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Magalhães LS, dos Santos KC, Diniz e Silva BV, da Silva Filho GF, da Costa e Silva GR, Guimarães RA, Pillon SC, Caetano KAA, Martins RMB, Carneiro MADS, Cook RL, Teles SA. Cocaine/crack and cannabis use among transgender women in Goiás, Central Brazil. PLoS One 2024; 19:e0304219. [PMID: 38843195 PMCID: PMC11156409 DOI: 10.1371/journal.pone.0304219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 05/08/2024] [Indexed: 06/09/2024] Open
Abstract
INTRODUCTION Illicit drug use is a significant public health problem. Studies have shown a high prevalence of cocaine and cannabis use in transgender women (TGW). OBJECTIVE To describe the consumption patterns of cannabis and cocaine/crack use and variables associated with their use in TGW in Central Brazil. METHODS A cross-sectional study was conducted on TGW in Goiás, Brazil. Participants were recruited using a respondent-driven sampling method and were interviewed face-to-face about cannabis and crack-cocaine and the variables associated with them. The Alcohol Smoking and Substance Involvement Screening Test was used to assess substance use. Unweighted logistic regression was used to identify variables associated with cannabis and crack cocaine use. P-values < 0.05 were considered statistically significant. RESULTS A total of 440 transgender women participated in the study. Their median age was 25 years (interquartile range: 20.5-29.5 years). Most participants were single (85.5%) and had engaged in sex work in their lifetime (58.6%). Cannabis was reported by 68.9% and 53.4% of participants in their lifetime and in the past three months, respectively, and cocaine/crack use was reported by 59.8% and 44.1% of participants in their lifetime and the past three months, respectively. Of the participants, 10.2% reported high-risk cannabis use, and 9.1% reported high-risk cocaine/crack use. Furthermore, 35% of participants reported using both drugs. Previous physical violence (Adjusted Odds Ratio (AOR): 2.37), inconsistent condom uses during anal sex (AOR: 2.17), and moderate-/high-risk cocaine/crack use (AOR: 3.14) were associated with high-risk cannabis use. Previous sexual violence (AOR: 2.84), previous STI (AOR: 2.90), moderate-/high-risk cannabis (AOR: 3.82), and binge drinking (AOR; 3.28) were associated with high-risk cocaine/crack use. CONCLUSION Our study found a high frequency, significant overlap in the use of cannabis and cocaine/crack use and violence associated with these drugs consumption among TGW, highlighting the urgent need for health policies for drug disorders among this socially marginalized group.
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Affiliation(s)
| | | | | | | | | | | | - Sandra Cristina Pillon
- Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | | | | | - Robert L. Cook
- Department of Epidemiology, University of Florida, Gainesville, Florida, United States of America
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Rafful C, Orozco R, Peralta D, Jiménez-Rivagorza L, Medina-Mora ME, Gutiérrez N, Morales-Gutierrez M. Feasibility, acceptability, and perceived usefulness of a community-evidence-based harm reduction intervention for sexualized stimulant use among Mexican gay, bisexual, and other men who have sex with men. Harm Reduct J 2024; 21:95. [PMID: 38755623 PMCID: PMC11097588 DOI: 10.1186/s12954-024-01020-y] [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: 04/01/2024] [Accepted: 05/10/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND The use of stimulants and other substances with the purpose of enhancing, maintaining, and prolonging sexual activity is known as sexualized substance use. Also known as chemsex, this pattern of use has been mainly explored in high-income countries. The aim of this article was to assess the feasibility, acceptability, and usefulness of a community- evidence-based harm reduction intervention among Mexican gay, bisexual, and other men who have sex with men (gbMSM) adults who reported sexualized stimulant use in the past 6 months and who were not enrolled in any psychosocial treatment. METHODS The in-person intervention was designed in partnership with gbMSM who used substances. It consisted of 39 harm reduction strategies before, during, and after episodes of use. The components of the intervention were health and self-care, safety, and psychopharmacology. The intervention was delivered at a university campus, a public recreational space, and an HIV public clinic. Feasibility to deliver the intervention was assessed based on enrolment and completion rates; acceptability through a 28-item, 5-point Likert scale (140 max.) constructed and validated for the Mexican population with good reliability coefficients; usefulness through a 5-point Likert scale ("not useful"-"very useful") for each of the 39 strategies; and potential behavioral change by subtracting the likelihood of implementing each strategy minus the frequency of use of the technique before the intervention. RESULTS Participants (n = 19; recruitment rate = 35.2%; completion rate = 84.2%) rated the intervention as acceptable with a mean score of 121.6 (SD = 7.5). The highest potential for behavioral change was regarding the use of information about the half-life of stimulants, polysubstance use, and overdose prevention. CONCLUSIONS This intervention is feasible when provided within public health services where potential participants are already in contact. Harm reduction strategies need to surpass sexually transmitted infections prevention and HIV care and focus on substance use and mental health strategies.
