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Sex Transm Infect. 2019 Aug 23. pii: sextrans-2019-054049. doi: 10.1136/sextrans-2019-054049. [Epub ahead of print]

Alcohol and drug use, partner PrEP use and STI prevalence among people with HIV.

Author information

Weill Institute for Neurosciences, Department of Psychiatry, University of California, San Francisco, California, USA
Kaiser Permanente Division of Research, Oakland, California, USA.
Department of Population Medicine, Harvard Medical School, Boston, Massachusetts, USA.
Department of Adult and Family Medicine, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA.
Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA.
Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
Weill Institute for Neurosciences, Department of Psychiatry, University of California, San Francisco, California, USA.
Contributed equally



People with HIV (PWH) have a high burden of bacterial sexually transmitted infections (STIs). We examined the relationship of alcohol and drug use and partner pre-exposure prophylaxis (PrEP) use to STI prevalence in a cohort of PWH with a history of unhealthy alcohol use.


We analysed data from a primary care-based alcohol intervention study at Kaiser Permanente Northern California (KPNC). Participants were recruited between April 2013 and May 2015 and were followed for up to 24 months. We linked participant responses to questions from the 24 month follow-up interview, including alcohol and drug use and partner PrEP use, with STI test results (ie, syphilis, chlamydia, gonorrhoea) in the KPNC electronic health record. Prevalence ratios (PR) were estimated using Poisson models fitted with robust variance estimators to evaluate the association of substance use and partner use of PrEP with STIs.


In the analytic sample (n=465), the median age was 52 years (IQR 45-59); 67% were white; 95% were men who have sex with men. Thirty-two per cent of participants had HIV-positive partners only; 31% had HIV-negative partners with at least one on PrEP in the previous year and 37% had HIV-negative partners without any on PrEP. Twenty-three per cent reported alcohol and drug use prior to sex in the last 6 months. Eight per cent of participants had an STI. Partner PrEP use (adjusted PR (aPR) 2.99 (95% CI 1.11 to 8.08)) was independently associated with higher STI prevalence. Participants who reported use of alcohol (aPR 1.53 (0.61 to 3.83)), drugs (aPR 1.97 (0.71 to 5.51)) or both (aPR 1.93 (0.75 to 4.97)) prior to sex had a higher STI prevalence.


The higher prevalence of STIs among PWH with unhealthy alcohol use who have partners on PrEP suggests that this subgroup may be a high-yield focus for targeted outreach, STI screening and sexual health counselling.



Conflict of interest statement

Competing interests: JM has received research grant support from Merck and has consulted on a research grant to Kaiser Permanente Northern California from Gilead Sciences. All other authors have no conflicts of interest to disclose.

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