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Gertzen M, Karcher S, Schwarz J, Rosenberger C, Strasburger M, Rabenstein A, Strasser AM, Palm U, Rüther T. "I Can't Get No Satisfaction"-Psychosocial Aspects and Awareness of Negative Impacts in Chemsex Users: Results from an Anonymous Online Survey. Brain Sci 2024; 14:666. [PMID: 39061406 PMCID: PMC11275116 DOI: 10.3390/brainsci14070666] [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: 06/04/2024] [Revised: 06/24/2024] [Accepted: 06/27/2024] [Indexed: 07/28/2024] Open
Abstract
Chemsex is the interplay of substance use by men who have sex with men (MSM) in sexual contexts. The minority stress model and the identity process theory are explanatory models. In this study, we investigated whether (i) differences in certain psychosocial aspects (i.e., shame, aspects of queer identity, and sexual self-concepts) exist between chemsex users and non-users, and (ii) which factors influence an awareness of negative impacts in chemsex users. We conducted an anonymous, cross-sectional, online survey, including sociodemography, sexual history, history of substance use, validated scales for shame-proneness, aspects of queer identity, and sexual self-concepts. Our analysis comprised descriptive statistics, t-tests, Spearman's correlations, and a multiple linear regression model. We recorded a total of 3257 datasets with 107 chemsex users. Chemsex users showed higher rates for risky sexual behavior. Values for shame proneness, more negative aspects of queer identity, and sexual self-concepts were elevated in chemsex users with an awareness of negative impacts. Sexual anxiety, intravenous substance use, and having had a difficult process coming out were significant predictors of feeling negative impacts. Aspects of shame, queer identity aspects, and sexual self-concepts play an important role in the field of chemsex. Different explanatory models seem to be relevant for different subgroups of chemsex users. Chemsex users with an awareness of a problem were particularly vulnerable and distressed but had the highest motivation for change. Prevention, counseling, and care might profit from the inclusion of these aspects. Further anti-stigma campaigns and a specialization of the healthcare system are needed. Registration: DRKS00022336, date: 29th of October, 2020.
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Affiliation(s)
- Marcus Gertzen
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical Faculty, University of Augsburg, 86156 Augsburg, Germany
| | - Sinan Karcher
- Department of Psychiatry and Psychotherapy, University Hospital Munich, 80336 Munich, Germany
| | - Johanna Schwarz
- Department of Psychiatry and Psychotherapy, University Hospital Munich, 80336 Munich, Germany
| | - Cornelia Rosenberger
- Department of Psychiatry and Psychotherapy, University Hospital Munich, 80336 Munich, Germany
| | - Moritz Strasburger
- Department of Psychiatry and Psychotherapy, University Hospital Munich, 80336 Munich, Germany
| | - Andrea Rabenstein
- Department of Psychiatry and Psychotherapy, University Hospital Munich, 80336 Munich, Germany
| | - Anna-Martina Strasser
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical Faculty, University of Augsburg, 86156 Augsburg, Germany
| | - Ulrich Palm
- Department of Psychiatry and Psychotherapy, University Hospital Munich, 80336 Munich, Germany
- P3 Clinic, 82327 Tutzing, Germany
| | - Tobias Rüther
- Department of Psychiatry and Psychotherapy, University Hospital Munich, 80336 Munich, Germany
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2
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Schroeder SE, Wilkinson AL, O'Keefe D, Bourne A, Doyle JS, Hellard M, Dietze P, Pedrana A. Does sexuality matter? A cross-sectional study of drug use, social injecting, and access to injection-specific care among men who inject drugs in Melbourne, Australia. Harm Reduct J 2023; 20:9. [PMID: 36691010 PMCID: PMC9869557 DOI: 10.1186/s12954-023-00737-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 01/14/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Gay, bisexual and other men who have sex with men (GBMSM) are overrepresented in cohorts of people who inject drugs. GBMSM's substance use is usually explored in the context of its contribution to sexual risk. We examined drug use practices, connectedness to other people who inject drugs, peer-to-peer injecting, and access to care among men who inject drugs in Melbourne, Australia. We aim to describe similarities and differences in these parameters for GBMSM and other men. METHODS Data were drawn from a prospective cohort study of people who inject drugs conducted in Melbourne, Australia, since 2009. This cross-sectional study used data collected between 2016 and 2021. Descriptive statistics were used to assess differences between GBMSM and other men. RESULTS Of 525 men who injected drugs over the study period, 48 (9%) identified as gay or bisexual, or reported sex with other men in the past 12 months. GBMSM and other men reported similar socio-demographics, drug practices (age of injecting initiation, most injected drug, peer-to-peer injecting, receptive syringe sharing) and access to injecting-specific care (drug treatment, source of needle-syringes). A significantly greater percentage of GBMSM reported past 12-month hepatitis C testing (69% vs. 52%, p = 0.028) and preferring methamphetamine (31% vs. 16%, p = 0.022). A higher percentage of GBMSM reported knowing > 50 other people who inject drugs (46% vs. 37%), but this difference was not statistically significant. Both groups primarily obtained injecting equipment from needle-syringe programs; a minority had accessed injecting-specific primary care. CONCLUSION Men who injected drugs in this cohort and those who identified as GBMSM reported similar drug and health-seeking practices. The higher prevalence of methamphetamine injecting among GBMSM may warrant different harm reduction support for this group. Health promotion should utilise opportunities to connect men who inject drugs in Melbourne to injecting-specific primary health care.
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Affiliation(s)
- Sophia E Schroeder
- Disease Elimination Program, Burnet Institute, 85 Commercial Road, Melbourne, 3004, Australia.
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - A L Wilkinson
- Disease Elimination Program, Burnet Institute, 85 Commercial Road, Melbourne, 3004, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - D O'Keefe
- Disease Elimination Program, Burnet Institute, 85 Commercial Road, Melbourne, 3004, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - A Bourne
- Australian Research Centre for Sex, Health and Society, La Trobe University, Bundoora, Australia
- Kirby Institute, UNSW Sydney, Sydney, Australia
| | - J S Doyle
- Disease Elimination Program, Burnet Institute, 85 Commercial Road, Melbourne, 3004, Australia
- Department of Infectious Diseases, The Alfred Hospital and Monash University, Melbourne, Australia
| | - M Hellard
- Disease Elimination Program, Burnet Institute, 85 Commercial Road, Melbourne, 3004, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Infectious Diseases, The Alfred Hospital and Monash University, Melbourne, Australia
- Doherty Institute and Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - P Dietze
- Disease Elimination Program, Burnet Institute, 85 Commercial Road, Melbourne, 3004, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- National Drug Research Institute, Curtin University, Perth, Australia
| | - A Pedrana
- Disease Elimination Program, Burnet Institute, 85 Commercial Road, Melbourne, 3004, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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3
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Constructing Taxonomies: Identifying Distinctive Class of HIV Support and Risk Networks among People Who Use Drugs (PWID) and Their Network Members in the HPTN 037 Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127205. [PMID: 35742460 PMCID: PMC9223677 DOI: 10.3390/ijerph19127205] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/06/2022] [Indexed: 02/04/2023]
Abstract
Injection drug use is a significant mode of HIV transmission. Social networks are potential avenues for behavior change among high-risk populations. Increasing knowledge should include a classification or taxonomy system of networks’ attributes, risks, and needs. The current study employed 232 networks comprising 232 indexes, with 464 network members enrolled in Philadelphia. LCA revealed a three-class solution, Low-Risk, Paraphernalia Risk, and High Sex/Moderate Paraphernalia Risk class, among participants. The analysis found receiving money or drugs for sex and employment status increased the odds of belonging to PR and PSR classes. Homelessness and incarceration increased the odds of belonging to the PR class when compared to the LR class. Our findings suggest that classes of risk among PWID comprise clusters of information concerning their members. These findings add depth to our understanding while extending our knowledge of the contextual environment that nurtures or exacerbates the problem.
