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Guerras JM, Hoyos J, Donat M, de la Fuente L, Palma Díaz D, Ayerdi O, García-Pérez JN, García de Olalla P, Belza MJ. Sexualized drug use among men who have sex with men in Madrid and Barcelona: The gateway to new drug use? Front Public Health 2022; 10:997730. [PMID: 36457321 PMCID: PMC9705339 DOI: 10.3389/fpubh.2022.997730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/25/2022] [Indexed: 11/17/2022] Open
Abstract
This original study compares the prevalences of drug use for any purpose and for sexualized drug use (SDU) among MSM. It also describes relevant characteristics of first SDU, analyzes to what extent SDU has been the first experience (the gateway) with different drugs by age and explores the correlates of SDU. Study participants included 2,919 HIV-negative MSM attending four HIV/STI diagnosis services in Madrid and Barcelona. They answered an online, self-administered questionnaire. Poisson regression models with robust variance were used. About 81.4% had ever used any drug, and 71.9% had done so in the last-12-months, while 56% had ever engaged in SDU, and 50% had done so in the last-12-months. Participants under 25 years old had the lowest prevalences of SDU, and the 25-39 age group the highest, except for Viagra, which was higher among those over age 40. The most frequently used drugs for first SDU were poppers (53.6%), cannabis (19.6%) and Viagra (12.2%). These drugs were also the most ever consumed for SDU. Among sexualized users, methamphetamine (78.3%) and Mephedrone (75.4%) were used always/most of the times for sex in the last-12-months. Around 72.2% of Mephedrone sexualized users and 69.6% of Methamphetamine vs 23.1% of ecstasy users' first consumption of these drugs involved use for sex. These drugs were provided to them free where they have sex for 66.8, 79.1, and 31.9%, respectively. On that occasion, 8.1% of Mephedrone, 6.8% of Methamphetamine and 18.4% of ecstasy users had sex only with steady partner; with 50.2, 56.2, and 26.2% respectively using a condom with any partner. SDU in the first use was associated with similar variables for recreational and chemsex drugs. The highest prevalence ratios were for having ever been penetrated by >20 men and having ever injected drugs. It can be concluded that the prevalence of SDU was more than half of the prevalence for any purpose. Thus SDU was the gateway to use for many drugs in an important proportion of users, who frequently consumed drugs that were free and had condomless anal sex with occasional and multiple partners. These circumstances were much more common for chemsex than for recreational drugs.
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Affiliation(s)
- Juan-Miguel Guerras
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, Spain,CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain
| | - Juan Hoyos
- Independent Researcher, Madrid, Spain,*Correspondence: Juan Hoyos
| | - Marta Donat
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, Spain,CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain
| | - Luis de la Fuente
- CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain,Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - David Palma Díaz
- CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain,Servicio de Epidemiología, Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - Oskar Ayerdi
- Centro Sanitario Sandoval, Instituto de Investigación Sanitaria San Carlos, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Patricia García de Olalla
- CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain,Servicio de Epidemiología, Agència de Salut Pública de Barcelona, Barcelona, Spain,Institut d'Investigació Biomèdica Sant Pau, Hospital Universitari Sant Pau, Barcelona, Spain
| | - María-José Belza
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, Spain,CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain
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102
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Nagington M, King S. Support, care and peer support for gay and bi men engaging in chemsex. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e6396-e6403. [PMID: 36256495 PMCID: PMC10092040 DOI: 10.1111/hsc.14081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 06/29/2022] [Accepted: 10/01/2022] [Indexed: 06/16/2023]
Abstract
The objective of this research was to explore how gay men use drugs in their sex lives, colloquially called "chemsex". This paper reports on a sub-theme within the research about support, care and peer support. Longitudinal interviews were conducted with 20 gay and bi men between April 2017 and July 2019. Participants were recruited via geolocated dating apps (n = 17) and snowball sampling (n = 3). The main findings of this research are that medicalised forms of support for gay and bi men engaging in chemsex are often tardy in their responses to need, and whilst helpful for cessation of drug use, fail to address the holistic needs of the participants. A wide variety of peer support was practiced amongst the sample which often echoed previous forms of peer support practiced in the LGBT+ community. It was offered by both people who engaged in chemsex and those who did not and was highly beneficial to people who experienced problems with chemsex. However, peer support was also limited by factors such as shame and the instability of those offering support. In conclusion, we suggest that medicalised forms of chemsex support could benefit from more rigorous and rapid forms of assessment for problematic chemsex, and also provide infrastructure and training to peer support initiatives. We also suggest that medical services could learn from patients and their peers about what support needs remain unaddressed by professional services, and engage in collaborative approaches to practice development.
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103
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Eger WH, Altice FL, Lee J, Vlahov D, Khati A, Osborne S, Wickersham JA, Bohonnon T, Powell L, Shrestha R. Using nominal group technique to identify barriers and facilitators to preventing HIV using combination same-day pre-exposure prophylaxis and medications for opioid use disorder. Harm Reduct J 2022; 19:120. [PMID: 36307817 PMCID: PMC9616614 DOI: 10.1186/s12954-022-00703-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 10/20/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Preventing HIV transmission among people who inject drugs (PWID) is a key element of the US Ending the HIV Epidemic strategy and includes both pre-exposure prophylaxis (PrEP) and medications for opioid use disorder (MOUD). While both lead to decreases in HIV transmission, MOUD has other social and health benefits; meanwhile, PrEP has additional HIV prevention advantages from sexual risk and the injection of stimulants. However, these medications are often prescribed in different settings and require multiple visits before initiation. Strategies to integrate these services (i.e., co-prescription) and offer same-day prescriptions may reduce demands on patients who could benefit from them. METHODS Nominal group technique, a consensus method that rapidly generates and ranks responses, was used to ascertain barriers and solutions for same-day delivery of PrEP and MOUD as an integrated approach among PWID (n = 14) and clinical (n = 9) stakeholders. The qualitative portion of the discussion generated themes for analysis, and the ranks of the proposed barriers and solutions to the program are presented. RESULTS The top three barriers among PWID to getting a same-day prescription for both PrEP and MOUD were (1) instability of insurance (e.g., insurance lapses); (2) access to a local prescriber; and (3) client-level implementation factors, such as lack of personal motivation. Among clinical stakeholders, the three greatest challenges were (1) time constraints on providers; (2) logistics (e.g., coordination between providers and labs); and (3) availability of providers who can prescribe both medications. Potential solutions identified by both stakeholders included pharmacy delivery of the medications, coordinated care between providers and health care systems (e.g., case management), and efficiencies in clinical care (e.g., clinical checklists), among others. CONCLUSIONS Implementing and sustaining a combined PrEP and MOUD strategy will require co-training providers on both medications while creating efficiencies in systems of care and innovations that encourage and retain PWID in care. Pilot testing the co-prescribing of PrEP and MOUD with quality performance improvement is a step toward new practice models.
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Affiliation(s)
- William H Eger
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
| | - Frederick L Altice
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
| | - Jessica Lee
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
| | | | - Antoine Khati
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | - Sydney Osborne
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | - Jeffrey A Wickersham
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
| | - Terry Bohonnon
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
| | | | - Roman Shrestha
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA.
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA.
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, 358 Mansfield Rd, Unit 1101, Storrs, CT, 06269, USA.
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Pérez-González A, Represa M, Coll P, Potel C, Rodríguez-Rivero S, Flores EV, Vázquez-Estévez C, Ocampo A, Pousada G, Poveda E. Real-life cohort experience after implementing HIV pre-exposure prophylaxis for one year in northwest Spain. Front Public Health 2022; 10:1005622. [PMID: 36388349 PMCID: PMC9650222 DOI: 10.3389/fpubh.2022.1005622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/10/2022] [Indexed: 01/27/2023] Open
Abstract
Introduction Pre-exposure prophylaxis (PrEP) has become a useful tool to reduce the transmission of human immunodeficiency virus (HIV) in key populations. In this article we assessed the effectiveness, safety, adherence, sexually transmitted infections (STIs) dynamics, and frequency of anal dysplasia among a real-life cohort of PrEP users in Northwest Spain. Methods A retrospective cohort study was undertaken in the Alvaro-Cunqueiro Hospital, Vigo which included every individual who started daily emtricitabine/tenofovir-disoproxil-fumarate (FTC/TDF) between November-2019 and October-2021. Clinical and epidemiological data were obtained from the patient's medical records. The effectiveness and safety of FTC/TDF were assessed by HIV serology and renal function monitoring every 3 months. Anal, urethral, and oropharyngeal exudates were collected quarterly after the baseline visit. Results A total of 126 individuals were considered eligible, most of the participants had previously been diagnosed with a STI (60.3%), 22% had consumed recreational drugs in the year prior, and 13% had engaged in chemsex. At the end of the follow-up, no cases of HIV infection were detected; 3 patients had discontinued FTC/TDF because of side effects but none of them had presented renal toxicity. In addition, the diagnosis of STIs during the follow-up was common (100 cases in 54 patients). Moreover, engagement in chemsex was more common within this latter group (22 vs. 6%, p = 0.013). Among the study population included in the anal screening programme, the frequency of dysplasia was 9%. Conclusions FTC/TDF was effective, safe, and tolerable in a real-life cohort; adherence remained high throughout the study period (79%). However, a high number of STIs were diagnosed, especially among patients who engaged in chemsex.
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Affiliation(s)
- Alexandre Pérez-González
- Group of Virology and Pathogenesis, Galicia Sur Health Research Institute (IIS Galicia Sur), Complexo Hospitalario Universitario de Vigo, SERGAS-UVigo, Vigo, Spain
- Infectious Diseases Unit, Internal Medicine Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Marta Represa
- Infectious Diseases Unit, Internal Medicine Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Pep Coll
- IrsiCaixa AIDS Research Institute, Barcelona, Spain
- Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Carmen Potel
- Microbiology Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Silvia Rodríguez-Rivero
- Anal Dysplasia Unit, General Surgery Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Erene V. Flores
- Anal Dysplasia Unit, General Surgery Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Claudia Vázquez-Estévez
- Infectious Diseases Group, Galicia Sur Health Research Institute (IIS Galicia Sur), Vigo, Spain
| | - Antonio Ocampo
- Infectious Diseases Unit, Internal Medicine Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Guillermo Pousada
- Infectious Diseases Group, Galicia Sur Health Research Institute (IIS Galicia Sur), Vigo, Spain
| | - Eva Poveda
- Group of Virology and Pathogenesis, Galicia Sur Health Research Institute (IIS Galicia Sur), Complexo Hospitalario Universitario de Vigo, SERGAS-UVigo, Vigo, Spain
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105
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Duracinsky M, Dimi S, Carrieri MP, Yaya I, Villes V, Valin N, Farfour E, Chassany O, Zucman D. Risk Prediction Score for Screening Asymptomatic Sexually Transmitted Infections in HIV-positive French Men Who Have Sex with Men (ANRS 9520 DRIVER). Am J Health Behav 2022; 46:558-566. [PMID: 36333826 DOI: 10.5993/ajhb.46.5.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Asymptomatic sexually transmitted infections (STI) are frequent among men who have sex with men (MSM). Identifying asymptomatic STIs is a crucial issue, not only for secondary but also for primary prevention, as early treatment can reduce transmission risk. We aimed to develop a self-reported predictive score for early identification of asymptomatic STIs. METHODS Participants provided clinical data and completed a self-administered questionnaire including sociodemographic variables and behaviors during the 6 previous months. We used multivariable logistic regression to identify factors associated with asymptomatic STIs. We calculated the accuracy of the model by the non-parametric area (AUC) under the receiver-operating-characteristic (ROC) curve to find the optimal discriminant threshold for screening. RESULTS A total of 781 HIV-positive MSM were included with a mean age of 46.8 years. Asymptomatic STI prevalence was 13.2%. Detectable plasma HIV RNA (adjusted odds ratio (aOR [95% CI): 2.54 [1.23;5.25]), inconsistent condom use during anal sex (2.20 [1.36;3.56]), group sex (2.00 [1.15;3.45]), during or-genital practices (1.83 [1.12;3.01]), not being in stable relationship (1.70 [1.01;2.66] and an item from a sensation-seeking behavioral scale "I don't like watching porn videos" (1.61 [1.01;2.59] were associated with asymptomatic STI. AUC was 0.7 and with optimal threshold of 0.1082 for this model; sensitivity was 80.4%. Self-reported asymptomatic STI predictive score was built with this threshold according to the 6 factors in the final model. CONCLUSIONS As this predictive score is not designed to be diagnostic, but to provide indications for diagnostic tests, its ease of administration and sensitivity remain the most important features. Its use in clinical practice for early detection of asymptomatic STIs potentially can reinforce STI primary and secondary prevention.
