Fetal impact of cystic fibrosis transmembrane conductance regulator modulator use during assisted and natural reproduction and partner pregnancy in men with cystic fibrosis

Background: Increasing availability of highly effective cystic fibrosis (CF) transmembrane conductance regulator (CFTR) modulator therapy (HEMT) has improved the quality of life and long-term prognosis for many people with CF. Thus, more people with CF are considering parenthood. Almost all menwith CF (MwCF) are infertile because of congenital bilateral absence of the vas deferens (CBAVD). Based on CF animal models, CBAVD occurs early in gestation and is unlikely to be reversible using HEMT, but assisted reproductive techniques (ARTs) can enable MwCF to father children using the sperm in their testes. Animal reproductive models suggest no HEMT teratogenicity, and the amount of exposure of the fetus to HEMT via absorption of seminal fluid through the vaginal wall is predicted to be negligible, although to ensure no sperm exposure to HEMT, the life span of sperm would require MwCF to discontinue CFTR modulators for approximately 3 months before ART. Because abrupt discontinuation of CFTR modulators may result in health decline, MwCF and their providers must consider all potential risks. There are no published data in MwCF regarding use of HEMT during conception and partner pregnancy. Method(s): Beginning in August 2021, CF center staff in the United States, United Kingdom, and Australia completed a two-page anonymous questionnaire regarding MwCF who used CFTR modulators during ART (sperm retrieval and in vitro fertilization) or natural conception with subsequent partner pregnancy. Result(s): Providers have submitted 34 surveys for MwCF on CFTR modulators whose partner became pregnant after use of ART (n = 32) or natural conception (n = 2). The median age of the samplewas 32 (range 24- 43). Fifteen were homozygous for F508del, median percentage predicted forced expiratory volume in 1 second was 76% (range (22-111%), and median body mass index was 24 kg/m2 (range 18.5-32.1). Twenty-three were taking elexacaftor/tezacaftor/ivacaftor. The median time that MwCF were taking CFTR modulators before partner conception was 18 months (range 0-82). One newly diagnosed man initiated HEMT after sperm retrieval. Four MwCF stopped CFTR modulators before sperm retrieval, one of whom experienced pulmonary decline. None of the 19 MwCF whose condom use during pregnancy was known used condoms. Fetal complications in partners of MwCF included three first-trimester miscarriages, two* COVID, two breech presentation, two* vaginal bleeding, and one vasa previa. None of the complications were deemed definitively related to use of CFTR modulators. One MwCF experienced testicular infection after sperm retrieval#. Postpartum complications included three# infants with hypoxemia requiring neonatal intensive care unit stay, three maternal blood loss, one forceps delivery, and one caesarean section. No congenital anomalies were reported for any infant. (*/# overlap). Conclusion(s): Use of CFTR modulator therapy during partner conception and pregnancy in 34 MwCF has not resulted in higher-than-expected miscarriage rates or congenital anomalies. Providers should consider the risk to the health of MwCF combined with the lack of teratogenicity in animal reproductive models and limited safety data in the human fetus before discontinuing CFTR modulators before ART or natural partner conception. Survey collection is ongoing;results will be updated for presentationCopyright © 2022, European Cystic Fibrosis Society. All rights reserved

Mpox Awareness, Risk Reduction, and Vaccine Acceptance among Pwh in Washington, Dc