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Affiliation(s)
- 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.
| | - Ricardo Orozco
- 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
| | - Daniela Peralta
- Center for Global Mental Health, National Institute of Psychiatry, Mexico City, Mexico
| | - Leonardo Jiménez-Rivagorza
- Faculty of Psychology, Universidad Nacional Autónoma de México, Circuito Ciudad Universitaria 04510, Coyoacan, 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
| | - Nely Gutiérrez
- Faculty of Psychology, Universidad Nacional Autónoma de México, Circuito Ciudad Universitaria 04510, Coyoacan, Mexico City, Mexico
| | - Missael Morales-Gutierrez
- Faculty of Psychology, Universidad Nacional Autónoma de México, Circuito Ciudad Universitaria 04510, Coyoacan, Mexico City, Mexico
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Hawkinson DE, Witzel TC, Gafos M. Exploring practices to enhance benefits and reduce risks of chemsex among gay, bisexual, and other men who have sex with men: A meta-ethnography. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 127:104398. [PMID: 38555721 DOI: 10.1016/j.drugpo.2024.104398] [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] [Received: 12/11/2023] [Revised: 03/16/2024] [Accepted: 03/18/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Chemsex is the intentional combining of specific drugs with sex, primarily by gay, bisexual, and other men who have sex with men (GBMSM), to enhance intimacy, pleasure, and prolong sexual sessions. Practices vary across geographic and social settings. Participants report benefits and risks of chemsex. Studies have previously reviewed chemsex practices and harm reduction interventions separately. This review aims to examine both together by describing and understanding practices that men employ to navigate the perceived benefits and risks of chemsex. METHODS We conducted a systematic meta-ethnographic review of published qualitative literature, screening titles, abstracts, and full texts on defined inclusion and exclusion criteria. Using reciprocal and refutational translation techniques, we analysed study participants' (first-order) and researchers' (second-order) accounts of benefit-enhancing and risk-reducing chemsex practices. Finally, we employed line-of-argument synthesis techniques to develop our own higher-level interpretations (third-order constructs) of these chemsex practices. RESULTS Our search yielded 6356 records, from which, we included 23 articles in our review. Most studies were conducted in high-income Western countries. Across studies, participants acted at the individual, interpersonal, and community levels to enhance benefits and reduce risks, which made up our third-order constructs. Eight themes emerged from first- and second-order constructs to describe these practices, which included personal preparation, personal boundaries, biomedical measures, structured use of drugs, leaning on partners, injecting practices, group organising, watching out for others, and teaching and learning. Contextual factors like trust, agency, access, stigma, and setting moderated whether and how participants engaged in these practices, and if practices enhanced benefits or reduced risks. CONCLUSION Health promotion programmes and research focused on chemsex must account for the benefits and the risks that GBMSM associate with this type of sexualised drug use and target the moderating factors that shape the practices they employ to navigate these benefits and risks.
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Affiliation(s)
- Drew E Hawkinson
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom
| | - T Charles Witzel
- Institute for Global Health, University College London, Gower Street, London, WC1E 6BT, United Kingdom; Center of Excellence in Research on Gender, Sexuality and Health, Mahidol University, 999 Phutthamonthon Sai 4 Rd, Nakhon Pathom, Thailand
| | - Mitzy Gafos
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom.
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Santos GRDS, Ribeiro CJN, Lima SVMA, Neto JC, de Sousa AR, Bulcao CDS, Dellagostini PG, Batista OMA, de Oliveira LB, Mendes IAC, de Sousa ÁFL. Chemsex among men who have sex with men during the Mpox health crisis in Brazil: A nationwide web survey. Public Health Nurs 2024; 41:589-601. [PMID: 38528749 DOI: 10.1111/phn.13308] [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: 08/10/2023] [Revised: 02/26/2024] [Accepted: 03/01/2024] [Indexed: 03/27/2024]
Abstract
OBJECTIVE To understand the factors associated with the practice of chemsex among MSM in Brazil, especially during the Mpox health crisis, and to design effective prevention and intervention strategies specifically for this population. DESIGN A cross-sectional and analytical study using an electronic survey, conducted from September to December 2022, during the peak of the Mpox outbreak in Brazil. SAMPLE A total of 1452 MSM aged 18 and older. MEASUREMENTS Data were collected via the REDCap platform through a survey with 46 questions. These addressed demographic data, sexual affiliations, practices, experiences with Mpox, healthcare service usage, and stigma or fear related to Mpox. RESULTS The prevalence of chemsex was 19.42% (n = 282). Multivariate Poisson modeling indicated a high incidence of chemsex among those diagnosed with Mpox and those involved in high-risk behaviors. The practice of chemsex was six times higher among those diagnosed with Mpox (95% CI: 4.73-9.10). MSM who engage in bugchasing had a prevalence twice that of the main outcome (95% CI: 1.31-3.16). CONCLUSION There is a significant need for targeted interventions for MSM in Brazil, especially given the Mpox outbreak. This study highlights the strong relationships between chemsex, experiences with Mpox, and various sexual behaviors, underscoring the importance of effective public health initiatives.