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4
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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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5
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Treloar C, Hopwood M, Drysdale K, Lea T, Holt M, Dowsett GW, Aggleton P, Bryant J. Stigma as understood by key informants: A social ecological approach to gay and bisexual men's use of crystal methamphetamine for sex. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 94:103229. [PMID: 33774423 DOI: 10.1016/j.drugpo.2021.103229] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 03/07/2021] [Accepted: 03/14/2021] [Indexed: 11/16/2022]
Abstract
This paper explores the perceptions of 35 key informants (KIs) in a range of relevant health and community sectors regarding the stigmatisation of GBM's crystal methamphetamine use and sexual practice with view to informing stigma reduction efforts. A modified social ecological model was used to guide analysis and interpretation. At the individual level, KI participants indicated that crystal methamphetamine was used by some GBM to reduce the effects of internalised stigma. At the network level, KIs thought that some drugs and types of use could attract more stigma and that this could erode support from GBM networks for men who use crystal. KIs felt that few "mainstream" organisations could provide appropriate services for GBM who use crystal and furthermore, that there was significant work to "undo" misperceptions of the harms of crystal use. At the policy level, mass media anti-drug campaigns were seen to be a significant generator of stigma with irrelevant and patronising messages that lacked useful information. Efforts to reduce stigma about crystal methamphetamine use amongst GBM must address individual, network, organisation and policy issues and be underpinned by understandings of social power in relation to sex, sexuality, drug use, infectious status and sexual minorities.
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Affiliation(s)
- Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia.
| | - Max Hopwood
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Kerryn Drysdale
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Toby Lea
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Gary W Dowsett
- Australian Research Centre in Sex, Health and Society, La Trobe University, 215 Franklin Street, Melbourne, VIC, 3000, Australia
| | - Peter Aggleton
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Joanne Bryant
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
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6
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Sansone A, Limoncin E, Colonnello E, Mollaioli D, Ciocca G, Corona G, Jannini EA. Harm Reduction in Sexual Medicine. Sex Med Rev 2021; 10:3-22. [DOI: 10.1016/j.sxmr.2021.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 01/21/2021] [Accepted: 01/24/2021] [Indexed: 12/22/2022]
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7
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Drysdale K, Bryant J, Dowsett GW, Lea T, Treloar C, Aggleton P, Holt M. Priorities and practices of risk reduction among gay and bisexual men in Australia who use crystal methamphetamine for sex. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 93:103163. [PMID: 33601217 DOI: 10.1016/j.drugpo.2021.103163] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 02/07/2023]
Abstract
Crystal methamphetamine (hereafter crystal) is associated with deleterious health outcomes, such as drug dependence and physical and mental health disorders. While some harms from crystal use can affect all users, there may be additional risks for people who combine the use of drug with sex. Compared with the broader population, gay and bisexual men in Australia report a higher prevalence of methamphetamine use, and crystal is the most commonly injected illicit drug among this population. The Crystal, Pleasures and Sex between Men research project was conducted between 2017 and 2019 and examined gay and bisexual men's crystal use in four capital cities in Australia, with the aim of identifying how to best support men who use crystal for sex. In this article, we examine how risk is understood and prioritised by gay and bisexual men who combine crystal use and sex and identify the range of risk reduction practices that they used. We classified these risks as those associated with the transmission of HIV, HCV and STIs, and those associated with dependence on either crystal or the sex it facilitated. Gay and bisexual men overwhelmingly prioritised the risk of dependence over any other risks associated with crystal-enhanced sex, and this prioritization was reflected in the risk reduction practices they employed. While some of the strategies that gay and bisexual men have adopted may contradict anticipated public health principles, they derive from a carefully considered and shared approaches to the generation of pleasure, the maintenance of a controlled form of feeling "out of control", and the negotiated reduction of risk. The consolidation of these strategies effectively constitutes a "counterpublic health" underpinned by forms of "sex-based sociality", which gives primacy to the priorities and practices of gay and bisexual men in Australia who combine crystal and sex.
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Affiliation(s)
- Kerryn Drysdale
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2054, Australia; Health Equity Research and Development Unit, Sydney Local Health District & UNSW Sydney, Sydney, NSW, 2054, Australia.
| | - Joanne Bryant
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2054, Australia
| | - Gary W Dowsett
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2054, Australia; Australian Research Centre for Sex, Health and Society, La Trobe University, Bundoora, VIC, 3086, Australia
| | - Toby Lea
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2054, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2054, Australia
| | - Peter Aggleton
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2054, Australia
| | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2054, Australia
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8
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Saxton PJW, McAllister SM, Noller GE, Newcombe DAL, Leafe KA. Injecting drug use among gay and bisexual men in New Zealand: Findings from national human immunodeficiency virus epidemiological and behavioural surveillance. Drug Alcohol Rev 2020; 39:365-374. [PMID: 32101629 DOI: 10.1111/dar.13046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 01/08/2020] [Accepted: 02/06/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND AIMS Gay and bisexual men (GBM) who inject drugs are disproportionately affected by human immunodeficiency virus (HIV) because of dual transmission risks. New Zealand has a progressive history of harm reduction and was the first country to publicly fund needle exchange programs in 1988 for people who inject drugs (PWID). We combine national HIV epidemiological and bio-behavioural surveillance data to understand HIV risk among this subpopulation. DESIGN AND METHODS We examine trends in new HIV diagnoses 1996-2018 by mode of transmission, and compare HIV cases attributed to sex between men (MSM-only), MSM/injecting drug use (IDU) and IDU-only. IDU among GBM in a national HIV behavioural surveillance survey was also examined. We compare GBM by IDU status (never, 'recent', previous) and identified predictors of recent IDU. RESULTS Of 1653 locally-acquired HIV diagnoses 1996-2018, 77.4% were MSM-only, 1.5% MSM/IDU, 1.4% IDU-only and 14.2% heterosexual mode of transmission. On average, just one HIV diagnosis attributed to MSM/IDU and IDU, respectively, occurred per annum. MSM/IDU cases were more likely than MSM-only cases to be indigenous Māori ethnicity. Of 3163 GBM survey participants, 5.4% reported lifetime IDU and 1.2% were recent IDU. Among GBM, HIV positivity was 20% among recent IDU and 5.3% among never injectors. Predictors of recent IDU were: age under 30; more than 20 male partners; female partner; condomless intercourse; HIV positivity. DISCUSSION AND CONCLUSION New Zealand has averted high endemic HIV rates seen among GBM and PWID in other countries and results have been sustained over 30 years.
