Unmet HIV and STI Prevention Needs and Limited Linkage to Care Among Gay, Bisexual, and Other Men Who Have Sex with Men in Southern Spain: A Community-Based Intervention Study.

Abstract

To evaluate the proportion of gay, bisexual, and other men who have sex with men (GBMSM) with ongoing high-risk sexual practices not engaged in care, and to assess linkage to and retention in care following a community-based intervention. A two-phase study was conducted (January-June 2023) in a sex-on-premises venue in Spain. Community-based screening for HIV and hepatitis C virus (HCV) was offered, followed by a fast-track referral intervention. Individuals with reactive results were linked to specialized care. Individuals with negative results not engaged in care were referred to pre-exposure prophylaxis or sexually transmitted infections (STI) screening programs. Outcomes: (i) Primary: proportion of participants requiring care who were not engaged in routine sexual health services; (ii) Secondary: linkage to and retention in care at 6 months. Of 614 individuals invited, 405 (66%) participated. At baseline, 226 participants (56%) were not engaged in HIV or PrEP follow-up. One (0.3%) previously undiagnosed HIV infection was identified. One (0.2%) HCV infection was detected. Among 165 HIV-negative GBMSM residing in Andalusia who were not engaged in care, 148 (89.7%) were either not linked to sexual health services or not retained in PrEP care, including 63 (42.6%) who fulfilled PrEP criteria. In conclusion, a substantial proportion of GBMSM with ongoing high-risk sexual practices were not engaged in sexual health services. While few HIV and HCV infections were identified, linkage to and retention in PrEP and STI prevention services were limited, with losses before or shortly after first contact, underscoring persistent gaps in the prevention cascade among GBMSM.