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Hanum N, Cambiano V, Loncar D, Mandalia S, Sharp A, Lwanga J, Tiraboschi J, Phillips AN, Lampe FC, Beck EJ, Fox J. Behaviour changes following HIV diagnosis among men who have sex with men in the era of treatment as prevention: data from a prospective study. AIDS Care 2024; 36:711-731. [PMID: 37527426 DOI: 10.1080/13548506.2023.2230884] [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: 09/24/2022] [Accepted: 06/23/2023] [Indexed: 08/03/2023]
Abstract
We described the longitudinal changes in sexual behaviour and associated factors among newly diagnosed with HIV men who have sex with men participating in a prospective observational study from a London HIV clinic (2015-2018). Participants self-completed questionnaires at baseline, months 3 and 12. Information collected included socio-demographic, sexual behaviour, health, lifestyle and social support. Trends in sexual behaviours over one year following diagnosis and associated factors were assessed using generalized estimating equations with logit link. Condomless sex (CLS) dropped from 62.2% at baseline to 47.6% at month-three but increased again to 61.8% at month-12 (p-trend = 0.790). Serodiscordant-CLS increased between month-three and month-12 (from 13.1% to 35.6%, p-trend < 0.001). The prevalence of serodiscordant-CLS with high risk of transmitting to their partners at month-three was 10.7%. CLS was higher among men who reported recreational drug use (adjusted Odds Ratio (aOR) 3.03, 95%CI 1.47-6.24, p = 0.003), those with undetectable viral load (aOR 2.17, 95%CI 1.22-3.84, p = 0.008) and those who agreed with a statement "condoms are not necessary when HIV viral load is undetectable" (aOR 3.41, 95%CI 1.58-7.38, p = 0.002). MSM continued to engage in CLS after HIV diagnosis, which coincided with U = U publications and increased throughout the study.
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Affiliation(s)
| | | | - Dejan Loncar
- University of Geneva Institute of Global Health, Geneva, Switzerland
| | | | - Alice Sharp
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | | | | | | | - Eduard J Beck
- NPMS-HHC CIC, London, UK
- London School of Hygiene & Tropical Medicine, London, UK
| | - Julie Fox
- Guy's and St Thomas' NHS Foundation Trust, London, UK
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2
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Dominguez-Dominguez L, Campbell L, Barbini B, Fox J, Nikiphorou E, Goff L, Lempp H, Tariq S, Hamzah L, Post FA. Associations between social determinants of health and comorbidity and multimorbidity in people of black ethnicities with HIV. AIDS 2024; 38:835-846. [PMID: 38265411 PMCID: PMC10994070 DOI: 10.1097/qad.0000000000003848] [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: 09/08/2023] [Revised: 12/22/2023] [Accepted: 01/07/2024] [Indexed: 01/25/2024]
Abstract
OBJECTIVE Social determinants of health (SDH) are important determinants of long-term conditions and multimorbidity in the general population. The intersecting relationship between SDH and multimorbidity in people with HIV remains poorly studied. DESIGN A cross-sectional study investigating the relationships between eight socio-economic parameters and prevalent comorbidities of clinical significance and multimorbidity in adults of African ancestry with HIV aged 18-65 years in South London, UK. METHODS Multivariable logistic regression analysis was used to evaluate associations between SDH and comorbidities and multimorbidity. RESULTS Between September 2020 and January 2022, 398 participants (median age 52 years, 55% women) were enrolled; 85% reported at least one SDH and 72% had at least one comorbidity. There were no associations between SDH and diabetes mellitus or kidney disease, few associations between SDH (job and food insecurity) and cardiovascular or lung disease, and multiple associations between SDH (financial, food, housing and job insecurity, low educational level, social isolation, and discrimination) and poor mental health or chronic pain. Associations between SDH and multimorbidity mirrored those for constituent comorbidities. CONCLUSION We demonstrate strong associations between SDH and poor mental health, chronic pain and multimorbidity in people of black ethnicities living with HIV in the UK. These findings highlight the likely impact of enduring socioeconomic hardship in these communities and underlines the importance of holistic health and social care for people with HIV to address these adverse psychosocial conditions.