Background: PWH are disproportionally affected by mpox and at high risk for severe complications. The recent mpox outbreak response included increasing awareness, encouraging behavioral changes and pre- and post-exposure vaccination. We assessed knowledge and perceptions of mpox, adoption of preventive behaviors, and attitudes towards vaccination among PWH in Washington, DC. Method(s): Data from a cross-sectional mpox survey were collected between August and December 2022 from PWH enrolled in a longitudinal HIV cohort, the DC Cohort. We conducted uni- and bivariable analyses comparing participants by vaccination status (vaccinated, plan to vaccinate, no plan to vaccinate) and by HIV risk group (MSM vs. non-MSM). We conducted multinomial regression to identify factors associated with vaccine acceptance. Result(s): Among 178 PWH completing the survey (median age 55;71% male, 81% non-Hispanic Black, 37% MSM), 162 (91%) had heard of mpox. Among 159 PWH who had heard of mpox and answered vaccination questions, 21% (n=33) were vaccinated, 43% (n=69) planned to vaccinate and 36% (n=57) did not plan to vaccinate. Comparing the 3 groups, significant differences were observed by age, gender, education, income, HIV risk group, and level of worry about mpox (all p< 0.01). Viral suppression, prior COVID and influenza vaccination, access to STI services, and STI diagnoses in the last year were not associated with vaccine status. Behaviorally, a higher proportion of vaccinated participants reported limiting their number of sexual partners (p< 0.001) and using more preventive behaviors (e.g., limiting gatherings, increased condom use, avoiding skin-to-skin contact;p=0.034) in response to mpox. A higher proportion of MSM reported limiting their number of sexual partners compared to non-MSM (33% vs 7%, p< 0.0001) and were more likely to be vaccinated or plan to vaccinate vs non-MSM (p< 0.001). In adjusted multinomial regression models comparing vaccinated PWH and those planning to vaccinate to those not planning to vaccinate, age (p= 0.0231) and HIV risk factor/gender (p< 0.0001) were significantly associated with vaccination status with younger PWH and MSM more likely to vaccinate (Figure). Conclusion(s): High levels of mpox awareness were observed among this cohort of PWH in Washington, DC with more MSM employing risk reduction behaviors and vaccination as mpox prevention strategies. Ensuring that all PWH, regardless of gender, sexual orientation, or age, understand the risks of mpox may improve vaccination uptake.

Impact of the COVID-19 pandemic on access to HIV testing and condom use among two-spirit, gay, bisexual, and queer (2SGBQ+) men in Manitoba.

This cross-sectional online survey (n = 347) examined the impact of the COVID-19 pandemic on access to HIV testing and condom use among Two-Spirit, gay, bisexual, and queer (2SGBQ+) men in Manitoba. Logistic regression assessed the relationship between socio-demographics and the impact of COVID-19 on access to HIV testing and condom use. Among those who answered a question on testing (n = 282), 27.7% reported reduced access to HIV testing. Among those who answered questions on condom use (n = 327), 54.4% reported decreased use of condoms. Compared to living in Winnipeg, living in a medium-sized city (Brandon) and in rural and remote areas were both associated with higher odds of reporting reduced access to HIV testing due to COVID-19. Participants who were dating (vs. married or partnered) were significantly more likely to report reduced access to HIV testing, but less likely to report decreased use of condoms, while younger age was associated with decreased use of condoms. Service providers must be prepared to respond to the impact of COVID-19 on HIV testing and condom use among younger, sexually active 2SGBQ + men, as well as those who live in small, rural, and remote areas in Manitoba.

DOAK 2023 / German-Austrian AIDS Conference

The proceedings contain 115 papers. The topics discussed include: prevention and health promotion regarding sexual transmitted infections among university students in Germany;sexual risk behavior and condom use among Arab men tourists in Pattaya, Thailand;prevalence of individuals with risk for severe COVID-19 in whom ritonavir-containing therapies are contraindicated or may lead to interactions with concomitant medications;therapy adjustment using proviral DNA information among multi-class resistant HIV-1 infected and ART-experienced patients;are we on track to reach the WHO elimination goals for viral hepatitis among HIV+-individuals? updates on HBV prevalence and incidence, 1996-2019;telehealth or in-person HIV care? care continuity drove the decision process during the COVID-19 pandemic. results from a qualitative study in South Carolina;high burden of human papilloma virus infection in people living with HIV;and safety and effectiveness outcomes from the CARISEL study: Phase 3b hybrid-3 implementation study integrating CAB+RPV LA Into European clinical settings.

