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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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Jiménez-Rivagorza L, Orozco R, Medina-Mora ME, Rafful C. HIV-Related Stigma and Treatment Adherence Among Gay, Bisexual, and Other Men Who Have Sex with Men Who Use Crystal Meth in the Metropolitan Area of Mexico City. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:1561-1574. [PMID: 38409457 PMCID: PMC10954905 DOI: 10.1007/s10508-024-02816-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 01/10/2024] [Accepted: 01/17/2024] [Indexed: 02/28/2024]
Abstract
Internationally, HIV-related stigma and crystal methamphetamine (meth) use have been described as barriers to treatment adherence among gay, bisexual, and other men who have sex with men (gbMSM). Crystal meth use has been increasing among gbMSM in the Metropolitan Area of Mexico City (MAMC). Therefore, this study aimed to determine the association between HIV-related stigma and HIV treatment adherence among gbMSM who use crystal meth in the MAMC. This study was undertaken as part of an exploratory study of crystal meth use in the MAMC. The data were collected from September to December 2021 through an encrypted online survey. Participants (n = 89) were gbMSM adults living with HIV who reported crystal meth use in the past month that were recruited through an online snowball sampling. The online survey included questions about HIV treatment adherence, sexual behaviors, the Alcohol, Smoking, and Substance Involved Screening Test, and the HIV-Related Stigma Mechanisms Scale. Logistic regression analyses assessed the association between HIV-related stigma and HIV treatment adherence. The multivariate logistic regression model showed that, controlling for health insurance [adjusted odds ratio (AOR) = 0.13; 95% confidence intervals (CI) = 0.02-0.59] and educational level (AOR = 0.16; 95% CI = 0.02-0.88), non-adherence to HIV treatment was independently associated with higher HIV-related stigma (AOR = 1.06; 95% CI = 1.01-1.12). Public health policies must include HIV-related stigma and substance use in treating gbMSM with HIV.
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Affiliation(s)
- Leonardo Jiménez-Rivagorza
- Faculty of Psychology, Universidad Nacional Autónoma de México, Circuito Ciudad Universitaria, 04510, Coyoacan, Mexico City, Mexico
| | - Ricardo Orozco
- Center for Global Mental Health, National Institute of Psychiatry, Mexico City, Mexico
| | - María Elena Medina-Mora
- Faculty of Psychology, Universidad Nacional Autónoma de México, Circuito Ciudad Universitaria, 04510, Coyoacan, Mexico City, Mexico
- Center for Global Mental Health, National Institute of Psychiatry, Mexico City, Mexico
| | - Claudia Rafful
- Faculty of Psychology, Universidad Nacional Autónoma de México, Circuito Ciudad Universitaria, 04510, Coyoacan, Mexico City, Mexico.
- Center for Global Mental Health, National Institute of Psychiatry, Mexico City, Mexico.
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Taylor A, Hayes R, Nwokolo N, Whitlock G, Dosekun O, McCormack S, Gafos M, Evangeli M. Psychological and Behavioural Within-participant Predictors of Adherence to Oral HIV Pre-Exposure Prophylaxis (PrEP). AIDS Behav 2024; 28:274-284. [PMID: 37580575 PMCID: PMC10803569 DOI: 10.1007/s10461-023-04151-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 08/16/2023]
Abstract
Oral PrEP's effectiveness relies on adequate adherence during periods of substantial HIV risk. Since most PrEP users will miss doses, understanding predictors within participants can help to explain adherence. We used a cross-sectional, within-participant design with 67 gay, bisexual, and other men who have sex with men taking PrEP daily. Using a questionnaire, informed by the Information Motivation Behavioral Skills Model, participants were asked about an adherent and a non-adherent episode. PrEP non-adherence was associated with non-normality of the day (p < .001), being out of the home (p < .001), weekend days (p = .01), having company (p = .02), using substances (p = 0.02), not using reminders (p = .03), lower PrEP information (p = .04), lower behavioural skills (p < .001) and less positive affect (p = .002). PrEP adherence assessment could focus on situational variations, supporting the construction of alternative strategies to facilitate adherence in these situations.
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Affiliation(s)
- Alison Taylor
- Department of Psychology, Royal Holloway University of London, London, UK
| | - Rosalie Hayes
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | | | | | | | - Sheena McCormack
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Mitzy Gafos
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Michael Evangeli
- Department of Psychology, Royal Holloway University of London, London, UK.
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Coukan F, Murray KK, Papageorgiou V, Lound A, Saunders J, Atchison C, Ward H. Barriers and facilitators to HIV Pre-Exposure Prophylaxis (PrEP) in Specialist Sexual Health Services in the United Kingdom: A systematic review using the PrEP Care Continuum. HIV Med 2023; 24:893-913. [PMID: 37078101 DOI: 10.1111/hiv.13492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 03/20/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVES HIV pre-exposure prophylaxis (PrEP) delivery in the UK is inequitable; over 95% of PrEP users were men who have sex with men (MSM) despite making up less than 50% of new HIV diagnoses. We conducted a systematic review to identify modifiable barriers and facilitators to PrEP delivery in the UK among underserved populations. METHODS We searched bibliographic/conference databases using the terms HIV, PrEP, barriers, facilitators, underserved populations, and UK. Modifiable factors were mapped along the PrEP Care Continuum (PCC) to identify targets for interventions. RESULTS In total, 44 studies were eligible: 29 quantitative, 12 qualitative and three mixed-methods studies. Over half (n = 24 [54.5%]) exclusively recruited MSM, whereas 11 were in mixed populations (all included MSM as a sub-population) and the other nine were in other underserved populations (gender and ethnicity minorities, women, and people who inject drugs). Of the 15 modifiable factors identified, two-thirds were at the PrEP contemplation and PrEParation steps of the PCC. The most reported barriers were lack of PrEP awareness (n = 16), knowledge (n = 19), willingness (n = 16), and access to a PrEP provider (n = 16), whereas the more reported facilitators were prior HIV testing (n = 8), agency and self-care (n = 8). All but three identified factors were at the patient rather than provider or structural level. CONCLUSIONS This review highlights that the bulk of the scientific literature focuses on MSM and on patient-level factors. Future research needs to ensure underserved populations are included and prioritized (e.g. ethnicity and gender minorities, people who inject drugs) and provider and structural factors are investigated.
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Affiliation(s)
- Flavien Coukan
- National Institute for Health Research Applied Research Collaboration North West London, Chelsea and Westminster Hospital, London, UK
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, UK
| | - Keitumetse-Kabelo Murray
- National Institute for Health Research Applied Research Collaboration North West London, Chelsea and Westminster Hospital, London, UK
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, UK
| | - Vasiliki Papageorgiou
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, UK
| | - Adam Lound
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, UK
| | - John Saunders
- UCL Centre for Clinical Research in Infection and Sexual Health, Institute for Global Health, University College London, London, UK
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Division, UK Health Security Agency, London, UK
| | - Christina Atchison
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, UK
- National Institute for Health Research Imperial Biomedical Research Centre, London, UK
| | - Helen Ward
- National Institute for Health Research Applied Research Collaboration North West London, Chelsea and Westminster Hospital, London, UK
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, UK
- National Institute for Health Research Imperial Biomedical Research Centre, London, UK
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Gebru NM, Canidate SS, Liu Y, Schaefer SE, Pavila E, Cook RL, Leeman RF. Substance Use and Adherence to HIV Pre-Exposure Prophylaxis in Studies Enrolling Men Who Have Sex with Men and Transgender Women: A Systematic Review. AIDS Behav 2023; 27:2131-2162. [PMID: 36538138 PMCID: PMC10869193 DOI: 10.1007/s10461-022-03948-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 12/24/2022]
Abstract
Optimal adherence to pre-exposure prophylaxis (PrEP) is critical, but challenging. Men who have sex with men and transgender women have high rates of HIV incidence and substance use. Substance use is associated with reduced adherence to other medications, but associations between substance use and adherence to PrEP are less clear. Thus, the current review 1) systematically evaluates the measurement of substance use and PrEP adherence in studies examining both and 2) summarizes reported findings. Peer-reviewed articles published between 2010 - April 2021 examining associations between substance use and PrEP adherence were reviewed. Fifty studies met inclusion criteria. Assessment of substance use (i.e., mostly via self-reports at baseline) and PrEP adherence (i.e., often via tenofovir diphosphate [TFV-DP] concentration levels at follow-up) varied considerably across studies. Many studies used categorical variables (e.g., substance use: yes/no). Studies using TFV-DP levels defined adherence consistently (i.e., TFV-DP ≥ 700 fmol/punch), with slight variations. Qualitative studies (n = 10) indicated that substance use (mainly alcohol) is related to poorer PrEP adherence. While quantitative findings to date are equivocal for alcohol, there is a pattern of findings linking stimulant use with poorer PrEP adherence. This review reveals four methodological gaps, which can be addressed in future research by: 1) use of uniform benchmarks for substance use measures, 2) prospective assessment for substance use, 3) use of continuous outcome variables wherever possible, and 4) more extensive consideration of potential confounders. Addressing these methodological gaps may help us reach more definitive conclusions regarding associations between substance use and PrEP adherence.