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Affiliation(s)
| | - Lucy Campbell
- Department of Sexual Health and HIV, Kings College Hospital NHS Foundation Trust
- HIV Research Group
| | - Birgit Barbini
- Department of Sexual Health and HIV, Kings College Hospital NHS Foundation Trust
- HIV Research Group
| | - Julie Fox
- Department of Infectious Diseases, King's College London
- Guy's and St Thomas’ Hospital NHS Foundation Trust
| | - Elena Nikiphorou
- Department of Rheumatology, Kings College Hospital NHS Foundation Trust
- Centre for Rheumatic Diseases
| | - Louise Goff
- Department of Nutritional Sciences, King's College London, London
- Leicester Diabetes Research Centre, Leicester
| | | | | | - Lisa Hamzah
- St George's Healthcare NHS Foundation Trust, London, UK
| | - Frank A. Post
- Department of Sexual Health and HIV, Kings College Hospital NHS Foundation Trust
- HIV Research Group
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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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4
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Zheng Y, Ye K, Ying M, He Y, Yu Q, Lan L, Xu W. Syphilis epidemic among men who have sex with men: A global systematic review and meta-analysis of prevalence, incidence, and associated factors. J Glob Health 2024; 14:04004. [PMID: 38236688 PMCID: PMC10795860 DOI: 10.7189/jogh.14.04004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2024] Open
Abstract
Background We aimed to estimate the prevalence and incidence of syphilis at global, regional and national levels for human immunodeficiency virus (HIV)-positive and HIV-negative men who have sex with men (MSM) and explore the association between demographic and social behavioural factors and syphilis infection. Methods We searched PubMed, Embase, and the Cochrane Library from 1 January 2012 to 31 December 2022 for studies of reported crude syphilis prevalence or incidence in MSM or with sufficient data to calculate prevalence or incidence rate in MSM. Results We included 376 articles reporting on 409 records from 62 countries to calculate syphilis prevalence and incidence in MSM. The pooled prevalence of syphilis in MSM was 10.4%, with substantial differences between countries and regions. Syphilis prevalence was substantially higher in HIV-positive than in HIV-negative MSM. The pooled incidence of syphilis in MSM was 76.4 per 1000 person-years. Older age, lower education, nitrite or recreational drug use, group sex, and multiple sexual partners were identified as risk factors for syphilis infection. Conclusions A disproportionate geographic pattern of syphilis infection in MSM and significant threats of syphilis infection were revealed. The 'hidden risk' in specific regions and the inadequately elucidated drivers of high-risk behaviours, need to be fully acknowledged and addressed. Registration PROSPERO: CRD42023422218.
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Affiliation(s)
- Yang Zheng
- Department of General Practice, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Department of Allergy, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Kangli Ye
- Department of General Practice, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Meike Ying
- Department of General Practice, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Ying He
- Department of General Practice, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Qi Yu
- Department of Endodontics, Stomatology Hospital, School of Stomatology, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Lei Lan
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Wenzhi Xu
- Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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Menza TW, Jensen A, Hixson LK. Predictors of Viral Suppression Among People Living with HIV in Rural Oregon. AIDS Behav 2024; 28:154-163. [PMID: 37610534 DOI: 10.1007/s10461-023-04145-6] [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: 07/19/2023] [Indexed: 08/24/2023]
Abstract
With recent outbreaks of HIV in rural areas of the United States, it has become increasingly important to understand the factors affecting health outcomes of people with HIV living in rural areas. We assessed predictors of durable HIV viral suppression among rural participants using a pooled 7-year dataset from the Medical Monitoring Project (MMP), a cross-sectional, representative sample of individuals receiving HIV medical care in Oregon. Only 77.3% of rural participants achieved durable HIV viral suppression, while 22.7% had at least one detectable HIV viral load measurement within the past 12 months. The primary predictors of viral suppression were ARV adherence, poverty, and reported heavy drinking in the past 30 days. These results highlight the influence of social factors on health outcomes for persons with HIV living in rural areas and inform areas for policy and program change.
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Affiliation(s)
- Timothy W Menza
- Public Health Division, Oregon Health Authority, Portland, OR, USA.