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Affiliation(s)
- Peter J W Saxton
- Gay Men's Sexual Health Research Group, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Susan M McAllister
- AIDS Epidemiology Group, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Geoffrey E Noller
- Needle Exchange Services Trust, New Zealand Needle Exchange Programme, Christchurch, New Zealand
| | - David A L Newcombe
- Centre for Addiction Research, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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9
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Wong A, Prestage GP, Poynten IM, Jin F, Hillman RJ, Law C, Fairley CK, Garland SM, Grulich AE, Templeton DJ. Effect of age on the association between recreational drug use and sexual risk behaviour: a cross-sectional observational analysis. Sex Health 2020; 17:538-542. [PMID: 33326745 DOI: 10.1071/sh20115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 11/09/2020] [Indexed: 11/23/2022]
Abstract
Recreational drug use (RDU) among gay and bisexual men (GBM) is associated with higher-risk sexual behaviours, however this has not been well defined among older GBM. We investigated the association between RDU and sexual behaviours among older GBM in Sydney, Australia. 617 GBM aged 35-79 years self-reported their RDU in the past 6 months and sexual behaviours. Age-stratified univariable associations between RDU and behaviour were examined. GBM aged 35-44 years were the most likely to report RDU, with rates decreasing with increasing age (Ptrend < 0.001). Associations between RDU and higher-risk sexual behaviours were most consistently found among GBM aged 35-54 years.
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Affiliation(s)
- Arthur Wong
- Sexual Health Service, Sydney Local Health District, Camperdown, NSW 2050, Australia; and School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2050, Australia; and Corresponding author.
| | | | - I Mary Poynten
- The Kirby Institute, UNSW Australia, Sydney, NSW 2052, Australia
| | - Fengyi Jin
- The Kirby Institute, UNSW Australia, Sydney, NSW 2052, Australia
| | - Richard J Hillman
- The Kirby Institute, UNSW Australia, Sydney, NSW 2052, Australia; and Dysplasia and Anal Cancer Services, St Vincent's Hospital, Darlinghurst, NSW 2010, Australia
| | - Carmella Law
- The Kirby Institute, UNSW Australia, Sydney, NSW 2052, Australia; and HIV, Immunology and Infectious Diseases Department, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, Sydney, NSW 2010, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Vic. 3053, Australia; and Central Clinical School, Monash University, Vic. 3181, Australia
| | - Suzanne M Garland
- Department of Obstetrics and Gynaecology, University of Melbourne, Vic. 3052, Australia; and Centre for Women's Infectious Diseases Research, Royal Women's Hospital, Melbourne, Vic. 3052, Australia; and Department of Infectious Diseases and Microbiology, Murdoch Children's Research Institute, Parkville, Vic. 3052, Australia
| | - Andrew E Grulich
- The Kirby Institute, UNSW Australia, Sydney, NSW 2052, Australia
| | - David J Templeton
- Sexual Health Service, Sydney Local Health District, Camperdown, NSW 2050, Australia; and The Kirby Institute, UNSW Australia, Sydney, NSW 2052, Australia; and Central Clinical School, The University of Sydney, Sydney, NSW 2006, Australia
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10
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Abstract
We examined factors associated with reporting sex with men among men who inject drugs in Vancouver, Canada. Data were drawn from three open prospective cohorts of people who use drugs between 2005 and 2014. Generalized estimating equations were used to identify factors associated with reporting non-transactional sex with men (MSM) in the previous 6 months. Of 1663 men who used injection drugs, 225 (13.5%) were MSM over the study period. Sex with men was independently associated with younger age [Adjusted Odds Ratio (AOR) = 0.96], childhood sexual abuse (AOR = 2.65), sex work (AOR = 3.33), crystal methamphetamine use (AOR = 1.30), borrowing used syringes (AOR = 1.39), inconsistent condom use (AOR = 1.76), and HIV seropositivity (AOR = 3.82). MSM were less likely to be Hepatitis C-positive (AOR = 0.43) and to have accessed addiction treatment in the previous 6 months (AOR = 0.83) (all p < 0.05). Findings highlight vulnerabilities and resiliencies among MSM-PWID and indicate a need for trauma-informed and affirming harm reduction and substance use treatment services for MSM-PWID.
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Asadollahi A, Najafi A. Do risk factors increase measurement of hepatitis B, C signs and HIV-AIDS among middle-aged and older IDUs in southwest Iran? DRUGS AND ALCOHOL TODAY 2019. [DOI: 10.1108/dat-05-2018-0026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Injecting drug use addiction is a main factor in hepatitis B, C infection and HIV–AIDS infection. The purpose of this paper is to measure seroprevalence of hepatitis B, C virus and HIV–AIDS amongst injecting drug users (IDUs) and its influencing factors.
Design/methodology/approach
The cross-sectional method was used in mid-2017 in Ahwaz city, southwest Iran. In total, 133 IDUs, aged 29–71 years (mean age=48.21 ± 10.4), were chosen from Aria addiction treatment centre. The data were collected on demographic and behavioural characteristics. In addition, serum samples were screened for those diseases.
Findings
In a total of 131 IDUs, 2 (1.5 per cent) were HIV+, 16 (11.7 per cent) HCV+ and 8 (6.1 per cent) HBV+. There was a significant correlation between diseases and IDU. Results of multiple regression stated that IDU was a more predicting variable as β=0.76 and the model was able to predict 74.1 per cent of the variance, F (3, 35)=12.42, ρ<0.001, R2=0.741, OR=3.01, 95% CI [1.44, 3.83]. The synchronised pairwise effect of age, imprisonment and IDU with GLM analysis was significant, F (2, 114)=20.433, ρ<0.000,
η
HCV
+
2
=
0.609
,
η
HBV
+
2
=
0.616
, and
η
HCV
+
2
=
0.612
, λWilks’=0.056. The infection rate among IDUs was significant and the most important risk factor for these infections has been intravenous drug use, together with age of misusing and imprisonment.
Research limitations/implications
The non-cooperation of two samples, lack of participation of three addiction rehabilitation centres in Ahwaz city, the end of cooperation in the first two months of the implementation of the plan, and the lack of consistency of the three serum samples in the cases (two cases) were limitations of the study.