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Affiliation(s)
- Martin Duracinsky
- Unité de Recherche Clinique en Economie de la Sant?? (URC-ECO), Hôpital Hôtel-Dieu, AP-HP, Paris, France. Patient-Centered Outcomes Research (PROQOL), UMR 1123, Université Paris cité, Inserm, Paris, France. Département de Médecine Interne et d???Immunologie Clinique, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
| | - Svetlane Dimi
- Hôpital Foch, Service de Médecine Interne, Suresnes, France
| | - Maria Patrizia Carrieri
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l???Information Médicale, ISSPAM, Marseille, France
| | - Issifou Yaya
- Unité de Recherche Clinique en Economie de la Santé (URC-ECO), Hôpital Hôtel-Dieu, AP-HP, Paris, France. Patient-Centered Outcomes Research (PROQOL), UMR 1123, Université Paris cité, Inserm, Paris, France
| | - Virginie Villes
- ORS Paca Observatoire régional de la santé Provence-Alpes-Côte-d???Azur, Marseille, France
| | - Nadia Valin
- Service de Maladies Infectieuses et Tropicales, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (APHP), France
| | - Eric Farfour
- Service de biologie Clinique, Hôpital Foch, Suresnes, France
| | - Olivier Chassany
- Unité de Recherche Clinique en Economie de la Santé (URC-ECO), Hôpital Hôtel-Dieu, AP-HP, Paris, France. Patient-Centered Outcomes Research (PROQOL), UMR 1123, Université Paris cité, Inserm, Paris, France
| | - David Zucman
- Hôpital Foch, Service de Médecine Interne, Suresnes, France
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Amundsen E, Haugstvedt Å, Skogen V, Berg RC. Health characteristics associated with chemsex among men who have sex with men: Results from a cross-sectional clinic survey in Norway. PLoS One 2022; 17:e0275618. [PMID: 36197878 PMCID: PMC9534388 DOI: 10.1371/journal.pone.0275618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 09/20/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Chemsex typically involves drugs such as GHB/GBL, crystal meth and mephedrone, and is increasingly common among MSM. The behaviour has been found to be associated with sexually transmitted infections (STIs) and mental health problems. We aimed to assess the extent of chemsex engagement and associations with different aspects of health, among MSM attending a free specialist walk-in clinic for STIs in Oslo, Norway. METHODS Anonymous cross-sectional survey data was collected from June to October 2016. Differences in STI health (chlamydia, gonorrhoea, syphilis, HIV diagnoses), mental health (depression/anxiety) and internalised homonegativity between MSM using and not using GHB/GBL, crystal meth, mephedrone, cocaine or ketamine with sex in the last year were assessed descriptively and in a multivariate logistic regression model. The predictors were number of self-reported chlamydia, gonorrhoea or syphilis diagnoses, HIV diagnosis, depression/anxiety, and degree of internalised homonegativity. We adjusted for age, education level and having lived abroad. RESULTS Of the 518 MSM respondents, 17% reported sexualised use of either GHB/GBL, crystal meth, mephedrone, cocaine or ketamine in the last year (chemsex). We found significant positive associations between chemsex and self-reported HIV diagnoses (adjusted odds ratio [aOR] = 3.26, 95%CI = 1.37-7.76), number of reported chlamydia, gonorrhoea or syphilis diagnoses in the last year (aOR = 1.63, 95%CI = 1.18-2.12), having lived more than one year abroad (aOR = 2.10, 95%CI = 1.20-3.65), but no significant association with depression/anxiety (aOR = 1.02, 95%CI = 0.53-1.93), nor internalised homonegativity (aOR = 0.62, 95%CI = 0.33-1.19). CONCLUSION Chemsex engagement in Norway is relatively low compared to findings from STI clinics in other European countries, and GHB/GBL and cocaine the two most commonly used drugs with sex. Chemsex was more common among MSM having lived more than one year abroad, reporting HIV diagnoses and a higher number of either chlamydia, gonorrhoea or syphilis diagnoses in the last year. Health care providers need to be made aware of chemsex as a behavioural phenomenon among MSM, and special care should be afforded to MSM living with HIV and being diagnosed with STIs.
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Affiliation(s)
- Eirik Amundsen
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Åse Haugstvedt
- The Olafia Clinic and the National Advisory Unit on Sexually Transmitted Infections, Oslo University Hospital, Oslo, Norway
| | - Vegard Skogen
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Infectious Diseases, Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Rigmor C. Berg
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Division for Health Services, Norwegian Institute of Public Health (NIPH), Oslo, Norway
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107
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Miskolci R, Signorelli MC, Canavese D, Teixeira FDB, Polidoro M, Moretti-Pires RO, Souza MHTD, Pereira PPG. Health challenges in the LGBTI+ population in Brazil: a scenario analysis through the triangulation of methods. CIENCIA & SAUDE COLETIVA 2022. [DOI: 10.1590/1413-812320222710.06602022en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract This article aims to reflect on the current health challenges of lesbians, gays, bisexuals, transgenders, intersex, and other sexual and gender minorities (LGBTI+) within the Brazilian scenario. This study adopted a triangulation approach, based on two studies developed in the Southeast and South of Brazil, which included policy analysis and qualitative research on the perceptions of key actors from the Brazilian Unified Health System (SUS) - LGBTI+ users, workers, and managers. All data were analyzed by an interdisciplinary team of researchers. The main problems faced by the LGBTI+ population were registered, indicating some of the necessary progress. Some of these challenges include: access of the LGBTI+ population to SUS; the need to train health professionals; the decentralization of health services sensitive to the LGBTI+ population; the distinct forms of violence and discrimination; the lack of research in health care conducted with specific groups, such as lesbians, bisexuals, intersex, and other sexual minorities. The results reinforce the urgency for the complete implementation of the “National Policy for the Comprehensive Health of LGBT”. The recognition of the LGBTI+ health needs will aid in achieving the principles which are the guiding principles of SUS.
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108
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Orviz E, Negredo A, Ayerdi O, Vázquez A, Muñoz-Gomez A, Monzón S, Clavo P, Zaballos A, Vera M, Sánchez P, Cabello N, Jiménez P, Pérez-García JA, Varona S, Del Romero J, Cuesta I, Delgado-Iribarren A, Torres M, Sagastagoitia I, Palacios G, Estrada V, Sánchez-Seco MP. Monkeypox outbreak in Madrid (Spain): Clinical and virological aspects. J Infect 2022; 85:412-417. [PMID: 35830908 PMCID: PMC9534097 DOI: 10.1016/j.jinf.2022.07.005] [Citation(s) in RCA: 97] [Impact Index Per Article: 48.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 07/05/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Monkeypox is the most prevalent Orthopoxvirus zoonosis infection since the eradication of smallpox. The current multi-country outbreak involves five WHO regions affecting mainly Europe. Accurate clinical and virological aspects of the disease outside endemic areas are needed. METHODS We performed an observational study of cases diagnosed in Madrid (Spain) (May/June 2022). Confirmation from vesicular lesions swabs, Orthopoxvirus real-time PCR, sequencing, phylogenetic analysis, and direct detection by Electron microscopy was performed. In addition, a structured epidemiological questionnaire was completed systematically to gather sociodemographic, clinical, and behavioral data from all confirmed cases. FINDINGS We extracted data from 48 patients, all cisgender men. The median age was 35 years (IQR 29 - 44), and 87.5% were MSM. The most prevalent symptoms were the presence of vesicular-umbilicated and pseudo-pustular skin lesions (93.8%), asthenia (66.6%), and fever (52.1%). In addition, the location of the lesions in the genital or perianal area was related to the role in sexual intercourse (p<0.001). Sequencing analysis indicated the virus circulating in Spain belongs to the western African clade. Like the other European cases in the outbreak, the Spanish isolates are a direct descendant of viruses previously detected in Nigeria, the UK, Singapore, and Israel in 2017-2018. CONCLUSIONS Monkeypox is an emerging infectious disease in Europe where community transmission is reported, mainly in MSM. The first symptom was skin lesions instead of classical fever and rash. The disease follows a self-limited course, and there have been no cases with a serious presentation or severe complications.
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Affiliation(s)
- Eva Orviz
- Centro Sandoval/Hospital Clínico San Carlos, IdISSC
| | - Anabel Negredo
- Laboratorio de Arbovirus y Enfermedades Víricas importadas, Centro Nacional de Microbiología. Instituto de Salud Carlos III; CIBERINFEC
| | - Oskar Ayerdi
- Centro Sandoval/Hospital Clínico San Carlos, IdISSC
| | - Ana Vázquez
- Laboratorio de Arbovirus y Enfermedades Víricas importadas, Centro Nacional de Microbiología. Instituto de Salud Carlos III; CIBERINFEC
| | | | - Sara Monzón
- Unidad de Bioinformática, Instituto de Salud Carlos III
| | | | | | - Mar Vera
- Centro Sandoval/Hospital Clínico San Carlos, IdISSC
| | - Patricia Sánchez
- Laboratorio de Arbovirus y Enfermedades Víricas importadas, Centro Nacional de Microbiología. Instituto de Salud Carlos III; CIBERINFEC
| | - Noemi Cabello
- Centro Sandoval/Hospital Clínico San Carlos, IdISSC; CIBERINFEC
| | | | | | - Sarai Varona
- Unidad de Bioinformática, Instituto de Salud Carlos III
| | | | - Isabel Cuesta
- Unidad de Bioinformática, Instituto de Salud Carlos III
| | | | - Montse Torres
- Centro Nacional de Microbiología, Instituto de Salud Carlos III
| | | | | | - Vicente Estrada
- Centro Sandoval/Hospital Clínico San Carlos, IdISSC; CIBERINFEC.
| | - Maria Paz Sánchez-Seco
- Laboratorio de Arbovirus y Enfermedades Víricas importadas, Centro Nacional de Microbiología. Instituto de Salud Carlos III; CIBERINFEC
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Miskolci R, Signorelli MC, Canavese D, Teixeira FDB, Polidoro M, Moretti-Pires RO, Souza MHTD, Pereira PPG. Health challenges in the LGBTI+ population in Brazil: a scenario analysis through the triangulation of methods. CIENCIA & SAUDE COLETIVA 2022; 27:3815-3824. [PMID: 36134788 DOI: 10.1590/1413-812320222710.06602022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 11/22/2022] Open
Abstract
This article aims to reflect on the current health challenges of lesbians, gays, bisexuals, transgenders, intersex, and other sexual and gender minorities (LGBTI+) within the Brazilian scenario. This study adopted a triangulation approach, based on two studies developed in the Southeast and South of Brazil, which included policy analysis and qualitative research on the perceptions of key actors from the Brazilian Unified Health System (SUS) - LGBTI+ users, workers, and managers. All data were analyzed by an interdisciplinary team of researchers. The main problems faced by the LGBTI+ population were registered, indicating some of the necessary progress. Some of these challenges include: access of the LGBTI+ population to SUS; the need to train health professionals; the decentralization of health services sensitive to the LGBTI+ population; the distinct forms of violence and discrimination; the lack of research in health care conducted with specific groups, such as lesbians, bisexuals, intersex, and other sexual minorities. The results reinforce the urgency for the complete implementation of the "National Policy for the Comprehensive Health of LGBT". The recognition of the LGBTI+ health needs will aid in achieving the principles which are the guiding principles of SUS.
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Affiliation(s)
- Richard Miskolci
- Departamento de Medicina Preventiva, Universidade Federal de São Paulo. R. Botucatu 740, Vila Clementino. 04023-062 São Paulo SP Brasil.
| | | | - Daniel Canavese
- Departamento de Saúde Coletiva, Universidade Federal do Rio Grande do Sul. Porto Alegre RS Brasil
| | | | | | | | | | - Pedro Paulo Gomes Pereira
- Departamento de Medicina Preventiva, Universidade Federal de São Paulo. R. Botucatu 740, Vila Clementino. 04023-062 São Paulo SP Brasil.
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HIV, chemsex, and the need for harm-reduction interventions to support gay, bisexual, and other men who have sex with men. Lancet HIV 2022; 9:e717-e725. [PMID: 35926550 DOI: 10.1016/s2352-3018(22)00124-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/11/2022] [Accepted: 04/11/2022] [Indexed: 11/21/2022]
Abstract
Numerous studies have identified an association between the use of drugs in sexual contexts (chemsex) and HIV among gay, bisexual, and other men who have sex with men (GBMSM), although whether a causal relationship exists is contentious. An intricate relationship exists between chemsex, HIV treatment and prevention, harm reduction, and the provision of community-grounded health services. Furthermore, potential harms exist beyond HIV, such as intoxication and overdose. Community-engaged responses to chemsex involve social and cultural strategies of harm reduction and sexual health promotion before, during, and after a chemsex session. Ultimately, this Review calls for actions and collaborations aimed at developing a greater understanding of chemsex as a practice within different GBMSM subpopulations and to develop tailored harm-reduction models that can accommodate GBMSM who engage in chemsex in various ways and with varied effects.