- Division of Infectious Diseases, Department of Medicine, Oregon Health and Science University, Portland, OR, USA.
| | - Ann Jensen
- School of Public Health, Oregon Health and Science University-Portland State University, Portland, OR, USA
| | - Lindsay K Hixson
- Public Health Division, Oregon Health Authority, Portland, OR, USA
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Lodge W, Kelly PJA, Napoleon S, Plezia S, Mimiaga MJ, Biello KB. Prevalence of methamphetamine use among gay, bisexual and other men who have sex with men: A systematic review and meta-analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 123:104271. [PMID: 38061224 DOI: 10.1016/j.drugpo.2023.104271] [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: 06/15/2023] [Revised: 11/09/2023] [Accepted: 11/16/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND International efforts have reduced the availability of methamphetamine precursors, but its distribution and use continue to rise. Methamphetamine use can lead to short- and long-term adverse effects, including addiction, physical and psychosocial health problems, socioeconomic troubles, incarceration, overdose, and death. Gay, bisexual, and other men who have sex with men (MSM) have been shown to have an elevated prevalence of methamphetamine use. METHODS We conducted a systematic review and meta-analysis to estimate the prevalence of methamphetamine use among MSM. We searched electronic databases, such as PubMed, for peer-reviewed literature published between 2011 and 2022. Data on methamphetamine use were extracted, including study features, location, study design, sampling method, recruitment period, specific MSM subgroups, prevalence period, and demographics. Employing a random-effects model, we computed the pooled prevalence of methamphetamine use among MSM across two prevalence periods: recent use (i.e., one month, three months, six months, one year) and lifetime use. RESULTS The systematic review included 56 studies with a total of 25,953 MSM who use methamphetamine. Most studies were conducted in Europe, with the highest prevalence reported in the United Kingdom. The studies primarily used cross-sectional or cohort study designs with convenience sampling. The pooled prevalence rates across recent use (i.e., past month, past three months, past six months, and past year) was 15% (95% CI [11-19%]). Additionally, we pooled lifetime use, which was 23% (95% CI [9-38%]). High heterogeneity (I2 > 99%) was observed, indicating significant variation. CONCLUSION This systematic review and meta-analysis provide a pooled prevalence of methamphetamine use among MSM. The analysis accounts for study design, prevalence period, specific MSM subgroups, and geographical areas to estimate methamphetamine use in diverse settings and populations. The review highlights the need for targeted interventions and harm reduction strategies focused on prevention, education, healthcare access, and stakeholder collaboration to address the multifaceted challenges of methamphetamine use among MSM.
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Affiliation(s)
- William Lodge
- Brown University School of Public Health, Providence, RI, USA; Center for Health Promotion and Health Equity, Brown School of Public Health, Providence, RI, USA.
| | - Patrick J A Kelly
- Brown University School of Public Health, Providence, RI, USA; Center for Health Promotion and Health Equity, Brown School of Public Health, Providence, RI, USA
| | - Siena Napoleon
- Brown University School of Public Health, Providence, RI, USA; Center for Health Promotion and Health Equity, Brown School of Public Health, Providence, RI, USA
| | - Samantha Plezia
- Brown University School of Public Health, Providence, RI, USA
| | - Matthew J Mimiaga
- Brown University School of Public Health, Providence, RI, USA; The Fenway Institute, Fenway Health, Boston, MA, USA; Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA; Department of Psychiatry & Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA, USA; UCLA Center for LGBTQ+ Advocacy, Research & Health, Los Angeles, CA, USA
| | - Katie B Biello
- Brown University School of Public Health, Providence, RI, USA; Center for Health Promotion and Health Equity, Brown School of Public Health, Providence, RI, USA; The Fenway Institute, Fenway Health, Boston, MA, USA
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Davy-Mendez T, Sarovar V, Levine-Hall T, Lea AN, Leibowitz AS, Luu MN, Flamm JA, Hare CB, Dumoit Smith J, Iturralde E, Dilley J, Silverberg MJ, Satre DD. Racial, ethnic, and age disparities in the association of mental health symptoms and polysubstance use among persons in HIV care. PLoS One 2023; 18:e0294483. [PMID: 38015975 PMCID: PMC10684077 DOI: 10.1371/journal.pone.0294483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/31/2023] [Indexed: 11/30/2023] Open