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Affiliation(s)
- Nioud Mulugeta Gebru
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 S. Main St, Box G-S121-3, 02912, Providence, RI, USA.
- Department of Health Education & Behavior, University of Florida, Gainesville, FL, USA.
| | - Shantrel S Canidate
- Department of Health Education & Behavior, University of Florida, Gainesville, FL, USA
- Southern HIV and Alcohol Research Consortium (SHARC), University of Florida, Gainesville, FL, USA
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Yiyang Liu
- Department of Health Education & Behavior, University of Florida, Gainesville, FL, USA
- Southern HIV and Alcohol Research Consortium (SHARC), University of Florida, Gainesville, FL, USA
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Sage E Schaefer
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 S. Main St, Box G-S121-3, 02912, Providence, RI, USA
| | - Emmely Pavila
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 S. Main St, Box G-S121-3, 02912, Providence, RI, USA
| | - Robert L Cook
- Department of Health Education & Behavior, University of Florida, Gainesville, FL, USA
- Southern HIV and Alcohol Research Consortium (SHARC), University of Florida, Gainesville, FL, USA
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Robert F Leeman
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 S. Main St, Box G-S121-3, 02912, Providence, RI, USA
- Department of Health Education & Behavior, University of Florida, Gainesville, FL, USA
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da Costa AR, Barros JF, Lima VP, Magalhães C, Silva HKR, Deusdará R, de Souza Lapa J. Substance Use and Risky Sexual Behavior in the PrEP Outpatient Clinic at the University Hospital of Brasília. Trop Med Infect Dis 2023; 8:323. [PMID: 37368741 DOI: 10.3390/tropicalmed8060323] [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: 03/22/2023] [Revised: 06/02/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
(1) Background: To evaluate the epidemiological profile of people who use drugs at the PrEP outpatient clinic of the University Hospital of Brasília; (2) Methods: Cross-sectional study with a review of data from medical records referring to the first medical consultation. The prevalence ratio was calculated using a Poisson regression model with robust variance; (3) Results: A total of 53% of subjects reported drug use in the last 3 months. The unadjusted prevalence ratio of drug use in trans women was PR: 9.0 (95%CI: 1.4-57.5). people who use drugs have a 1.9 times higher prevalence of STI diagnosis, and a 2.4 times higher prevalence of partners compared to non-users; (4) Conclusions: Substance use was associated with a higher STI prevalence ratio and number of sexual partners.
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Affiliation(s)
- Alan Rodrigues da Costa
- Núcleo de Medicina Tropical, Faculdade de Medicina, Campus Universitário Darcy Ribeiro, Universidade de Brasília, Asa Norte, Brasília 70910-900, Brazil
| | - Jônatas Ferreira Barros
- Núcleo de Medicina Tropical, Faculdade de Medicina, Campus Universitário Darcy Ribeiro, Universidade de Brasília, Asa Norte, Brasília 70910-900, Brazil
| | - Valéria Paes Lima
- Núcleo de Medicina Tropical, Faculdade de Medicina, Campus Universitário Darcy Ribeiro, Universidade de Brasília, Asa Norte, Brasília 70910-900, Brazil
| | - Camila Magalhães
- Núcleo de Medicina Tropical, Faculdade de Medicina, Campus Universitário Darcy Ribeiro, Universidade de Brasília, Asa Norte, Brasília 70910-900, Brazil
| | - Hellen Kássia Rezende Silva
- Núcleo de Medicina Tropical, Faculdade de Medicina, Campus Universitário Darcy Ribeiro, Universidade de Brasília, Asa Norte, Brasília 70910-900, Brazil
| | - Rodolfo Deusdará
- Núcleo de Medicina Tropical, Faculdade de Medicina, Campus Universitário Darcy Ribeiro, Universidade de Brasília, Asa Norte, Brasília 70910-900, Brazil
| | - Juliana de Souza Lapa
- Núcleo de Medicina Tropical, Faculdade de Medicina, Campus Universitário Darcy Ribeiro, Universidade de Brasília, Asa Norte, Brasília 70910-900, Brazil
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Dharan NJ, Jin F, Vaccher S, Bavinton B, Yeung B, Guy R, Carr A, Zablotska I, Amin J, Read P, Templeton DJ, Ooi C, Martin SJ, Ryder N, Smith DE, McNulty A, Brown K, Price K, Holden J, Grulich AE. Characteristics of Human Immunodeficiency Virus (HIV) Seroconversions in a Large Prospective Implementation Cohort Study of Oral HIV Preexposure Prophylaxis in Men Who Have Sex with Men (EPIC-NSW). Clin Infect Dis 2023; 76:e622-e628. [PMID: 35982613 DOI: 10.1093/cid/ciac660] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/26/2022] [Accepted: 08/12/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Most human immunodeficiency virus (HIV) seroconversions in people who have initiated preexposure prophylaxis (PrEP) occur in the context of insufficient adherence. We describe participants who seroconverted after being dispensed PrEP in a large PrEP implementation study in Australia. METHODS Expanded PrEP Implementation in Communities in New South Wales was an implementation study of daily oral PrEP in individuals aged ≥18 years at high risk for acquiring HIV. HIV seroconversions were defined as a positive HIV test by either antigen, antibody, or detectable HIV viral load after enrollment. Insufficient adherence, measured by dispensing logs or participant self-report, was defined as <4 PrEP doses per week. RESULTS A total of 9596 participants were enrolled and dispensed PrEP between 1 March 2016 and 30 April 2018; 30 were diagnosed with HIV by 31 March 2019. The median (interquartile range [IQR]) age was 31 (25-38) years, all identified as male, 29 (97%) identified as gay or homosexual, and 20 (69%) lived in a postcode with a low concentration of gay male residents. The median (IQR) days from first PrEP dispensing to diagnosis was 409 (347-656). There was no evidence that participants who seroconverted had been sufficiently adherent to PrEP. Nineteen (63%) participants who seroconverted were diagnosed with chlamydia, gonorrhoea, syphilis, or new hepatitis C infection. One participant had resistance to emtricitabine (M184V mutation) at diagnosis. CONCLUSIONS Participants who seroconverted were insufficiently adherent to PrEP despite being at high risk for acquiring HIV. Understanding the reasons for poor PrEP adherence in individuals who subsequently acquire HIV is critical to improving PrEP effectiveness.