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Acide γ-Hydroxybutyrique (GHB), γ-butyrolactone (GBL) et 1,4-butanediol (1,4-BD) : revue de la littérature des aspects pharmacologiques, cliniques, analytiques et médico-légaux. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2022. [DOI: 10.1016/j.toxac.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Jaspal R. Chemsex, Identity and Sexual Health among Gay and Bisexual Men. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12124. [PMID: 36231424 PMCID: PMC9564711 DOI: 10.3390/ijerph191912124] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 09/19/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
This article focuses on some of the social, cultural and psychological aspects of drug use in sexualized settings in gay and bisexual men (referred to as "chemsex"). Using a narrative review approach, the article examines previous empirical research in this area and presents a novel theoretical approach for understanding and predicting chemsex behavior. Tenets of identity process theory from social psychology are drawn upon to offer an integrative theoretical framework within which the social, cultural and psychological underpinnings of chemsex can be collectively examined. Existing empirical research suggests that gay and bisexual men may experience sexuality-related stressors that can undermine feelings of self-esteem, self-efficacy, continuity and positive distinctiveness. Identity process theory examines how individuals react to threats to identity brought about by these stressors. In response to identity threat, gay and bisexual men may engage in chemsex as a coping response that encompasses and facilitates various, largely maladaptive, coping strategies and tactics. The more chemsex is perceived as enhancing identity processes and as averting identity threat, the more central it is likely to be to the identities of participants. The centrality of chemsex to one's identity may preclude self-withdrawal from the practice. Several directions for future research are presented based on existing work on chemsex viewed through the lens of identity process theory. These should form the basis of future empirical research in the sphere of sexual health among gay and bisexual men and the outcomes of this research should inform policy and practice in this area.
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Affiliation(s)
- Rusi Jaspal
- Vice-Chancellor's Office, University of Brighton, Brighton BN2 4GJ, UK
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113
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Methamphetamine use and adoption of preventive behaviors early in the COVID-19 pandemic among men who have sex with men in Los Angeles, California. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 5:100097. [PMID: 36193108 PMCID: PMC9519521 DOI: 10.1016/j.dadr.2022.100097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/14/2022] [Accepted: 09/15/2022] [Indexed: 11/23/2022]
Abstract
Background Methamphetamine (MA) use increased during COVID-19, with men who have sex with men (MSM) exhibiting 3-fold greater use than heterosexual men. Understanding links between reported MA use and COVID-19 prevention behaviors among MSM can inform current transmission risks for HIV, Monkeypox, and other infectious diseases. Methods This study assesses relationships between self-reported pattern of MA use (past six months; past two weeks) and reported COVID-19 preventive behaviors, adjusting for participant characteristics (HIV serostatus, race/ethnicity, employment and housing stability), in a cohort of ethnically diverse MSM in Los Angeles, California, between April 1 and September 30, 2020. Results Compared to those who reported no MA use, MSM who reported weekly or more MA use in the past six months were significantly less likely to use COVID-19 protective behaviors of physical distancing (61.8% vs. 81.6%; AOR = 0.39, 95% CI [0.19, 0.81]), of avoiding public transportation (34.5% vs. 60.3%; AOR = 0.42, 95% CI [0.21, 0.83]) and of avoiding traveling overall (32.7% vs. 62.6%; AOR = 0.32, 95% CI [0.16, 0.63]). Parallel findings were observed in analyses of past two-week reported MA use and COVID-19 protective behaviors. Conclusion Findings highlight ways in which reported MA use frequency links with avoidance of reported preventive behaviors for COVID-19 in urban diverse MSM. Findings also provide evidence to guide public health interventions in future outbreaks of COVID-19 and other infectious diseases among MSM.
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Abstract
Rates of stimulant use, including misuse of prescription stimulants and use of cocaine and methamphetamine, are rising rapidly among adolescents and young adults ("youth"). Stimulant misuse is associated with overdose, polysubstance use, substance use disorders, and other medical harms. Substance use is often initiated during adolescence and young adulthood, and interventions during these crucial years have the potential to impact the lifetime risk of stimulant use disorder and associated harms. In this narrative review, we review recent data on prescription and illicit stimulant use in youth. We describe the rising contribution of stimulants to polysubstance use involving opioids and other substances and to overdose, as well as ways to minimize harm. We also discuss prescription stimulant misuse, which is especially prevalent among youth relative to other age groups, and the limited evidence on potential pathways from prescription stimulant use to illicit stimulant use. Last, we assess potential strategies for the prevention and treatment of stimulant use disorder in youth.
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Affiliation(s)
- Natalie J LaBossier
- Boston University School of Medicine, 72 E Concord St, Boston, MA 02118, United States.
| | - Scott E Hadland
- Division of Adolescent and Young Adult Medicine, Mass General for Children, 175 Cambridge St., 5th Floor, Boston, MA 02114, United States; Department of Pediatrics, Harvard Medical School, 25 Shattuck St., Boston, MA 02115, United States
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115
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Playing at the edges, navigating sexual boundaries, and narrating sexual distress; Practices and perspectives of sexuality and gender diverse people who use GHB. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 108:103811. [PMID: 35939948 DOI: 10.1016/j.drugpo.2022.103811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND Research addressing sexualised use of GHB to date has largely focussed on gay and bisexual men's GHB use in the context of chemsex, this research has highlighted risks and experiences associated with sexual violence. No studies have included people of diverse sexualities and genders and documented reported practices to ensure mutually gratifying and consensual sex in the context of sexualised drug use (SDU). METHODS Semi-structured interviews were conducted with 31 people from sexuality and gender diverse communities living in Australia who reported three or more occasions of GHB use in the previous 12 months. Participants were asked about their use of GHB for sex, their experiences of GHB sex and their approaches to negotiating sexual boundaries. Data were analysed thematically. RESULTS Most participants valued the sexual possibilities enabled by disinhibitory components of GHB and were cognisant of respecting other's sexual boundaries in the context of GHB sex. Participants reported strategies to ensure communication prior to and throughout GHB sex. However, several participants narrated experiences of GHB sex that they felt were distressing and, in some circumstances, sexually violent. In most instances participant's resisted terminology of sexual violence or non-consent as descriptors of their experience and none reported accessing sexual violence services. CONCLUSION Positive strategies to facilitate sexual communication prior to and throughout GHB sex should be reflected in health promotion and service level responses to promote affirmative and continuous consent among people who use GHB for sex. Education initiatives to help people engaged in SDU to recognise and respond to sexual violence if it occurs ought to be prioritised.
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Eger WH, Adaralegbe A, Khati A, Azwa I, Wickersham JA, Osborne S, Shrestha R. Exploring drivers of pre-exposure prophylaxis uptake among gay, bisexual, and other men who have sex with men in Malaysia. Int J STD AIDS 2022; 33:821-828. [PMID: 35772943 PMCID: PMC10069270 DOI: 10.1177/09564624221106535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) is a valuable HIV prevention strategy, particularly among men who have sex with men (MSM); however, PrEP uptake is below the threshold needed to curb the HIV epidemic among this group, especially in settings like Malaysia, where same-sex sexual behavior is illegal. METHODS A sample of 355 participants completed an online survey between June and July 2020, recruited through geosocial networking apps for MSM and social networking websites (e.g. Facebook). We used descriptive and multivariable analyses to examine correlates of PrEP use within this population. RESULTS The sample was predominantly Malay (53.5%), had monthly incomes greater than RM 3000 (USD 730) (52.7%), and a tertiary level of education (84.5%). About 80% of participants heard of PrEP prior to the survey, with significantly less (18.3%) having ever taken PrEP. In the adjusted multivariable logistic model, using drugs before or during sexual intercourse ("chemsex") (AOR: 3.37; 95% CI: 1.44-7.89), being diagnosed with a sexually transmitted infection in the last 12 months (AOR: 2.08; 95% CI: 1.13-3.85), HIV testing in the previous 6 months (AOR: 3.23; 95% CI: 1.74-5.99), and disclosure of sexual orientation (AOR: 1.85; 95% CI: 1.02-3.34) were associated with having taken PrEP in the past. CONCLUSIONS This study revealed that PrEP use among Malaysian MSM is relatively low, despite high awareness, and is associated with healthcare engagement and high-risk behaviors. These results highlight the need to tailor outreach activities for individuals at increased risk for HIV and those disengaged with the health system.
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Affiliation(s)
- William H Eger
- Department of Internal Medicine, Section of Infectious Diseases, 12228Yale School of Medicine, New Haven, CT, USA
| | - Adeleye Adaralegbe
- Department of Allied Health Sciences, 7712University of Connecticut, Mansfield, CT, USA
| | - Antoine Khati
- Department of Allied Health Sciences, 7712University of Connecticut, Mansfield, CT, USA
| | - Iskandar Azwa
- Department of Medicine, Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia.,Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Jeffrey A Wickersham
- Department of Internal Medicine, Section of Infectious Diseases, 12228Yale School of Medicine, New Haven, CT, USA.,Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Sydney Osborne
- Department of Allied Health Sciences, 7712University of Connecticut, Mansfield, CT, USA
| | - Roman Shrestha
- Department of Internal Medicine, Section of Infectious Diseases, 12228Yale School of Medicine, New Haven, CT, USA.,Department of Allied Health Sciences, 7712University of Connecticut, Mansfield, CT, USA.,Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia.,Institute for Collaboration on Health, Intervention, and Policy (InCHIP), 7712University of Connecticut, Mansfield, CT, USA
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Bolmont M, Tshikung ON, Trellu LT. Chemsex, a Contemporary Challenge for Public Health. J Sex Med 2022; 19:1210-1213. [DOI: 10.1016/j.jsxm.2022.03.616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/18/2022] [Accepted: 03/25/2022] [Indexed: 11/30/2022]
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Individual level peer interventions for gay and bisexual men who have sex with men between 2000 and 2020: A scoping review. PLoS One 2022; 17:e0270649. [PMID: 35839245 PMCID: PMC9286286 DOI: 10.1371/journal.pone.0270649] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 06/14/2022] [Indexed: 11/19/2022] Open
Abstract
Background Peer-led interventions are central to the global HIV response for gay and bisexual men who have sex with men [GBMSM]. Since the year 2000, technological advancements in HIV and an increased response to the health disparities faced by GBMSM outside of HIV, have contributed to the expanding scope of their content and delivery. This review sets out to characterise the evidence base for individual level peer interventions for GBMSM, overview approaches to implementing and evaluating them and identify future priorities for their delivery and evaluation. Methods A scoping review methodology was applied and evaluations of peer programs for GBMSM published in peer reviewed journals were identified via subject heading and keyword searches across five electronic databases. Titles and abstracts were reviewed, and full texts were assessed against eligibility criteria. A coding framework was used to extract data from included studies against intervention implementation and evaluation components. Results A total of 38 studies evaluating peer led interventions against effectiveness outcomes were deemed eligible for inclusion and coded into four intervention modalities; peer counselling [n = 6], groupwork programs [n = 15], peer navigation [n = 7] and peer education [n = 10]. Most addressed HIV [n = 32] and across intervention modalities, evaluations demonstrated compelling evidence of significant effect. Intervention effects on broader indicators of psychosocial wellbeing were not extensively evaluated. Expertise regarding the implementation and evaluation of peer interventions addressing HIV among GBMSM ought to be leveraged to expand the scope of peer intervention to meet the diverse health and wellbeing needs of GBMSM.