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Affiliation(s)
| | - Caíque Jordan Nunes Ribeiro
- Graduate Program in Nursing, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
- Departament of Nursing, Federal University of Sergipe, Lagarto, Sergipe, Brazil
| | - Shirley Verônica Melo Almeida Lima
- Graduate Program in Nursing, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
- Departament of Nursing, Federal University of Sergipe, Lagarto, Sergipe, Brazil
| | - João Cruz Neto
- University for International Integration of the Afro-Brazilian Lusophony, Redenção, Ceará, Brazil
| | | | | | | | | | - Layze Braz de Oliveira
- Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | - Álvaro Francisco Lopes de Sousa
- NOVA National School of Public Health, Public Health Research Center, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
- Institute of Teaching and Research, Sírio-Libanese Hospital, São Paulo, São Paulo, Brazil
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Arrington-Sanders R, Galai N, Falade-Nwulia O, Hammond C, Wirtz A, Beyrer C, Arteaga A, Celentano D. Patterns of Polysubstance Use in Young Black and Latinx Sexual Minority Men and Transgender Women and Its Association with Sexual Partnership Factors: The PUSH Study. Subst Use Misuse 2024; 59:317-328. [PMID: 38146133 DOI: 10.1080/10826084.2023.2267655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
Abstract
Background: Adult studies have demonstrated that polysubstance use increases HIV acquisition risk through increased sexual behaviors, however, few studies have examined polysubstance in young Black and Latinx sexual minority men (SMM) and transgender women (TW). Methods: We used cross-sectional data from 466 young Black and Latinx SMM and TW living in four high HIV-burden US cities enrolled in the PUSH Study, a status-neutral randomized control trial to increase HIV prevention and treatment adherence. We examined data for patterns of polysubstance use comparing age differences of use and explored associations between substance use and sexual partnership factors - inconsistent condom use, pressure to have condomless anal sex, and older partner, using bivariate and multivariate analyses. Results: Most participants described prior substance use with alcohol and cannabis being most common (76% each) and 23% described other illicit drug use, including stimulants, cocaine, hallucinogens, sedatives, opioids, and inhalants. Polysubstance use was common with nearly half (47%) of participants reporting alcohol and cannabis use, 20% reporting alcohol, cannabis, and one other illicit drug use, and 19% reporting alcohol or cannabis use plus one other illicit drug use. Polysubstance use was associated with greater adjusted odds of pressure to have condomless anal sex, older partner (>5 years older), and inconsistent condom use. Conclusions: Associations of polysubstance use with sexual practices and sexual partnerships that are known predictors of HIV acquisition or transmission among Black and Latinx SMM and TW underscore the need for combination interventions that include substance use treatment alongside antiretroviral-based and partner-based HIV prevention and treatment interventions.Trial Registration: ClinicalTrials.gov Identifier: NCT03194477.
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Affiliation(s)
- Renata Arrington-Sanders
- Department of Pediatrics, Division of Adolescent & Young Adult Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Medicine, Division of Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia Perelman School of Medicine, University of Pennsylvania
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Statistics, University of Haifa, Mt Carmel, Israel
| | - Oluwaseun Falade-Nwulia
- Department of Medicine, Division of Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christopher Hammond
- Department of Pediatrics, Division of Adolescent & Young Adult Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andrea Wirtz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Chris Beyrer
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Aubrey Arteaga
- Department of Pediatrics, Division of Adolescent & Young Adult Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - David Celentano
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Janulis P, Jenness SM, Risher K, Phillips G, Mustanski B, Birkett M. Substance use and variation in sexual partnership rates among young MSM and young transgender women: Disaggregating between and within-person associations. Drug Alcohol Depend 2023; 252:110968. [PMID: 37774516 PMCID: PMC10615872 DOI: 10.1016/j.drugalcdep.2023.110968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 09/15/2023] [Accepted: 09/17/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Substance use has been extensively linked to sexual behavior and HIV/STI risk among men who have sex with men (MSM) and transgender women (TW). However, the impact of specific substances and on specific partnership types is not well characterized. The current study seeks to estimate the association between specific substances and partnership rates while carefully disaggregating between and within-person associations to characterize the nature of these associations and inform prevention interventions. METHODS Using data from a longitudinal cohort (n = 1159) of young MSM (YMSM) and young TW (YTW), we utilized a series of hybrid mixed effect models to estimate the associations between substance use (i.e., heavy episodic drinking [HED], marijuana, cocaine, ecstasy, methamphetamine, poppers, prescription stimulant, prescription painkiller, and prescription depressants) and partnerships (i.e., one-time, casual, and main). RESULTS Results from multivariable models indicated people using substances had higher one-time (HED, poppers) and casual (HED, methamphetamine, poppers) partnership rates. In addition, participants reported higher rates of one-time (HED, ecstasy, methamphetamine, poppers) and casual partners (HED, marijuana, cocaine, methamphetamines, poppers) during periods of substance use. CONCLUSION These findings confirm that the highest rates of sexual activity occur among YMSM-YTW using substances during periods of substance use. Yet, these findings should caution researchers against simplistic generalizations as these associations differ across substance and partnership types. Efforts to promote the health of MSM-YTW who use substances should carefully consider this complexity as interventions accounting for the unique cultural context of substance use in these populations are most likely to be successful.