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Affiliation(s)
- Nila J Dharan
- Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Fengyi Jin
- Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Stefanie Vaccher
- Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Benjamin Bavinton
- Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Barbara Yeung
- Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Rebecca Guy
- Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Andrew Carr
- St Vincent's Hospital, Darlinghurst, New South Wales, Australia.,University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Iryna Zablotska
- Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Westmead, New South Wales, Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Westmead, New South Wales, Australia.,Western Sydney Sexual Health Centre, Western Sydney Local Health District, Parramatta, New South Wales, Australia
| | - Janaki Amin
- Department Health Sciences, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Philip Read
- Kirketon Road Centre, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | - David J Templeton
- Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia.,Department of Sexual Health Medicine, Sydney Local Health District, Camperdown, New South Wales, Australia.,Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Catriona Ooi
- Clinic 16, St Leonards, New South Wales, Australia.,Northern Clinical School, Faculty of Health and Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Sarah J Martin
- Canberra Sexual Health Centre, Canberra Health Services, Woden, Australia Capital Territory, Australia.,The Australian National University Medical School, Canberra, Australia Capital Territory, Australia
| | - Nathan Ryder
- Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Don E Smith
- Albion Centre, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Anna McNulty
- School of Population Health, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Katherine Brown
- Illawarra Sexual Health, Warrawong, New South Wales, Australia
| | - Karen Price
- AIDS Council of New South Wales (ACON), Sydney, New South Wales, Australia
| | - Jo Holden
- New South Wales Health, Sydney, New South Wales, Australia
| | - Andrew E Grulich
- Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
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PrEP program experience in a hospital HIV unit. Description of baseline user profile and identification of opportunities for improvement. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2023; 41:24-28. [PMID: 35810144 DOI: 10.1016/j.eimce.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 04/03/2021] [Accepted: 04/07/2021] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Pre-Exposure Prophylaxis (PrEP) is a biomedical intervention to prevent HIV infection in seronegative people at high risk of becoming infected. This strategy was endorsed in October 2019 by the Spanish Ministry of Health. OBJECTIVE To present the PrEP initial experience in the HIV Unit of the Hospital Clínic of Barcelona, paying special attention to the analysis of the vulnerability factors in the cohort. MATERIALS AND METHODS Retrospective, descriptive study. The epidemiological, sociodemographic, and clinical characteristics of the users included in the program during the first year are analyzed, paying particular attention to Infections, risky practices, and substance use. RESULTS 190 individuals were included, 177 men and 12 trans women with a mean age of 35 years (8 SD). 70% had higher education, and half had Spanish nationality. An average of 10 couples per trimester and 60% reported unprotected anal sex. 31% had at least one positive PCR for STIs, with N. gonorrhoeae being the most prevalent microorganism (51%) and the rectal sample the most affected (21%). 63% reported chemsex use, 19% polydrug use, and 8% "slamming". Half expressed concern about consumption and/or sexual practices and 25% the need for help. CONCLUSIONS The PrEP user profile attended in our Hospital Unit justifies the creation of multidisciplinary teams that allow us to provide holistic attention to the sexual life of these people.
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de Sousa ÁFL, Nunes Ribeiro CJ, Santos GRDS, de Oliveira LB, Camargo ELS, Lima SVMA, de Oliveira Sena IV, Bezerra-Santos M, Batista OMA, Reis de Sousa A, Mendes IAC. Intention to use PrEP among men who have sex with men and engage in chemsex: an international descriptive study. Ther Adv Infect Dis 2023; 10:20499361231206918. [PMID: 37900982 PMCID: PMC10612445 DOI: 10.1177/20499361231206918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023] Open
Abstract
Background Pre-exposure prophylaxis (PrEP) is a valuable tool in the response to the HIV epidemic, recommended for groups with a higher risk of HIV infection, such as men who have sex with men (MSM), particularly in the context of high-risk sexual behavior such as chemsex. Purpose This study aimed to analyze the prevalence and factors associated with the intention to use PrEP among MSM who engage in chemsex in Brazil and Portugal. Methods This was a cross-sectional study of a secondary dataset from a larger study conducted between January 2020 and May 2021 throughout Brazil and Portugal involving 1852 MSM who engage in chemsex. An initial descriptive analysis was performed to calculate the absolute and relative frequencies of independent variables related to the intention to use PrEP among MSM. A multivariate regression model was developed to identify factors independently associated with the intention to use PrEP. Results Although a high level of PrEP knowledge (85.75%) was observed among MSM who engage in chemsex, the prevalence of intention to use PrEP was only 59.07%. Five variables were associated with a higher prevalence of intention to use PrEP [engaging in double penetration - adjusted prevalence ratio (aPR): 1.56, 95% CI: 1.44-1.69; being assigned female sex at birth - aPR: 1.34, 95% CI: 1.12-1.61; cruising - aPR: 1.21, 95% CI: 1.06-1.38; not using condoms - aPR: 1.20, 95% CI: 1.05-1.36; and being an immigrant - aPR: 1.16; 95% CI: 1.07-1.25], while having knowledge of postexposure prophylaxis (aPR: 0.91; 95% CI: 0.84-0.98), having a casual sexual partner (aPR: 0.86 and 0.85; 95% CI: 0.74-0.99 and 0.74-0.98), and engaging in group sex (aPR: 0.81; 95% CI: 0.73-0.90) were associated with a lower intention to use PrEP. Conclusion The intention to use PrEP among MSM who engage in chemsex was high, and several factors were associated with this intention. Understanding the factors associated with the intention to use PrEP among MSM practicing chemsex is crucial for developing targeted interventions to increase PrEP uptake in this population. The results of this study suggest that tailored approaches are necessary to promote PrEP use in this population.
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Affiliation(s)
- Álvaro Francisco Lopes de Sousa
- Hospital Sírio-Libânes, Instituto de Ensino e Pesquisa, São Paulo, Daher Cutait, 69 - Bela Vista, São Paulo - SP, 01308-060, Brazil
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Caíque Jordan Nunes Ribeiro
- Collective Health Research Center (NISC), Federal University of Sergipe, Lagarto, Sergipe, Brazil
- Graduate Program in Nursing, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | | | - Layze Braz de Oliveira
- Ribeirão Preto College of Nursing, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | - Shirley Verônica Melo Almeida Lima
- Collective Health Research Center (NISC), Federal University of Sergipe, Lagarto, Sergipe, Brazil
- Graduate Program in Nursing, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | | | - Márcio Bezerra-Santos
- Complex of Medical Sciences and Nursing, Universidade Federal de Alagoas, Alagoas, Brazil
| | | | - Anderson Reis de Sousa
- Graduate Program in Nursing and Health of the Nursing School, Federal University of Bahia, Salvador, Bahia, Brazil
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Ugarte A, de la Mora L, García D, Martínez-Rebollar M, de Lazzari E, Torres B, Inciarte A, Ambrosioni J, Chivite I, Solbes E, de Loredo N, Del Carlo GF, González-Cordón A, Blanco JL, Martínez E, Mallolas J, Laguno M. Evolution of Risk Behaviors, Sexually Transmitted Infections and PrEP Care Continuum in a Hospital-Based PrEP Program in Barcelona, Spain: A Descriptive Study of the First 2 Years' Experience. Infect Dis Ther 2022; 12:425-442. [PMID: 36520330 PMCID: PMC9753893 DOI: 10.1007/s40121-022-00733-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/15/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Pre-exposure prophylaxis (PrEP) is effective for HIV prevention, but the PrEP care continuum also involves improving PrEP awareness, uptake, adherence, and retention in care. Users' awareness is often compromised because of vulnerability factors and risk behaviors, such as chemsex practice or specific substance use, which could lead to risk compensation. Correct adherence and retention in care are essential to achieve the full effectiveness of PrEP. This study describes changes in users' risk behaviors and sexually transmitted infections (STIs), as well also PrEP care continuum details. METHODS This was a descriptive single-center retrospective study including adults at high HIV risk screened between November 2019 and June 2021 in the PrEP program of our hospital. Demographic, behavioral, STI, adherence, and retention in care variables were assessed. Data were collected from medical records and self-report questionnaires. RESULTS A total of 295 people were included, 94% men and 5% transgender women, with a mean age of 34 years (SD 10) and 10% sex workers. At baseline, 55% disclosed chemsex practice and 3% slamming. During follow-up, condom use for anal intercourse decreased from 41% to 13% (p ≤ 0.0001) and one HIV infection was detected; other risk behaviors and STIs remained stable. Chemsex, group sex, fluid exchange, and condomless anal intercourse were related to STI risk. Adherence was correct in 80% of users, and retention in care was 57%. Discontinuations and loss to follow-up were high, mainly affecting transgender women, sex workers, and people practicing fisting. CONCLUSION PrEP program implementation in our hospital was adequate, since it allowed, in a population at high HIV risk, overall users' risk behaviors and STIs to remain stable, with only one HIV diagnosis during the follow-up. We should target specific strategies to improve adherence and retention in care, as vulnerable subgroups at higher risk of loss to follow-up are identified.