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Freestone J, Prestage G, Bourne A, Ezard N, Race K, Nedanoski A, Murray J, Siefried KJ. Controlling for pleasure and risk: The experiences of sexuality and gender diverse people who use GHB. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 105:103747. [DOI: 10.1016/j.drugpo.2022.103747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/23/2022] [Accepted: 05/04/2022] [Indexed: 10/18/2022]
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Nation A, Dawson-Rose C, Waters C. Substance use experiences of HIV-positive and HIV-negative black, non-hispanic men who have sex with men (msm) ages 18-34 in the Bay Area: A qualitative narrative perspective. J Ethn Subst Abuse 2022:1-16. [PMID: 35767381 DOI: 10.1080/15332640.2022.2090043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Young Black men who have sex with men (MSM) represent the majority of individuals with new HIV infections in the U.S. Substance use is related to risk and acquisition t of HIV. The purpose of this study was to explore the perceptions and experiences about the role substance use plays in the lives HIV-positive and HIV-negative young Black MSM between the ages of 18-34. METHODS Using a qualitative, narrative perspective, we recruited and then interviewed participants in partnership with AIDS Service Organizations. Narrative and thematic analysis was used to analyze these Black men's personal stories with harm reduction used as the conceptual approach. RESULTS Nine HIV-positive and 3 HIV-negative participants(n = 12) shared stories about their own personal experiences with family relationships and substance use. Themes related to family included early exposure and initiation of substance use, substance use as a response to stigma around sexual orientation, kicked out of house, asked to leave or left home so they could be themselves and perceived benefits and advantages of methamphetamine. CONCLUSIONS The participants are subjected to adverse and stressful childhood experiences. These are important stories to understand if we expect to mount an adequate response, utilizing harm reduction, to the growing number of young Black MSM at-risk for HIV.
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Affiliation(s)
- Austin Nation
- California State University, Fullerton, California, USA
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121
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De La Mora L, Ugarte A, Martínez-Rebollar M, De Lazzari E, García-Hernández D, Font G, De Loredo N, Solbes E, Miquel L, Blanch J, Torres B, Riera J, Chivite I, Ambrosioni J, Inciarte A, González-Cordón A, Martínez E, Blanco JL, Mallolas J, Laguno M. Chemsex Practices in PrEP: Beyond Addiction and Risk Toward a Healthy Sex Life-Baseline Experiences from a Hospital-Based PrEP Program in Barcelona, Spain. AIDS Behav 2022; 26:4055-4062. [PMID: 35732910 DOI: 10.1007/s10461-022-03730-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2022] [Indexed: 11/26/2022]
Abstract
Pre-exposure prophylaxis (PrEP) is a biomedical intervention that has demonstrated efficacy in HIV prevention in individuals at high-risk, among them chemsex users. Out of 190 PrEP users followed at Hospital Clinic of Barcelona until October 2020, 89% reported drug use, and 63% disclosed that they had engaged in chemsex practices, initiated in 64% of cases within the past year. Twenty-one percent used 3 or more drugs simultaneously, being GHB/GBL, nitrites, sildenafil, and methamphetamine the most prevalent combination. Eight percent reported slamming. Forty-one percent described having had negative experiences and 8% did not remember the last time they had sober sex. Methamphetamine, mephedrone, GHB/GBL, and having had open relationships, group sex, double penetration, and fisting were significantly more prevalent. Forty-nine percent admitted being worried about chemsex use, and 18% said they needed help. A comprehensive, interdisciplinary approach is mandatory to enable the attainment of a healthy approach to one's sex life.
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Affiliation(s)
- Lorena De La Mora
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Ainoa Ugarte
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Maria Martínez-Rebollar
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain.
| | - Elisa De Lazzari
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - David García-Hernández
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Guillermo Font
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Nicolás De Loredo
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Estela Solbes
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Laia Miquel
- Addiction Unit (GRAC). Psychiatry and Psychology Department, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, Barcelona University, Barcelona, Spain
| | - Jordi Blanch
- Addiction Unit (GRAC). Psychiatry and Psychology Department, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, Barcelona University, Barcelona, Spain
| | - Berta Torres
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Josep Riera
- Dermatology Service, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Iván Chivite
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Juan Ambrosioni
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Alexy Inciarte
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Ana González-Cordón
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Esteban Martínez
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - José Luis Blanco
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Josep Mallolas
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Montserrat Laguno
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
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Platteau T, Florence E, de Wit JBF. Self-Control as Conceptual Framework to Understand and Support People Who Use Drugs During Sex. Front Public Health 2022; 10:894415. [PMID: 35784207 PMCID: PMC9240261 DOI: 10.3389/fpubh.2022.894415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/24/2022] [Indexed: 11/18/2022] Open
Abstract
Few theory-informed interventions to support people who use drugs during sex have been conceptualized and developed. We conceptualize sexualized drug use, also referred to as chemsex or pharmacosex, as a self-control challenge, and draw on extant theory and research to propose intervention approaches that can be tailored to meet the differing needs of people who engage in sexualized drug use. We draw on a continuum perspective of sexualized drug use, in particular chemsex, and discuss the role of reasoned and automatic processes in behavioral decisions, as well as critical components of effective self-control of behavior. A self-control approach can empower people to tackle their sexualized drug use, and classify their experienced sex-related drug use as problematic. Self-control encompasses clarifying one's goals and identifying strategies to mitigate behaviors to achieve these goals, despite competing pharmacosex desires. Our approach to self-control sexualized drug use contains three critical components: goal setting, goal enactment, and goal progress appraisal and goal adjustment. Goals should be formulated specific, ambitious yet realistic, and tailored to the individual's needs and wishes. Goals may target aspects of drug use, protecting sexual health and mitigating negative impacts. Implementing goal enactment implies translating goals into concrete (short-term) actions to move toward the higher-order goal via goal intentions and action/coping plans. During the goal progress appraisal and adjustment stage, people compare their actual with their planned behavior. This reflection may result in goal adjustment through feedback loops to adjust their goals and action/coping plans. We propose that our self-control approach can guide the development of interventions to effectively support people to prevent or limit pharmacosex, and helps to effectively mitigate or reduce negative impacts via self-help, peer support or professional support, offered via personal counseling or digital tools.
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Affiliation(s)
- Tom Platteau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Faculty of Psychology, Open University, Heerlen, Netherlands
- *Correspondence: Tom Platteau
| | - Eric Florence
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - John B. F. de Wit
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, Netherlands
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Zhang K, Chen S, Chan PSF, Fang Y, Cao H, Chen H, Hu T, Chen Y, Zhou X, Wang Z. Changes in HIV Testing Utilization Among Chinese Men Who Have Sex With Men During the COVID-19 Pandemic in Shenzhen, China: An Observational Prospective Cohort Study. Front Med (Lausanne) 2022; 9:842121. [PMID: 35755039 PMCID: PMC9218425 DOI: 10.3389/fmed.2022.842121] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 05/16/2022] [Indexed: 12/03/2022] Open
Abstract
Background The Coronavirus Diseases 2019 (COVID-19) directly affects HIV prevention and sexual health services utilization among men who have sex with men (MSM). This study investigated changes in human immunodeficiency virus (HIV) testing utilization among MSM before and after the COVID-19 pandemic received initial control in Shenzhen, China. Methods This study was a sub-analysis of a prospective observational cohort study conducted among MSM in Shenzhen, China between August 2020 and May 2021. Participants were recruited through outreaching in gay venues, online recruitment, and peer referral. Participants completed a baseline online survey between August and September 2020 and a follow-up online survey between April and May 2021. This study was based on 412 MSM who reported to be HIV-negative/unknown sero-status at baseline, 297 (72.1%) of them completed the follow-up online survey. Multilevel logistic regression models (level 1: sources of recruitment; level 2: individual participants) were fitted. Results When comparing follow-up data with baseline data, a significant increase was observed in the uptake of any type of HIV testing (77.9% at Month 6 vs. 59.2% at baseline, p < 0.001). After adjusting for age group, education level, current employment status and monthly personal income, two predisposing factors were associated with higher uptake of HIV testing during the follow-up period. They were: (1) condomless anal intercourse with male non-regular male sex partners at follow-up only (AOR: 5.29, 95%CI: 1.27, 22.01) and (2) sanitizing before and after sex at baseline (AOR: 1.26, 95%CI: 1.02, 1.47). Regarding enabling factors, utilization of HIV testing (AOR: 3.90, 95%CI: 2.27, 6.69) and STI testing (AOR: 2.43, 95%CI: 1.20, 4.93) 6 months prior to the baseline survey was associated with higher uptake of HIV testing during the follow-up period. Having the experience that HIV testing service providers reduced service hours during the follow-up period was also positively associated with the dependent variable (AOR: 3.45, 95%CI: 1.26, 9.41). Conclusions HIV testing utilization among MSM might rebound to the level before the COVID-19 outbreak after the pandemic received initial control in China. This study offered a comprehensive overview to identify potential reasons that can influence the uptake of HIV testing among Chinese MSM.
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Affiliation(s)
- Kechun Zhang
- Longhua District Center for Disease Control and Prevention, Shenzhen, China
| | - Siyu Chen
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Paul Shing-fong Chan
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Yuan Fang
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - He Cao
- Longhua District Center for Disease Control and Prevention, Shenzhen, China
| | - Hongbiao Chen
- Longhua District Center for Disease Control and Prevention, Shenzhen, China
| | - Tian Hu
- Longhua District Center for Disease Control and Prevention, Shenzhen, China
| | - Yaqi Chen
- Longhua District Center for Disease Control and Prevention, Shenzhen, China
| | - Xiaofeng Zhou
- Longhua District Center for Disease Control and Prevention, Shenzhen, China
| | - Zixin Wang
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- *Correspondence: Zixin Wang
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Understanding the Service Needs and Preferences of Men Who Have Sex with Men Who Use Crystal Methamphetamine in British Columbia, Canada: a Qualitative Study. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00848-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Uholyeva X, Pitoňák M. Chemsex users in Czechia: EMIS survey. Cent Eur J Public Health 2022; 30:86-92. [PMID: 35876596 DOI: 10.21101/cejph.a6923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 05/13/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Chemsex is a phenomenon highly relevant to public health concerns. Our primary aim is to describe the Czech chemsex scene regarding substances used, sexual behaviour, mental health, sexual life satisfaction, internalization of homonegative attitudes, and prevalent chemsex patterns. METHODS The data from the European Men Who Have Sex With Men Internet Survey (EMIS) 2017 were used. The mental health of chemsex users was assessed by the Patient Health Questionnaire 4 (PHQ4), internalized homonegativity was measured using the Short Internalized Homonegativity Scale. A sample of 87 men who have sex with men (MSM) chemsex users and a comparison group of 261 MSM were selected from the total sample of 1,688 respondents. Mann-Whitney and χ2 tests were used to compare groups. RESULTS Active chemsex users made up 5% of the sample (87 of 1,688), with an average age of 37 years. Chemsex users were more likely to engage in condomless sex with non-steady partners (χ2 = 46.8, p < 0.001), and had dramatically more STIs, such as HIV (χ2 = 52.9, p < 0.001), HCV (χ2 = 25.9, p < 0.001), and syphilis (χ2 = 41.5, p < 0.001). Chemsex users frequently injected drugs (n = 19, 20%). More than half (n = 48; 55%) of chemsex users had sober sex in the last 4 weeks. Chemsex culture was associated with riskier substance use, both in terms of mode and frequency. The mental health of chemsex users in our sample did not differ significantly from the comparison group (χ2 = 0.2, p < 0.7). Chemsex users did not conceal their sexual identity more often than the comparison group, on the contrary, 69% (n = 59) of them were out to most significant others, compared to 53% (n = 134) in the comparison group (χ2 = 8.8, p < 0.05). In addition, we did not find differences in the degree of internalized homonegativity (χ2 = 0.9, p < 0.4). Chemsex users were clearly and significantly more satisfied with their sex life than the comparison group (Mann-Whitney U test, p < 0.001). CONCLUSIONS In our sample, chemsex use was not associated with a negative impact on health or wellbeing. Our results suggest that chemsex is not a homogeneous phenomenon. Many different patterns and subcultures exist, some of them are riskier, some safer than others.
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Affiliation(s)
| | - Michal Pitoňák
- National Institute of Mental Health, Klecany, Czech Republic
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Risky Sexual Practices, Sexually Transmitted Infections, Motivations, and Mental Health among Heterosexual Women and Men Who Practice Sexualized Drug Use in Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116387. [PMID: 35681972 PMCID: PMC9180103 DOI: 10.3390/ijerph19116387] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/18/2022] [Accepted: 05/21/2022] [Indexed: 12/10/2022]
Abstract
Sexualized drug use (SDU) has been poorly studied among heterosexuals. The purpose of the present study was to analyze the prevalence of and gender differences in types of substances, risky sexual practices, sexually transmitted infections (STIs), motivations, and psychological adjustment among heterosexual women and men who engage in SDU. The study sample consisted of 1181 heterosexuals (795 women) between 18 and 78 years old (mean age = 24.4, SD = 7.4). Approximately 12% of the participants had engaged in SDU. No differences were found in the prevalence of SDU between men and women. Alcohol, cannabis, and 3,4-methylenedioxy-methamphetamine (MDMA) were the substances most frequently used for sexual purposes. Men were significantly more likely to use MDMA, ecstasy, cocaine, and erectile dysfunction (ED) drugs, and they tended to have more sexual partners than women. Likewise, SDU was related to have more sexual partners, penetrative sex without a condom, practice a fetish, be diagnosed with syphilis, chlamydia, and others STIs, and present more depression symptoms (but not with more anxiety). In conclusion, SDU was associated with poorer physical and mental health. It is, therefore, necessary to design programs aimed at reducing the incidence of the consequences of SDU on the physical and mental health of both men and women. Moreover, programs that seek to understand why these individuals engage in SDU should be undertaken.
