CROI 2016 Abstract eBook

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Poster Abstracts

an urban southern county that includes the City of Memphis, the largest metropolitan area in Tennessee. Shelby County has a population of 940,000+ residents, 52% of which are non-Hispanic Black residents. Methods: The initial study population included 1,184 people diagnosed with either Primary or Secondary Syphilis from 2005-2014 inclusive. After eliminating duplicate reports, 1,020 unique Syphilis patients were matched against the Enhanced HIV/AIDS Reporting System (eHARS) used to track HIV Disease and AIDS diagnoses in the United States, maintained by the Centers for Disease Control and Prevention and State Health Departments. Data and statistical analysis was conducted in SAS, including descriptive epidemiology, HIV Free survival estimation, adjusted hazard ratio analysis, odds ratio analysis and assessment of interaction effects. Data were represented graphically and in tabular formwith estimate values and calculated 95% confidence intervals. Results: Overall, 54 of 1,021 or 5% of P&S patients were subsequently diagnosed HIV+ in the study population, findings that initially appeared consistent with the New York City experience. For specific subpopulations, however, the risk of developing subsequent HIV disease was greater. For MSM, the overall risk of subsequent HIV infection was 1:16 or 6.25%, and for Black MSM the risk of subsequent HIV Disease diagnosis was 1:8 or 12.5%within 30 months. 50% of male P&S Syphilis patients who later tested HIV+ did so within 24 months. HIV Free survival times were less for P&S patients > 35 years old at the age of Syphilis diagnosis (1.3 years compared with 2.1 years HIV Free for < 35 year old patients). Conclusions: HIV negative patients diagnosed with P&S Syphilis are at extremely high risk to subsequently be diagnosed with HIV Disease. Particularly for Black MSM, the risk may exceed 10% that they will become infected within 24 months. HIV-, Syphilis +MSMmust be offered pre-exposure prophylaxis and other interventions to lower their risk of HIV. 930 Behavioral Differences Between Young and Older Black MenWho Have Sex With Men Teresa Finlayson ;William L. Jeffries; Kristen Hess; Alexandra Balaji; Gabriela Paz-Bailey; for the NHBS Study Group CDC, Atlanta, GA, USA Background: In the United States, black men who have sex with men (BMSM) are disproportionately affected by HIV. Among BMSM, HIV incidence is highest and increasing in those younger than 25 years old. The aim of this study was to identify behavioral and service utilization differences between young and older BMSM to help explain the higher and increasing incidence among the younger group. Methods: We used data from the 2011 National HIV Behavioral Surveillance SystemMSM cycle. The analysis was limited to BMSM aged 18-44 years. We compared selected characteristics between young BMSM (aged 18-24 years) and older BMSM (aged 25-44 years) using chi-square tests, stratified by self-reported (SR) HIV status. Variables associated with age in bivariate analyses were analyzed as outcomes using separate log-linked Poisson regression models with generalized estimating equations to estimate adjusted prevalence ratios (aPR) and 95% confidence intervals. Models were adjusted for potential confounders and clustered on recruitment event. Results: Of 1,876 BMSM interviewed, 43% (n=802) were 18-24 years old and 57% (n=1,074) were older. HIV prevalence was 21% among young men and 32% among older men (p=<0.01). The percent with HIV who were unaware of their infection was 56% among young men and 47% among older men (p=0.04). Among SR HIV-negative BMSM (including some who were infected), young men were more likely to know their last sex partner for <1 year (aPR 1.14, 1.07-1.22) and have a black partner (aPR 1.14, 1.07-1.22) or report receptive sex (aPR 1.21, 1.08-1.36) at last sex with a man. Few SR HIV-negative BMSM had taken pre-exposure prophylaxis (PrEP) (1%, n=13) and many did not know their last partner’s HIV status (42%, n=671); these factors were not associated with age. Among SR HIV-positive BMSM, young men were less likely to be on antiretroviral therapy (ART) (aPR 0.67, 0.51-0.89) and more likely to have a black partner at last sex with a man (aPR 1.16, 1.03-1.29). Conclusions: Among HIV-negative BMSM, younger men are more likely than older men to engage in sexual behaviors with higher risks for infection and have black sex partners, a partner pool with potentially high HIV prevalence. Among HIV-positive BMSM, young men are less likely to be on ART. These differences may contribute to increasing HIV incidence among young BMSM. Increasing awareness of acquisition risks associated with different sexual behaviors and of effective