; p<0.01)], but not for non-ART (3.9, 3.9; p=0.71). Similarly, condom use with insertive sex increased for ART users (<200, >200) as compared to non-ART during follow-up (p<0.01, p<0.01, p=0.70). The combined prevalence of rectal CT and GC at baseline was 26.9% in ART <200, 40% in ART>200, and 50% in non-ART (p=0.02). The prevalence of urethral STIs was 5.3%, 8.8%, and 13.3% (p=0.27). The crude incidence of rectal STIs was 46.2 per 100 person-years (PY) among ART <200, 43.2/100 PY among ART >200, and 32.7/100 PY among non-ART (p=0.73, p=0.28). The crude incidence of urethral STIs was 5.8/100 PY, 5.4/100 PY, and 12.2, respectively (p=0.90, p=0.22). In a stratified analysis, incidence of rectal STIs remained high regardless of consistent condom use with receptive sex during follow-up (always vs. < always; 39.5/100 PY vs. 47.4/100 PY, p=0.42). Similarly, incidence of urethral STIs did not differ by consistent condom use with insertive sex during follow-up (p=0.60). Conclusions: Adherence to ART translates into increased condom use but in the absence of 100% condom use STI incidence remains high. 924 Online Sex-Seeking Among MSM in Nigeria: Implications for Online Intervention Shauna Stahlman 1 ; Rebecca G. Nowak 2 ; Hongjie Liu 3 ;Trevor A. Crowell 4 ; Sosthenes Ketende 1 ;William A. Blattner 2 ; Manhattan E. Charurat 2 ; Stefan Baral 1 ; for theTRUST Study Group 1 Johns Hopkins Bloomberg Sch of PH, Baltimore, MD, USA; 2 Inst of Human Virology, Baltimore, MD, USA; 3 Sch of PH, Univ of Maryland, College Park, MD, USA; 4 US Military HIV Rsr Prog, Walter Reed Army Inst of Rsr, Silver Spring, MD, USA Background: The TRUST project was undertaken to apply innovative strategies to engage Nigerian MSM into HIV care. Respondent Driven Sampling (RDS) was found to be effective in reaching marginalized MSM especially in later waves of recruitment. In this analysis we evaluate characteristics of Nigerian MSM who use the Internet for sex-seeking. Methods: We analyzed data collected from the TRUST study, a cohort of 1,370 MSM recruited using RDS fromMarch 2013 to August 2015 in Abuja and Lagos, Nigeria. Participants were administered face-to-face interviews and HIV/sexually transmitted infection (STI) testing over the course of 7 study visits for up to 15 follow-up months. Logistic regression models were used to measure associations of MSM social/sexual networks, stigma, and HIV with online sex-seeking at baseline. Generalized estimating equation models were used to assess associations of online sex-seeking with STIs and HIV treatment-related variables across study visits. Results: Most (61.5%) participants reported meeting male sex partners online at baseline, primarily using websites/mobile-apps such as 2GO (22%), Facebook (20%), and WhatsApp (12%). Grindr, a popular sex-seeking mobile-app among MSM in the US, was reported by 1.5%. Online sex-seeking was positively associated with reporting participation

Poster Abstracts

390

CROI 2016