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Affiliation(s)
- Ainoa Ugarte
- Infectious Diseases Department, HIV/AIDS Unit, Hospital Clinic of Barcelona, Villarroel Street 170, 08036, Barcelona, Spain.
| | - Lorena de la Mora
- Infectious Diseases Department, HIV/AIDS Unit, Hospital Clinic of Barcelona, Villarroel Street 170, 08036 Barcelona, Spain
| | - David García
- Infectious Diseases Department, HIV/AIDS Unit, Hospital Clinic of Barcelona, Villarroel Street 170, 08036 Barcelona, Spain
| | - María Martínez-Rebollar
- Infectious Diseases Department, HIV/AIDS Unit, Hospital Clinic of Barcelona, Villarroel Street 170, 08036 Barcelona, Spain
| | - Elisa de Lazzari
- Infectious Diseases Department, HIV/AIDS Unit, Hospital Clinic of Barcelona, Villarroel Street 170, 08036 Barcelona, Spain
| | - Berta Torres
- Infectious Diseases Department, HIV/AIDS Unit, Hospital Clinic of Barcelona, Villarroel Street 170, 08036 Barcelona, Spain
| | - Alexy Inciarte
- Infectious Diseases Department, HIV/AIDS Unit, Hospital Clinic of Barcelona, Villarroel Street 170, 08036 Barcelona, Spain
| | - Juan Ambrosioni
- Infectious Diseases Department, HIV/AIDS Unit, Hospital Clinic of Barcelona, Villarroel Street 170, 08036 Barcelona, Spain
| | - Iván Chivite
- Infectious Diseases Department, HIV/AIDS Unit, Hospital Clinic of Barcelona, Villarroel Street 170, 08036 Barcelona, Spain
| | - Estela Solbes
- Infectious Diseases Department, HIV/AIDS Unit, Hospital Clinic of Barcelona, Villarroel Street 170, 08036 Barcelona, Spain
| | - Nicolás de Loredo
- Infectious Diseases Department, HIV/AIDS Unit, Hospital Clinic of Barcelona, Villarroel Street 170, 08036 Barcelona, Spain
| | - Guillermo Federico Del Carlo
- Infectious Diseases Department, HIV/AIDS Unit, Hospital Clinic of Barcelona, Villarroel Street 170, 08036 Barcelona, Spain
| | - Ana González-Cordón
- Infectious Diseases Department, HIV/AIDS Unit, Hospital Clinic of Barcelona, Villarroel Street 170, 08036 Barcelona, Spain
| | - José Luis Blanco
- Infectious Diseases Department, HIV/AIDS Unit, Hospital Clinic of Barcelona, Villarroel Street 170, 08036 Barcelona, Spain
| | - Esteban Martínez
- Infectious Diseases Department, HIV/AIDS Unit, Hospital Clinic of Barcelona, Villarroel Street 170, 08036 Barcelona, Spain
| | - Josep Mallolas
- Infectious Diseases Department, HIV/AIDS Unit, Hospital Clinic of Barcelona, Villarroel Street 170, 08036 Barcelona, Spain
| | - Montserrat Laguno
- Infectious Diseases Department, HIV/AIDS Unit, Hospital Clinic of Barcelona, Villarroel Street 170, 08036 Barcelona, Spain
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11
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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 PMCID: PMC9640403 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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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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13
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Viamonte M, Ghanooni D, Reynolds JM, Grov C, Carrico AW. Running with Scissors: a Systematic Review of Substance Use and the Pre-exposure Prophylaxis Care Continuum Among Sexual Minority Men. Curr HIV/AIDS Rep 2022; 19:235-250. [PMID: 35701713 PMCID: PMC9279195 DOI: 10.1007/s11904-022-00608-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2022] [Indexed: 11/26/2022]
Abstract
Purpose of Review Patterns of sexualized drug use, including stimulants (e.g., methamphetamine) and chemsex drugs, are key drivers of HIV incidence among sexual minority men (SMM). Although pre-exposure prophylaxis (PrEP) mitigates HIV risk, there is no consensus regarding the associations of substance use with the PrEP care continuum. Recent Findings SMM who use substances are as likely or more likely to use PrEP. Although SMM who use stimulants experience greater difficulties with daily oral PrEP adherence, some evidence shows that SMM who use stimulants or chemsex drugs may achieve better adherence in the context of recent condomless anal sex. Finally, SMM who use substances may experience greater difficulties with PrEP persistence (including retention in PrEP care). Summary SMM who use stimulants and other substances would benefit from more comprehensive efforts to support PrEP re-uptake, adherence, and persistence, including delivering behavioral interventions, considering event-based dosing, and providing injectable PrEP.
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Affiliation(s)
- Michael Viamonte
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St., Office 1010, Miami, FL, 33136, USA
| | - Delaram Ghanooni
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St., Office 1010, Miami, FL, 33136, USA
| | - John M Reynolds
- Calder Memorial Library, University of Miami, FL, Miami, USA
| | - Christian Grov
- City University of New York Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Adam W Carrico
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St., Office 1010, Miami, FL, 33136, USA.
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14
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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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15
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Amin J, Vaccher S, Templeton DJ, Bavinton B B, Jin F, ZablotskaI I, Matthews G, Oglvie E, Yeung B, Ooi C, Dharan N, Baker DA, Read P, Grulich AE. Low prior exposure and incidence of hepatitis C in HIV negative gay and bisexual men taking PrEP: findings from the EPIC-NSW prospective implementation study. Clin Infect Dis 2022; 75:1497-1502. [PMID: 35352102 DOI: 10.1093/cid/ciac231] [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: 11/15/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The use of pre-exposure prophylaxis (PrEP) for the prevention of HIV has raised concerns of increased sexual risk behaviours. These behaviours may be associated with increased incidence of sexually acquired hepatitis C (HCV) among gay and bisexual men (GBM). METHODS The Expanded PrEP Implementation in Communities-New South Wales (EPIC-NSW) study was a cohort study of daily co-formulated tenofovir disoproxil fumarate and emtricitabine for HIV prevention. We recruited 9596 people at high risk of HIV acquisition from 31 clinics across New South Wales and the Australia Capital Territory in Australia. We report prior exposure to HCV and incidence in this cohort between 2016 and 2019. RESULTS At least one HCV test result was available for 8658 (90.2%) participants. These individuals had a median age of 34 years (IQR 28-43), most of whom were male (8530, 98.5%), identified as gay (7944, 91.8%), and were born in Australia (51.8%). Prior exposure to HCV was detected among 81 participants at baseline (0.9%, 95% CI 0.7 to 1.2%). Twenty of 8577 participants were diagnosed with incident infection (rate 0.2/100 person years (95%CI 0.1 to 0.3/100py)). They were significantly older (median age 41 years vs 34 years, p=0.044), and more likely to report methamphetamine use at baseline (IRR 2.7 (95%CI 1.00-7.2)) than those without incident infection. CONCLUSIONS In this population of PrEP users, HCV prior exposure and incidence were low. With high levels of HCV and HIV testing and treatment, the dual goals of HIV and HCV elimination could be achieved in this population.