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Abrahão ABB, Kortas GT, Blaas IK, Koch Gimenes G, Leopoldo K, Malbergier A, Torales J, Ventriglio A, Castaldelli-Maia JM. The impact of discrimination on substance use disorders among sexual minorities. Int Rev Psychiatry 2022; 34:423-431. [PMID: 36151837 DOI: 10.1080/09540261.2022.2094223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This paper aimed to review the literature regarding the impact of discrimination on substance use disorders among Sexual Minorities (SM), with a focus on alcohol, opioids, stimulants, polydrug use, chemsex, cannabis and tobacco, as well as inequalities in the access to health care services. It is alarmingly clear that SM report higher rates of morbidity if compared to the general population. Health care delivery inequalities have also been reported in this special population. Also, the lack of data from low- and middle-income countries on substance use among SM is a major concern. Certainly, discrimination play a key-role among leading factors to substance abuse, continued use, disorders, and lower levels of preventive and treatment interventions. However, it may be difficult to estimate the impact of discrimination because of the lack of research data and different methodologies of literature studies. Moreover, SM are differently categorized and defined and evidences may be not comparable between studies. There is an urgent need of strategic guidelines and research investments aimed at prioritizing these populations disproportionately impacted by substance use. Equity-oriented policies and programs can facilitate opportunities and decrease substance use in these vulnerable subgroups, including community- and peer-led initiatives and nonjudgmental and inclusive health services.
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Affiliation(s)
| | | | - Israel Kanaan Blaas
- Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil.,Department of Neuroscience, Medical School, FMABC University Center, Santo André, Brazil
| | | | - Kae Leopoldo
- Institute of Psychology, University of São Paulo, São Paulo, Brazil
| | - André Malbergier
- Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Julio Torales
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, Asunción, Paraguay
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - João Mauricio Castaldelli-Maia
- Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil.,Department of Neuroscience, Medical School, FMABC University Center, Santo André, Brazil
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128
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Maxwell S, Shahmanesh M, Gafos M. Pre-exposure prophylaxis (PrEP) uptake and adherence experiences of gay and bisexual men who engage in chemsex: A qualitative study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 103:103630. [DOI: 10.1016/j.drugpo.2022.103630] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 02/15/2022] [Accepted: 02/17/2022] [Indexed: 11/24/2022]
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Rathakrishnan D, Purpura LJ, Salcuni PM, Myers JE, Wahnich A, Daskalakis DC, Edelstein ZR. PrEP Use and Correlates of Use Among a Large, Urban Sample of Men and Transgender Persons Who Have Sex with Men. AIDS Behav 2022; 26:1017-1025. [PMID: 34599419 DOI: 10.1007/s10461-021-03456-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2021] [Indexed: 11/26/2022]
Abstract
We examined recent pre-exposure prophylaxis (PrEP) use (past 6 months) and its correlates among a large sample of men who have sex with men and transgender and gender non-conforming persons participating in a home HIV self-testing program conducted by the New York City Health Department between 11/2016 and 1/2017. Correlates examined included demographic characteristics and HIV-related behaviors in the past 6 months. Associations with recent PrEP use were assessed using log-binomial regression. 400 (22.5%) of 1776 participants reported recent PrEP use. In adjusted models, recent PrEP use was associated with Manhattan residence [adjusted prevalence ratio (aPR) 1.26; 95% confidence interval (CI) (1.04, 1.53)], higher income [aPR 1.29; 95% CI (1.03, 1.62)], and having insurance [aPR 1.89; 95% CI (1.33, 2.69)]. All HIV-related behaviors, except for injection drug use, were individually associated with PrEP use. More research is needed to better understand barriers to PrEP use among patients who are low income and/or uninsured as this may help improve current public health efforts to increase PrEP uptake among disproportionately impacted populations.
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Affiliation(s)
- Dinesh Rathakrishnan
- New York City Department of Health and Mental Hygiene, Queens, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Lawrence J Purpura
- New York City Department of Health and Mental Hygiene, Queens, NY, USA.
- Division of Infectious Diseases, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, 630 West 168th Street, New York, NY, 10032, USA.
- ICAP, Columbia University Mailman School of Public Health, New York, NY, USA.
| | - Paul M Salcuni
- New York City Department of Health and Mental Hygiene, Queens, NY, USA
| | - Julie E Myers
- New York City Department of Health and Mental Hygiene, Queens, NY, USA
- Division of Infectious Diseases, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, 630 West 168th Street, New York, NY, 10032, USA
| | - Amanda Wahnich
- New York City Department of Health and Mental Hygiene, Queens, NY, USA
| | | | - Zoe R Edelstein
- New York City Department of Health and Mental Hygiene, Queens, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
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130
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Poulios A, Apostolidou A, Triantafyllidou S, Protopapas K, Tapeinos A, Papadopetrakis G, Papadopoulou M, Antoniadou A, Psichogiou M, Canellopoulos L. Sexualized Drug Use and Chemsex: Their Association with Sexual Health Among Men who have Sex with Men Living in Greece. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2022; 34:450-461. [PMID: 38596273 PMCID: PMC10903580 DOI: 10.1080/19317611.2022.2045417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 01/12/2022] [Accepted: 02/15/2022] [Indexed: 04/11/2024]
Abstract
Objectives: The study aims to investigate rates of sexualized drug use (SDU) and chemsex, a type of SDU involving specifically the use of crystal methamphetamine, mephedrone, or GHB/GBL and their association with the rates of negative sexual health outcomes among men who have sex with men (MSM) in Greece. Methods: Survey of 485 MSM in internal disease departments and community testing centers. Results: Twenty-eight percent of participants were involved in SDU and 20.4% in chemsex. HIV positive status and recent STI diagnoses were associated with SDU involvement. Conclusion: SDU and chemsex rates and their impact on health reveal the need for informed community-based services.
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Affiliation(s)
- Antonios Poulios
- Laboratory of Clinical Research “Subjectivity and Social Bond”, Department of Psychology, School of Philosophy, National and Kapodistrian University of Athens, Athens, Greece
- Greek Association of People Living with HIV – Positive Voice, Athens, Greece
| | - Anna Apostolidou
- Laboratory of Clinical Research “Subjectivity and Social Bond”, Department of Psychology, School of Philosophy, National and Kapodistrian University of Athens, Athens, Greece
- Greek Association of People Living with HIV – Positive Voice, Athens, Greece
| | | | | | - Athanasios Tapeinos
- Greek Association of People Living with HIV – Positive Voice, Athens, Greece
| | | | - Martha Papadopoulou
- First Department of Internal Medicine, “Laiko” General Hospital, Athens, Greece
| | - Anastasia Antoniadou
- Fourth Department of Internal Medicine, “Attikon” University Hospital, Chaidari, Greece
| | - Mina Psichogiou
- First Department of Internal Medicine, “Laiko” General Hospital, Athens, Greece
| | - Lissy Canellopoulos
- Laboratory of Clinical Research “Subjectivity and Social Bond”, Department of Psychology, School of Philosophy, National and Kapodistrian University of Athens, Athens, Greece
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Chollier M, Bonierbale M, Polesel JM, Clergue F, Maquigneau A, Micaelli P, Korchia T, Jarillot E, Jourdan L, Pillas N, De Wever R, Enel P. Exploring sexualized substance use, sexual behaviors and HIV-screening practices in people attending erotic industry shows. AIDS Care 2022; 35:876-882. [PMID: 35277091 DOI: 10.1080/09540121.2022.2050173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Previous studies showed that Erotic industry sShows (ES) were appropriate events for sexual health promotion and testing interventions. A cross-sectional survey exploring screening practices, sexual behaviors, substance use, and sexual motives for substance use was conducted in ES in December 2017 and completed by 781 respondents. Overall, . Eighteen18% percent reported substance use in the last 3 months (51% alcohol), 26%. Twenty-six percent reported a sexual purpose for substance use. Main sexual partners were spouse (68%), regular (21%), unknown (18%) and several (17%) partners. Main sexual practices were libertinism (22%), partner swapping (15%) and threesome (15%). Twenty-seven percent of respondents reported cContactless sex was reported by 27% of the respondents. 18% reported no previous HIV test. Univariate analysis showed that having or not previous HIV test was linked to male sex (76.8% vs. 54.5%, p < 10-3), alcohol consumption in the last three months (58.7% vs. 49.4%, p = .043), number of drugs in a lifetime (1.3% vs. 1.6%, p = .022), sexual partnership with spouse/long-term partner (57.3% vs. 70.5%; p = .002), at least one multiple-partner sexual practice (23.1% vs. 31.8%, p = .040) and type of sexual attraction (p = <10-3). Results contribute to establishing the usefulness of HIV-testing and awareness campaigns in ES eventsand informing potential combined risk behaviors and related interventions.
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Affiliation(s)
- M Chollier
- Psychiatry Department Prof. Lançon, Assistance Publique Hôpitaux de Marseille, Marseille, France.,Post-University Interdisciplinary Association of Sexology, AIUS, Marseille, France
| | - M Bonierbale
- Post-University Interdisciplinary Association of Sexology, AIUS, Marseille, France
| | - J M Polesel
- COREVIH PACA Ouest Corse, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - F Clergue
- Psychiatry Department Prof. Lançon, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - A Maquigneau
- Psychiatry Department Prof. Lançon, Assistance Publique Hôpitaux de Marseille, Marseille, France.,Post-University Interdisciplinary Association of Sexology, AIUS, Marseille, France
| | - P Micaelli
- Psychiatry Department Prof. Lançon, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - T Korchia
- Psychiatry Department Prof. Lançon, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - E Jarillot
- Independent Researcher, Marseille, France
| | - L Jourdan
- Health Prevention National Association for Festive Venues, ENIPSE, Marseille, France
| | - N Pillas
- Health Prevention National Association for Festive Venues, ENIPSE, Marseille, France
| | - R De Wever
- Health Prevention National Association for Festive Venues, ENIPSE, Marseille, France
| | - P Enel
- COREVIH PACA Ouest Corse, Assistance Publique Hôpitaux de Marseille, Marseille, France.,Center for Studies and Research on Health Services and Quality of Life EA3279, Aix-Marseille University, Marseille, France
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"It's not just the hit itself": the social practice of injecting drug use among gay and bisexual men in Australia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 103:103642. [PMID: 35247865 DOI: 10.1016/j.drugpo.2022.103642] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/20/2022] [Accepted: 02/21/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Injecting drug use is purportedly more common among gay and bisexual men (GBM) than the general Australian population. Approaches designed to support the wellbeing of people who inject drugs may not be effective for GBM who inject, due to divergent settings, substances, and/or symbolism. We sought to identify the critical elements shaping injecting among GBM as a social practice and the implications for health and psychosocial wellbeing. METHODS We conducted 19 in-depth interviews with GBM in Australia with lifetime experience of injecting drug use, adopting the Frameworks Method for data analysis. Framed by social practice theory, transcripts were coded to delineate the constituent material, competency, and meaning elements of GBM's injecting practices. We developed themes encompassing the dynamic interrelationship between practice elements and wellbeing aspects. RESULTS Of 19 participants interviewed (aged 24-60 years), 17 identified as gay, two as bisexual. Injecting histories ranged from 2-32 years; most injected methamphetamine (n = 18). Injecting involved the integration of sexual function with substances and injecting skills in dyadic/communal settings. Beyond traditional harm reduction aspects, 'safe injecting' concerned trustworthiness of fellow practitioners, preventing addiction, and maintaining a solid self-concept. Injecting occurred as a dyadic/communal practice, in which an uneven distribution of materials (substances, sexual capital) and competencies (self-injecting) influenced risk and power dynamics. Pleasurable meanings of belonging, desirability and self-actualisation - gained from communities of practice - conflicted with injecting-related stigma, social dependencies, and fear of harms to body, mind, and sense of self. CONCLUSION Injecting is a heterogenous practice, including among GBM. Shifting configurations of its composite elements influence GBM's perceptions and experiences of pleasure, risk, and harms. Efforts to support their wellbeing should take a dyadic/communal approach and seek to rectify the uneven distribution of material and competency elements in these settings.
