Laura Waters

This oral poster session covered integrating sexual & reproductive health (SRH) services in HIV prevention/care. STI rates were presented in PrEP-using MSM & TGW and in female sex workers. Two abstracts covered safer peri-conception interventions & finally a qualitative analysis flagged issues related to risk perception in PrEP using women.

STI prevalence was high in >1000 German MSM, most frequently mycoplasma genitalium (19%) with no difference between PrEP & non-PrEP users. Longitudinal data in 744 MSM/TGW Chicago PrEP users showed no significant relationship between PrEP and rectal STI. A cross-sectional study of 385 female sex workers (FSW) in Russia showed high prevalence of STI (43%) & HIV (3.1%). Reported physical/sexual violence was frequent; authors called for improved access SRH, adapted to FSW needs. A safer conception package delivered to 692 people with HIV (454 female) exceeded 90:90:90 in women, 70% unsuppressed people achieved viral suppression & all tested infants (68/71) were HIV-negative. The ZINK study evaluated TDF/FTC oral PrEP in 203 women planning pregnancy: 97% didn’t know their partner’s HIV status, 64% started PrEP but only 38% had protective month 3 blood tenofovir levels. A qualitative sub-study of HPTN052 PrEP trial showed being ‘in love’ was associated with risk underestimation.

Mycoplasma genitalium testing isn’t routine in many settings, particularly in MSM, but higher prevalence than gonorrhoea or chlamydia in German MSM warrants more research. Although PrEP use has been associated with higher STI rates in several trials/cohorts, this is not universal; regardless, HIV fear should not be a STI prevention tool. Safer conception interventions can improve HIV cascades and reduce PMTCT but PrEP adherence in this context was low with many women not achieving protective drug levels; this may be driven partly by young women’s underestimation of risk – supported self risk assessment is a crucial part of PREP counselling.

Ana Cristina Garcia Ferreira

Integration is one of the most important goals of HIV prevention. The session presented different important aspects in sexual and reproductive health, focusing on HIV and STI prevalence and prevention and safer conception strategies, supporting the importance of improving SRH HIV integration to progress towards 90-90-90 targets.

Presenters showed important aspects of sexual and reproductive health, embracing the WHO goal to leave no one behind. Khoza evaluated parameters of risk perception among young women in South Africa and how they differed from those used in HIV prevention messaging, emphasizing the importance of improving comprehension of their risk behavior. Matthews and Davies presented successful strategies of safe conception services, including HIV and STI testing, counseling, PrEP and HIV treatment to women and men with reproductive desire, thrilling a resolutive pathway against vertical transmission and contributing to enhancing the 90-90-90 cascade. Wisse observed higher prevalence and different vulnerabilities in female outdoor sex workers in Moscow and highlighted the need to improve access to prevention. Morgan and Streeck discussed the impact of PrEP in STI prevalence and incidence, with a high frequency of asymptomatic infections and no significant association between PrEP and STI diagnosis, even in baseline or longitudinal evaluation.

This session covered different aspects and characters involved in reproductive and sexual health, with high-quality studies and inspiring strategies in integrating and improving reproductive and sexual health. There were important messages and lessons, including the need to unveil the risk perception in different populations and make them protagonists of their sexual and reproductive health, expand safer conception clinics and policies, improve counseling and provide harm reduction to specific key populations and ultimately advocate for increasing efforts to achieve SRH inclusion in social, clinical and political level.