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Affiliation(s)
- Patrick Janulis
- Department of Medical Social Sciences, Northwestern University, United States; Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, United States.
| | | | - Kathryn Risher
- Department of Public Health Sciences, Penn State College of Medicine, United States
| | - Gregory Phillips
- Department of Medical Social Sciences, Northwestern University, United States; Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, United States
| | - Brian Mustanski
- Department of Medical Social Sciences, Northwestern University, United States; Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, United States
| | - Michelle Birkett
- Department of Medical Social Sciences, Northwestern University, United States; Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, United States
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Luz I, Vinhaes E, Cruz I, Travassos AG, Luz E, Netto EM, Brites C. High Prevalence of Anal Sexually Transmitted Infections among Men Who Have Sex with Men and Transgender Women Attending a Clinic for Prevention of Anal Cancer in Salvador, Brazil. Pathogens 2023; 12:1297. [PMID: 38003762 PMCID: PMC10675476 DOI: 10.3390/pathogens12111297] [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: 08/29/2023] [Revised: 10/18/2023] [Accepted: 10/24/2023] [Indexed: 11/26/2023] Open
Abstract
Men who have sex with men (MSM) and transgender women (TGW) are highly vulnerable to anal sexually transmitted infections (STIs). Objectives-to evaluate the prevalence of anal STIs among MSM and TGW attending a referral clinic for anal cancer prevention. Methods-MSM and TGW attending a medical visit for high-resolution anoscopy in Salvador, Brazil, from February 2021 to June 2022 were screened for HPV, gonorrhea, and chlamydial infection by PCR of anal swab and by serum VDRL titration for syphilis screening. They also responded to a questionnaire on sociodemographic characteristics and sexual behavior. Results-we evaluated 141 participants: 117 (82.9%) MSM, 9 (6.4%) bisexual men (BSM), and 15 (10.6%) TGW. Most (111/141, 78.7%) were older than 30 years, 89 (63.1%) had over 12 years of education, and 124 (87.9%) had a family income of up to five minimum wages. At least one STI was detected in 112 (79.4%) of the participants (86.7% among TGW). HIV infection was detected in 102 (72.3%) participants; HIV frequency was higher in BSM (7/9, 88.9%) and in MSM (89/116, 76.1%) than in TGW (5/15, 33.3%). A lower income (p = 0.004) was predictive of anal STIs, while syphilis was significantly more frequent among participants with HIV (29.1% vs. 5,3%, for HIV positive and negative, respectively, p = 0.002). Presenting at least one active STI was also associated with having had group sex in the last year (p = 0.03) and with use of sexualized drugs (p = 0.02). Conclusions-MSM and TGW present a high vulnerability to anal STIs. Number of sexual partners, use of sexualized drugs, and lower income are predictive of a higher risk of acquiring an STI in such populations.
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Affiliation(s)
- Ivana Luz
- Fundação Bahiana de Infectologia, Salvador 40110-060, Brazil; (I.L.); (E.V.); (E.L.); (E.M.N.)
- Programa de Pós-Graduação em Medicina e Saúde, Universidade Federal da Bahia, Salvador 40110-060, Brazil
| | - Eda Vinhaes
- Fundação Bahiana de Infectologia, Salvador 40110-060, Brazil; (I.L.); (E.V.); (E.L.); (E.M.N.)
| | - Isabela Cruz
- Hospital Universitário Professor Edgard Santos, UFBA-EBSERH, Salvador 40110-060, Brazil;
| | | | - Estela Luz
- Fundação Bahiana de Infectologia, Salvador 40110-060, Brazil; (I.L.); (E.V.); (E.L.); (E.M.N.)
- Programa de Pós-Graduação em Medicina e Saúde, Universidade Federal da Bahia, Salvador 40110-060, Brazil
| | - Eduardo Martins Netto
- Fundação Bahiana de Infectologia, Salvador 40110-060, Brazil; (I.L.); (E.V.); (E.L.); (E.M.N.)
- Programa de Pós-Graduação em Medicina e Saúde, Universidade Federal da Bahia, Salvador 40110-060, Brazil
| | - Carlos Brites
- Fundação Bahiana de Infectologia, Salvador 40110-060, Brazil; (I.L.); (E.V.); (E.L.); (E.M.N.)
