261   Increases in STDs among Men Who Have Sex with Men (MSM) and in Risk Behavior among HIV-Positive MSM in Amsterdam, Possibly Related to HAART-Induced Immunologic and Virologic Improvements.

I. G. Stolte¹, N. H. T. M. Dukers¹, J. B. F. de Wit², J. S. A. Fennema¹, J. Goudsmit³, and R. A. Coutinho*¹.
¹Municipal Hlth. Service, Amsterdam;²Univ. of Utrecht; and³Academic Med. Ctr., Univ. of Amsterdam, The Netherlands.

Background:Recently, several industrialized countries reported an increase in gonorrhea (GO), syphilis (SY) and risk behavior (RB) among men who have sex with men (MSM), possibly related to the availability of HAART (1996). We examined 1) trends in rectal GO and SY among MSM visiting the Amsterdam STD clinic (Am-STD) and 2) RB among HIV-1-positive MSM participating in the Amsterdam Cohort Study (ACS).

Methods:1) 85,470 visits were reported at the Am-STD (1994—99); 11,240 visits were by MSM. Standardized information was collected at each visit and analyzed by calendar year; risk factors for GO and SY were determined using logistic regression. 2) Longitudinal data about RB while receiving HAART were available on 84 HIV-1-positive MSM in the ACS.

Results:1) Among MSM, absolute numbers (#) of rectal GO increased from 56 in '94 to 83 in '98 and then doubled to 167 in '99. The infection rate of rectal GO increased from 4.0% in '94 to 6.8% in '99; absolute # of infectious SY increased from 6 in '94, to 9 in '98 and then increased to 35 in '99. The infection rate of SY increased from 0.4% in '94 to 1.4% in '99. These increasing trends continued in 2000. Risk factors for rectal GO (younger age, co-infection with another STD, Western nationality) did not change over time. For SY, having a non-Western nationality was a strong risk factor before 1996 (OR 16.48, p < 0.01), but after 1996 the OR decreased to 2.15 (p < 0.05). 2) Among HIV-1-positive men, a short and temporary increase in the practice of unprotected sex with casual partners was observed after the HIV-1 RNA became undetectable and CD4 counts increased with use of HAART.

Conclusions:Strong increases were seen in rectal GO and SY among MSM; the latter seems to have become (again) endemic in this group. HAART-induced immunologic and virologic improvements in HIV-1-positive MSM result in increased RB with casual partners. An explanation for the rise in rectal GO and SY among MSM could be a relapse into RB possibly associated with the introduction of HAART. Innovative prevention activities among MSM are necessary to turn this tide.