142. The Reach, Implementation, and Effectiveness of Virtual Sex Education for Youth in Foster Care

Purpose: Youth in foster care have high rates of adverse sexual health outcomes and are important targets for evidence-based sex education. With the COVID-19 pandemic, sexual health programming was moved to a virtual format. However, few data existed to guide this transition. While it lowers expenses and can potentially broaden geographic reach, it is unclear if virtual programming meets the needs of youth in foster care or other vulnerable populations. We conducted a mixed-methods analysis comparing the reach, implementation, and effectiveness of virtual vs in-person sex education for youth in foster care before and during the COVID-19 pandemic. Methods: Indiana Proud and Connected Teens (IN-PACT) provides evidenced-based sex education programs to system-involved youth. The data used in this study focused exclusively on foster-care programming and includes attendance records, facilitator session reviews (n=64) from 2020-2021 virtual programs, and youth surveys from 2018-2020 in-person (n=965) and virtual (n=50) programs. Reach was measured using youth baseline survey demographics and sexual behaviors;implementation by free responses from facilitators on challenges and adaptation for virtual teaching;and effectiveness by attendance records and youth behavior intention on follow-up surveys. Results: Reach: Youth demographic diversity was maintained for virtual programming in ethnicity, race, sex, and sexual orientation. However, youth in virtual programs had lower rates of self-reported risk behaviors including lower rates of involvement with juvenile justice (35.0% vs 59.4%, p<0.01) to have ever had sex (44.4% vs 78.8%, p<0.001) or contributed to a pregnancy (4.4% vs 23.4%, p<0.05). And though not statistically significant, virtual youth reported higher rates of condom use (44.4% vs 30.4%, p=0.371) and lower rates of substance use before sex in the past 3 months (15.6% vs 28.5%, p=0.114) as compared to in-person youth. Implementation: Technical challenges included connection difficulties and learning curves to using Zoom. Virtual facilitators incorporated more technology than they did in-person by playing videos on complicated topics such as conception and STIs. In terms of curriculum, hands-on condom demonstrations were changed to facilitator-run experiments such as having youth use socks at home to simulate condoms on their arms. Breakout rooms were utilized to maintain small group work but were cumbersome. Relational challenges included awkward silences, disengagement, and a decrease in group trust due to cameras being turned off during sensitive topics and less connection between youth and facilitators. Effectiveness: Attendance records show that fewer virtual youth completed 100% of programming, as compared to in-person youth (23% vs 54%). More virtual youth answered yes to the question "As a result of this program, will you abstain from sex for the next three months?” as compared to in-person youth (55% vs 45%, p=0.462). However, virtual youth were significantly less likely to have baseline sexual experience. Conclusions: In-person sexual health programming had a wider reach, experienced fewer implementation challenges, and was potentially more effective than virtual programming for youth in foster care. If virtual programming becomes necessary again, sex educators and researchers can use these data to redesign virtual programming that maximizes reach, implementation, and effectiveness. Sources of Support: HHS 90AK0041-02-00 to Health Care Education and Training Inc.

Differences in Important Components of Sexual Satisfaction as Identified and Experienced by Undergraduate Males and Females

Few studies explore the components of sexual satisfaction as specified by college students. This cross-sectional study examined sexual satisfaction at the event level for undergraduate students (n = 1,090), focusing on differences between males/females. Survey results revealed for both males and females, being comfortable with a partner, experiencing orgasm, and having a partner "with skills" predicted sexual satisfaction. Satisfied males reported feeling safe with their partners, spent time touching/kissing, and had "romantic" partners. Satisfied females had partners with previous sexual experience, whom they desired, and vice-versa. These findings can inform comprehensive sexuality education efforts to incorporate the teaching of satisfaction into sexual health.