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Affiliation(s)
- Janaki Amin
- Department of Health Systems and Populations, Macquarie University, Sydney, New South Wales, Australia.,The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Stefanie Vaccher
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - David J Templeton
- Department of Sexual Health Medicine and Sexual Assault Medical Service, Sydney Local Health District, and Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Fengyi Jin
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Iryna ZablotskaI
- Western Sydney Sexual Health Centre & Sydney Medical School - Westmead, University of Sydney, Sydney, New South Wales, Australia
| | - Gail Matthews
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Erin Oglvie
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Barbra Yeung
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Catriona Ooi
- Clinic 16, St Leonards, Sydney, New South Wales, Australia
| | - Nila Dharan
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - David A Baker
- East Sydney Doctors, Darlinghurst, Sydney, New South Wales, Australia
| | - Phillip Read
- Kirketon Road Centre, Kings Cross, Sydney, New South Wales, Australia
| | - Andrew E Grulich
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
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16
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Arnold-Forster D, Horne R, Nutland W, Wayal S, Rayment M, Rae C, Desai M, Clarke A, Sullivan A, McCormack S, Gafos M. Perceptions and Practicalities Influencing Pre-exposure Prophylaxis Adherence Among Men Who Have Sex with Men in England. AIDS Behav 2022; 26:2768-2782. [PMID: 35182281 PMCID: PMC9252952 DOI: 10.1007/s10461-022-03624-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 12/27/2022]
Abstract
PrEP is highly effective for HIV prevention but requires adequate adherence. In this paper we use the perceptions and practicalities approach (PAPA) to identify factors that influenced PrEP adherence using qualitative data from the PROUD study. From February 2014 to January 2016, we interviewed 41 gay, bisexual and other men-who-have-sex-with-men and one trans woman who were enrolled in the study. We purposively recruited participants for interview based on trial arm allocation, adherence and sexual risk behaviours. The interviews were conducted in English, audio-recorded, transcribed, coded and analysed using framework analysis. Participants in general were highly motivated to use and adhere to PrEP, and this was linked to strong perceptions of personal necessity for PrEP as they felt at risk of HIV and viewed PrEP as highly effective. On the other hand, concerns about side effects and HIV resistance did inhibit PrEP initiation and adherence although this was uncommon. Practical factors such as daily routine, existing habitual pill-taking and pill storage impacted adherence. Drug and alcohol use rarely caused participants to miss doses. These findings indicate that using the principals of PAPA to unpick influencers of PrEP use, could help tailor adherence support in PrEP programmes.
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Affiliation(s)
- Dora Arnold-Forster
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Kepple Street, London, WC1E 7HT, UK
| | - Robert Horne
- School of Pharmacy, University College London, London, UK
| | | | - Sonali Wayal
- Institute for Global Health, University College London, London, UK
| | - Michael Rayment
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Caroline Rae
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Monica Desai
- National Institute for Health and Care Excellence, London, UK
| | - Amanda Clarke
- Claude Nicol Centre, Royal Sussex County Hospital, Brighton, UK
| | - Ann Sullivan
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Sheena McCormack
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Mitzy Gafos
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Kepple Street, London, WC1E 7HT, UK.
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK.
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17
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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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De Baetselier I, Reyniers T, Platteau T, Wouters K, Nöstlinger C, Cuylaerts V, Buyze J, Laga M, Kenyon C, Crucitti T, Vuylsteke B. Recurrent Sexually Transmitted Infections Among a Cohort of Men Who Have Sex With Men Using Preexposure Prophylaxis in Belgium Are Highly Associated With Sexualized Drug Use. Sex Transm Dis 2021; 48:726-732. [PMID: 34110745 DOI: 10.1097/olq.0000000000001424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Men who have sex with men (MSM) experiencing recurrent sexually transmitted infections (STIs) may play a crucial role in the STI epidemic. However, there is limited understanding of what kind of behavior leads to recurrent STIs. METHODS A total of 179 MSM using preexposure prophylaxis were followed up for 18 months and were screened quarterly for chlamydia, gonorrhea, and syphilis from 2015 to 2018 in Belgium. Participants were stratified into 3 different groups (no STI, one STI episode, recurrent STI episodes during the study). Sociodemographic and sexual behavioral characteristics were compared between the 3 groups, and significant associations with recurrent STI were explored using multivariate logistic regression models. RESULTS A total of 62.0% (n = 111/179) of participants experienced at least one STI during the study, and more than 1 in 3 became reinfected with an STI at another visit (n = 66/179 [36.9%]). Participants experiencing recurrent STIs reported the highest frequency of sexualized drug use (86.4%) compared with participants experiencing one (60.0%) or no STI (47.1%). Therefore, sexualized drug use was highly associated with recurrent STIs (adjusted odds ratio [aOR]. 4.35). Other factors associated with recurrent STIs were being younger than 40 years (aOR, 3.29), had a high number (>4) of nonsteady partners with whom receptive (aOR, 1.17) or insertive (aOR, 1.12) condomless anal intercourse occurred in the last 3 months. CONCLUSIONS Sexualized drug use was the greatest risk factor for having recurrent STIs. Tailoring prevention and care, including specialized services tackling problematic drug use in a sexual context, may help to curb the STI epidemic among MSM.
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Affiliation(s)
- Irith De Baetselier
- From the STI Reference Laboratory, Clinical Reference Laboratory, Department of Clinical Sciences
| | | | | | | | | | - Vicky Cuylaerts
- From the STI Reference Laboratory, Clinical Reference Laboratory, Department of Clinical Sciences
| | - Jozefien Buyze
- Clinical Trials Unit, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Marie Laga
- HIV/STD Unit, Department of Public Health
| | | | - Tania Crucitti
- From the STI Reference Laboratory, Clinical Reference Laboratory, Department of Clinical Sciences
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Flores Anato JL, Panagiotoglou D, Greenwald ZR, Trottier C, Vaziri M, Thomas R, Maheu-Giroux M. Chemsex practices and pre-exposure prophylaxis (PrEP) trajectories among individuals consulting for PrEP at a large sexual health clinic in Montréal, Canada (2013-2020). Drug Alcohol Depend 2021; 226:108875. [PMID: 34218004 DOI: 10.1016/j.drugalcdep.2021.108875] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Chemsex among gay, bisexual and other men who have sex with men (gbMSM) has raised public health concerns because of its association with sexual behaviours that can increase transmission of sexually transmitted infections, including HIV. Pre-exposure prophylaxis (PrEP) is highly effective at blocking HIV acquisition, addressing important prevention needs among individuals practicing chemsex. This study aims to improve our understanding of chemsex practices and PrEP trajectories of gbMSM and transgender women consulting for PrEP. METHODS We used data from the PrEP cohort of Clinique médicale l'Actuel, a major sexual health clinic in Montréal. We describe the sociodemographic profile of clients consulting for PrEP, characterize chemsex and polysubstance use trends over time, and evaluate PrEP trajectories using Kaplan-Meier curves. RESULTS Among 2923 clients who consulted for PrEP between 2013-2020 (2910 cisgender gbMSM, 6 transgender gbMSM, 7 transgender women), 24 % reported chemsex in the past year and 13 % reported polysubstance use. The most common chemsex substances were ecstasy (14 %), GHB (13 %), and cocaine (12 %). The proportion of clients reporting chemsex and polysubstance use decreased over time. In both the chemsex and no-chemsex group, 73 % of clients initiated PrEP. The median time to discontinuation was similar between the chemsex (6.5 months; 95 %CI: 5.3-7.2) and no-chemsex group (6.9 months; 95 %CI: 6.3-7.5). CONCLUSION Chemsex is not a barrier to PrEP initiation or persistence. However, these results suggest a high prevalence of chemsex among gbMSM consulting for PrEP, highlighting the need for services addressing the intersection of sexual health and substance use for this population.
