Frequency of lab HIV and self-reported STI history and its predictors among a sexually compulsive clinical sample: a cross-sectional study.

Abstract

Background and aims: Individuals with compulsive sexual behavior (CSB) are at increased risk for sexually transmitted infections (STI) and Human Immunodeficiency Virus (HIV).

Aim: To investigate the frequency of STIs and HIV in a CSB clinical sample and the associated predictors.

Methods: A cross-sectional study was conducted between 2012 and 2021 in a specialized outpatient clinic at a large tertiary hospital in São Paulo, Brazil. We disclosed the study through noticeboards in the institution and advertisements on the official website and social media. Participants underwent a psychiatric interview to assess CSB and exclusion criteria. Individuals who sought treatment for difficulty in controlling sexual impulses and got confirmation of a CSB diagnosis were included. Those who did not were included as controls. Healthy volunteers who sought to participate as controls and did not confirm CSB diagnosis were also included. Comprehensive laboratory tests were requested. We investigated sexual compulsivity, impulsivity, patterns of CSB, condomless anal and vaginal sex and sex under the influence of alcohol/drugs, self-reported STI diagnoses or history, and screening tests. Logistic regression analysis was used.

Outcomes: Laboratory results of HIV tests and self-reported STI diagnoses or history.

Results: A total of 275 participants (67.5%) met the criteria for CSB, and 132 (32.5%) were eligible as controls. The frequency of HIV in tested participants was 10.8% (n = 23) in the CSB group and 2.4% (n = 2) among controls. Regarding self-reported STI diagnoses or history, 43.9% of CSB outpatients and 17.8% of the control group reported it [χ² ₍₁₎ = 25.58, P < .001]. The HIV-positive test was associated with self-identifying as gay or bisexual [OR 31.58, 95% CI 4.09-243.72, P < .05] and sex under the influence of drugs [OR 6.49, 95% CI 1.10-38.35] in the final multivariate analysis model, adjusted for other variables. Sexual compulsivity [OR 1.03, 95% CI 1.00-1.07, P < .05], excessive casual sex [OR 1.84, 95% CI 1.07-3.17, P < .05], and self-identifying as of African descent [OR 0.50, 95% CI 0.29-0.88, P < .05] behave as predictors of self-reported STI.

Clinical implications: We suggest incorporating frequent and periodic screening tests for HIV/STI in the management protocols of CSB patients, considering the potential morbidity and social burden of STI.

Strengths and limitations: To our knowledge, this is the first study investigating the frequency of HIV in a sexually compulsive clinical sample using laboratory tests, including women and participants of diverse sexual orientations. However, the prolonged data collection time was a limitation and many outpatient CSB participants commonly avoided taking exams and even left before this step. Because many tests for non-HIV were missing, self-reported history data of STI were preferred. Sensitivity analyses suggest that sexual orientation may have a modifying effect on the relationship between other predictors and HIV, which should be explored in further studies.

Conclusions: the current study shows distinct predictors for HIV and STI considering the CSB clinical sample, pointing out specific clinical care and prevention.