- Hospital Universitário Professor Edgard Santos, UFBA-EBSERH, Salvador 40110-060, Brazil;
- School of Medicine, Universidade Federal da Bahia, Salvador 40110-060, Brazil
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Torres TS, Silva MST, Coutinho C, Hoagland B, Jalil EM, Cardoso SW, Moreira J, Magalhaes MA, Luz PM, Veloso VG, Grinsztejn B. Evaluation of Mpox Knowledge, Stigma, and Willingness to Vaccinate for Mpox: Cross-Sectional Web-Based Survey Among Sexual and Gender Minorities. JMIR Public Health Surveill 2023; 9:e46489. [PMID: 37459174 PMCID: PMC10411424 DOI: 10.2196/46489] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/30/2023] [Accepted: 06/20/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND The 2022 multicountry mpox outbreak positioned the condition as a public health emergency of international concern. By May 2023, Brazil ranked second globally in the cumulative number of mpox cases and deaths. The higher incidence of mpox among gay and other men who have sex with men in the current mpox outbreak deepens the stigma and discrimination against sexual and gender minorities (SGM). This might worsen the structural barriers impacting access to health services, which ultimately leads to undertesting and underreporting of cases. There are no data available on mpox knowledge and stigma in Latin America. OBJECTIVE We aimed to evaluate mpox knowledge, stigma, and willingness to vaccinate for mpox among SGM, and to describe sociodemographic and behavioral characteristics according to self-reported mpox diagnosis. METHODS A cross-sectional, internet-based survey was conducted in a convenience sample of adults (aged >18 years) living in Brazil recruited through advertisements on dating apps, social media, referral institutions for infectious diseases websites, and mass media (October-November 2022). We compared participants' characteristics according to self-reported mpox diagnosis using chi-square test or Fisher exact test for qualitative variables and Kruskal-Wallis test for quantitative variables. RESULTS We enrolled 6236 participants: 5685 (91.2%) were cisgender men; 6032 (96.7%) were gay, bisexual, or pansexual; 3877 (62.2%) were White; 4902 (78.7%) had tertiary education; and 4070 (65.2%) reported low or middle income. Most participants (n=5258, 84.4%) agreed or strongly agreed that "LGBTQIA+ individuals are being discriminated and stigmatized due to mpox." Mpox awareness was 96.9% (n=6044), and 5008 (95.1%) were willing to get vaccinated for mpox. Overall, 324 (5.2%) reported an mpox diagnosis. Among these, 318 (98.1%) reported lesions, 178 (56%) local pain, and 316 (99.4%) sought health care. Among participants not reporting a diagnosis, 288 (4.9%) had a suspicious lesion, but only 158 (54.9%) of these had sought health care. Compared to participants with no diagnosis, those reporting an mpox diagnosis were younger (P<.001), reported more sex partners (P<.001), and changes in sexual behavior after mpox onset (P=.002). Moreover, participants diagnosed with mpox reported more frequently being tested for HIV in the prior 3 months (P<.001), living with HIV (P<.001), currently using HIV pre-exposure prophylaxis (P<.001), and previous sexually transmitted infection diagnosis (P<.001). CONCLUSIONS Our results point to high mpox knowledge and willingness to vaccinate among SGM in Brazil. Participants self-reporting mpox diagnosis more frequently reported to be living with HIV, STI diagnosis, and current pre-exposure prophylaxis use, highlighting the importance of an mpox assessment that includes comprehensive sexual health screenings. Efforts to decrease stigma related to mpox among SGM are necessary to avoid mpox underdiagnosis.
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Affiliation(s)
- Thiago Silva Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Carolina Coutinho
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Brenda Hoagland
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Emilia Moreira Jalil
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Sandra Wagner Cardoso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Monica Avelar Magalhaes
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz (ICICT-Fiocruz), Rio de Janeiro, Brazil
| | - Paula Mendes Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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Irfan SD, Sarwar G, Emran J, Khan SI. An uncharted territory of sexualized drug use: exploring the dynamics of chemsex among young and adolescent MSM including self-identified gay men in urban Dhaka, Bangladesh. Front Psychol 2023; 14:1124971. [PMID: 37425169 PMCID: PMC10324373 DOI: 10.3389/fpsyg.2023.1124971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 06/06/2023] [Indexed: 07/11/2023] Open
Abstract
Global and local literature depicted the pervasiveness of chemsex among men who have sex with men (MSM), yet there is limited evidence on adolescents and youth. Though literature showed their engagement in chemsex, further exploration is warranted about their socio-sexual contexts and implications. Therefore, this article explored the contexts and implications of chemsex on young and adolescent MSM. This article is extracted from qualitative research evidence, and research data are triangulated by programmatic evidence on adolescent and young MSM from two ongoing pilot interventions. The key motivational factors for engaging in chemsex were primarily rooted in the dynamics of their peer networks. Specifically, the onset of drug use is predominantly attributed to curiosity toward experimentation with methamphetamine, peer influence, propensity to lose weight, and increasing courage to approach potential sexual partners. Moreover, they continued taking drugs as it enhanced their sexual performance, thus perpetuating chemsex. Additionally, the findings revealed several sexual implications of methamphetamine, e.g., bolstering their sexual "stamina," increasing their propensity toward sexual violence, and reducing their decision-making abilities and judgment, thus collectively decreasing condom use. In essence, chemsex is considerably driven by their socio-sexual contexts, thus perpetuating sexual risk behaviors and compromising sexual health outcomes. Therefore, harm reduction interventions targeted need to be designed keeping in mind their socio-sexual dynamics and age.