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Brooks O, Bach P, Dong H, Milloy MJ, Fairbairn N, Kerr T, Hayashi K. Crystal methamphetamine use subgroups and associated addiction care access and overdose risk in a Canadian urban setting. Drug Alcohol Depend 2022; 232:109274. [PMID: 35033951 PMCID: PMC8890780 DOI: 10.1016/j.drugalcdep.2022.109274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Methamphetamine use is rising globally and we have limited treatments for this. Subgroups within the diverse methamphetamine-using population may have distinct treatment needs. Among a community-recruited sample of people who use crystal methamphetamine, we aimed to identify subgroups and characterize their overdose risk and access to addiction care. METHODS Data from prospective cohorts of people who use drugs in Vancouver, Canada from 2014 to 2018 were used to conduct a repeated measures latent class analysis among participants who used crystal methamphetamine. Multivariable generalized estimating equations models were fit to determine the associated factors. RESULTS Among 824 eligible participants, a five-class model was identified as the best fit: (1) primary stimulant use (15.7%); (2) women engaged in sex work and opioid use (21.4%); (3) street income generation and opioid use (31.6%); (4) opioid agonist therapy (OAT) patients (22.3%); and (5) men who have sex with men (9.0%). In multivariable analyses, compared to the primary stimulant use group, non-fatal overdose was positively associated with street income generation (adjusted odds ratio [AOR] = 1.49, 95% confidence interval [95% CI]=1.30-1.71), sex work (AOR = 1.38, 95% CI=1.20-1.59) and OAT (AOR = 1.22, 95% CI=1.06-1.41) subgroups; engagement in non-OAT addiction care was negatively associated with street income generation (AOR = 0.81, 95% CI=0.68-0.97) and sex work (AOR = 0.78, 95% CI=0.63-0.98) subgroups. DISCUSSION Socioeconomically marginalized subgroups with opioid and crystal methamphetamine co-use were at highest risk of non-fatal overdose and had poorer access to addiction care, highlighting the need for tailored interventions.
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Affiliation(s)
- Olivia Brooks
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada,Department of Medicine, University of British Columbia, 2775 Laurel Street, 10th Floor, Rm 10203, Vancouver, BC V6T 1Z3, Canada
| | - Paxton Bach
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada,Department of Medicine, University of British Columbia, 2775 Laurel Street, 10th Floor, Rm 10203, Vancouver, BC V6T 1Z3, Canada
| | - Huiru Dong
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - M.-J. Milloy
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada,Department of Medicine, University of British Columbia, 2775 Laurel Street, 10th Floor, Rm 10203, Vancouver, BC V6T 1Z3, Canada
| | - Nadia Fairbairn
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada,Department of Medicine, University of British Columbia, 2775 Laurel Street, 10th Floor, Rm 10203, Vancouver, BC V6T 1Z3, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada,Department of Medicine, University of British Columbia, 2775 Laurel Street, 10th Floor, Rm 10203, Vancouver, BC V6T 1Z3, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada.
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Coyer L, Boyd A, Davidovich U, van Bilsen WPH, Prins M, Matser A. Increase in recreational drug use between 2008 and 2018: results from a prospective cohort study among HIV-negative men who have sex with men. Addiction 2022; 117:656-665. [PMID: 34402120 PMCID: PMC9292014 DOI: 10.1111/add.15666] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 08/04/2021] [Indexed: 11/28/2022]
Abstract
AIMS To test whether recreational drug use (RDU) and sexualized drug use (SDU) changed in the Amsterdam area between 2008 and 2018 and quantify associations of SDU with condomless anal sex (CAS), recent human immunodeficiency virus (HIV) or sexually transmitted infections (STI) among human immunodeficiency virus (HIV)-negative men who have sex with men (MSM). DESIGN Open prospective cohort study. SETTING Public Health Service of Amsterdam, the Netherlands. PARTICIPANTS A total of 976 HIV-negative MSM, aged ≥ 18 years. MEASUREMENTS Self-reported RDU and sexual behaviour in the past 6 months. Laboratory-confirmed HIV and STI (chlamydia, gonorrhoea and syphilis). We studied: any RDU; any SDU (i.e. any RDU during sex); specific SDU (i.e. use of mephedrone, methamphetamine, gamma-hydroxybutyric acid/gamma-butyrolactone, ketamine, amphetamine, cocaine and/or ecstasy during sex); use of individual drugs; and use of individual drugs during sex. We evaluated changes over calendar years in the proportion of individuals with these end-points [using logistic regression with generalized estimating equations (GEE)] and number of drugs (using negative binomial regression with GEE), adjusted for current age, country of birth and education level. FINDINGS Median age of participants in 2008 was 33.2 years (interquartile range = 27.8-40.1); 83.1% were born in the Netherlands. The proportion of any RDU increased from 67.2% in 2008 to 69.5% in 2018 [adjusted odds ratio (aOR) = 1.25; 95% confidence interval (CI) = 1.03-1.51]. Any SDU increased from 53.8% in 2008 to 59.8% in 2013 (aOR = 1.23; 95% CI = 1.07-1.42) and remained stable afterwards. Specific SDU increased from 25.0% in 2008 to 36.1% in 2018 (aOR = 2.10; 95% CI = 1.71-2.58). The average number of drugs used increased for those reporting any RDU, any SDU and specific SDU (all P < 0.05. Among those engaging in sex, any SDU was associated with CAS (aOR = 1.36; 95% CI = 1.19-1.55), HIV (aOR = 5.86; 95% CI = 2.39-14.4) and STI (aOR = 2.31; 95% CI = 1.95-2.73). Specific SDU was associated with CAS (aOR = 1.58; 95% CI = 1.37-1.81), HIV (aOR = 6.30; 95% CI = 3.28-12.1) and STI (aOR = 2.15; 95% CI = 1.81-2.55). CONCLUSIONS Among human immunodeficiency virus (HIV)-negative men who have sex with men in Amsterdam, recreational drug use, including sexualized drug use, increased between 2008 and 2018. Sexualized drug use was strongly associated with condomless anal sex, HIV and sexually transmitted infections.
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Affiliation(s)
- Liza Coyer
- Department of Infectious DiseasesPublic Health Service of AmsterdamAmsterdamthe Netherlands
| | - Anders Boyd
- Department of Infectious DiseasesPublic Health Service of AmsterdamAmsterdamthe Netherlands,Stichting HIV MonitoringAmsterdamthe Netherlands
| | - Udi Davidovich
- Department of Infectious DiseasesPublic Health Service of AmsterdamAmsterdamthe Netherlands,Department of Social PsychologyUniversity of AmsterdamAmsterdamthe Netherlands
| | - Ward P. H. van Bilsen
- Department of Infectious DiseasesPublic Health Service of AmsterdamAmsterdamthe Netherlands
| | - Maria Prins
- Department of Infectious DiseasesPublic Health Service of AmsterdamAmsterdamthe Netherlands,Department of Internal Medicine, Division of Infectious Diseases, Amsterdam Infection and Immunity (AII), Amsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - Amy Matser
- Department of Infectious DiseasesPublic Health Service of AmsterdamAmsterdamthe Netherlands
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Aho J, Lybeck C, Tetteh A, Issa C, Kouyoumdjian F, Wong J, Anderson A, Popovic N. Rising syphilis rates in Canada, 2011-2020. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2022; 48:52-60. [PMID: 35341093 PMCID: PMC8889924 DOI: 10.14745/ccdr.v48i23a01] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Background Syphilis rates are of public health concern in Canada, with multiple jurisdictions reporting outbreaks over the past five years. The objective of this article is to describe trends in infectious and congenital syphilis in Canada 2011-2020. Methods Routine surveillance of syphilis is conducted through the Canadian Notifiable Disease Surveillance System (CNDSS). In response to rising rates of syphilis, all provinces and territories (P/Ts) have also submitted enhanced surveillance data on infectious syphilis to the Public Health Agency of Canada through the Syphilis Outbreak Investigation Coordinating Committee (SOICC) starting in 2018. Descriptive analyses of CNDSS and SOICC surveillance data 2011-2020 by age, sex, pregnancy status, male sexual orientation and P/Ts were performed. Results The national rate of infectious syphilis increased from 5.1 per 100,000 population in 2011 to 24.7 per 100,000 population in 2020.The rates increased in almost all P/Ts, with the Prairie provinces reporting the greatest relative increases from 2016 to 2020 (more than 400%). Rates in males were consistently higher than rates in females over the past 10 years; however, from 2016 to 2020, rates among females increased by 773%, compared with 73% among males. Although the proportion of cases who self-identify as gay, bisexual and other men who have sex with men decreased from 54% to 38% between 2018 and 2020, they still represent a high proportion of cases (according to data from eight P/Ts). From 2016 to 2020, rates of infectious syphilis increased in every age group, especially in females aged 15-39 years. Confirmed early congenital syphilis cases for 2020 increased considerably from prior years, with 50 cases reported in 2020, compared with 4 cases in 2016. Conclusion Infectious and congenital syphilis rates are a growing concern in Canada and the nature of the syphilis epidemics across Canada appears to be evolving, as evidenced by recent trends. More data and research are needed to better understand the drivers associated with the recent changes in the epidemiology of syphilis in Canada.
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Affiliation(s)
- Josephine Aho
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
| | - Cassandra Lybeck
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
| | - Ashorkor Tetteh
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
| | - Carmen Issa
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
| | | | - Jason Wong
- BC Centre for Disease Control, Vancouver, BC
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC
| | - Alexandrea Anderson
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
| | - Nashira Popovic
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
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136
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Increasing emergency department admissions for chemsex-related intoxications in Barcelona, Spain, among people living with HIV: an observational study from 2018 to 2020. BMC Public Health 2022; 22:346. [PMID: 35180855 PMCID: PMC8855565 DOI: 10.1186/s12889-022-12763-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 02/09/2022] [Indexed: 11/16/2022] Open
Abstract
Background Chemsex is a novel phenomenon referring to the use of drugs, including crystal methamphetamine, gammahydroxybutyric acid (GHB)/gamma-butyrolactone (GABA) and mephedrone, to facilitate, enhance, and prolong the sexual experience in men who have sex with men in large cities internationally. There is a growing concern about chemsex and fatal cases among people living with HIV on antiretroviral therapy. This study aimed to describe the clinical characteristics of chemsex-related intoxications. Material and methods An observational study was conducted in people living with HIV who were admitted for chemsex-related intoxications in an emergency department of a teaching hospital in Barcelona, Spain, from 2018 to 2020. Severe acute intoxications were defined according to the Poisoning Severity Score. Results One hundred and fifteen male patients with a median age of 35.6±7 years were included in the study:15 (13.1%) in 2018, 32 (27.8%) in 2019 and 68 (59.1%) in 2020. All patients had stable housing, 107(93.0%) were Spanish citizen and 32 (27.8%) had mental health disorders. Median CD4 lymphocyte count was 624 (500–765) cells/mm3 and 99 (86.1%) had HIV-1 RNA suppression. Poly-drug use was observed in 51(44.3%) cases and methamphetamine in 75(65,2%) and gammahydroxibutiric acid in 68 (59.1%) were the main drugs used. Potential drug interactions due to the inhibition of cytochrome P450 by antiviral therapy was determined in 36 (31.3%) patients. Severe intoxications cases affecting neurologic and respiratory systems were diagnosed in 12 (10.4%) patients and no patient died. CD4 cell counts ≤500 cells (O.R.:4.2; C.I.95%:1.2–14.6) and mental health disorders (O.R.: 2.9; C. I 95%: 0.8–9.9) were associated with severe acute drug intoxications in the bivariate analyses. Conclusions Chemsex-related intoxications are an increasing clinical problem in people living with HIV. Chemsex should be routinely screened and addressed in clinical practice, particularly for people with mental illness and low CD4 cell counts, who are at higher risk for severe intoxications.
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Crozier B, Sayer N, Varma R. Chemsex questions: what are we actually asking? Sex Health 2022; 19:76-78. [PMID: 35176220 DOI: 10.1071/sh21223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/18/2022] [Indexed: 11/23/2022]
Abstract
Among men who have sex with men (MSM), sexualised drug use (SDU) is related to high risk sexual behaviour and a higher chance of contracting STIs. Chemsex, a subset of SDU, has a particularly high risk factor for STIs. We describe the implementation of a new question about Chemsex for first time clients attending Sydney Sexual Health Centre through a retrospective review of electronic medical records. Between 1 December 2018 and 30 November 2019, 227 MSM reported engaging in 'Chemsex'. 74 respondents (33%) had a specific drug used during sex noted. Of these, the majority (52, 70%; 95% CI 60-81) used a drug commonly associated with Chemsex (crystal methamphetamine, gamma-hydroxybutyrate, or mephedrone), however, a sizeable minority (22, 30%; 95% CI 19-40) only described a drug not commonly associated with Chemsex. The question asked appeared to be more broadly interpreted as SDU. Broad SDU questions, not just questions on Chemsex, may be more appropriate for identifying risk behaviours in MSM in clinical contexts.