Abstract
We characterized polysubstance use burden and associations with mental health problems across demographic subgroups of PWH. In 2018-2020, as part of a primary care-based intervention study, PWH in care at three medical centers in Kaiser Permanente Northern California were screened for depression (PHQ-9≥10), anxiety (GAD-2≥3), and substance use (Tobacco, Alcohol, Prescription medication, and other Substance use [TAPS]≥1 per substance). We used Poisson regression to estimate prevalence ratios (PRs) comparing polysubstance use prevalence (TAPS≥1 for ≥2 substances) between PWH with positive screens for depression or anxiety vs. neither, among all PWH, and stratified by race/ethnicity and age (restricted to men), adjusting for sociodemographics, CD4, and HIV load. Screened PWH (N = 2865) included 92% men, 56% White, 19% Black, and 15% Hispanic PWH, with a median age of 55 years. Overall, polysubstance use prevalence was 26.4% (95% CI 24.9%-28.1%). PWH with depression or anxiety (n = 515) had an adjusted polysubstance use PR of 1.26 (1.09-1.46) vs. PWH with neither (n = 2350). Adjusted PRs were 1.47 (1.11-1.96), 1.07 (0.74-1.54), and 1.10 (0.85-1.41) among Black, Hispanic, and White men, respectively. Adjusted PRs did not differ by age group. Interventions should consider jointly addressing mental health and substance use problems and potential drivers, e.g. stigma or socioeconomic factors.
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Affiliation(s)
- Thibaut Davy-Mendez
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States of America
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Varada Sarovar
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Tory Levine-Hall
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Alexandra N. Lea
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Amy S. Leibowitz
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Mitchell N. Luu
- Oakland Medical Center, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Jason A. Flamm
- Sacramento Medical Center, Kaiser Permanente Northern California, Sacramento, CA, United States of America
| | - C. Bradley Hare
- San Francisco Medical Center, Kaiser Permanente Northern California, San Francisco, CA, United States of America
| | - Jaime Dumoit Smith
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States of America
| | - Esti Iturralde
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - James Dilley
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States of America
| | - Michael J. Silverberg
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Derek D. Satre
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States of America
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
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Chiang C, Gessner N, Burli A, Liszewski W, Mansh M, Nguyen CV, Yeung H, Trinidad JC. Poppers Dermatitis: A Systematic Review on a Unique Form of Contact Dermatitis in the MSM Community. Dermatitis 2023. [PMID: 37788394 DOI: 10.1089/derm.2023.0157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
There are certain demographic characteristics that may serve as risk factors for exposure to a contact allergen. Volatile alkyl nitrites, colloquially known as "poppers," are commonly inhaled by men who have sex with men (MSM) for their psychoactive and muscle-relaxing effects. They have been reported to cause either allergic contact dermatitis (ACD) or irritant contact dermatitis (ICD), termed "poppers dermatitis." We searched PubMed, Embase, and Web of Science to understand the patient population, clinical presentation, diagnosis, and clinical course of poppers dermatitis. Our search returned 13 articles detailing 18 patients total. Most patient cases were male (n = 13/15; 87%), of whom 5 were MSM. The reports on the remaining 8 men did not disclose their sexual behaviors. The chemicals deemed responsible for adverse cutaneous side effects included amyl nitrite (6/18; 33%), butyl nitrite (3/18; 167%), isobutyl nitrite (2/18; 11%), and an unspecified alkyl nitrite (7/18, 39%). The most common diagnosis was ICD (10/18; 56%). Only 3 patients underwent alkyl nitrite patch testing, with 2 testing positive for ACD. The most commonly involved anatomic sites were perinasal (13/18; 72%) and perioral regions (10/18; 56%). Rash morphology has been described as yellow crusting, impetigo-like, eczematous, vesicular, edematous, and erythematous. Ulceration can occur with direct skin contact to concentrated nitrite solution. Poppers dermatitis was often self-limited with complete resolution. Dermatologists should consider poppers dermatitis in those presenting with a characteristic midfacial rash, especially in MSM.