Practical implications
Based on the results, the following suggestions could be presented: establishing “Intervention Clubs” for treatment in the peripheral urban areas for the participation of women drug users – the responsible organisation is Cultural and Social Deputy of Ahwaz Municipality Organisation. Integration of “Small Self-caring Groups” in Sepidar Women’s Penitentiary in the East Ahwaz region – the responsible organisation is Khuzistan Province Prisons Organisation (the southwestern Iranian prisons authority); constructing “Community-based Committees” to increase the level of social intervention – the responsible organisation is the Iran Drug Control Headquarters at Iranian Presidential Office; screening of injecting drug use in the populations at risk, especially girls and women in marginalised areas – the responsible organisation is Deputy Director of Prevention and Treatment of Addiction in the Iran Welfare and Rehabilitation Organisation; establishing an “Patient Treatment Center” in high-risk areas along with directing drug users and supervising the relevant authorities – the responsible organisation is Deputy Police Commander on Social Assistance; providing education to families involved with addiction in the “Neighborhood Parks” – the responsible organisation is Deputy for Health Affairs.
Social implications
They are mixed with practical implications as well.
Originality/value
The comprehensive harm reduction plan and prison-related issues of IDUs with shared syringe along with the pairwise age and imprisonment need to consider the above factors.
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Edmunds BL, Miller ER, Tsourtos G. The distribution and socioeconomic burden of Hepatitis C virus in South Australia: a cross-sectional study 2010-2016. BMC Public Health 2019; 19:527. [PMID: 31068170 PMCID: PMC6505114 DOI: 10.1186/s12889-019-6847-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 04/17/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatitis C virus infection (HCV) is a communicable disease of increasing global importance with 1.75 million new infections and 400,000 related deaths annually. Until recently, treatment options have had low uptake and most infected people remain untreated. New Direct Acting Antiviral medications can clear the virus in around 95% of cases, with few side-effects. These medications are restricted in most countries but freely accessible in Australia, yet most people still remain untreated. This study applies a cross-sectional research design to investigate the socio-spatial distribution of HCV in South Australia, to identify vulnerable populations, and examine epidemiological factors to potentially inform future targeted strategies for improved treatment uptake. METHOD HCV surveillance data were sourced from South Australia's Communicable Diseases Control Branch and socio-economic population data from the Australian Bureau of Statistics from January 2010 to December 2016 inclusive. HCV cases were spatially mapped at postcode level. Multivariate logistic regression identified independent predictors of demographic risks for HCV notification and notification source. RESULTS HCV notifications (n = 3356) were seven times more likely to be from people residing in the poorest areas with high rates of non-employment (75%; n = 1876) and injecting drug use (74%; n = 1862) reported. Notifications among Aboriginal and Torres Strait Islander people were around six times that of non-Indigenous people. HCV notifications negatively correlated (Spearman's rho - 0.426; p < 0.001) with socio-economic status (residential postcode socio-economic resources Index). History of imprisonment independently predicted HCV diagnoses in lesser economically-resourced areas (RR1.5; p < 0.001). Independent predictors of diagnosis elsewhere than in general practices were non-employment (RR 4.6; p = 0.028), being male (RR 2.5; p < 0.001), and younger than mean age at diagnosis (RR 2.1; p = 0.006). CONCLUSIONS Most people diagnosed with HCV were from marginalised sub-populations. Given general practitioners are pivotal to providing effective HCV treatment for many people in Australia a most concerning finding was that non-employed people were statistically less likely to be diagnosed by general practitioners. These findings highlight a need for further action aimed at improving healthcare access and treatment uptake to help reduce the burden of HCV for marginalised people, and progress the vision of eliminating HCV as a major public health threat.
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Affiliation(s)
| | - Emma Ruth Miller
- Flinders University, GPO Box 2100, Adelaide, 5001 South Australia
| | - George Tsourtos
- Flinders University, GPO Box 2100, Adelaide, 5001 South Australia
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Maxwell S, Shahmanesh M, Gafos M. Chemsex behaviours among men who have sex with men: A systematic review of the literature. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 63:74-89. [PMID: 30513473 DOI: 10.1016/j.drugpo.2018.11.014] [Citation(s) in RCA: 246] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/13/2018] [Accepted: 11/26/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND 'Chemsex' is the use of drugs before or during planned sexual events to facilitate, enhance, prolong and sustain the experience. Drugs associated with chemsex are methamphetamine, GHB/GBL, mephedrone, cocaine and ketamine. This review syntheses published research on the antecedents, behaviours and consequences associated with chemsex behaviours among men who have sex with men (MSM). METHODS Papers from high income countries which were published between January 2000 and September 2018 reporting the use of chemsex drugs before or during sex were identified through Medline, Web of Science, CINAHL and Central. Results were synthesised using a narrative approach and conceptualised using a behavioural analysis framework. RESULTS The search identified 2492 publications, of which 38 were included in the final synthesis. There were wide variations in chemsex prevalence estimates due to the heterogeneous sampling in the studies. Chemsex participants have expectations that the drugs will positively affect their sexual encounters and HIV positive MSM are more likely to engage in the behaviour than HIV negative MSM. There were wide ranging prevalence estimates on injecting drugs for sexual purposes and the sharing of injecting equipment with some evidence of unsafe injecting practices. Participants were more likely to engage in condomless anal intercourse than men who do not engage in chemsex. This may increase the risk of transmission for HIV and other sexually transmitted infections. CONCLUSION A minority of MSM appear to engage in chemsex behaviours but they are at risk of this negatively impacting on their health and well-being. Further research is required to examine high risk chemsex behaviours, impact of chemsex on psycho-social well-being and if chemsex influences uptake of PrEP, PEP and sexual health screening.
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Affiliation(s)
- Steven Maxwell
- King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 9NN, United Kingdom.
| | - Maryam Shahmanesh
- Institute for Global Health, University College London, Capper Street, London, WC1E 6JB, United Kingdom.
| | - Mitzy Gafos
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SN, United Kingdom.
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14
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Bryant J, Hopwood M, Dowsett GW, Aggleton P, Holt M, Lea T, Drysdale K, Treloar C. The rush to risk when interrogating the relationship between methamphetamine use and sexual practice among gay and bisexual men. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 55:242-248. [DOI: 10.1016/j.drugpo.2017.12.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 12/01/2017] [Accepted: 12/08/2017] [Indexed: 10/18/2022]
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15
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Bui H, Zablotska-Manos I, Hammoud M, Jin F, Lea T, Bourne A, Iversen J, Bath N, Grierson J, Degenhardt L, Prestage G, Maher L. Prevalence and correlates of recent injecting drug use among gay and bisexual men in Australia: Results from the FLUX study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 55:222-230. [DOI: 10.1016/j.drugpo.2018.01.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 01/12/2018] [Accepted: 01/26/2018] [Indexed: 10/18/2022]
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16
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O'Keefe D, Bowring A, Aitken C, Dietze P. The Association between Intentional Overdose and Same-Sex Sexual Intercourse in a Cohort of People who Inject Drugs in Melbourne, Australia. Subst Use Misuse 2018; 53:755-762. [PMID: 28960149 DOI: 10.1080/10826084.2017.1363240] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND People who inject drugs (PWID) are at disproportionately high risk of suicidal behaviors, as are individuals who report same-sex attraction or experience. However, there is little evidence of compounded risk of suicide for individuals who report same-sex sexual intercourse (SSI) and are PWID. OBJECTIVES To explore the associations of lifetime intentional overdose amongst a cohort of PWID, with particular attention to those reporting SSI. METHODS The sample included 529 participants, from an ongoing cohort of 757 PWID. An "ever" SSI variable was created for participants who reported sexual intercourse with a same-sex partner at any longitudinal interview. We explored the adjusted associations between SSI and lifetime intentional overdose using logistic regression. RESULTS Ninety-one (17%) participants reported ever experiencing an intentional overdose. Forty-one (8%) participants reported SSI at any interview. Three hundred and sixty (68%) participants reported diagnosis of a mental health condition. Diagnosis of a mental health condition (AOR = 2.02, 95% CIs: 1.14, 3.59) and SSI (AOR = 2.58, 95% CIs: 1.22, 5.48) significantly increased the odds of lifetime intentional overdose. Conclusions/Importance: We found a heightened risk of intentional overdose amongst PWID reporting SSI, after controlling for diagnosis of a mental health condition. Services need to be aware of this heightened risk and target interventions appropriately.