SORE THROAT SAGA: A TALE OF A MISDIAGNOSED PERSIST SORE THROAT DURING THE COVID-19 PANDEMIC

CASE: A 24-year-old male without past medical history aside from high-risk sexual activity (multiple female sexual partners complicated by a distant history of chlamydia) however with frequent negative testing (recent negative HIV, syphilis RPR, and urinary gonorrhea/chlamydia RNA tests) and consistent condom use presents to an urgent care visit for 1 week history of sore throat with difficulty swallowing. The symptoms presented gradually with reported lymph node swelling of upper neck without associated cough, congestion, or fever. He denies sick contacts however there is high local transmission of COVID-19. Exam shows bilateral tonsillar swelling with right-sided white exudate and midline uvula;bilateral tender anterior cervical lymphadenopathy is present. COVID-19 PCR and Strep antigen/culture tests are negative. Patient is advised to treat symptomatically with ibuprofen and saltwater gargles for a likely viral upper respiratory tract infection. Symptoms persist without improvement;he presents again 1 week later. He now reveals that prior to this sore throat he had receptive oral intercourse with a female partner of unknown sexual history. Exam is unchanged. Repeat COVID-19 PCR test is negative. Monospot and HIV RNA tests are negative but gonorrhea RNA pharyngeal swab results positive. Patient is given IM ceftriaxone and symptoms resolve;patient tests negative on repeat swab 10 days later. IMPACT/DISCUSSION: This case demonstrates the difficulty in expeditious diagnosis of gonococcal pharyngitis without high index of suspicion. Spread primarily through receptive oral intercourse, most oropharyngeal infections with N. gonorrhoeae are asymptomatic, although symptoms shared with other common upper respiratory infections like sore throat, exudate, and cervical lymphadenopathy as well as fever may occur. Management is a single 500mg IM injection of ceftriaxone, notification of relevant partners, as well as a test of cure 7-14 days after initial treatment due to challenges of effective treatment when at this site. Expeditious diagnosis and eradication are important as pharyngeal gonococcal infections can contribute to high level of gonococcal transmission, uneradicated gonococcal infection could disseminate, and the pharynx is thought to be where horizontal transfer of gonococcal antimicrobial resistance genes commonly occurs. Given the increasing prevalence of gonococcal infections nationally and increasing rates of antimicrobial-resistant gonococcal infections, which were estimated to be 550,000 infections in 2019 and increasing when studied from 2000-2017 as per the CDC's 2019 Antibiotic Resistance Threats Report, this concern becomes increasingly urgent with time. CONCLUSION: -A high index of suspicion is required for expeditious diagnosis of gonococcal pharyngitis -A test of cure is recommended after treatment given the challenge of eradication at the pharynx -Eradication is important to decrease gonorrhea transmission and horizontal transfer of antimicrobial resistance genes.

Reducing New Chlamydia Infection Among Young Men by Promoting Correct and Consistent Condom Use: Protocol for a Randomized Controlled Trial.

BACKGROUND: The health, social, and economic costs of sexually transmitted infections (STIs) represent a major public health concern. Young people are considered one of the groups most at risk for acquiring and transmitting STIs. Correct and consistent condom use has been shown to be the most effective method for reducing STIs; however, condoms are often not used properly. Evidence shows that brief behavior change interventions that focus on skills, communication, and motivation to acquire safe sex practices should be adopted into routine care to reduce STIs. Funding for sexual health services in England has declined dramatically, so novel ways of reducing clinic attendance are being sought. The home-based intervention strategy (HIS-UK) to promote condom use among young men has shown promise in feasibility and pilot studies by demonstrating high acceptability of the intervention in participant and health professional feedback, including aiding men to find condoms they like and feel more confident when using condoms. OBJECTIVE: The aim of this study is to determine the effectiveness and cost-effectiveness of HIS-UK when compared to usual condom distribution care among young men. METHODS: The 3 trial arms consisting of "e-HIS" (HIS-UK delivered digitally), "ProHIS" (HIS-UK delivered face-to-face), and control condition (usual National Health Service [NHS] care) will be compared against the following 3 primary outcomes: the extent to which correct and consistent condom use is increased; improvement of condom use experiences (pleasure as well as fit and feel); and decrease in chlamydia test positivity. Eligibility criteria include men aged 16-25 years at risk of STIs through reporting of condom use errors (ie, breakage or slippage) or condomless penile-vaginal or penile-anal intercourse with casual or new sexual partners during the previous 3 months. Prospective participants will be recruited through targeted advertisements and an opportunistic direct approach at selected sexual health and genitourinary medicine services and university-associated health centers and general practitioner practices. Community and educational establishments will be used to further advertise the study and signpost men to recruitment sites. Participants will be randomly allocated to 1 of 3 trial arms. A repeated measures design will assess the parallel arms with baseline and 12 monthly follow-up questionnaires after intervention and 3 chlamydia screening points (baseline, 6, and 12 months). RESULTS: Recruitment commenced in March 2020. Due to the COVID-19 pandemic, the study was halted and has since reopened for recruitment in Summer 2021. A 30-month recruitment period is planned. CONCLUSIONS: If effective and cost-effective, HIS-UK can be scaled up into routine NHS usual care to reduce both STI transmission in young people and pressure on NHS resources. This intervention may further encourage sexual health services to adopt digital technologies, allowing for them to become more widely available to young people while decreasing health inequalities and fear of stigmatization. TRIAL REGISTRATION: ISRCTN Registry ISRCTN11400820; https://www.isrctn.com/ISRCTN11400820.

Use of a Practitioner-Friendly Behavior Model to Identify Factors Associated with COVID-19 Vaccination and Other Behaviors.