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Affiliation(s)
- Brendan Crozier
- Sydney Sexual Health Centre, Nightingale Wing, Sydney Hospital and Sydney Eye Hospital, 8 Macquarie Street, Sydney, NSW 2000, Australia
| | - Nathan Sayer
- School of Medicine, The University of Queensland, Brisbane, Qld, Australia
| | - Rick Varma
- Sydney Sexual Health Centre, Nightingale Wing, Sydney Hospital and Sydney Eye Hospital, 8 Macquarie Street, Sydney, NSW 2000, Australia; and The Kirby Institute, University of New South Wales, Kensington, NSW, Australia
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Roux P, Donadille C, Girard G, Spire B, Protière C, Velter A. Impact of COVID-19 Pandemic on Men Who Have Sex With Men That Practice Chemsex in France: Results From the National ERAS Web Survey. Am J Mens Health 2022; 16:15579883211073225. [PMID: 35156425 PMCID: PMC8848067 DOI: 10.1177/15579883211073225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Chemsex-the use of drugs in a sexual context-has been associated with more at-risk sexual practices and substance-related complications in men who have sex with men (MSM). To date, no study has focused on the impact of France's first coronavirus disease 2019 (COVID-19)-related lockdown on the mental health and drug/alcohol use of MSM who practice chemsex. We implemented a web-based survey of 9,488 MSM living in France in June 2020 (after the country's first COVID-19 lockdown). Specifically, we first compared the subpopulation of MSM who self-reported practicing chemsex during their most recent sexual intercourse (defined as "chemsexers") with other MSM, using five outcomes: increased 1/tobacco use, 2/alcohol use, and 3/other psychoactive drug use. 4/using psychotropic medication during the lockdown, and finally 5/psychological distress. We then analyzed the outcomes' associations with the main explanatory variable "chemsexer," after adjusting for all relevant variables. Among 7,195 MSM who had sexual intercourse with a man during the previous 6 months, 359 participants (5%) were identified as "chemsexers." Multivariable analyses showed that during the first lockdown period, chemsexers were significantly more likely than non-chemsexers to have increased their use of tobacco, alcohol, and other psychoactive substances. Chemsexers were also more likely to have used psychotropic medication and to have experienced psychological distress during the previous month. Given the ongoing COVID-19 pandemic in France and worldwide, this finding highlights the need to develop psychosocial interventions and harm reduction services for MSM chemsexers, potentially via mobile health.
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Affiliation(s)
- Perrine Roux
- Aix-Marseille University, INSERM, IRD, U1252 SESSTIM, Sciences économiques & sociales de la santé & traitement de l'information médicale, ISSPAM, Marseille, France
| | - Cécile Donadille
- Aix-Marseille University, INSERM, IRD, U1252 SESSTIM, Sciences économiques & sociales de la santé & traitement de l'information médicale, ISSPAM, Marseille, France
| | - Gabriel Girard
- Aix-Marseille University, INSERM, IRD, U1252 SESSTIM, Sciences économiques & sociales de la santé & traitement de l'information médicale, ISSPAM, Marseille, France
| | - Bruno Spire
- Aix-Marseille University, INSERM, IRD, U1252 SESSTIM, Sciences économiques & sociales de la santé & traitement de l'information médicale, ISSPAM, Marseille, France
| | - Christel Protière
- Aix-Marseille University, INSERM, IRD, U1252 SESSTIM, Sciences économiques & sociales de la santé & traitement de l'information médicale, ISSPAM, Marseille, France
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Zeggagh J, Bauer R, Delaugerre C, Carette D, Fressard L, Charreau I, Chidiac C, Pialoux G, Tremblay C, Cua E, Robineau O, Raffi F, Capitant C, Spire B, Meyer L, Molina JM. Incidence and risk factors for recurrent sexually transmitted infections among men who have sex with men on HIV pre-exposure prophylaxis. AIDS 2022; 36:1129-1134. [PMID: 35142708 DOI: 10.1097/qad.0000000000003187] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE High rates of sexually transmitted infections (STIs) have been reported among PrEP users. We wished to assess the incidence and risk factors for recurrent STIs. DESIGN The ANRS IPERGAY trial was a prospective study investigating PrEP among MSM and transgender women in outpatient clinics in France and Canada. In all, 429 participants were enrolled, offered up to four years of PrEP and screened for bacterial STIs (syphilis, chlamydia, and gonorrhea) at baseline and every 6 months. METHODS STIs incidence was calculated yearly. Cox proportional hazards model regression was used to explore associations between participants characteristics at baseline and recurrent STI during follow-up. RESULTS Over a median follow-up of 23 months, bacterial STI incidence was 75, 33, 13, 32 and 30 per 100 person-years (PY) for all STIs, rectal STIs, syphilis, gonorrhoea and chlamydia, respectively. STI incidence significantly increased from the first year to the fourth year of the study (55 vs. 90 per 100 PY, p < 0.001). During the study period, 167 participants (39%) presented with more than one bacterial STIs which accounted for 86% of all STIs. Baseline risk factors associated with recurrent STIs in a multivariate analysis were an STI at baseline (HR: 1.48 (95% CI: 1.06-2.07, p = 0.02), more than 8 sexual partners in prior 2 months (HR: 1.72 (95% CI: 1.21-2.43, p = 0.002), and the use of GHB (HR: 1.66 (95% CI: 1.16-2.38, p = 0.005). CONCLUSIONS STI incidence was high and increased over time. Most STIs were concentrated in a high-risk group that should be targeted for future interventions.
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140
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High Rates of Sexualized Drug Use or Chemsex among Brazilian Transgender Women and Young Sexual and Gender Minorities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031704. [PMID: 35162728 PMCID: PMC8835457 DOI: 10.3390/ijerph19031704] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 11/17/2022]
Abstract
(1) Background: We aimed to estimate sexualized drug use (SDU) prevalence and its predictors among sexual and gender minorities. (2) Methods: We used an online and on-site survey to enroll sexual/gender minorities people between October-December/2020, and multivariate logistic regression to obtain SDU correlates. (3) Results: We enrolled 3924 individuals (280 transgender women [TGW], 3553 men who have sex with men [MSM], and 91 non-binary), 29.0% currently on pre-exposure prophylaxis (PrEP). SDU prevalence was 28.8% (95% confidence interval [CI] 27.4-30.2). TGW had 2.44-times increased odds (95%CI 1.75-3.39) of engaging in SDU compared to MSM, regardless of PrEP use. PrEP use (aOR 1.19, 95%CI 1.00-1.41), South/Southeast region (aOR 1.26, 95%CI 1.04-1.53), younger age (18-24 years: aOR 1.41, 95%CI 1.10-1.81; 25-35 years: aOR 1.24, 95%CI 1.04-1.53), white race/color (aOR 1.21, 95%CI 1.02-1.42), high income (aOR 1.32, 95%CI 1.05-1.67), binge drinking (aOR 2.66, 95%CI 2.25-3.14), >5 sexual partners (aOR 1.88, 95%CI 1.61-2.21), condomless anal sex (aOR 1.49, 95%CI 1.25-1.79), self-reported sexually transmitted infection (aOR 1.40, 95%CI 1.14-1.71), and higher perceived HIV-risk (aOR 1.37, 95%CI 1.14-1.64) were associated with SDU. (4) Conclusions: TGW had the highest SDU odds. SDU may impact HIV vulnerability among key populations and should be addressed in HIV prevention approaches.
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141
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Smiles C, O’Donnell A, Jackson K. Needle exchange practitioners accounts of delivering harm reduction advice for chemsex: implications for policy and practice. DRUGS: EDUCATION, PREVENTION AND POLICY 2022. [DOI: 10.1080/09687637.2022.2027345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Claire Smiles
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Amy O’Donnell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Katherine Jackson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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142
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Post-Exposure Prophylaxis and Methamphetamine Use among Young Sexual Minority Men: The P18 Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020712. [PMID: 35055534 PMCID: PMC8775683 DOI: 10.3390/ijerph19020712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/03/2022] [Accepted: 01/05/2022] [Indexed: 02/01/2023]
Abstract
Methamphetamine use is associated with increased risk of HIV infection among young sexual minority men (SMM). Post-exposure prophylaxis (PEP) is an effective strategy for individuals who are exposed to HIV, but there is limited research about PEP use among young SMM and its relationship with methamphetamine use. This study analyzes the association between ever PEP use and recent methamphetamine use among young SMM in New York City, using cross-sectional data from the P18 Cohort Study (n = 429). Multivariable logistic regression models were used to assess the association between methamphetamine use and ever PEP use. Compared with those who had not used methamphetamine in the last 6 months, young SMM who did use methamphetamine were significantly more likely to have ever used PEP (AOR = 6.07, 95% CI: 2.10–16.86). Young SMM who had ever used PrEP had 16 times higher odds of ever using PEP (AOR = 16, 95% CI: 7.41–35.95). Those who completed bachelor’s degrees were 61% less likely to have ever used PEP (AOR = 0.39, 95% CI: 0.17–0.88). These data suggest that methamphetamine use could increase the risk of HIV infection, highlighting the critical need to target interventions for young SMM who use methamphetamine and are more likely to engage in unprotected intercourse.
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143
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Schuler MS, Collins RL, Ramchand R. Disparities in Use/Misuse of Specific Illicit and Prescription Drugs among Sexual Minority Adults in a National Sample. Subst Use Misuse 2022; 57:461-471. [PMID: 35067155 DOI: 10.1080/10826084.2021.2019776] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background: Compared to heterosexual adults, lesbian, gay, and bisexual (LGB) adults have higher rates of any illicit drug use and any prescription drug misuse, yet disparities regarding specific drugs remain poorly characterized. Methods: We examined disparities by sexual identity and sex for 8 illicit and prescription drugs using 2015-2019 National Survey on Drug Use and Health data. Outcomes included past-year use/misuse of cocaine/crack, hallucinogens, inhalants, methamphetamine, heroin, prescription opioids, prescription stimulants, prescription tranquilizers/sedatives, and level of polydrug use/misuse (2 substances; 3+ substances). For each outcome, odds ratios relative to heterosexual adults of same sex were estimated using logistic regression controlling for demographics; significant estimates were interpreted as a disparity. Results: Among gay men, significant disparities were present for all drugs except prescription stimulants and heroin; inhalant use was particularly elevated. Bisexual women exhibited significant disparities for every drug examined, as did bisexual men (except heroin). Among lesbian/gay women, disparities were only present for prescription opioids and stimulants. Relative to heterosexual peers, use of 3+ substances was 3 times higher among gay men and bisexual women and 2 times higher among bisexual men. Conclusions: Consistent with minority stress theory, prevalences of illicit and prescription drug use/misuse were 2-3 times higher among LGB adults than heterosexual adults. Illicit drug use should not be perceived as only impacting gay/bisexual men - bisexual women had similar - or higher - prevalences of hallucinogen, cocaine, methamphetamine, and heroin use. Yet, in contrast to bisexual women, lesbian/gay women did not exhibit disparities for any illicit drugs.
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144
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Íncera-Fernández D, Gámez-Guadix M, Moreno-Guillén S. Mental Health Symptoms Associated with Sexualized Drug Use (Chemsex) among Men Who Have Sex with Men: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413299. [PMID: 34948907 PMCID: PMC8701799 DOI: 10.3390/ijerph182413299] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/10/2021] [Accepted: 12/14/2021] [Indexed: 01/21/2023]
Abstract
Background: Sexualized drug use (SDU), also known as chemsex, refers to the use of psychoactive substances for sexual purposes among men who have sex with men (MSM), which has been associated with mental health symptoms. The objective of this review is to systematically review the available evidence on mental health outcomes in MSM who use sexualized drugs. Methods: To prepare this systematic review, search strategies were developed and applied to the Web of Science, Science Direct, PubMed, and Scopus databases. A total of 117 articles were found, of which 12 were selected for the final review. Results: Those MSM who practiced SDU were more likely to experience from depression, anxiety, or a substance dependence, although these results were not found in all the studies analyzed. Among those who practiced the administration of intravenous drugs (referred to as slamsex), the mental health symptoms were more severe. Conclusions: This systematic review contributes to a fuller understanding of the mental health symptoms present in MSM who consume drugs for sexual purposes. Greater uniformity in data collection instruments is required, as well as the need to conduct a more in-depth assessment of the psychosocial adjustment of people who practice chemsex.
