ED Drugs Associated with Sexual Risk Behaviors and STIs in HIV+ Men

PHILADELPHIA, PA—Use of prescription erectile dysfunction (ED) medication was significantly associated with sexual risk behavior in HIV-positive men, according to data presented at IDWeek 2014 by Greer Burkholder, MD, of the Infectious Diseases Department, University of Alabama at Birmingham.

Previous studies have found that recreational use of ED medication is associated with sexual risk behaviors and sexually transmitted infections (STIs). Dr. Burkholder and colleagues conducted a retrospective cross-sectional study to investigate the relationship between prescription ED medication use, sexual risk behaviors, and STI screening HIV-positive men. Patients were included if male, ≥19 years old, in care for >1 year, with at least 2 visits ≥90 days apart within the last year. 

Of 1,170 HIV-positive study subjects, 269 (23%) were prescribed ED medication. The mean age was 50, 27% were heterosexual and 73% were men who have sex with men (MSM), and 41% were African-American. ED medication prescription was similar for heterosexual men (26%) and MSM (22%). 

Among men on ED medications, 77% reported multiple partners, 40% reported sex without condom use, and 32% reported sex after alcohol/drug use. 

Variables significantly associated with ED medication prescription by multivariate analysis included: age ≥50 years (Prevalence Ratio [PR] 1.46; 95% Cl 1.18–1.82, P<0.001), current substance abuse (PR 1.55, 95% CI 1.10–2.19, P<0.03), self report of ≥1 sexual risk behaviors (PR 1.95, 95% CI 1.51–2.52, P<0.001), and prior STI (PR 1.35, 95% CI 1.08–1.68, P<0.03). Sexual orientation, race, insurance status, and viral load were not significant.  

Annual protocol-driven syphilis testing was done in 94% of men on ED medication, and 4% were positive for a new infection. Annual testing for Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) infections were only performed in 31% of heterosexual men, and 28% of MSM (3 GC-positive and 1 CT-positive).

 “Screening for GC and CT needs to be increased, particularly among MSM,” suggested Dr. Burkholder, and added that “prescription of ED medication to HIV-positive men should be accompanied by assessment and counselling regarding sexual risk behaviours and illicit drug use.” 

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