The lack of capacity for the design and implementation of behavioral interventions in low-and-middle income countries (LMICs) has been recognized by the World Health Organization (WHO) and other global health institutions. There is a need to task-shift, to translate social and behavioral science concepts into "practitioner-friendly" models-models which can be used by intervention designers, implementers, and evaluators with limited technical and financial resources. We illustrate the use of the Fogg Behavior Model (FBM), a model identified as being easy for practitioners to adopt in low-resource settings. The study uses data across four different behaviors in Nigeria, Pakistan, and India. The behaviors examined are COVID-19 vaccine uptake, condom use, iron folate use, and modern contraceptive use. The data are from surveys of healthcare workers (HCWs), married men, women of reproductive age, and adolescents, respectively. The FBM states that behavior happens when both motivation and ability are present, and a prompt occurs. In other words, persons with high motivation and high ability are the first to adopt a behavior. We created a categorical variable for motivation and ability and tested whether high motivation and high ability are associated with a greater likelihood of adopting a behavior. In Nigeria, HCWs with high motivation and high ability had 27 times higher odds of being vaccinated. In Pakistan, married men with high motivation and high ability had 35 times higher odds of condom use with their wives. In India, women with high motivation and high ability had 9 times higher odds of iron folate use. In Nigeria, adolescents and young women with high motivation and high ability had 8 times higher odds of contraceptive use. The study findings suggest that the FBM has the potential to be applied in low resource settings for the design, implementation, and evaluation of behavioral interventions. Rigorous testing of the FBM using data from experimental or quasi-experimental studies is recommended.

Factors associated with risk sexual behaviours of HIV/STDs infection among university students in Henan, China: a cross-sectional study.

BACKGROUND: This study aimed to identify factors associated with risk sexual behaviours and target high-risk groups at risk of HIV/STDs infection among university students. METHODS: The cross-sectional study was conducted from 1 November to 31 December 2020 in one university, located in Henan Province. A total of 1602 individuals who reported having ever had sex were analyzed as the subjects of this study. Descriptive analysis and multivariable logistic regression analysis were applied for this study to assess factors associated with risk sexual behaviours among university students. RESULTS: University students who reported having ever had sex accounted for about 9%, with an average age of 19.37 ± 1.03. Of them, having multiple sexual partners and inconsistent condom use during the last 6 months were 37.3% and 35%, respectively. Over 50% of participants had their sexual debut before the age of 18. Bisexual students (AOR = 0.27; 95% CI 0.16, 0.44) and those who lived on over 3000 Yuan per month (AOR = 0.50; 95% CI 0.28, 0.91) were consistently less likely to engage in condom use during the last 6 months. University students who were from high-grade (AOR = 1.56; 95% CI 1.12, 2.18 for sophomore; AOR = 1.84; 95% CI 1.28, 2.65 for junior; AOR = 2.07; 95% CI 1.38, 3.11 for senior), who lived on over 3,000 Yuan per month (AOR = 4.19; 95% CI 2.17, 8.11) or who reported being homosexual (AOR = 3.92; 95% CI 2.17, 7.06) and bisexual (AOR = 33.22; 95% CI 13.11, 84.15) were more likely to have multiple sexual relationships. University students who had sexual debut before the age of 18 were more likely to engage in risk sexual behaviours. CONCLUSIONS: The prevalence of sexual activity among Chinese university students is generally low, but risk sexual behaviours are of considerable concern. University students with higher living expenses, who are not heterosexual and who are younger at first sexual intercourse tend to engage in risk sexual behaviours. The scale-up of intervention is the need to prevent the expansion of the HIV epidemic among young students.

The HIV epidemic among university students is considerable, with the tendency of the high-risk population towards the general population. University students at risk of HIV/STDs infection tend to engage in risk sexual behaviours and were targeted for assessing factors corelated with their risk sexual behaviours in this study. Participants who reported having had sexual relations were selected. Information on the practice of risk sexual behaviours including multiple sexual partners and inconsistent condom use were collected and analyzed using a multivariable logistic regression model.Bisexual students were consistently less likely to use condoms within the last 6 months. University students from high-grade, who lived on over 3000 Yuan monthly, homosexual students and bisexual students were more likely to have multiple sexual relationships. University students who had sexual debut before the age of 18 were more likely to engage in risk sexual behaviours.In conclusion, University students with high cost of living per month, non-heterosexual, who are younger at first sexual intercourse tend to engage in risk sexual behaviours. Intensified intervention is the need to prevent the expansion of the HIV epidemic amongst young students.