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Affiliation(s)
- Daniel Íncera-Fernández
- Department of Personality, Assessment and Psychological Treatment, Autonomous University of Madrid, 28049 Madrid, Spain;
- Correspondence: ; Tel.: +34-686-454-251
| | - Manuel Gámez-Guadix
- Department of Personality, Assessment and Psychological Treatment, Autonomous University of Madrid, 28049 Madrid, Spain;
| | - Santiago Moreno-Guillén
- Department of Medicine and Medical Specialties, Alcalá University, 28871 Alcala de Henares, Spain;
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145
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Aboujaoude E, Kuss DJ, Yao MZ, Leung LW. Editorial: Online Psychology Beyond Addiction and Gaming: A Global Look at Mental Health and Internet-Related Technologies. Front Psychol 2021; 12:815013. [PMID: 34975704 PMCID: PMC8716553 DOI: 10.3389/fpsyg.2021.815013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 11/22/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Elias Aboujaoude
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, CA, United States
| | - Daria Joanna Kuss
- Psychology Department, Nottingham Trent University, Nottingham, United Kingdom
| | - Mike Z. Yao
- College of Media, University of Illinois at Urbana-Champaign, Champaign, IL, United States
| | - Louis W. Leung
- Department of Journalism and Communications, Hong Kong Shue Yan University, Hong Kong, Hong Kong SAR, China
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146
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Cao W, You X, Li J, Peng L, Gu J, Hao C, Hou F, Wei D, Deng Y, Hao Y, Mo PKH. Same-sex behavior disclosure to health care providers associated with greater awareness of pre-exposure prophylaxis. BMC Public Health 2021; 21:2243. [PMID: 34893061 PMCID: PMC8665488 DOI: 10.1186/s12889-021-12317-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 11/24/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND This study aimed to determine whether the disclosure of same-sex behavior to health care providers (HCPs) is associated with higher rates of prior human immunodeficiency virus (HIV) testing experience and greater awareness of immediate antiretroviral therapy (ART), Undetectable = Untransmittable (U=U), and pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM). METHODS We conducted a cross-sectional survey among 689 adult males in Chengdu, China who self-reported having had anal intercourse with at least one man in the past 6 months. We measured same-sex behavior disclosure to three types of HCPs (hospital clinicians, community-based organization peer educators, and Center for Disease Control and Prevention public health specialists), and the awareness of immediate ART, U=U, and PrEP. RESULTS Of the 689 enrolled participants, 31.4% had disclosed their same-sex behavior to some or all of the clinicians, 83.9% had done so to the peer educators, and 56.8% had done so to the public health specialists. Approximately four in five (82.1%) of the participants had ever been tested for HIV. The awareness rate was 84.8% for immediate ART, 20.2% for U=U, and 50.7% for PrEP. After controlling for significant background variables, same-sex behavior disclosure to clinicians was associated with greater awareness of PrEP (adjusted odds ratio [AOR] = 1.64; 95% confidence interval [CI]: 1.08-2.48), but similar findings were not reported regarding disclosure to peer educators or public health specialist. Same-sex behavior disclosure to any types of HCPs was not associated with HIV testing experience, and awareness of immediate ART or U=U. CONCLUSIONS The rates of same-sex behavior disclosure varied with different types of HCPs. Disclosure to clinicians was associated with greater awareness of PrEP, but not awareness of immediate ART or U=U.
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Affiliation(s)
- Wangnan Cao
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| | - Xinyi You
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Jinghua Li
- School of Public Health, Sun Yat-Sen University, Guangzhou, China.,Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
| | - Liping Peng
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Jing Gu
- School of Public Health, Sun Yat-Sen University, Guangzhou, China.,Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
| | - Chun Hao
- School of Public Health, Sun Yat-Sen University, Guangzhou, China.,Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
| | - Fengsu Hou
- Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China.,Department of Public Mental Health, Kangning Hospital, Shenzhen, Guangdong, China
| | - Dannuo Wei
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Yang Deng
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Yuantao Hao
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Phoenix Kit-Han Mo
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Ngan Shing St, Shatin, Hong Kong.
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147
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Apers L, Vanhamel J, Caluwaerts S, Platteau T, Kenyon C, Florence E. Impact of PrEP on a STI clinic in a Belgian context: a provider's perspective. Acta Clin Belg 2021; 76:477-481. [PMID: 32468957 DOI: 10.1080/17843286.2020.1767995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objectives: To assess the impact of Pre-Exposure Prophylaxis (PrEP) to avoid HIV infection as an additional service in a routine Sexually Transmitted Infections (STI) clinic.Methods: We used routinely obtained retrospective data to estimate the increased workload on the existing facilities. We focussed on STI registration through the laboratory registration system and put this in a national perspective. A critical appraisal was made of the national HIV notifications, as an indicator of the impact of PrEP. Additional challenges were identified via face-to-face interviews with clinicians with at least five years experience in the STI clinic.Results: PrEP delivery puts a substantial burden on a routine STI clinic, in terms of counselling users and prescribing drugs, and regular screening and treating of STIs. Psycho-social aspects need to be incorporated as part of a comprehensive approach of the PrEP user. This requires skills and resources that are not yet always available in a clinic, specialised in HIV and STI care. The increasing demand for this service calls for a careful and critical appraisal of the existing service model.Conclusion: PrEP has gained an important and irreplaceable position in the prevention of HIV infection. New models of care need to be studied, preferably in close collaboration with the users, to make this intervention sustainable for the health system in which it is introduced.
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Affiliation(s)
- Ludwig Apers
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jef Vanhamel
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Séverine Caluwaerts
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Tom Platteau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Chris Kenyon
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Eric Florence
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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148
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Card K, McGuire M, Bond-Gorr J, Nguyen T, Wells GA, Fulcher K, Berlin G, Pal N, Hull M, Lachowsky NJ. Perceived difficulty of getting help to reduce or abstain from substances among sexual and gender minority men who have sex with men (SGMSM) and use methamphetamine during the early period of the COVID-19 pandemic. Subst Abuse Treat Prev Policy 2021; 16:88. [PMID: 34903260 PMCID: PMC8667539 DOI: 10.1186/s13011-021-00425-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2021] [Indexed: 11/29/2022] Open
Abstract
Background This study examined the perceived difficulty of getting help with substance use among sexual and gender minorities who have sex with men (SGMSM) who use methamphetamine during the early COVID-19 period. Methods SGMSM, aged 18+, who reported sex with a man and methamphetamine use in the past 6 months were recruited to complete an online survey using online advertisements. Ordinal regression models examined predictors of greater perceived difficulty of getting help. Explanatory variables included participant characteristics (i.e., age, HIV status, ethnicity, sexuality, gender, region, income) and variables assessing patterns of methamphetamine use (i.e., frequency, % time methamphetamine is used alone and during sex; perceived need for help) and patterns of healthcare access (i.e., regular provider, past substance use service utilization). Results Of 376 participants, most were gay-identified (76.6%), white (72.3%), cisgender (93.6%), and had annual incomes of less than $60,000 CAD (68.9%). Greater perceived difficulty of getting help was associated with having lower income, sometimes using methamphetamine prior to or during sex, and greater perceived need for help. Conclusion Based on these results, we urge greater investments in one-stop, low-barrier, culturally-appropriate care for SGMSM who use methamphetamine. This is especially important given that participants who perceive themselves as needing help to reduce or abstain from substance use perceive the greatest difficulty of getting such help.
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149
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Demant D, Carroll JA, Saliba B, Bourne A. Information-seeking behaviours in Australian sexual minority men engaged in chemsex. Addict Behav Rep 2021; 16:100399. [PMID: 35712328 PMCID: PMC9193851 DOI: 10.1016/j.abrep.2021.100399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/28/2021] [Accepted: 12/08/2021] [Indexed: 12/01/2022] Open
Abstract
Participants engaged in chemsex over long periods of time and on a regular basis. Most know where to seek professional help and access harm reduction information. Many worry about being judged by health professionals and few seek out assistance. Participants feel uncomfortable discussing chemsex with most health professionals. Information from sexual health professionals is trusted the most.
Introduction Chemsex refers to using illicit substances to facilitate sexual experiences in men who have sex with men. Chemsex has been linked to significant negative impacts on psychological, social, and physical wellbeing. Little is known about information-seeking behaviours in this population. This study aims to provide an in-depth understanding of seeking and engaging with health information. Methods Self-identified Australian sexual minority men who engage in chemsex (N = 184) participated in an anonymous cross-sectional survey. Variables included chemsex engagement, knowledge, perception and use of harm-reduction information, and associated health and support services. Pearson correlation and ANOVAs were conducted. Wilcoxon-Signed-Rank and Friedman tests were applied to analyse the perceived trustworthiness of information sources. Results Chemsex represented a meaningful part of sexual events. Most participants knew where to access professional help and harm-reduction information but worried about being judged. Most did not feel comfortable discussing chemsex with health professionals except with sexual health doctors/counsellors. Few users discussed health risks with a professional. Information on chemsex was received through multiple sources with significant differences in perceived relevance and trustworthiness, with sexual health doctors/nurses ranked the most trustworthy information. Interest in non-traditional sources of information was low except for formal peer networks and anonymous personal expert advice. Conclusion Engagement with health professionals and harm-reduction information is limited in this population, despite high risk and potentially significant adverse health outcomes. Results suggest that new and combined approaches are necessary to reach this population, including peer support networks, anonymous personal advice and changing community attitudes towards chemsex.
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Affiliation(s)
- Daniel Demant
- School of Public Health, University of Technology Sydney, Ultimo, Australia
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
- Corresponding author at: School of Public Health, Faculty of Health, University of Technology Sydney, 235-253 Jones Street, Ultimo, New South Wales 2007, Australia.
| | - Julie-Anne Carroll
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Bernard Saliba
- School of Public Health, University of Technology Sydney, Ultimo, Australia
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
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Hansen ER, Carvalho S, McDonald M, Havens JR. A qualitative examination of recent increases in methamphetamine use in a cohort of rural people who use drugs. Drug Alcohol Depend 2021; 229:109145. [PMID: 34763138 PMCID: PMC8665094 DOI: 10.1016/j.drugalcdep.2021.109145] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 10/08/2021] [Accepted: 10/10/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Rising rates of methamphetamine use among populations using opioids is an escalating public health concern. The purpose of this manuscript is to identify socioecologic factors driving increases in methamphetamine use among Appalachian Kentucky adults with a history of opioid use. METHODS Semi-structured qualitative interviews were conducted among 20 Appalachian Kentuckians in the Social Network of Appalachian Peoples (SNAP) cohort who reported lifetime opioid use and past 30-day methamphetamine use. Interviews focused on initiation of methamphetamine use, factors that influence methamphetamine use at the individual, interpersonal, community and society levels. RESULTS Participants reported using methamphetamine to self-treat underlying issues, including withdrawal from opioids, chronic pain, and emotional distress. Initiation of use was most often facilitated through their drug networks. Participants reported that methamphetamine was widely available and affordable in their community. Several participants with extensive histories of non-medical prescription opioid (NMPO) use described transitioning to methamphetamine as their drug of choice as opioids became less available in their community. Participants also reported economic distress and lack of recreational opportunities as drivers of increased methamphetamine use. DISCUSSION Recent increases in methamphetamine use among those with a history of opioid use is facilitated by methamphetamine's relative availability and affordability. Methamphetamine use was also highly influenced by societal factors such as economic deprivation and policies that decreased availability of NMPOs. Surging methamphetamine use exacerbates inequities in addiction care brought to light by the opioid epidemic. Interventions aimed at addressing the socioecological drivers of methamphetamine use among people who use opioids are warranted.
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Affiliation(s)
- Elizabeth R Hansen
- University of Kentucky College of Medicine, Department of Behavioral Science, Center on Drug and Alcohol Research, 845 Angliana Avenue, Lexington, KY 40508, USA; University of Kentucky College of Medicine, William R. Willard Medical Education Building, MN 150, Lexington, KY 40536-0298, USA
| | - Shelby Carvalho
- University of Kentucky College of Medicine, William R. Willard Medical Education Building, MN 150, Lexington, KY 40536-0298, USA
| | - Madelyn McDonald
- University of Kentucky Center for Innovation in Population Health, College of Public Health, 111 Washington Avenue, Lexington, KY 40526, USA
| | - Jennifer R Havens
- University of Kentucky College of Medicine, Department of Behavioral Science, Center on Drug and Alcohol Research, 845 Angliana Avenue, Lexington, KY 40508, USA.
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