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Affiliation(s)
- Chavy Chiang
- From the University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Nicholas Gessner
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Anuk Burli
- Department of Dermatology, Stanford University, Palo Alto, California, USA
| | - Walter Liszewski
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Matthew Mansh
- Department of Dermatology, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
| | - Cuong V Nguyen
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Howa Yeung
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - John C Trinidad
- Department of Dermatology, Massachusetts General Hospital, Cambridge, Massachusetts, USA
- Department of Dermatology, Harvard Medical School, Cambridge, Massachusetts, USA
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Norman T, Power J, Clifton B, Murray J, Bourne A. People living with HIV who inject or have injected non-prescription drugs: Evidence of substantial differences in health inequalities and experiences of clinical care. Drug Alcohol Rev 2023; 42:1517-1528. [PMID: 37171154 DOI: 10.1111/dar.13681] [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: 09/14/2022] [Revised: 04/25/2023] [Accepted: 04/27/2023] [Indexed: 05/13/2023]
Abstract
INTRODUCTION This study investigates differences in health and well-being associated with current, past or no injecting drug use (IDU) among people living with HIV (PLHIV) in Australia, identifying key health care considerations between injecting experiences. METHODS Data were extracted from the HIV Futures 9 study; a survey of PLHIV conducted in 2018-2019. Chi-square and analysis of variance analyses compared clinical and treatment characteristics, major physical and mental comorbidities, sexually transmitted infection diagnoses, and quality of life for those who reported current (last 12 months), past (12+ months ago) or no IDU. RESULTS Current IDU (n = 106) was associated with higher rates of sexually transmitted infection testing and diagnoses, higher frequency of self-reported antiretroviral therapy non-adherence due to drug use and greater social quality of life than past (n = 126) or no IDU (n = 508; total N = 740). Past and current IDUs were associated with more mental illness diagnoses and self-reported concern about drug use. Past IDU was associated with more physical comorbidities, lower satisfaction with clinical care and greater difficulty in affording health care than current or no IDU. DISCUSSION AND CONCLUSIONS Past and current IDUs are associated with unique health concerns. However, past IDU appears to be related to greater dissatisfaction in navigating health care than individuals with current IDU experience. Higher social connection and the types of services being accessed by individuals who currently inject may play a role in shaping service satisfaction. Peer-based interventions to help support individuals in accessing services that are affirming of their needs is an ongoing priority.
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Affiliation(s)
- Thomas Norman
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Jennifer Power
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Brent Clifton
- National Association of People with HIV Australia, Sydney, Australia
| | - Joel Murray
- National Association of People with HIV Australia, Sydney, Australia
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
- Kirby Institute, UNSW Sydney, Sydney, Australia
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Gautam K, Paudel K, Jacobs J, Wickersham JA, Ikhtiaruddin WM, Azwa I, Saifi R, Lim SH, Shrestha R. An mHealth-Delivered Sexual Harm Reduction Tool (PartyPack) for Men Who Have Sex With Men in Malaysia: Usability Study. JMIR Form Res 2023; 7:e48113. [PMID: 37616034 PMCID: PMC10485720 DOI: 10.2196/48113] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/27/2023] [Accepted: 07/19/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Chemsex-the use of psychoactive drugs to enhance the sexual experience-is an increasing phenomenon globally. Despite the increasing burden and associated harms of chemsex, evidence-based interventions (ie, behavioral and pharmacological) for chemsex users are nonexistent. OBJECTIVE In this study, we assessed the usability and acceptability of a mobile health (mHealth)-delivered safer chemsex package ("PartyPack") as a sexual harm reduction strategy among men who have sex with men in Malaysia-a setting where chemsex is becoming increasingly prevalent. METHODS This study is part of a larger smartphone app-based intervention (ie, JomPrEP; University of Connecticut) designed to improve access to HIV prevention services among Malaysian men who have sex with men. A total of 50 participants were recruited from the Greater Kuala Lumpur region of Malaysia to use the JomPrEP app, which included a feature allowing participants to order PartyPack, for 30 days (March-April 2022). The usability and acceptability of the PartyPack were assessed using self-report, app analytics, and exit interviews (n=20). RESULTS Overall, 8% (4/50) of participants reported having engaged in chemsex in the past 6 months; however, engagement in condomless sex (34/50, 68%) and group sex (9/50, 18%) was much higher. A total of 43 (86%) participants ordered PartyPack, of which 27 (63%) made multiple orders during the 30 days. Most participants (41/43, 95%) reported being satisfied with the PartyPack order feature in the app, with 91% (39/43) indicating the order and tracking process was easy. Thematic data exploration further revealed important information for understanding (eg, items included in the package, use of mHealth platform to order package, and discreetness of the PartyPack box and order and delivery) and refining the logistical preferences (eg, using branded items and allowing customization during order). CONCLUSIONS Our findings provide strong evidence of the usability and acceptability of a mHealth-delivered safer chemsex package as a potential sexual harm reduction tool among this underserved population. Replication in a study with a larger sample size to test the efficacy of the PartyPack is warranted.