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Affiliation(s)
- Jorge Luis Flores Anato
- Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, McGill University, Montréal, QC, Canada
| | - Dimitra Panagiotoglou
- Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, McGill University, Montréal, QC, Canada
| | - Zoë R Greenwald
- Clinique Médicale l'Actuel, Montréal, QC, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | | | | | - Mathieu Maheu-Giroux
- Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, McGill University, Montréal, QC, Canada.
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Laguno M, Ugarte A, Martinez-Rebollar M, Sobrino Y, Font G, de Lazzari E, de la Mora L, Torres B, Chivite I, Riera J, Ambrosioni J, Inciarte A, González-Cordón A, Rojas J, Cordón E, Blanco JL, Martínez E, Mallolas J. PrEP program experience in a hospital HIV unit. Description of baseline user profile and identification of opportunities for improvement. Enferm Infecc Microbiol Clin 2021; 41:S0213-005X(21)00178-6. [PMID: 34045097 DOI: 10.1016/j.eimc.2021.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 04/03/2021] [Accepted: 04/07/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Pre-Exposure Prophylaxis (PrEP) is a biomedical intervention to prevent HIV infection in seronegative people at high risk of becoming infected. This strategy was endorsed in October 2019 by the Spanish Ministry of Health. OBJECTIVE To present the PrEP initial experience in the HIV Unit of the Hospital Clínic of Barcelona, paying special attention to the analysis of the vulnerability factors in the cohort. MATERIALS AND METHODS Retrospective, descriptive study. The epidemiological, sociodemographic, and clinical characteristics of the users included in the program during the first year are analyzed, paying particular attention to Infections, risky practices, and substance use. RESULTS 190 individuals were included, 177 men and 12 trans women with a mean age of 35 years (8 SD). 70% had higher education, and half had Spanish nationality. An average of 10 couples per trimester and 60% reported unprotected anal sex. 31% had at least one positive PCR for STIs, with N. gonorrhoeae being the most prevalent microorganism (51%) and the rectal sample the most affected (21%). 63% reported chemsex use, 19% polydrug use, and 8% "slamming". Half expressed concern about consumption and/or sexual practices and 25% the need for help. CONCLUSIONS The PrEP user profile attended in our Hospital Unit justifies the creation of multidisciplinary teams that allow us to provide holistic attention to the sexual life of these people.
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Affiliation(s)
- Montserrat Laguno
- Unidad de VIH, Hospital Clínic e IDIBAPS, Universidad de Barcelona, Barcelona, España.
| | - Ainoa Ugarte
- Unidad de VIH, Hospital Clínic e IDIBAPS, Universidad de Barcelona, Barcelona, España
| | | | - Yeray Sobrino
- Unidad de VIH, Hospital Clínic e IDIBAPS, Universidad de Barcelona, Barcelona, España
| | - Guillermo Font
- Unidad de VIH, Hospital Clínic e IDIBAPS, Universidad de Barcelona, Barcelona, España
| | - Elisa de Lazzari
- Unidad de VIH, Hospital Clínic e IDIBAPS, Universidad de Barcelona, Barcelona, España
| | - Lorena de la Mora
- Unidad de VIH, Hospital Clínic e IDIBAPS, Universidad de Barcelona, Barcelona, España
| | - Berta Torres
- Unidad de VIH, Hospital Clínic e IDIBAPS, Universidad de Barcelona, Barcelona, España
| | - Iván Chivite
- Unidad de VIH, Hospital Clínic e IDIBAPS, Universidad de Barcelona, Barcelona, España
| | - Josep Riera
- Servicio de Dermatología, Hospital Clínic e IDIBAPS, Universidad de Barcelona, Barcelona, España
| | - Juan Ambrosioni
- Unidad de VIH, Hospital Clínic e IDIBAPS, Universidad de Barcelona, Barcelona, España
| | - Alexy Inciarte
- Unidad de VIH, Hospital Clínic e IDIBAPS, Universidad de Barcelona, Barcelona, España
| | - Ana González-Cordón
- Unidad de VIH, Hospital Clínic e IDIBAPS, Universidad de Barcelona, Barcelona, España
| | - Jhon Rojas
- Unidad de VIH, Hospital Clínic e IDIBAPS, Universidad de Barcelona, Barcelona, España
| | - Encarna Cordón
- Unidad de VIH, Hospital Clínic e IDIBAPS, Universidad de Barcelona, Barcelona, España
| | - José Luis Blanco
- Unidad de VIH, Hospital Clínic e IDIBAPS, Universidad de Barcelona, Barcelona, España
| | - Esteban Martínez
- Unidad de VIH, Hospital Clínic e IDIBAPS, Universidad de Barcelona, Barcelona, España
| | - Josep Mallolas
- Unidad de VIH, Hospital Clínic e IDIBAPS, Universidad de Barcelona, Barcelona, España
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21
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[Chemsex : A new challenge in addiction medicine and infectious diseases]. DER NERVENARZT 2021; 93:263-278. [PMID: 33852029 DOI: 10.1007/s00115-021-01116-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/07/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Recently there has been an increase in reports of the phenomenon called chemsex, a subform of sexualized substance use. Chemsex is a neologism consisting of the two terms "chemicals" and "sex". It describes the use of methamphetamine, γ‑hydroxybutyrate/γ-butyrolactone (GHB/GBL), mephedrone and sometimes other substances in a sexual context, especially by men who have sex with men (MSM). Chemsex has been described as a significant risk factor for mental and physical diseases. OBJECTIVE Due to the increasing importance of the phenomenon and the significantly increased number of publications on the subject, this article provides an overview of the current and relevant literature. The aim is to raise awareness on this topic among practitioners and researchers and thus to facilitate access to the help system for those affected. METHOD A literature search was conducted in PubMed/Medline, Cochrane and Embase for the terms "chemsex", "sexualized drug use" and "slamming. A total of 22 articles were identified as being relevant. RESULTS In the published literature on chemsex the current focus lies on somatic comorbidities. There is a significantly increased risk of sexually transmitted diseases. Mental illnesses such as depression, substance-induced psychosis and addiction also appear to be a significant consequence of chemsex. An individualized and specialized treatment approach is not yet established. DISCUSSION The complexity of chemsex with its psychiatric and somatic aspects does not yet appear to be sufficiently reflected by the current data situation; however, due to the mutual influence of these different comorbidities, this patient clientele appears to be particularly at risk in the absence of a specialized treatment option, which is why further research on this topic is needed.
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Drückler S, Speulman J, van Rooijen M, De Vries HJC. Sexual consent and chemsex: a quantitative study on sexualised drug use and non-consensual sex among men who have sex with men in Amsterdam, the Netherlands. Sex Transm Infect 2021; 97:268-275. [PMID: 33833086 PMCID: PMC8165144 DOI: 10.1136/sextrans-2020-054840] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/08/2021] [Accepted: 01/17/2021] [Indexed: 11/21/2022] Open
Abstract
Background Chemsex (drug use to enhance sex) has emerged among men who have sex with men (MSM). Non-consensual sex (NCS) is hypothesised to occur frequently under the influence of chemsex, however data are scarce. In this cross-sectional study, it was aimed to assess whether NCS is associated with chemsex. Methods We offered a survey about chemsex in the past 6 months (crystal methamphetamine, mephedrone and/or gamma-hydroxybutyrate/gamma-butyrolacton use) and NCS (sexual experiences beyond one’s limits or unpleasant sexual experiences) in the past 5 years to Amsterdam-located gay dating platform users. Associations were assessed using χ² test, Fisher’s exact test and multivariable logistic regression. Results Of 891 participants, 30.6% (273 of 891) engaged in chemsex; 21.2% engaging and 16.7% not engaging in chemsex reported any NCS experiences (p=0.109). Among MSM who reported any NCS experiences, chemsex engagers reported being touched against one’s will less often compared with non-engagers (22.4% vs 39.8%; p=0.036). Yet, chemsex engagers reported passing out and not remembering what happened during drug use more often (41.4% vs 8.7%; p<0.001). The level of suffering from NCS experiences did not differ between chemsex engagers and non-engagers (p=0.539); and was rated by most participants with no suffering at all or low suffering (77.1%). In the multivariable regression analyses, chemsex engagement in the past 6 months was associated with NCS (adjusted OR 1.46; 95% CI 1.01 to 2.11). Conclusions A substantial proportion of MSM (regardless of chemsex engagement) reported NCS in the past 5 years. In multivariate logistic regression analysis, chemsex engagement was associated with an NCS experience. Among participants who reported NCS, suffering related to NCS however, did not differ between chemsex engagers and non-engagers. Sexual healthcare professionals need to address chemsex and NCS during consultations involving MSM and refer men for specialised help if deemed necessary.
