"The theme of this year's conference is transcending barriers and creating opportunities," said Cornelis (Kees) Rietmeijer, MD, PhD, at the opening plenary session of the Centers for Disease Control and Prevention 2016 STD Prevention Conference on September 20, 2016 in Atlanta, Georgia.
"One of the big barriers, one of the big challenges … is how to integrate high-impact HIV prevention with the delivery of high-quality STD services. … STD programs in clinics play a very important role in HIV prevention. They diagnose a disproportionate number of HIV-infected persons and link them to HIV care, and they identify those who are at highest risk for HIV infection and would benefit from PEP (post-exposure prophylaxis) and PrEP (pre-exposure prophylaxis)," added Dr. Rietmeijer, professor of community and behavioral health at the Colorado School of Public Health Public Health, Aurora.
New prevention and treatment models are needed worldwide, he said, highlighting the Dean Street Express Clinic in London, England, as a successful high-volume mainly self-service STI-testing clinic that has caught international attention, where clients receive their results through text messaging, usually on the same day. He introduced Dr. Sheena McCormack, MBBS, MSc, FRCP, Dip Ven, of the University College London, Chelsea and Westminster Hospital in London, England, who helped develop and works with the clinic and who gave the Ward Cates Memorial Lecture, "PrEPortunity for STD Control."
"We can transcend barriers. There are really big opportunities at the moment and we need to grab them and take advantage of them," said Dr. McCormack, a clinical epidemiologist who has been coordinating HIV prevention trials since 1994 and has been involved in HIV prevention in Europe and Africa. She was the lead scientist on the PROUD PrEP study in the United Kingdom, which found that daily PrEP was very effective in gay and other men who have sex with men (MSM).
"We've been seeing lots of gonorrhea over the last 5 years and lots of other bacterial STIs in MSM as well. Between 2013 and 2014, chlamydia went up by 26%, gonorrhea by 32% and syphilis by 46%, and we're seeing these figures universally. There has been a change in drugs used around sex. … With them, sex can go on for a long time, and that facilitates the transmission of hepatitis C, lymphogranuloma venereum (LGV), as well as all the other infections."
"In Grindr (grindr.com) and other social apps for gay men and others wanting sex—whatever kind of sex you want, there will be an app for you out there somewhere—you find parties that facilitate condomless sex. In South London, about a third of people who attend these parties only use condoms the whole time, so there is very little risk of transmission there; a third of people are exclusively having sex with HIV-positive concordant partners, so there's no risk of transmission of HIV there; but there is risk of other infections."
"As always with sexual behavior, it's diverse, and that's what makes our jobs interesting," she added.
Who is most at risk of HIV? In the PROUD PrEP study conducted in 13 clinics in the UK, Dr. McCormack and her colleagues found a surprisingly high rate—9% per year—of HIV in patients who were not taking PrEP, even though they had PEP, condom promotion, motivational interviewing, and STI diagnosis and treatment.
"PrEP has had a profound effect on a substantive population of men: an 86% reduction rate in HIV," she said.