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10
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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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11
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Pereira CCDA, Torres TS, Luz PM, Hoagland B, Farias A, Brito JDU, Lacerda MVG, Silva DAR, Benedetti M, Pimenta MC, Grinsztejn B, Veloso VG. Preferences for pre-exposure prophylaxis (PrEP) among sexual and gender minorities: a discrete choice experiment in Brazil. LANCET REGIONAL HEALTH. AMERICAS 2023; 19:100432. [PMID: 36950036 PMCID: PMC10025414 DOI: 10.1016/j.lana.2023.100432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 10/27/2022] [Accepted: 01/10/2023] [Indexed: 02/09/2023]
Abstract
Background Men who have sex with men (MSM) and transgender women (TGW) are disproportionally affected by HIV infection in Latin America. This study aims to assess pre-exposure prophylaxis (PrEP) preferences among sexual and gender minorities (SGM) and identify attributes and levels that are related to PrEP uptake and adherence, both crucial for PrEP success. Methods We conducted a discrete choice experiment (DCE) among SGM from all Brazilian regions (September-December/2020). The survey was administered face-to-face (five Brazilian capitals) and online (entire country). We used a D-efficient zero-prior blocked experimental design to select 60 paired-profile DCE choice tasks. Findings The total sample size was 3924 (90.5% MSM; 7.2% TGW and 2.3% non-binary or gender diverse persons). In random-effects logit models, highest levels of protection and "no side effects" were the most important attribute levels. For "presentation", injectable and implant were preferred over oral. Participants were willing to accept a 4.1% protection reduction to receive injectable PrEP or a 4.2% reduction if PrEP were taken monthly. The largest class in the latent class models was defined predominantly by the preference for the highest HIV protection level (p < 0.005). Respondents in this class also preferred no side effects, injectable and implant presentations. Interpretation Higher HIV protection, no side effects, and presentation, whether injectable or implant, were the most important attributes in PrEP preferences. Protection against HIV was the most important attribute. PrEP programs should make available technologies such as long-acting presentations that could reunite the most desired attributes, thus maximizing acceptability and user-appropriateness. Funding Unitaid.
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Affiliation(s)
| | - Thiago Silva Torres
- Laboratório de Pesquisa Clínica em HIV/AIDS (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas – INI, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Paula Mendes Luz
- Laboratório de Pesquisa Clínica em HIV/AIDS (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas – INI, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Brenda Hoagland
- Laboratório de Pesquisa Clínica em HIV/AIDS (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas – INI, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Alessandro Farias
- Centro Especializado em Diagnóstico, Assistência e Pesquisa (CEDAP), Salvador, BA, Brazil
| | | | | | - Daila Alena Raenck Silva
- Centro de Testagem e Aconselhamento (CTA) Santa Marta, Secretaria Municipal de Saúde de Porto Alegre, RS, Brazil
| | - Marcos Benedetti
- Laboratório de Pesquisa Clínica em HIV/AIDS (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas – INI, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | | | - Beatriz Grinsztejn
- Laboratório de Pesquisa Clínica em HIV/AIDS (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas – INI, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Valdilea Gonçalves Veloso
- Laboratório de Pesquisa Clínica em HIV/AIDS (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas – INI, FIOCRUZ, Rio de Janeiro, RJ, Brazil
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12
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Torres TS, Nascimento AR, Coelho LE, Konda KA, Vega-Ramirez EH, Elorreaga OA, Diaz-Sosa D, Hoagland B, Guanira JV, Pimenta C, Benedetti M, Caceres CF, Veloso VG, Grinsztejn B. Preferences for PrEP modalities among gay, bisexual, and other men who have sex with men from Brazil, Mexico, and Peru: a cross-sectional study. Ther Adv Infect Dis 2023; 10:20499361231153548. [PMID: 36814515 PMCID: PMC9940158 DOI: 10.1177/20499361231153548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 01/11/2023] [Indexed: 02/20/2023] Open
Abstract
Background Pre-exposure prophylaxis (PrEP) scale-up is urgent to reduce new HIV cases among gay, bisexual, and other men who have sex with men (MSM) in Latin America. Different PrEP modalities may increase PrEP uptake and adherence, especially among young MSM. Objectives To assess preferences for PrEP modalities among MSM from Brazil, Mexico, and Peru. Design Cross-sectional web-based study (March-May 2018) targeting MSM through advertisements on Grindr, Hornet, and Facebook. We included MSM aged ⩾ 18 years and who reported HIV-negative status. Methods We assessed preferences for PrEP modalities with the following question: 'Considering that all following PrEP modalities were available, which one would you prefer considering a scale from 1 to 3 (1 = most preferred): daily oral PrEP, event-driven PrEP (ED-PrEP), and long-acting injectable PrEP'. We assessed factors associated with each most preferred PrEP modality per country using multivariable logistic regression models. Results A total of 19,457 MSM completed the questionnaire (Brazil: 58%; Mexico: 31%; Peru: 11%); median age was 28 years [interquartile range (IQR): 24-34]. Overall, injectable PrEP was the most preferred modality [42%; 95% confidence interval (CI): 41-43], followed by daily PrEP (35%; 95% CI: 34-35), and ED-PrEP (23%; 95% CI: 23-24). In multivariable models, preferring injectable PrEP was associated with PrEP awareness in all three countries, while PrEP eligibility only in Brazil. Preferring daily PrEP was associated with younger age and lower income in Brazil and Mexico, and lower education only in Brazil. The odds of preferring ED-PrEP were lower among MSM aware and eligible for PrEP in Brazil and Mexico. Conclusions Long-acting injectable PrEP was the preferred PrEP modality among MSM in Brazil, Mexico, and Peru, especially those aware and eligible for PrEP. Public health interventions to increase PrEP modalities literacy and availability in Latin America are urgent especially among MSM of young age, lower income, and lower education.