MAINTAINED ACCESS to PREVENTION & CARE for PWID DESPITE COVID-19 in HAIPHONG, VIETNAM

Background: Haiphong is a Vietnamese city of 2 million people and a historic hotspot for HIV and drug use. The DRIVE community research program recently demonstrated the end of the HIV epidemic among PWID in the city, with an incidence of 0.085/100PY, and a substantial decrease in HCV incidence in the past 5 years. After the emergence of COVID-19, a one-month strict lockdown was imposed in April 2020 in Vietnam, followed by lighter social distancing restrictions over the year. We investigated whether those measures affected PWID in terms of risk behaviors and access to prevention and care. Methods: Participants were PWID that had been enrolled in a respondent-driven sampling (RDS) survey as part of DRIVE in the last quarter of 2019. They were recalled and interviewed in the last quarter of 2020 by peer educators on their socioeconomic situation, drug use and sexual behaviors, relations to methadone maintenance treatment (MMT) and ART services. They were tested for drugs and methadone in the urine, and for HIV, HCV, and HIV plasma viral load when HIV(+). Changes following the restrictions were assessed by comparing these "after" data to the "before" data collected one year earlier during the RDS survey. In-depth interviews were conducted with 30 participants including 5 female sex workers (FSW). Results: 780 PWID were enrolled. Their mean age was 44 years and 94% were male. 56% were still actively injecting (100% heroin) at the time of the interview;their monthly consumption had decreased from 24 to 17 days on average. The main source of syringes remained pharmacies for 83% before, during and after the lockdown. The proportion of PWID still engaging in sharing decreased from 6.0 to 1.5%. No change in the frequency of condom use was reported. The proportion of PWID on MMT increased from 68.7 to 75.3%. There was no alteration in the HIV cascade of care that was still above 90/90/90. No HIV seroconversion was observed, and HCV incidence remained stable (2.6/100PY, 95%CI: 0.7-6.7). 53% reported a monthly income of less than 130 USD "after" compared to only 9% "before". One FSW reported accepting unsafe sex during the lockdown due to financial pressure. Conclusion: Six months after the beginning of COVID-19-related restrictions, access to harm reduction materials and care services for PWID was maintained and no increase in the number of new HIV or HCV infections was observed. However, this period was a major financial challenge, especially for FSW that were more likely to engage in risky sexual behaviors.

MENSTRUATION IRREGULARITIES among REPRODUCTIVE-AGE WOMEN during the COVID-19 PANDEMIC

Background: Women have reported increased menstrual irregularities during the COVID-19 pandemic. It is unknown if this is due to biological (i.e., the effect of SARS-CoV-2 infection or vaccination) and/or psychosocial factors. This study examined menstrual irregularities during the COVID-19 pandemic and the association of abnormal menses with the presence of SARS-CoV-2 antibodies, stress, and mental health among reproductive age women. Methods: A cross-sectional study of 182 HIV-negative, sexually active, 18-to 45-year-old cisgender women was conducted on biobehavioral factors influencing HIV risk. From January 2019 to September 2021, participants completed a survey of menstrual irregularities over the previous three months, previous month condomless vaginal intercourse, and plans to conceive. Starting October 2020, SARS-CoV-2 IgG antibodies were measured using an FDA EUA rapid test assay using whole blood, and participants completed the Centers for Epidemiological Studies Depression Scale, the Loneliness Brief Form, the Perceived Stress Scale. History of COVID-19 vaccination was self-reported. Menstrual irregularities were compared by recruitment date (pre-pandemic vs. during pandemic/after April 2020) and by IgG antibody status. Logistic regression models tested if the presence of antibodies was associated with menstrual irregularities when controlling for age (in all models) and stress, depression, and loneliness in separate models. Results: Key variables are illustrated in Table 1. Menstrual irregularities did not differ by enrollment date. About half of women (n=36) had detectable IgG;5 had been vaccinated. Controlling for age, women with detectable IgG had 7.3, 95% CI [1.5, 36.5], times the odds of menstrual irregularities. Neither age, stress, nor mental health were associated with irregular menstruation. Among unvaccinated women (n=31), 35% with IgG antibodies had irregular menstruation compared to 0% without IgG antibodies. Among women with no plans to conceive, 74% had condomless intercourse, of whom 11% had irregular menstruation. Conclusion: Findings suggest a relationship between SARS-CoV-2 infection and irregular menstruation that was not accounted for by stress or mental health. During the COVID-19 pandemic, increased condom use and routine pregnancy testing may be merited among women not intending to conceive.

