Disruptive e-prevention from 2019: dummy online drug selling sites to reach new consumers

Background

The last three decades have seen the development of chemsex, the diversification of substances through New Psychoactive Substances (NPS), and new technologies allowing people to buy online and find peers to consume on applications while remaining in private spheres (Trend, Cadet-Taillou, 2020). The latter has made it more difficult to reach users, so as to document their uses and the population, and to design public health schemes aimed at users, except through targeting metapopulations known to consume more than the general population (Léobon et al., 2018; Talley et al., 2011).

Methods

The PlaySafe association designed two dummy websites, one selling GBL, the other NPS. These websites use the same graphics and syntactic codes as the main websites of the field, except for: 1) a fake drug named “love machine”; 2) an automatic redirection to a health promotion page instead of payment finalization. The information collected is: delivery region, birth year, gender, perceived usefulness of the health promotion messages, whether people would recommend to friends, the contents and quantities of the shopping cart, the time spent on each page, and data gathered via Google Analytics.

Results

On both websites 21,459 order attempts have been placed. This pathfinder research project has allowed to reach 6,203 people on the GBL website in 30 months and 7,927 people in 12 months on the NPS website, with people spending on average 1 min 35 s on the first website's prevention page and 1 min 27 s on the second. Around 85% of people consider the content useful, among whom 75% would recommend the website to friends. This communication also aims to present the characteristics of the reached population.

Conclusions

This innovative approach has allowed to precisely target a population escaping public health research and prevention schemes. It appears interesting to explore online prevention, especially since most of the respondents consider the experience helpful and recommendable.

Key messages

Hospital STI prevention scheme adapted to target undiagnosed LGBT migrants in Paris area since 2018

Background

In Île-de-France region, 10 000 people do not know they are living with HIV (Supervie, 2016). 70% are men, including 40% men having sex with other men (MSM) and 40% sub-Saharan African migrants. From 35% to 49% of those sub-Saharan African migrants are infected in France. The main HIV prevention issues is to target populations that are unrepresented in screening test centers.

Methods

To achieve these aims, a sexual health promotion scheme has been designed by a public health association, a Sexual Transmitted Infections (STI) center and an association supporting people asking asylum because of their “sexual orientation or gender identity”. Outreach STI screening test actions are organized monthly in places crowded by asylum seekers and associative sexual health consultation including screening, results reporting, treatments, vaccinations and Pre-Exposition Prophylaxis (PrEP), devoted to asylum seekers are taking place weekly into the hospital. Pear community members have been trained to be referent in health matters and enhance the scheme effectiveness.

Results

549 people were screened for STI through 110 actions from March 2018 to December 2019, of which 25 were outreach and 85 inside the hospital. 74% were from sub-Saharan Africa and 86% were presumed MSM. 89% were under 40 years old. 20% of the screened people were diagnosed positive to at least one STI and 52 people have been engaged in PrEP treatment after a risky assessment. Pear referent involvement reduced the number of unreported results, 10% are still unreported. 21 people have stopped PrEP follow-up. Around 3/4 of those followed by the association on the period stand unreached.

Conclusions

The scheme allowed to targeted population according to epidemiology's indicators but we don't know if the most exposed part of the population is reached. Partnership between associations and hospital improved public health system as well as community involvement.

Key messages

Public health system needs adaptations to struggles epidemics. Community involvement must be a priority to increase prevention’s efficiency .

Hospital “Outside the walls” against HIV and other Sexually Transmitted Infections (STIs) in Russia

Background

Though sponsored by UNAIDS support program, Russia struggles to curb its soaring HIV epidemic. French authorities invited Russian leaders of the HIV strategy, medical institutions or civil society in December 2018, to discover the practices of their French peers. A bridging process designed by the Public Health association AREMEDIA and developed in partnership with Fernand-Widal Hospital’s testing center, to reach underserved populations, was shown. Merging associative and medical cultures, they created bonds with community associations to efficiently export free prevention, treatments and care for HIV and STIs, “outside the walls” of hospital facilities. In March 2019, they were mandated to detect dependable partners to transpose this method in the high-HIV burden Ural region.

Objectives

Selecting local political leaders, field associations and public health structures, jointly designing a project to adapt AREMEDIA’s model in Perm. Developing a training to implement locally outreach program in 2020.

Results

Contractual partnership with 4 entities in Perm and educational program. Presenting the interventional methodology at Perm University Conference on “World AIDS day”, 1st December 2019. Theoretical and field trainings of Russian stakeholders to outreach sexual health interventions towards key populations, by associative and medical staff from AREMEDIA and the testing center in Paris. Practical support to implement outreach actions in urban areas of Perm from March to December 2020. Valorization of scientific results in Saint Petersburg International Conference, July 2020.

Conclusions

Consensus found on a pilot training and research-action outreach program, approved by authorities. Advancing access to local key populations should foster switching the Russian strategy against HIV towards a comprehensive sexual health promotion paradigm, resulting among others in destigmatization.

Key messages

Support local stakeholders to promote equitable management of HIV and overall sexual health. Enhance socio-medical interface to reduce the hidden epidemic through reaching HIV key populations.

Combined sexual prevention targeted to LGBTI+ migrants: between ’outdoor’ and ’indoor’ hospial

Issue

It is estimated that there are about 10,000 HIV-positive and undiagnosed people in Île-de-France (French region). They are composed of 70% men, 40% of whom are MSM and 40% of sub-Saharan African migrants. A bridging process has been designed by the Public Health association AREMEDIA and developed in partnership with Fernand-Widal Hospital’s testing center, to reach underserved populations. From March 2018, a screening test session for sexually transmitted infections (STIs) is taking place weekly in the hospital walls. This action is dedicated to the population of ARDHIS association, which accompanies more than 1,000 people each year, seeking asylum because of their sexual orientation or gender identity.

Description of the problem

Despite the promotion of this ’indoor’ targeted consultation via ARDHIS volunteers and directly to asylum seekers during occasional community events, the consultation only allowed the screening of 23 people in 4 months. It has been decided to carry out screening ’outside the hospitals walls’, where the people are, in order to promote the return of results, treatment, access to PrEP, HBV vaccination at the weekly indoor hospital consultation. “Community health relays” training together with the development of phone contact procedures were developed to facilitate the access to the indoor consultation.

Results

The methodology made it possible to double the average number of consultations over the following 5 months from 5 to 10 consultations per 3-hour slot, not counting PrEP appointments and vaccines, which averaged 6 per session. By the end of 2018, 261 people were screened, 23 had a PrEP treatment and many were vaccinated. As the scheme continues to develop, the results from January to July 2019 will be reported.

Leçons

To reach the most at risk populations, specific public health approaches are needed, taking account the context and representations of the target populations. Community involvement has proven to be effective.

Key messages

To fight HIV, innovative devices are needed to reach targeted populations. This has allowed hundreds of LGBTI asylum seekers to be screened and a significant number to receive preventive treatment.