interventions like ART and PrEP may help reduce HIV incidence in young BMSM. 931 Association Between Family Environment and HIV-Related Risk Behavior Among Young MSM Alexandra Balaji 1 ; Gabriela Paz-Bailey 1 ; Lina Nerlander 1 ; CyprianWejnert 1 ; Justin Smith 1 ; Michael Newcomb 2 ; Brian Mustanski 2 ; Kathleen Brady 3 ; Sarah L. Braunstein 4 ;Teresa Finlayson 1 1 CDC, Atlanta, GA, USA; 2 Northwestern Univ, Feinberg Sch of Med, Chicago, IL, USA; 3 Philadelphia Dept of PH, Philadelphia, PA, USA; 4 New York City DHMH, Queens, NY, USA Background: HIV incidence estimates suggest that young men who have sex with men (YMSM) are increasingly affected by HIV. Given that high levels of social support have been associated with safer behaviors, we evaluated the association between measures of family environment and HIV-related sexual risk behaviors among YMSM 13 to 18 years of age. Methods: We examined data from the National HIV Behavioral Surveillance System among YMSM in three cities (Chicago; New York City; Philadelphia). YMSM ages 13 to 18 years (y) were recruited for interview and HIV testing. We used separate GEE models with a robust error variance procedure to estimate adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) for the associations between measures of family environment (currently living with parents vs. other living arrangements, ever kicked out of the house or run away, perceived family support scale, out to mother, out to father) and engagement in each of three sexual risk behaviors as outcomes: condomless anal sex in past 12 months (CAS), ≥ 4 male oral or anal sex partners in past 12 months, and vaginal or anal sex before 13y. Models were adjusted for age, race/ethnicity, and city. Results: Of 278 YMSM, 79% ever had oral or anal sex with a male, 41% had CAS, 32% reported ≥ 4 partners, and 23% had vaginal or anal sex before 13y. Multivariable analyses revealed that positive family environment factors were associated with a lower prevalence of all three risk behaviors. YMSMwho lived with parents were less likely to report CAS (aPR 0.64, CI 0.47-0.86), ≥ 4 partners (0.45, 0.32-0.64), and sex before 13y (0.60, 0.41-0.89). Those who had never been kicked out were less likely to report CAS (0.69, 0.53-0.90), ≥ 4 partners (0.49, 0.35-0.69), and sex before 13y (0.69, CI 0.49-0.97). Higher perceived family support was associated with a lower likelihood of reporting sex before 13y (0.92, 0.88-0.96). Being out to one’s mother or father was associated with a lower likelihood of CAS [(0.59, 0.38-0.90) / (0.72, 0.53-0.98)] and ≥ 4 partners [(0.35, CI 0.18-0.66) / (0.61, CI 0.42-0.89)]. Conclusions: These findings suggests that for YMSM, a stable and supportive family environment may serve as a protective factor against engaging in HIV-related risk behaviors. Interventions that build upon these protective factors and promote acceptance within the families of YMSMmay play an important role in comprehensive HIV prevention efforts for this population. 932 STIs and Predictive Sexual Risk Behaviors Among HIV+Military Cohort Members Grace E. Macalino 1 ; Morgan Byrne 1 ; Anuradha Ganesan 2 ; Robert Deiss 3 ; Jason Okulicz 4 ;Tahaniyat Lalani 2 ; Brian Agan 1 1 Infectious Disease Clinical Rsr Prog, Rockville, MD, USA; 2 Uniformed Services Univ of the Hlth Scis, Bethesda, MD, USA; 3 Infectious Disease Clinical Rsr Prog, San Diego, CA, USA; 4 San Antonio Military Med Cntr, San Antonio, TX, USA Background: HIV+ individuals often continue to engage in behaviors that put them at risk for STIs. We have shown that STI incidence occurs within the U.S. Military HIV Natural History Study (NHS), a cohort of HIV+ active duty members and beneficiaries, Prior to the repeal of Don’t Ask Don’t Tell (DADT), very little sexual risk behavior data were available frommilitary populations. A risk behavior survey was recently implemented to begin to identify individual risk to ultimately target for prevention. We were interested in identifying associations between sexual behaviors and STIs. Methods: All NHS participants are screened for STIs every six months. From 9/2014-2/2015, participants were administered a tablet-based CASI survey on sexual risk behaviors, with the option to respond “prefer not to answer” (PNA) on each question. Incident STIs (chlamydia, gonorrhea, HBV, HSV2, and syphilis) were defined as a negative followed by a positive test within one year of their survey. Results: 1349 NHS participants completed the risk survey, 93.62%male, 39%%white, 44% African-American, 17% Hispanic/Other, 37% active duty, 32%married, median 11 yrs from HIV (IQR 3.8-21), CD4 656 cells/mm3, VL 1.3 log10 at survey. 76% of men reported ever engaging in MSM behavior (6% PNA), 88% at last sexual encounter (5.6% PNA).

Poster Abstracts

393

CROI 2016