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BACKGROUND: The advent of new HIV therapies, better access to medications, and education about the importance of adhering to treatment has helped transform HIV infection into a “chronic disease” and may prompt reduced concern about HIV and sexual risk. Individuals who are infected with a sexually transmitted infection (STI) are two to five times more likely than uninfected individuals to acquire HIV if they are exposed to the virus through sexual contact. To reduce HIV/AIDS impact in Nebraska we identified persons living with HIV/AIDS (PLWHA) who are at increased risk for having ever been diagnosed with a STI. Nebraska maintains separate databases for HIV and STI surveillance activities making it difficult to identify highly affected PLWHA populations.
METHODS: Demographic and laboratory information was extracted from Enhanced HIV/AIDS Reporting System (eHARS) for HIV infected persons diagnosed in Nebraska between January 1, 2003 and December 31, 2012. Demographic and laboratory information was extracted from the Sexually Transmitted Diseases Management Information System (STDMIS) for persons infected with chlamydia, gonorrhea, and syphilis diagnosed in Nebraska between January 1, 2003 and December 31, 2012. Each record in eHARS was compared to each record in STDMIS by name, date of birth, and gender to identify PLWHAs who had and had not ever been diagnosed with an STI. A logistic regression model controlled for age, race, gender, HIV transmission category, and geographic location (rural vs urban), using “ever had an STI” as the outcome variable. SAS was used to analyze all data.
RESULTS: Of 1,076 cases, results overall are as follows respectively for each category: (Age 13–24 [odds: 2.35, CI: 1.41, 3.92], 25–34 [odds: 1.74, CI: 1.21, 2.49], 45–64 [odds: 0.44, CI: 0.29, 0.68]); race/ethnicity (Black [odds: 1.64, CI: 0.29, 0.92], Hispanic [odds: 0.51, CI: 0.29, 0.92]); geographic location (Urban [odds: 2.70, CI:1.75, 4.18); HIV transmission category (Male no identified risk [odds: 0.24, CI: 0.11, 0.52], Female injecting drug use [odds: 5.03, CI: 1.54, 16.47]).
CONCLUSIONS: Linking HIV/AIDS and STI data helps identify PLWHA who are at increased risk for STIs. PLWHA whom have ever been diagnosed with an STI indicate unabated risk behavior. Our results indicate that age, race, geographic location, and HIV transmission mode were associated with an increased risk for STIs among PLWHA. The Nebraska STI and HIV programs should continue to improve access to clinical services, promote early and effective treatment, and reach highly affected populations with prevention messages with emphasis on marginalized and underserved populations.