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Affiliation(s)
- Susanne Drückler
- Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Jilke Speulman
- Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Martijn van Rooijen
- Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Henry J C De Vries
- Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands.,Department of Dermatology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
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23
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Rivera AV, Harriman G, Carrillo SA, Braunstein SL. Trends in Methamphetamine Use Among Men Who Have Sex with Men in New York City, 2004-2017. AIDS Behav 2021; 25:1210-1218. [PMID: 33185774 DOI: 10.1007/s10461-020-03097-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2020] [Indexed: 10/23/2022]
Abstract
Methamphetamine (meth) use among men who have sex with men (MSM) has been documented to be associated with HIV transmission among those who are HIV-negative and worsening HIV outcomes among those who are HIV-positive. Recent media reports have suggested recent increases in meth use in New York City (NYC), particularly among Hispanic/Latino and Black MSM. Using serial cross-sectional data from 2004 to 2017, we aim to describe trends in meth use and describe racial/ethnic patterns among MSM in NYC. Overall, we observed a decrease in meth use among MSM from 2004 to 2011 and an increase from 2011 to 2017. When stratified by race/ethnicity, use among White MSM decreased. Beginning in 2008, use among both Hispanic/Latino and Black MSM increased over time. These data provide more evidence that meth use may be increasing in Hispanic/Latino and Black MSM. Culturally-tailored and status-neutral interventions should be explored.
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Brief Report: Associations Between Self-Reported Substance Use Behaviors and PrEP Acceptance and Adherence Among Black MSM in the HPTN 073 Study. J Acquir Immune Defic Syndr 2021; 85:23-29. [PMID: 32452970 DOI: 10.1097/qai.0000000000002407] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) is efficacious for HIV prevention. Black men who have sex with men (MSM) accounted for the largest proportion of new HIV diagnoses in the United States relative to other racial/ethnic groups. Black MSM who use substances are at an increased risk for HIV infection and are ideal candidates for PrEP, but barriers to maintaining PrEP adherence remain a concern. We assessed whether substance use behaviors are associated with initiation and adherence to PrEP among a sample of black MSM in the United States. METHODS Data for this analysis come from the HIV Prevention Trails Network Study 073 (HPTN 073). Substance use behaviors-including alcohol, marijuana, poppers (ie, alkyl nitrites), and stimulants (ie, methamphetamine/cocaine use) including use of these substances before/during condomless anal intercourse (CAI)-were assessed longitudinally through self-report. PrEP adherence was assessed by pharmacological testing in blood. Generalized estimating equations were used to evaluate association between substance use behaviors and PrEP initiation and adherence. RESULTS Among 226 HIV-negative black MSM, the majority (60%) were 25+ years of age. Most of the substance use behaviors were not significantly associated with PrEP initiation or adherence. However, stimulant use before/during CAI was significantly associated with lower odds of PrEP adherence (adjusted odds ratio = 0.21, 95% confidence interval = 0.07 to 0.61; P = <0.01). CONCLUSIONS These findings suggest that PrEP adherence is feasible among black MSM who use substances. However, black MSM who engage in stimulant use before/during CAI may present a unique group for additional study and support with enhanced behavioral health and support services.
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25
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Low use of condom and high STI incidence among men who have sex with men in PrEP programs. PLoS One 2021; 16:e0245925. [PMID: 33539363 PMCID: PMC7861516 DOI: 10.1371/journal.pone.0245925] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 01/08/2021] [Indexed: 11/20/2022] Open
Abstract
Objective Since the recent introduction of preexposure prophylaxis (PrEP), several studies have reported a decrease in the use of condoms and a rise in STIs among users. This rise in risk behavior associated with the advent of PrEP is known as “risk compensation.” The aim of this study is to measure clinical and behavioral changes associated with the introduction of PrEP by analyzing condom use for anal intercourse, number of sexual partners, sexualized drug use and STI incidence. Methods We performed a retrospective descriptive study of PrEP users followed every 3months over a 2-year period spanning 2017–2019 in a referral clinic specializing in STI/HIV in Madrid, Spain. One hundred ten men who have sex with men and transgender women underwent regular screening for STIs and hepatitis C virus (HCV) infection. Sociodemographic, clinical, and behavioral data were gathered for all subjects studied. Results The risk compensation observed in this study consisted primarily of a lower rate of condom use, while the number of sexual partners and recreational drug consumption remained stable. We observed a very high incidence of STIs in this sample, particularly rectal gonorrhea and chlamydia. The factors shown to be independently associated with the presence of an STI on multivariate analysis were age below 30 years and over 10 sexual partners/month. Conclusion The incidence of STI acquisition was higher than expected, indicating a need for strategies to minimize this impact, particularly among younger individuals with a higher number of sexual partners.
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26
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Sousa ÁFLD, Queiroz AAFLN, Lima SVMA, Almeida PD, Oliveira LBD, Chone JS, Araújo TME, Brignol SMS, Sousa ARD, Mendes IAC, Dias S, Fronteira I. Chemsex practice among men who have sex with men (MSM) during social isolation from COVID-19: multicentric online survey. CAD SAUDE PUBLICA 2020; 36:e00202420. [PMID: 33237252 DOI: 10.1590/0102-311x00202420] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 08/11/2020] [Indexed: 12/20/2022] Open
Abstract
The aim of this study was to investigate factors associated with sex practice under the effect of drugs (chemsex) among men who have sex with men (MSM) during the period of social isolation in the context of the COVID-19 pandemic. A multicenter online survey was applied to Brazil and Portugal in April 2020 when the two countries were under restrictive health measures due to the pandemic. Participants were recruited with an adaptation of the respondent driven sampling (RDS) method in the online environment. Data were collected using social networks and dating apps for MSM. We used bivariate and multivariate logistic regression to produce crude (OR) and adjusted odds ratios (aOR). In a universe of 2,361 subjects, 920 (38.9%) reported engaging in chemsex practice, which involved casual partners in 95% of the cases. Higher OR of engaging in chemsex were associated with Brazil (aOR = 15.4; 95%CI: 10.7-22.1), not being in social isolation (aOR = 4.9; 95%CI: 2.2-10.9), engaging in casual sex during social distancing (aOR = 52.4; 95%CI: 33.8-81.4), group sex (aOR = 2.9; 95%CI: 2.0-4.4), not presenting any symptom of COVID-19 (aOR = 1.3; 95%CI: 1.1-1.8), not living with the sex partner (aOR = 1.8; 95%CI: 1.2-2.6), and using pre-exposure prophylaxis (aOR = 2.6; 95%CI: 1.8-3.7). The occurrence of chemsex was high, especially in Brazil, where the proposed social distancing did not gain adherence by MSM.