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Affiliation(s)
- Daniel O'Keefe
- a Burnet Institute , Melbourne , Victoria , Australia.,b School of Public Health and Preventive Medicine , Monash University , Melbourne , Victoria , Australia
| | - Anna Bowring
- a Burnet Institute , Melbourne , Victoria , Australia.,c Bloomberg School of Public Health , Johns Hopkins University , Baltimore , Maryland , USA
| | - Campbell Aitken
- a Burnet Institute , Melbourne , Victoria , Australia.,b School of Public Health and Preventive Medicine , Monash University , Melbourne , Victoria , Australia
| | - Paul Dietze
- a Burnet Institute , Melbourne , Victoria , Australia.,b School of Public Health and Preventive Medicine , Monash University , Melbourne , Victoria , Australia
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17
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Bourne A, Weatherburn P. Substance use among men who have sex with men: patterns, motivations, impacts and intervention development need. Sex Transm Infect 2017; 93:342-346. [DOI: 10.1136/sextrans-2016-052674] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 01/31/2017] [Accepted: 03/18/2017] [Indexed: 01/28/2023] Open
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18
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Hammoud MA, Jin F, Degenhardt L, Lea T, Maher L, Grierson J, Mackie B, Pastorelli M, Batrouney C, Bath N, Bradley J, Prestage GP. Following Lives Undergoing Change (Flux) study: Implementation and baseline prevalence of drug use in an online cohort study of gay and bisexual men in Australia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 41:41-50. [PMID: 28081482 DOI: 10.1016/j.drugpo.2016.11.012] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/03/2016] [Accepted: 11/20/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Drug use among gay and bisexual men (GBM) is higher than most populations. The use of crystal methamphetamine, erectile dysfunction medication (EDM), and amyl nitrite have been associated with sexual risk behaviour and HIV infection among gay and bisexual men (GBM). OBJECTIVE This paper describes an online prospective observational study of licit and illicit drug use among GBM and explores baseline prevalence of drug use in this sample. Capturing these data poses challenges as participants are required to disclose potentially illegal behaviours in a geographically dispersed country. To address this issue, an entirely online and study specific methodology was chosen. METHODS Men living in Australia, aged 16.5 years of age or older, who identified as homosexual or bisexual or had sex with at least one man in the preceding 12 months were eligible to enrol. RESULTS Between September 2014 and July 2015, a total of 2250 participants completed the baseline questionnaire, of whom, 1710 (76.0%) consented to six-monthly follow-up. The majority (65.7%) were recruited through Facebook targeted advertising. At baseline, over half (50.5%) the men reported the use of any illicit drug in the previous six months, and 28.0% had used party drugs. In the six months prior to enrolment, 12.0% had used crystal methamphetamine, 21.8% had used EDM, and 32.1% had used amyl nitrite. Among the 1710 men enrolled into the cohort, 790 men had used none of these drugs. CONCLUSION Ease of entry and minimal research burden on participants helped ensure successful recruitment into this online cohort study. Study outcomes will include the initiation and cessation of drug use, associated risk behaviours, and health consequences, over time. Results will provide insights into the role gay community plays in patterns of drug use among GBM.
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Affiliation(s)
- Mohamed A Hammoud
- The Kirby Institute, UNSW Australia, Level 6, Wallace Wurth Building, Kensington, NSW 2052, Australia.
| | - Fengyi Jin
- The Kirby Institute, UNSW Australia, Level 6, Wallace Wurth Building, Kensington, NSW 2052, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Australia, Kensington, NSW 2052, Australia
| | - Toby Lea
- Centre for Social Research in Health, UNSW Australia, Kensington, NSW 2052, Australia
| | - Lisa Maher
- The Kirby Institute, UNSW Australia, Level 6, Wallace Wurth Building, Kensington, NSW 2052, Australia
| | - Jeffrey Grierson
- Anglia Ruskin University, Cambridge Campus, Cambridge CB1 1PT, United Kingdom
| | - Brent Mackie
- ACON NSW, 414 Elizabeth St, Surry Hills, NSW 2010, Australia
| | | | - Colin Batrouney
- Victorian AIDS Council, 6 Claremont St, South Yarra, VIC 3141, Australia
| | - Nicky Bath
- NSW Users and AIDS Association, 5, 414 Elizabeth St, Surry Hills, NSW 2010, Australia
| | - Jack Bradley
- The Kirby Institute, UNSW Australia, Level 6, Wallace Wurth Building, Kensington, NSW 2052, Australia
| | - Garrett P Prestage
- The Kirby Institute, UNSW Australia, Level 6, Wallace Wurth Building, Kensington, NSW 2052, Australia
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Midgard H, Weir A, Palmateer N, Lo Re V, Pineda JA, Macías J, Dalgard O. HCV epidemiology in high-risk groups and the risk of reinfection. J Hepatol 2016; 65:S33-S45. [PMID: 27641987 DOI: 10.1016/j.jhep.2016.07.012] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 07/08/2016] [Accepted: 07/12/2016] [Indexed: 12/18/2022]
Abstract
Injecting risk behaviours among people who inject drugs (PWID) and high-risk sexual practices among men who have sex with men (MSM) are important routes of hepatitis C virus (HCV) transmission. Current direct-acting antiviral treatment offers unique opportunities for reductions in HCV-related liver disease burden and epidemic control in high-risk groups, but these prospects could be counteracted by HCV reinfection due to on-going risk behaviours after successful treatment. Based on existing data from small and heterogeneous studies of interferon-based treatment, the incidence of reinfection after sustained virological response range from 2-6/100 person years among PWID to 10-15/100 person years among human immunodeficiency virus-infected MSM. These differences mainly reflect heterogeneity in study populations with regards to risk behaviours, but also reflect variations in study designs and applied virological methods. Increasing levels of reinfection are to be expected as we enter the interferon-free treatment era. Individual- and population-level efforts to address and prevent reinfection should therefore be undertaken when providing HCV care for people with on-going risk behaviour. Constructive strategies include acknowledgement, education and counselling, harm reduction optimization, scaled-up treatment including treatment of injecting networks, post-treatment screening, and rapid retreatment of reinfections.