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Affiliation(s)
| | | | - Lara E. Coelho
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | | | | | | | - Dulce Diaz-Sosa
- National Institute of Psychiatry Ramon de la Fuente Muñiz, Mexico City, Mexico
| | - Brenda Hoagland
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | | | | | - Marcos Benedetti
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | | | - Valdilea G. Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
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13
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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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14
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Chen Y, Chang R, Hu F, Xu C, Yu X, Liu S, Xia D, Chen H, Wang R, Liu Y, Ge X, Ma T, Wang Y, Cai Y. Exploring the long-term sequelae of childhood sexual abuse on risky sexual behavior among Chinese transgender women. Front Psychol 2023; 14:1057225. [PMID: 37123291 PMCID: PMC10140497 DOI: 10.3389/fpsyg.2023.1057225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/13/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction Childhood sexual abuse (CSA) is a hidden but serious public health issue that can lead to a series of behavioral consequences and health problems in adulthood. It has been well documented that transgender women (TGW) have a high prevalence of CSA victimization. Moreover, risky sexual behaviors are also widespread among TGW; nevertheless, research investigating the associations between CSA victimization and risky sexual behaviors in TGW represents a gap in the literature. Methods Our research was carried out mainly in Shenyang of China from November 2018 to January 2019. Sociodemographic characteristics, as well as information on participants' HIV awareness and sexual behaviors, were collected through face-to-face interviews. The impact of CSA was examined through hierarchical logistic regression, adjusted for sociodemographic factors and HIV awareness. Results In the sample of 247 adult TGW, 14.2% of them had a CSA history. In the previous 6 months, 30.8% of the participants reported condomless anal intercourse (CAI) and 38.5% of them had multiple sexual partners (MSP). The findings demonstrated that TGW with CSA history were more likely to take part in CAI (p = 0.001, OR = 4.252) or have MSP (p = 0.004, OR = 3.260) in adulthood. Furthermore, HIV knowledge was not a predictor of CAI or MSP, but higher HIV risk perception was associated with a greater probability of CAI. Conclusion Transgender women with a history of CSA were more prone to engage in CAI and have MSP in China.
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Affiliation(s)
- Yingjie Chen
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ruijie Chang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fan Hu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chen Xu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoyue Yu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shangbin Liu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Danni Xia
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui Chen
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rongxi Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yujie Liu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xin Ge
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Ying Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Ying Wang,
| | - Yong Cai
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Yong Cai,
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15
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Chemsex and Psychosis: A Systematic Review. Behav Sci (Basel) 2022; 12:bs12120516. [PMID: 36546999 PMCID: PMC9774634 DOI: 10.3390/bs12120516] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Chemsex is presented as a major challenge in public health, with numerous physical and mental consequences. The general objective of this review was to analyze the relationship between the practice of chemsex and the development of psychosis. A mixed systematic review model was chosen. PubMed, PsycINFO, and Web of Science databases were searched following a predetermined search strategy. The studies were selected, and their information was extracted following a systematic method. A total of 10 articles were included. Psychotic symptoms ranged from 6.7% to 37.2%, being one of the most frequent psychiatric diagnoses. Slamsex, polydrug use and smoked methamphetamine posed up to a 3-fold increased risk of psychosis within this practice. The risk factors found were foreign or ethnic minority status, location in large cities, stress and anxiety, trauma, loneliness, sexually transmitted infections (STIs), hepatitis, and previous psychotic history. In conclusion, chemsex is associated with psychosis development; we found numerous converging risk factors and a clear mediating role of drugs. It is important, in approaching the prevention and treatment of this addiction, to take into account motivations and psychosocial circumstances.
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16
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Reyes-Díaz M, Celly A, Folch C, Lorente N, Stuardo V, Veras MA, Barros H, Meireles P, Ramírez D, Jonas KJ, Marcus U, Schmidt AJ, Caceres CF, Casabona J. Latin American Internet Survey for Men who have Sex with Men (LAMIS-2018): Design, methods and implementation. PLoS One 2022; 17:e0277518. [PMID: 36395121 PMCID: PMC9671301 DOI: 10.1371/journal.pone.0277518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 10/28/2022] [Indexed: 11/19/2022] Open
Abstract
Despite men-who-have-sex-with-men (MSM) from Latin America (LA) are still a vulnerable population for known health-related conditions and social problems, availability of comparable data across LA countries for assessment and monitoring purposes is limited. The objective of this article is to present the study design and the questionnaire of LAMIS-2018 (Latin America MSM Internet Survey), its recruitment strategy, rates and sources by country, and the lessons learned from its implementation. LAMIS-2018 was a cross-sectional, internet-based survey targeting MSM living in 18 LA countries (Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Suriname, Uruguay, and Venezuela) that gathered data about sexual behaviors, HIV/STI and viral hepatitis knowledge, prophylactic use of antiretrovirals, psychosocial health, and access to sexual health services. The survey went online for four months and was available in three languages (Spanish, Portuguese, and Dutch). Promotion was carried out using dating apps, websites, social networks, and by community-based and academic organizations of each participating country directly in gay venues and in their own premises. Overall, 64,655 MSM participated in LAMIS-2018. Dating apps and websites were the most important recruitment source in most countries, except for Honduras, Nicaragua, and Suriname, where community-based organizations recruited most of the participants. Beyond the LAMIS-2018 implementation description, we highlight the feasibility of such a study in this context, based on the collaboration between community-based and academic organizations to obtain a large sample of MSM in the region. LAMIS-2018 data will contribute to identify determinants of risk behaviors and prevention needs of vulnerable MSM populations in each country of the region.