HIGH LEVEL of HIV VIRAL SUPPRESSION in UGANDAN MEN with URETHRITIS and BACTERIAL STI

Background: Historically, control of HIV infection in young men living with HIV (LWH) has been problematic. We examined the STI/HIV burden in young men with urethral discharge syndrome (UDS) in Kampala, Uganda. Methods: Between Oct 2019-Nov 2020, 250 men with UDS were enrolled at 6 urban sites. All HIV positive men (20%, 50/250) had plasma viral load testing (Abbott m2000 RealTime HIV-1);when VL>1000 copies/mL, resistance and recency testing (Asanté HIV-1 Rapid Recency Assay, Sedia Biosciences) were performed. Penile meatal swabs were retrospectively tested for gonorrhea, chlamydia, trichomoniasis, and Mycoplasma genitalium (Hologic Aptima CT/NG, TV, MG). Descriptive statistical analysis, logistic, and bivariable and multivariable regression were undertaken. Results: Among the men LWH, 92% (46/50) had VL<1000;4 were not suppressed, 1 of whom was previously undiagnosed. Among the viremic individuals, no major resistance mutations were found and none appeared recently infected. Men (median age 24[22;32]) reported sex partners/previous 2 months (median 2[1;2]), 61.6% engaged in transactional sex in the previous 6 months, and 48.4% reported alcohol use. 44.4% reported alcohol use before sex in the previous 6 months. Overall, 0.4% reported 'always' condom use, 21.8% continued condomless sex since onset of UDS symptoms. There was a high burden of active, undiagnosed STIs found in these men (see Table);of the 10% who had syphilis, 80% were previously undiagnosed. Agreement between HIV-and syphilis-POC and lab-based testing was 100% and 95% (19/20), respectively. By multivariable logistic regression, alcohol use (OR, 3.32 (95% CI:1.61, 7.11)), and condomless sexual activity since symptom onset (OR, 2.86 (95% CI:1.20, 6.84)) were significantly associated with HIV;92% had at least one other STI. Conclusion: Among men presenting with UDS, bacterial STIs were very common. 20% had HIV with a surprisingly high level of viral suppression and no evidence of resistance in those with detectable VL. Recency testing results were non-discriminatory;none appeared recently infected. Risk of future HIV acquisition is high in those not LWH. Given the high frequency of bacterial STI, alcohol use and unprotected high-risk sexual behavior in this population, men with UDS who test negative for HIV should be prioritized for PrEP. Future research, evaluating the effect of SARS-CoV-2 on the burden of STI and level of viral suppression in this population, is required.

The International Sexual Health And REproductive Health during COVID-19 (I-SHARE) Study: A Multicountry Analysis of Adults from 30 Countries Prior to and During the Initial Coronavirus Disease 2019 Wave.

BACKGROUND: There is limited evidence to date about changes to sexual and reproductive health (SRH) during the initial wave of coronavirus disease 2019 (COVID-19). To address this gap, our team organized a multicountry, cross-sectional online survey as part of a global consortium. METHODS: Consortium research teams conducted online surveys in 30 countries. Sampling methods included convenience, online panels, and population-representative. Primary outcomes included sexual behaviors, partner violence, and SRH service use, and we compared 3 months prior to and during policy measures to mitigate COVID-19. We conducted meta-analyses for primary outcomes and graded the certainty of the evidence. RESULTS: Among 4546 respondents with casual partners, condom use stayed the same for 3374 (74.4%), and 640 (14.1%) reported a decline. Fewer respondents reported physical or sexual partner violence during COVID-19 measures (1063 of 15 144, 7.0%) compared to before COVID-19 measures (1469 of 15 887, 9.3%). COVID-19 measures impeded access to condoms (933 of 10 790, 8.7%), contraceptives (610 of 8175, 7.5%), and human immunodeficiency virus/sexually transmitted infection (HIV/STI) testing (750 of 1965, 30.7%). Pooled estimates from meta-analysis indicate that during COVID-19 measures, 32.3% (95% confidence interval [CI], 23.9%-42.1%) of people needing HIV/STI testing had hindered access, 4.4% (95% CI, 3.4%-5.4%) experienced partner violence, and 5.8% (95% CI, 5.4%-8.2%) decreased casual partner condom use (moderate certainty of evidence for each outcome). Meta-analysis findings were robust in sensitivity analyses that examined country income level, sample size, and sampling strategy. CONCLUSIONS: Open science methods are feasible to organize research studies as part of emergency responses. The initial COVID-19 wave impacted SRH behaviors and access to services across diverse global settings.