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Affiliation(s)
- Kamal Gautam
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
| | - Kiran Paudel
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
| | - Jerome Jacobs
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
| | - Jeffrey A Wickersham
- AIDS Program, Yale School of Medicine, New Haven, CT, United States
- Centre of Excellence for Research in AIDS, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Wan Mohd Ikhtiaruddin
- Centre of Excellence for Research in AIDS, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Iskandar Azwa
- Centre of Excellence for Research in AIDS, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Infectious Diseases Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Rumana Saifi
- Centre of Excellence for Research in AIDS, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sin How Lim
- Centre of Excellence for Research in AIDS, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Roman Shrestha
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
- AIDS Program, Yale School of Medicine, New Haven, CT, United States
- Centre of Excellence for Research in AIDS, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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11
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Lee F, Jain JP, Duthely LM, Ikeda J, Santos GM. Stimulant Use Associated With Psychosocial Factors, HIV Risk, and Concurrent Hazardous Alcohol Use Among US Adults: Exploratory Cross-Sectional Questionnaire Study. JMIR Form Res 2023; 7:e45717. [PMID: 37590045 PMCID: PMC10472175 DOI: 10.2196/45717] [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: 01/13/2023] [Revised: 03/04/2023] [Accepted: 04/14/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Stimulant use is a major public health problem that contributes to morbidity and mortality among men who have sex with men (MSM) in the United States. To reduce the harms associated with stimulant use, there is a need to identify the factors associated with stimulant use to inform interventions. Additionally, there is a need to use large crowdsourcing platforms like Amazon Mechanical Turk (MTurk) to engage more individuals who use substances across the United States. OBJECTIVE We identified the correlates of stimulant use among people who use alcohol or stimulants in the United States recruited using MTurk. METHODS Participants who were aged ≥18 years in the United States and reported alcohol or stimulant (ie, cocaine, crack cocaine, and methamphetamine) use were deemed eligible and recruited via the web platform MTurk. Participants completed a baseline survey, which assessed sociodemographics, psychosocial (ie, depression, affect, self-esteem, and stress) factors, substance use, and sexual behaviors. Data were collected and analyzed with STATA (version 17; StataCorp). Stratifying by MSM status, bivariate and multivariable logistic regression models were built in STATA to examine the correlates of stimulant use. Multivariable models controlled for age, race, health insurance, and relationship status. RESULTS Of 272 participants, 201 (73.9%) identified as male, 134 (49.2%) were MSM, 52 (19.1%) were from racial and ethnic minoritized communities, and 158 (58%) were in a relationship. The mean age was 36.10 (SD 10.3) years. A total of 40 (14.7%) participants reported stimulant use in the past 6 months. Factors significantly associated with stimulant use were being MSM (adjusted odds ratio [aOR] 4.61, 95% CI 1.97-10.81), a higher Alcohol Use Disorders Identification Test-Concise score (aOR 1.24, 95% CI 1.08-1.42), more intense cravings for alcohol in the past 24 hours (aOR 1.03, 95% CI 1.01-1.04), a higher depression score (aOR 1.06, 95% CI 1.01-1.12), a greater number of male partners in the last 6 months (aOR 1.32, 95% CI 1.08-1.61), a greater number of female partners in the last 6 months (aOR 1.42, 95% CI 1.04-1.92), and being diagnosed with a sexually transmitted infection (eg, syphilis, gonorrhea, chlamydia, herpes simplex virus, human papillomavirus, and other) in the last 6 months (aOR 14.61, 95% CI 3.45-61.87). Additionally, there was a significant additive interaction between MSM status and negative affect, such that the impact of negative affect on stimulant use was significantly greater among MSM compared with non-MSM (relative excess risk due to interaction 0.085, 95% CI 0.037-0.13). CONCLUSIONS Interventions that address stimulant use should use evidence-based approaches that reduce negative affect, depression, and cravings for alcohol. Additionally, interventions should be customized for MSM populations.