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Affiliation(s)
- Håvard Midgard
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway; Institute for Clinical Medicine, University of Oslo, Norway; Department of Gastroenterology, Oslo University Hospital, Norway.
| | - Amanda Weir
- School of Health and Life Sciences, Glasgow Caledonian University, United Kingdom; NHS National Services Scotland, Health Protection Scotland, Glasgow, United Kingdom
| | - Norah Palmateer
- School of Health and Life Sciences, Glasgow Caledonian University, United Kingdom; NHS National Services Scotland, Health Protection Scotland, Glasgow, United Kingdom
| | - Vincent Lo Re
- Division of Infectious Diseases, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, United States
| | - Juan A Pineda
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Sevilla, Spain
| | - Juan Macías
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Sevilla, Spain
| | - Olav Dalgard
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway; Institute for Clinical Medicine, University of Oslo, Norway
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Moore CL, Gidding HF, Jin F, Mao L, Petoumenos K, Zablotska IB, Poynten IM, Prestage G, Law MG, Grulich AE, Amin J. Patterns of Drug Use and Drug-related Hospital Admissions in HIV-Positive and -Negative Gay and Bisexual Men. AIDS Behav 2016; 20:2372-2386. [PMID: 26837635 DOI: 10.1007/s10461-016-1303-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We aimed to compare rates of illicit drug-related hospitalisations in HIV-negative (HIV-ve) (n = 1325) and HIV-positive (HIV+ve) (n = 557) gay and bisexual men (GBM) with rates seen in the general male population and to examine the association between self-reported illicit drug use and drug-related hospitalisation. Participants were asked how often they used a range of illicit drugs in the previous 6 months at annual interviews. Drug-related hospital admissions were defined as hospital admissions for mental or behavioural disorders due to illicit drug use (ICD 10: F11-16, F18, F19), drug poisoning (T40-T45, T50) or toxic effect of gases (T53, T59, T65). Drug-related hospitalisations were 4.8 times higher in the HIV-ve cohort [SIR 4.75 (95 % CI 3.30-6.91)] and 3.5 times higher in the HIV+ve cohort [SIR 3.51 (1.92-5.88)] compared with the general population. Periods of weekly drug use [IRR 1.86 (1.01-3.46)], poly-drug use [IRR 2.17 (1.07-4.38)] and cannabis use [low use-IRR 1.95 (1.01-3.77), high use-IRR 2.58 (1.29-5.16)] were associated with drug-related hospitalisation in both cohorts, as was being a consistently high meth/amphetamine user throughout follow-up [IRR 3.24 (1.07-9.83)] and being an inconsistent or consistent injecting drug user throughout follow-up [IRR 3.94 (1.61-9.66), IRR 4.43(1.04-18.76), respectively]. Other risk factors for drug-related hospitalisation indicated the likelihood of comorbid drug and mental health issues in GBM hospitalised for drug use.
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Affiliation(s)
- Cecilia L Moore
- The Kirby Institute, University of New South Wales, Wallace Wurth Building, Sydney, NSW, 2052, Australia.
| | - Heather F Gidding
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Fengyi Jin
- The Kirby Institute, University of New South Wales, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Limin Mao
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - Kathy Petoumenos
- The Kirby Institute, University of New South Wales, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Iryna B Zablotska
- The Kirby Institute, University of New South Wales, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - I Mary Poynten
- The Kirby Institute, University of New South Wales, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Garrett Prestage
- The Kirby Institute, University of New South Wales, Wallace Wurth Building, Sydney, NSW, 2052, Australia
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Matthew G Law
- The Kirby Institute, University of New South Wales, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Andrew E Grulich
- The Kirby Institute, University of New South Wales, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Janaki Amin
- The Kirby Institute, University of New South Wales, Wallace Wurth Building, Sydney, NSW, 2052, Australia
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Illicit drug use and its association with sexual risk behaviour among MSM: more questions than answers? Curr Opin Infect Dis 2016; 29:58-63. [PMID: 26694620 DOI: 10.1097/qco.0000000000000234] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Illicit drug use before or during sex - known as sexualized drug use (colloquially 'chemsex' or 'party and play') - has evolved as novel psychoactive substances have entered the market in many parts of the world. Here, we review key conceptual issues in associations between illicit drug use and sexual risk-behaviour in MSM. RECENT FINDINGS Although many studies have confirmed that MSM use drugs with greater prevalence than the general population, evidence is of variable quality and a sampling frame is difficult to establish. Moreover, psychosocial hypotheses linking drug use and sexual risk, including cognitive escape and sensation seeking, are unsatisfactory and generally ignore strategic use of drugs for sexual aims. Person-level associations between drug use history and both sexual risk behaviour and HIV infection tend to be consistent around the world, but evidence comparing encounters within subjects is generally unclear and out of date. SUMMARY There is a need for interventions for harm reduction targeted at MSM that account specifically for the social and cultural contexts of sexualized drug use. Expanded attention to surveillance of emerging drug use trends can help clinicians in sexual health and infectious diseases best anticipate the needs of their service users.
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Down I, Prestage G, Ellard J, Triffitt K, Brown G, Callander D. Australian Gay Men Describe the Details of Their HIV Infection Through a Cross-Sectional Web-Based Survey. J Med Internet Res 2016; 18:e227. [PMID: 27663447 PMCID: PMC5055591 DOI: 10.2196/jmir.5707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 07/10/2016] [Accepted: 07/26/2016] [Indexed: 11/26/2022] Open
Abstract
Background With emerging opportunities for preventing human immunodeficiency virus (HIV) transmission, it remains important to identify those at greatest risk of infection and to describe and understand the contexts in which transmissions occur. Some gay and bisexual men with recently diagnosed HIV infection are initially unable to identify high-risk behaviors that would explain their HIV infection. We explored whether Web-based data collection could assist them in identifying the circumstances of their infection. Objective To assess the capacity of a Web-based survey to collect reliable self-report data on the event to which gay and bisexual men ascribe their HIV infection. Methods The HIV Seroconversion Study included a Web-based survey of gay and bisexual men with recently diagnosed HIV infection in Australia. Participants were asked if they could identify and describe the event they believe led to their infection. Men were also asked about their sexual and other risk practices during the 6 months before their diagnosis. Results Most (403/506, 79.6%) gay and bisexual men with newly diagnosed HIV infection were able to identify and describe the circumstances that likely led to their infection. Among those who were initially unable to identify possible exposure events, many could nonetheless provide sensible information that ostensibly explained their seroconversion. Free-text responses allowed men to provide more detailed and contextual information, whereas questions about the totality of their sexual behavior before diagnosis provided opportunities for men to describe their sexual risk behavior in general. Overall, 84.0% indicated having engaged in condomless anal intercourse before their HIV diagnosis, including 71.8% in the receptive position. Conclusions This study demonstrates the effectiveness of using Internet-based technologies to capture sensitive information about the circumstances in which HIV infection occurs among gay and bisexual men. By providing a range of opportunities for relaying experience, this research reveals some of the complexity in how individuals come to understand and explain their HIV infection. These findings may assist in obtaining detailed sexual history in the clinical setting.