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Affiliation(s)
- Michael Reyes-Díaz
- Centro de Investigación Interdisciplinaria en Sexualidad, Sida y Sociedad (CIISSS), Universidad Peruana Cayetano Heredia, San Martín de Porres, Peru
| | - Ana Celly
- Universidad Autónoma de Barcelona, Barcelona, Spain
- Centre d’Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Madrid, Spain
| | - Cinta Folch
- Centre d’Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Madrid, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- * E-mail:
| | - Nicolas Lorente
- Centre d’Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Madrid, Spain
- Coalition PLUS
| | - Valeria Stuardo
- Instituto de Salud Pública, Universidad Andrés Bello, Santiago, Chile
| | - Maria Amelia Veras
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - Henrique Barros
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, Porto, Portugal
| | - Paula Meireles
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, Porto, Portugal
| | | | - Kai J. Jonas
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | | | - Axel J. Schmidt
- Sigma Research, Department of Public Health, Environments & Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Carlos F. Caceres
- Centro de Investigación Interdisciplinaria en Sexualidad, Sida y Sociedad (CIISSS), Universidad Peruana Cayetano Heredia, San Martín de Porres, Peru
| | - Jordi Casabona
- Universidad Autónoma de Barcelona, Barcelona, Spain
- Centre d’Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Madrid, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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17
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Abrahão ABB, Kortas GT, Blaas IK, Koch Gimenes G, Leopoldo K, Malbergier A, Torales J, Ventriglio A, Castaldelli-Maia JM. The impact of discrimination on substance use disorders among sexual minorities. Int Rev Psychiatry 2022; 34:423-431. [PMID: 36151837 DOI: 10.1080/09540261.2022.2094223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This paper aimed to review the literature regarding the impact of discrimination on substance use disorders among Sexual Minorities (SM), with a focus on alcohol, opioids, stimulants, polydrug use, chemsex, cannabis and tobacco, as well as inequalities in the access to health care services. It is alarmingly clear that SM report higher rates of morbidity if compared to the general population. Health care delivery inequalities have also been reported in this special population. Also, the lack of data from low- and middle-income countries on substance use among SM is a major concern. Certainly, discrimination play a key-role among leading factors to substance abuse, continued use, disorders, and lower levels of preventive and treatment interventions. However, it may be difficult to estimate the impact of discrimination because of the lack of research data and different methodologies of literature studies. Moreover, SM are differently categorized and defined and evidences may be not comparable between studies. There is an urgent need of strategic guidelines and research investments aimed at prioritizing these populations disproportionately impacted by substance use. Equity-oriented policies and programs can facilitate opportunities and decrease substance use in these vulnerable subgroups, including community- and peer-led initiatives and nonjudgmental and inclusive health services.
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Affiliation(s)
| | | | - Israel Kanaan Blaas
- Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil.,Department of Neuroscience, Medical School, FMABC University Center, Santo André, Brazil
| | | | - Kae Leopoldo
- Institute of Psychology, University of São Paulo, São Paulo, Brazil
| | - André Malbergier
- Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Julio Torales
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, Asunción, Paraguay
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - João Mauricio Castaldelli-Maia
- Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil.,Department of Neuroscience, Medical School, FMABC University Center, Santo André, Brazil
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18
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Bezerra DRB, Jalil CM, Jalil EM, Coelho LE, Carvalheira E, Freitas J, Monteiro L, Santos T, Souza C, Hoagland B, Veloso VG, Grinsztejn B, Cardoso SW, Torres TS. Complementary Recruitment Strategies to Reach Men Who Have Sex with Men and Transgender Women: The Experience of a Large Brazilian HIV Prevention Service. AIDS Behav 2022; 26:2643-2652. [PMID: 35122578 DOI: 10.1007/s10461-022-03609-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2022] [Indexed: 11/29/2022]
Abstract
Different strategies have been used to reach men who have sex with men (MSM) and transgender women (TGW) for HIV prevention services. We described the characteristics of MSM and TGW attending a large HIV prevention service in Brazil according to different recruitment strategies or referrals. A total of 2713 individuals (2246[82.8%] MSM and 467[17.2%] TGW) attended the service. Among HIV-negative MSM and TGW, 74.6% and 82.8% were eligible for pre-exposure prophylaxis (PrEP), respectively. PrEP uptake among MSM and TGW was 56.4% and 39.1%, respectively. Participants were mostly referred by peers (43.6%), followed by web-based (24.1%) and venue-based recruitment (16.2%). More young and Black MSM were referred from venue-based recruitment, and web-based strategies more frequently referred MSM with higher education. TGW who were younger and had higher education were more frequently referred from venue-based recruitment. Web-based recruitment failed to reach TGW. Multiple strategies were complementary to reach diverse MSM and TGW populations.
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Affiliation(s)
- Daniel R B Bezerra
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Cristina M Jalil
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Emilia M Jalil
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Lara E Coelho
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Eduardo Carvalheira
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Josias Freitas
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Laylla Monteiro
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Toni Santos
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Cleo Souza
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Brenda Hoagland
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Valdilea G Veloso
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Beatriz Grinsztejn
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Sandra W Cardoso
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Thiago S Torres
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil.
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