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Affiliation(s)
- Frank Lee
- Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco, CA, United States
| | - Jennifer Payaal Jain
- Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco, CA, United States
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Lunthita M Duthely
- Obstetrics, Gynecology & Reproductive Sciences, Miller School of Medicine, University of Miami, Miami, FL, United States
- Department of Public Health Sciences, University of Miami, Miami, FL, United States
| | - Janet Ikeda
- Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco, CA, United States
| | - Glenn-Milo Santos
- Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco, CA, United States
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA, United States
- Division of Prevention Science, School of Medicine, University of California San Francisco, San Francisco, CA, United States
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12
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Daly FP, O'Donnell K, Davoren MP, Noone C, Weatherburn P, Quinlan M, Foley B, Lyons F, Igoe D, Barrett P. Recreational and sexualised drug use among gay, bisexual, and other men who have sex with men (gbMSM) in Ireland-Findings from the European MSM internet survey (EMIS) 2017. PLoS One 2023; 18:e0288171. [PMID: 37506129 PMCID: PMC10381075 DOI: 10.1371/journal.pone.0288171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/20/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Gay, bisexual, and other men who have sex with men (gbMSM) report a higher prevalence of drug use in comparison to the general male population. However, in Ireland, there is a paucity of literature regarding the prevalence of drug use and its determinants among gbMSM. AIMS/OBJECTIVES To quantify the prevalence of (i) recreational drug use (RDU) and (ii) sexualised drug use (SDU) among gbMSM in Ireland, and to identify the factors associated with these drug use practices. METHODS The European MSM Internet Survey (EMIS) 2017 was an online, anonymous, internationally-promoted questionnaire. Two binary outcomes were included in our analyses: (1) RDU and (2) SDU in the previous year. Multivariable-adjusted logistic regression explored factors associated with these outcomes, and all independent covariates were adjusted for one another. RESULTS Among gbMSM without HIV (n = 1,898), 40.9% and 13.1% engaged in RDU and SDU in the previous year, respectively. Among diagnosed-positive gbMSM (n = 141), the past-year respective prevalence estimates were 51.8% and 26.2%. Increased odds of RDU were observed among gbMSM who were younger (vs. 40+ years) (18-24 years; AOR 2.96, 95% CI 2.05-4.28, 25-39 years; AOR 1.66, 95% CI 1.27-2.16), lived in Dublin (vs. elsewhere) (AOR 1.47, 95% CI 1.17-1.83), and engaged in condomless anal intercourse (CAI) in the previous year (vs. none) (1-2 partners; AOR 1.79, 95% CI 1.34-2.38, 6+ partners; AOR 1.79, 95% CI 1.18-2.71). Greater odds of SDU were identified among those who lived in Dublin (vs. elsewhere) (AOR 1.50, 95% CI 1.07-2.10), and engaged in CAI (vs. none) (1-2 partners; AOR 3.16, 95% CI 2.05-4.88, 3-5 partners; AOR 2.50, 95% CI 1.47-4.26, and 6+ partners; AOR 3.79, 95% CI 2.23-6.43). CONCLUSION GbMSM report a high prevalence of drug use in Ireland. Targeted interventions, including harm reduction campaigns, may be needed to support healthier drug use choices among this community.