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Affiliation(s)
| | | | | | | | - Layze Braz de Oliveira
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brasil
| | | | | | | | | | | | - Sónia Dias
- Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Inês Fronteira
- Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa, Lisboa, Portugal
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Desai N, Burns L, Gong Y, Zhi K, Kumar A, Summers N, Kumar S, Cory TJ. An update on drug-drug interactions between antiretroviral therapies and drugs of abuse in HIV systems. Expert Opin Drug Metab Toxicol 2020; 16:1005-1018. [PMID: 32842791 DOI: 10.1080/17425255.2020.1814737] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION While considerable progress has been made in the fight against HIV/AIDS, to date there has not been a cure, and millions of people around the world are currently living with HIV/AIDS. People living with HIV/AIDS have substance abuse disorders at higher rates than non-infected individuals, which puts them at an increased risk of drug-drug interactions. AREAS COVERED Potential drug-drug interactions are reviewed for a variety of potential drugs of abuse, both licit and illicit. These drugs include alcohol, cigarettes or other nicotine delivery systems, methamphetamine, cocaine, opioids, and marijuana. Potential interactions include decreased adherence, modulation of drug transporters, or modulation of metabolic enzymes. We also review the relative incidence of the use of these drugs of abuse in People living with HIV/AIDS. EXPERT OPINION Despite considerable improvements in outcomes, disparities in outcomes between PLWHA who use drugs of abuse, vs those who do not still exist. It is of critical necessity to improve outcomes in these patients and to work with them to stop abusing drugs of abuse.
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Affiliation(s)
- Nuti Desai
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy , Memphis, TN, USA
| | - Leah Burns
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy , Memphis, TN, USA
| | - Yuqing Gong
- Department of Pharmacy Science, University of Tennessee Health Science Center College of Pharmacy , Memphis, TN, USA
| | - Kaining Zhi
- Plough Center for Sterile Drug Delivery Solutions, University of Tennessee Health Science Center , Memphis, TN, USA
| | - Asit Kumar
- Department of Pharmacy Science, University of Tennessee Health Science Center College of Pharmacy , Memphis, TN, USA
| | - Nathan Summers
- Division of Infectious Diseases, University of Tennessee Health Science Center College of Medicine , Memphis, TN, USA
| | - Santosh Kumar
- Department of Pharmacy Science, University of Tennessee Health Science Center College of Pharmacy , Memphis, TN, USA
| | - Theodore J Cory
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy , Memphis, TN, USA
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Spinelli MA, Laborde N, Kinley P, Whitacre R, Scott HM, Walker N, Liu AY, Gandhi M, Buchbinder SP. Missed opportunities to prevent HIV infections among pre-exposure prophylaxis users: a population-based mixed methods study, San Francisco, United States. J Int AIDS Soc 2020; 23:e25472. [PMID: 32294338 PMCID: PMC7159249 DOI: 10.1002/jia2.25472] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 01/24/2020] [Accepted: 02/14/2020] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Pre-exposure prophylaxis (PrEP) is highly effective, although PrEP adherence and persistence has been variable during real world implementation. Little is known about missed opportunities to enhance PrEP adherence among individuals who later HIV seroconverted after using PrEP. The goal of this analysis was to identify all HIV infections among individuals who had accessed PrEP in an integrated health system in San Francisco, and to identify potentially intervenable factors that could have prevented HIV infection through in-depth interviews with people who HIV seroconverted after using PrEP. METHODS We identified individuals who initiated PrEP in an integrated safety-net public health system and performed in-depth chart review to determine person-time on and after stopping PrEP over six years. We identified all PrEP seroconversions using the Centers for Disease Control and Prevention's Enhanced HIV/AIDS Reporting System and then calculated HIV incidence while using PrEP and during gaps in use. We then performed in-depth interviews with those who seroconverted. RESULTS Overall, 986 initiated PrEP across the San Francisco Department of Public Health from July 2012 to November 2018. Data were gathered from 895 person-years on PrEP and 953 after stopping PrEP. The HIV incidence was 7.5-fold higher after stopping PrEP compared to while on PrEP (95% CI 1 to 336). Of the eight individuals who HIV seroconverted; only one was taking PrEP at the time of seroconversion but was using on-demand PrEP inconsistently. All eight agreed to qualitative interviews. Major barriers to PrEP persistence included substance use, mental health and housing loss; difficulty accessing PrEP due to cost, insurance, and the cost and time of medical visits; difficulty weighing PrEP's benefit versus self-perceived risk; and entering a primary partnership. The individual who developed HIV using on-demand PrEP reported confusion about the dosing regimen and which sexual encounters required accompanying PrEP dosing. CONCLUSIONS HIV incidence during gaps in PrEP use was nearly eight-fold higher than while on PrEP in this large cohort in San Francisco. Many individuals who stop PrEP remain at risk of HIV, and participants reported that proactive outreach could potentially have prevented HIV infections. Individuals using non-daily PrEP may require additional education and support in the United States.
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Affiliation(s)
- Matthew A Spinelli
- University of California, San Francisco, Division of HIV, ID, and Global MedicineSan FranciscoCAUSA
- San Francisco Department of Public HealthSan FranciscoCAUSA
| | - Nicole Laborde
- San Francisco Department of Public HealthSan FranciscoCAUSA
| | - Patrick Kinley
- San Francisco Department of Public HealthSan FranciscoCAUSA
| | - Ryan Whitacre
- Graduate Institute of International and Development StudiesDepartment of Sociology and AnthropologyGeneveSwitzerland
| | - Hyman M Scott
- San Francisco Department of Public HealthSan FranciscoCAUSA
| | - Nicole Walker
- San Francisco Department of Public HealthSan FranciscoCAUSA
| | - Albert Y Liu
- San Francisco Department of Public HealthSan FranciscoCAUSA
| | - Monica Gandhi
- University of California, San Francisco, Division of HIV, ID, and Global MedicineSan FranciscoCAUSA
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Maxwell S, Gafos M, Moncrieff M, Shahmanesh M, Stirrup O. Pre-exposure prophylaxis use among men who have sex with men who have experienced problematic chemsex. Int J STD AIDS 2020; 31:474-480. [PMID: 32075538 PMCID: PMC7814093 DOI: 10.1177/0956462420906927] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 01/12/2020] [Indexed: 11/17/2022]
Abstract
Men who have sex with men (MSM) who experience problematic chemsex are at high risk of acquiring HIV due to combined drug use and sexual behaviours. Pre-exposure prophylaxis (PrEP) could substantially reduce the risk of HIV transmission in this group of men. The aim of this study was to examine the biopsychosocial characteristics associated with PrEP use among HIV-negative MSM who have experienced problematic chemsex. This was a cross-sectional analysis of secondary data collected during client assessments at a specialist alcohol and drug service based within the United Kingdom. We compared the socio-demographics, substance use, sexual behaviours and mental health of MSM who reported ever using PrEP to those who reported never using PrEP. Statistical analysis was conducted using the Mann–Whitney U-test for continuous variables and Fisher’s exact test for categorical variables. Between August 2016 and July 2018, 165 HIV-negative MSM who engaged in chemsex had an assessment completed. Thirty-four per cent (n = 50/145) had ever used PrEP. The median age was 36 years (IQR: 30–42), 92% identified as gay (n = 152/165) and 79% were of white ethnicity (n = 130/164). The use of crystal methamphetamine was associated with higher levels of men ever using PrEP (40% versus 21%) (p= 0.047). Men who had ever used PrEP had a higher median number of sexual partners in the previous three months (20 versus 10) (p= 0.004) and had lower level of condom use in their sex lives (median reported 5% versus 50%) (p= 0.010) in comparison to men who had never used PrEP. It is encouraging that men having higher-risk sex had been accessing PrEP. However, further research is required to explore PrEP uptake, retention and adherence in this high-risk group.
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Affiliation(s)
- Steven Maxwell
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Mitzy Gafos
- London School of Hygiene and Tropical Medicine, London, UK
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