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Affiliation(s)
- Ian Down
- Kirby Institute, University of New South Wales Australia, Sydney, Australia.
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Chan DP, Sun HY, Wong HT, Lee SS, Hung CC. Sexually acquired hepatitis C virus infection: a review. Int J Infect Dis 2016; 49:47-58. [DOI: 10.1016/j.ijid.2016.05.030] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 05/26/2016] [Accepted: 05/28/2016] [Indexed: 12/19/2022] Open
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Lee E, Murphy D, Mao L, de Wit J, Prestage G, Zablotska I, Holt M. Social and Behavioural Correlates of HIV Testing Among Australian Gay and Bisexual Men in Regular Relationships. AIDS Behav 2016; 20:1295-301. [PMID: 26324077 DOI: 10.1007/s10461-015-1167-y] [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] [Indexed: 11/26/2022]
Abstract
In this study we sought to identify the social and behavioural characteristics of Australian gay and bisexual men who had and had not tested for HIV during their current relationship. The results were based on 2012 and 2013 data collected from ongoing cross-sectional and community-based surveys held in six Australian states and territories. One thousand five hundred and sixty-one non-HIV-positive men reported that they were in a primary relationship. The majority of gay and bisexual men in primary relationships had tested for HIV during the relationship (73.4 %). Among men who had not tested during the relationship, almost half of these men had never tested for HIV. As untested men within relationships are potentially at risk of acquiring and transmitting HIV to their partners unknowingly, it is important to promote HIV testing to these men.
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Affiliation(s)
- Evelyn Lee
- Centre for Social Research in Health, UNSW, Sydney, NSW, 2052, Australia.
| | - Dean Murphy
- Centre for Social Research in Health, UNSW, Sydney, NSW, 2052, Australia
- National Drug Research Institute, Curtin University, Melbourne, 3065, Australia
| | - Limin Mao
- Centre for Social Research in Health, UNSW, Sydney, NSW, 2052, Australia
| | - John de Wit
- Centre for Social Research in Health, UNSW, Sydney, NSW, 2052, Australia
| | - Garrett Prestage
- The Kirby Institute, Wallace Wurth Building, UNSW, Kensington, NSW, 2033, Australia
| | - Iryna Zablotska
- The Kirby Institute, Wallace Wurth Building, UNSW, Kensington, NSW, 2033, Australia
| | - Martin Holt
- Centre for Social Research in Health, UNSW, Sydney, NSW, 2052, Australia
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Methamphetamine use among gay and bisexual men in Australia: Trends in recent and regular use from the Gay Community Periodic Surveys. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 29:66-72. [DOI: 10.1016/j.drugpo.2016.01.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 12/09/2015] [Accepted: 01/06/2016] [Indexed: 12/22/2022]
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Lea T, Hopwood M, Aggleton P. Hepatitis C knowledge among gay and other homosexually active men in Australia. Drug Alcohol Rev 2015; 35:477-83. [PMID: 26369759 DOI: 10.1111/dar.12333] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 08/13/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND AIMS Gay and other homosexually active men (hereafter 'gay men') are at elevated risk of becoming infected with hepatitis C virus (HCV) via injecting drug use and sexual risk practices. This paper aimed to measure HCV knowledge among gay men in Australia and whether knowledge differed according to HCV risk. DESIGN AND METHODS In 2013, a cross-sectional, online survey of 405 Australian gay men explored the social aspects of HCV. Bivariate and multivariate linear regressions were used to examine factors associated with higher HCV knowledge. RESULTS The mean age of respondents was 39.2 years (SD = 13.3), and most men (75.3%) were born in Australia. According to self-report, 32.1% were HIV-positive, 3.0% were HCV-positive and 8.9% were HIV/HCV co-infected. The mean number of correct HCV knowledge items was 8.2 (SD = 3.9; range 0-15). In a multivariate analysis, higher HCV knowledge was associated with higher educational attainment, being HCV-positive, being HIV-positive and injecting drug use. DISCUSSION AND CONCLUSIONS HCV knowledge among gay men was moderately good, although knowledge of testing, treatment and natural history of HCV was generally quite poor. Encouragingly, higher knowledge was reported among men at highest HCV risk. Viral hepatitis and HIV organisations, together with general practitioners and other health services, should continue to target gay men at a high risk of acquiring HCV with education and health promotion. [Lea T, Hopwood M, Aggleton P. Hepatitis C knowledge among gay and other homosexually active men in Australia. Drug Alcohol Rev 2016;35:477-483].
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Affiliation(s)
- Toby Lea
- Centre for Social Research in Health, UNSW Australia (The University of New South Wales), Sydney, Australia
| | - Max Hopwood
- Centre for Social Research in Health, UNSW Australia (The University of New South Wales), Sydney, Australia
| | - Peter Aggleton
- Centre for Social Research in Health, UNSW Australia (The University of New South Wales), Sydney, Australia
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Abstract
OBJECTIVE To characterize prevalence, incidence, and associated correlates of HIV infection among MSM in 12 cities across India. DESIGN Cross-sectional sample using respondent-driven sampling from September 2012 to June 2013. METHODS A total 12022 MSM (~1000/city) were recruited. Participants had to be at least 18 years, self-identify as male, and report oral/anal intercourse with a man in the prior year. HIV infection was diagnosed using three rapid tests. Cross-sectional HIV incidence was estimated using a multiassay algorithm. All estimates incorporate respondent-driven sampling-II weights. RESULTS Median age was 25 years, 45% self-identified as 'panthi' (predominantly penetrative anal intercourse) and 30.6% reported being married to a woman. Weighted HIV prevalence was 7.0% (range: 1.7-13.1%). In multivariate analysis, significantly higher odds of HIV infection was observed among those who were older, had lower educational attainment, were practicing purely receptive anal sex or both receptive and penetrative sex, and those who were herpes simplex virus-2 positive. Of 1147 MSM who tested HIV positive, 53 were identified as recent HIV infections (annualized incidence = 0.87%; range = 0-2.2%). In multivariate analysis, injecting drugs in the prior 6 months, syphilis, and higher number of male partners and fewer female partners were significantly associated with recent HIV infection. CONCLUSION We observed a high burden of HIV among MSM in India with tremendous diversity in prevalence, incidence, and risk behaviors. In particular, we observed high incidence in areas with relatively low prevalence suggesting emerging epidemics in areas not previously recognized to have high HIV burden.
