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BACKGROUND: Little is known about the differences between people living with HIV/AIDS (PLWHA) in Washington State (WA) who have and have not been diagnosed with a sexually transmitted disease (STD) following their HIV/AIDS diagnosis. An STD may be indicative of high-risk sexual activity among PLWHA and therefore an increased likelihood of transmitting HIV. The purpose of this analysis was to describe the population of PLWHA in WA who were subsequently diagnosed with an STD and to determine how this co-infected population differs from the HIV mono-infected population.
METHODS: Patient demographics, risk information, health, and care status were collected for all PLWHA in WA as of December 31, 2012 from WA HIV surveillance (eHARS) and Ryan White services systems. STD case information for chlamydia (CT), gonorrhea (GC), and primary and secondary (P&S) syphilis cases reported in 2013 and 2014 was extracted from the WA STD reporting system and matched to PLWHA in WA as of December 31, 2012. Of those diagnosed with an STD during the selected period, STD cases were excluded if their HIV and STD diagnoses were considered concurrent. Strata were defined by those who had and had not been diagnosed with an STD in 2013 or 2014. Statistical significance was calculated using chi-square tests and odds ratios.
RESULTS: Of the 11,910 PLWHA in WA as of December 31, 2012, 7.6% were diagnosed with one or more STDs in 2013 or 2014. Among the co-infected population, 60.7% were diagnosed with CT at least once, 57.8% with GC at least once, and 17.7% with P&S syphilis at least once. PLWHA in care in WA as of December 31, 2012 were 1.81 times more likely to be diagnosed with an STD in 2013-2014 than those not in care (95% CI: 1.50-2.20). PLWHA receiving state funded Ryan White Services (EIP) were 1.50 times more likely to be diagnosed with an STD in 2013-2014 than those who were not EIP clients (95% CI: 1.30-1.73). Fewer PLWHA diagnosed with an STD in 2013-2014 had a suppressed viral load (under 200 copies/mL) than those without an STD diagnosis with an STD (74.2% versus 85.2%, p<.0001).
CONCLUSIONS: High-risk sexual activity continues to occur in a moderate portion of PLWHA in WA. Future interventions should seek to target PLWHA who are enrolled in EIP and who are not virally suppressed.