Sex work and COVID-19 pandemic: Sexual and mental health of a sample of sex workers from Colombia

Introduction: In different countries, women sex workers have been stigmatized and discriminated against causing mental and sexual health problems in them. However, it is unknown how the pandemic and social distancing have impacted on their health. The objective of this descriptive research was to evaluate psychosocial factors, mental health, strategies for safe sexual practices, attitudes towards HIV and sexuality during the confinement period. Method: 98 female sex workers from three sectors of Bogota participated, who responded to psychometric scales on mental and sexual health. Results: More than 60% of the participants indicate feeling abandonment of the state, low clientele and little or no economic income;emotional involvement, a tendency to present negative attitudes towards sexuality, positive attitudes towards condom use, HIV testing and a high tendency to use persuasion strategies when the client refuses to use protection. Conclusions: Mental and sexual health problems continue and intensify in pandemic for sex workers in Colombia, which continues to be a national challenge that requires efficient and effective intervention from the economic and psychosocial aspects. (PsycInfo Database Record (c) 2022 APA, all rights reserved) (Spanish) Introduccion: En diversos paises las mujeres trabajadoras sexuales han sido estigmatizadas y discriminadas, lo que causa en ellas problemas de salud mental y sexual. No obstante, se desconoce como la pandemia por COVID-19 y el distanciamiento social han impactado en su salud. El objetivo de la presente investigacion, de tipo descriptivo, fue evaluar factores psicosociales, la salud mental, las estrategias para practicas sexuales con proteccion, las actitudes hacia el VIH y la sexualidad durante el periodo de confinamiento. Metodo: Participaron 98 mujeres trabajadoras sexuales de tres sectores de la Bogota, quienes respondieron a escalas psicometricas en salud mental y sexual. Resultados: Mas del 60 % de las participantes indican sentir abandono estatal, baja clientela y poco o ningun ingreso economico;afectacion emocional, una tendencia a presentar actitudes negativas frente a la sexualidad, actitudes favorables hacia el uso del condon, las pruebas de deteccion del VIH y una alta tendencia a emplear estrategias de persuasion cuando el cliente se niega a usar proteccion. Conclusiones: Las problematicas en salud mental y sexual se mantienen e intensifican en pandemia para las trabajadoras sexuales en Colombia, lo cual sigue siendo un reto a escala nacional que requiere una intervencion eficaz y efectiva desde lo economico y psicosocial. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Sex work and COVID-19 pandemic: Sexual and mental health of a sample of sex wor- kers from Colombia

Introduction: In different countries, women sex workers have been stigmatized and discriminated against causing mental and sexual health problems in them. However, it is unknown how the pandemic and social distancing have impacted on their health. The objective of this descriptive research was to evaluate psychosocial factors, mental health, strategies for safe sexual practices, attitudes towards HIV and sexuality during the confinement period. Method: 98 female sex workers from three sectors of Bogota participated, who responded to psychometric scales on mental and sexual health. Results: More than 60% of the participants indicate feeling abandonment of the state, low clientele and little or no economic income;emotional involvement, a tendency to present negative attitudes towards sexuality, positive attitudes towards condom use, HIV testing and a high tendency to use persuasion strategies when the client refuses to use protection. Conclusions: Mental and sexual health problems continue and intensify in pandemic for sex workers in Colombia, which continues to be a national challenge that requires efficient and effective intervention from the economic and psychosocial aspects. (c) 2021 Fundacion Universitaria Konrad Lorenz. Este es un articulo Open Access bajo la licencia CC BY-NC-ND (http://creativecommons.org/licenses/by-nc-nd/4.0/).