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Hopwood M, Lea T, Aggleton P. Multiple strategies are required to address the information and support needs of gay and bisexual men with hepatitis C in Australia. J Public Health (Oxf) 2015; 38:156-62. [PMID: 25626415 DOI: 10.1093/pubmed/fdv002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) infection is increasingly reported among gay and bisexual men. However, little is known about the personal and social dimensions of HCV-related experience among these men in Australia. METHODS An online survey of 474 Australian gay and bisexual men was conducted from August to December 2013. A subsample of 48 HCV mono-infected and HIV/HCV co-infected men was analysed to explore HCV knowledge, sources of information, unmet information needs and use of HCV-related services. RESULTS More than half of respondents in the subsample were unaware that HIV infection increases the risk of sexually acquired HCV and most wanted information about how to prevent the sexual transmission of HCV. A majority of respondents requested gay-specific HCV services, and approximately similar proportions of men indicated that they would like these services delivered by a hepatitis organization, a lesbian, gay, bisexual, transgender and intersex (LGBTI) organization and a HIV organization. Men in receipt of HIV antiretroviral treatments were most likely to request that gay-specific HCV information and support services be delivered by a LGBTI or HIV organization (OR = 8.63). CONCLUSION These findings suggest that a variety of organizations are required to address the information and support needs of Australian gay and bisexual men with HCV.
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Affiliation(s)
- Max Hopwood
- Centre for Social Research in Health, University of New South Wales Australia, Sydney 2052, Australia
| | - Toby Lea
- Centre for Social Research in Health, University of New South Wales Australia, Sydney 2052, Australia
| | - Peter Aggleton
- Centre for Social Research in Health, University of New South Wales Australia, Sydney 2052, Australia
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Salamanca SA, Sorrentino EE, Nosanchuk JD, Martinez LR. Impact of methamphetamine on infection and immunity. Front Neurosci 2015; 8:445. [PMID: 25628526 PMCID: PMC4290678 DOI: 10.3389/fnins.2014.00445] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 12/17/2014] [Indexed: 12/21/2022] Open
Abstract
The prevalence of methamphetamine (METH) use is estimated at ~35 million people worldwide, with over 10 million users in the United States. METH use elicits a myriad of social consequences and the behavioral impact of the drug is well understood. However, new information has recently emerged detailing the devastating effects of METH on host immunity, increasing the acquisition of diverse pathogens and exacerbating the severity of disease. These outcomes manifest as modifications in protective physical and chemical defenses, pro-inflammatory responses, and the induction of oxidative stress pathways. Through these processes, significant neurotoxicities arise, and, as such, chronic abusers with these conditions are at a higher risk for heightened consequences. METH use also influences the adaptive immune response, permitting the unrestrained development of opportunistic diseases. In this review, we discuss recent literature addressing the impact of METH on infection and immunity, and identify areas ripe for future investigation.
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Affiliation(s)
- Sergio A Salamanca
- Department of Biomedical Sciences, Long Island University-Post Brookville, NY, USA
| | - Edra E Sorrentino
- Department of Biomedical Sciences, Long Island University-Post Brookville, NY, USA
| | - Joshua D Nosanchuk
- Microbiology and Immunology, Albert Einstein College of Medicine Bronx, NY, USA ; Medicine (Division of Infectious Diseases), Albert Einstein College of Medicine Bronx, NY, USA
| | - Luis R Martinez
- Department of Biomedical Sciences, NYIT College of Osteopathic Medicine, New York Institute of Technology Old Westbury, NY, USA
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Lovett C, Yamamoto T, Hunter L, White J, Dargan PI, Wood DM. Problematic recreational drug use: is there a role for outpatient sexual health clinics in identifying those not already engaged with treatment services? Sex Health 2015; 12:501-5. [DOI: 10.1071/sh15052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 07/06/2015] [Indexed: 11/23/2022]
Abstract
Background
There is an association between recreational drug use, high-risk sexual activity and sexually transmissible infections. Studies have shown a higher prevalence of drug use in those accessing sexual health services; however, there are minimal data on the proportion with problematic recreational drug use. We aimed to understand whether sexual health clinics could identify problematic drug and alcohol use as a novel referral pathway into treatment services. Methods: Males attending two sexual health clinics in London completed questionnaires. Data were collected on demographics; gender of sexual partner; use of alcohol and recreational drugs; if they felt they had problematic use of drugs, alcohol or both; and if they had sought help for their problematic use. Results: In total, 867 males completed the questionnaire; 387 (44.7%) were men who have sex with men (MSM). MSM had significantly higher lifetime use of any drug compared with non-MSM (80.6% vs. 62.5%; P < 0.0001). Thirty-five (4.7%) self-identified problematic drug or alcohol use, with no difference between MSM and non-MSM (6.3% vs. 3.5%; P = 0.08). Of those with problematic drug or alcohol use, 20 were currently or had been engaged with a treatment service and 15 had never engaged with treatment services. MSM were more likely to have ever sought help for drug or alcohol problems compared with non-MSM (P = 0.003). Conclusions: Some individuals attending sexual health clinics with problematic drug use have not engaged with treatment services. It is therefore appropriate to develop screening tools for sexual health clinics to identify these individuals and novel referral pathways to engage them in treatment services.
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Hopwood M, Lea T, Aggleton P. Drug, sex and sociality: factors associated with the recent sharing of injecting equipment among gay and bisexual men in Australia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2014; 26:210-3. [PMID: 25480395 DOI: 10.1016/j.drugpo.2014.10.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 09/16/2014] [Accepted: 10/31/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Max Hopwood
- Centre for Social Research in Health, UNSW-Australia, Sydney 2052, Australia.
| | - Toby Lea
- Centre for Social Research in Health, UNSW-Australia, Sydney 2052, Australia
| | - Peter Aggleton
- Centre for Social Research in Health, UNSW-Australia, Sydney 2052, Australia
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van Dooren K, Kinner SA, Hellard M. A comparison of risk factors for hepatitis C among young and older adult prisoners. JOURNAL OF CORRECTIONAL HEALTH CARE 2014; 20:280-91. [PMID: 25134604 DOI: 10.1177/1078345814541536] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Internationally, the prevalence of hepatitis C infection is higher among prisoners when compared to the general population, particularly among people who inject drugs. This study estimates the prevalence of, and compares the risk factors for, hepatitis C in young (< 25 years) and older (≥ 25 years) prisoners with a history of injection drug use. Participants were 677 sentenced prisoners in Queensland, Australia, with a lifetime history of injection drug use, recruited in the 6 weeks prior to release from custody. The prevalence of hepatitis C exposure was significantly lower in young prisoners than in older prisoners (20.7% vs. 29.4%, p = .03). Risk factors for hepatitis C varied between young and older prisoners. Young people who inject drugs and who have had shorter time at risk of hepatitis C exposure are an important target group for hepatitis C prevention efforts.
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Affiliation(s)
- Kate van Dooren
- Queensland Centre for Intellectual and Developmental Disability, School of Medicine, The University of Queensland, Brisbane, Australia
| | - Stuart A Kinner
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia School of Medicine, The University of Queensland, Brisbane, Australia School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Margaret Hellard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia Centre for Population Health, Burnet Institute, Melbourne, Australia The Nossal Institute for Global Health, The University of Melbourne, Melbourne, Australia
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