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Affiliation(s)
- Fionn P Daly
- School of Medicine and Health, University College Cork, Cork, Ireland
- School of Public Health, University College Cork, Cork, Ireland
| | - Kate O'Donnell
- HSE Health Protection Surveillance Centre, Dublin, Ireland
| | - Martin P Davoren
- School of Public Health, University College Cork, Cork, Ireland
- Sexual Health Centre, Cork, Ireland
| | - Chris Noone
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Peter Weatherburn
- Sigma Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | - Fiona Lyons
- St. James's Hospital, James St, Saint James' (part of Phoenix Park), Dublin 8, Dublin, Ireland
| | - Derval Igoe
- HSE Health Protection Surveillance Centre, Dublin, Ireland
| | - Peter Barrett
- School of Public Health, University College Cork, Cork, Ireland
- Department of Public Health HSE-South, St. Finbarr's Hospital, Cork, Ireland
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Blomaard CM, Jongen VW, Achterbergh RC, van der Loeff MFS, de Vries HJ. Sexualized drug use and STD and HIV incidence among men who have sex with men in Amsterdam, the Netherlands. Int J STD AIDS 2023:9564624231180781. [PMID: 37279926 DOI: 10.1177/09564624231180781] [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: 06/08/2023]
Abstract
BACKGROUND We assessed the association between sexualized drug use (SDU), and incident sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV) infections among men who have sex with men (MSM). METHODS We used data from the MS2 cohort study, conducted at the STI Outpatient Clinic of the Public Health Service of Amsterdam, the Netherlands, in 2014-2019. Eligible participants were adult HIV-negative MSM with ≥2 STDs in the preceding year and MSM living with HIV and ≥1 STD. Participation encompassed 3-monthly visits including STD screening and questionnaires on drug use. Primary outcomes were incident HIV, anal chlamydia/gonorrhoea, and syphilis. We studied the association between SDU of individual drugs and incident HIV and STDs, using Poisson regression. Analyses were adjusted for age and HIV-status. RESULTS 131 HIV-negative MSM and 173 MSM living with HIV were included for analysis. SDU with GHB/GBL (aIRR = 7.2, 95% CI = 1.4-35.5) in the 3 months before testing was associated with incident HIV. SDU with GHB/GBL (aIRR = 1.2, 95% CI = 1.0-1.4), ketamine (aIRR = 1.3, 95% CI = 1.0-1.6) or methamphetamine (aIRR = 1.3, 95% CI = 1.0-1.6) was associated with incident anal chlamydia/gonorrhoea. We found no association between SDU with specific drug types and syphilis incidence. CONCLUSIONS SDU with GHB/GBL, ketamine and methamphetamine among MSM was associated with incident HIV and anal chlamydia/gonorrhoea. HIV-negative MSM engaging in SDU should be advised to use HIV pre-exposure prophylaxis, and all MSM engaging in SDU should be advised to have STD screening regularly. We suggest counselling on STDs among MSM engaging in SDU.
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Affiliation(s)
- Carien M Blomaard
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Vita W Jongen
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Roel Ch Achterbergh
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Maarten F Schim van der Loeff
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- Department of Internal Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity (AII), Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute (APH), Amsterdam, the Netherlands
| | - Henry Jc de Vries
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Institute for Infection and Immunity (AII), Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute (APH), Amsterdam, the Netherlands
- Department of Dermatology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
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14
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Goldshear JL, Westmoreland DA, Carrico AW, Grov C. Drug use typology, demographic covariates, and associations with condomless anal sex: A latent class analysis among a U.S. national cohort of men who have sex with men. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 112:103949. [PMID: 36587507 PMCID: PMC9975079 DOI: 10.1016/j.drugpo.2022.103949] [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: 05/05/2022] [Revised: 12/15/2022] [Accepted: 12/24/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Prior research has shown that men who have sex with men (MSM) who use drugs are at increased risk of sexually transmitted infections (STI) and Human Immunodeficiency Virus (HIV). Often, MSM who use drugs use multiple substances at once and research has indicated that certain substances are used in combination more frequently. As a vulnerable population, it is important to understand the various ways in which this population uses drugs in order to structure prevention, harm reduction, and treatment programs to their needs. METHODS Data for this analysis were taken from a cohort of geographically diverse U.S. national sample of cisgender men who have sex with men (n = 6111). After assessing prevalence of drug use in the sample, we used iterative latent class analysis to determine substance use classes for 10 substances. After a model was selected, class assignments were examined for association with mean number of insertive and receptive condomless anal sex (CAS) partners in the past three months. RESULTS The final model indicated six latent classes: class 1 = "cannabis use" (n = 1,996), class 2 = "diverse use" (n = 299), class 3 = "cocaine and inhalant use" (n = 421), class 4 = "methamphetamine, GHB, and inhalant use" (n = 345), class 5 = "no use" (n = 2431), class 6 = "sedative use" (n = 619). Age, race, annual income, residence in EHE jurisdictions, past history of houselessness, and past history of incarceration was significantly associated with membership in some classes. In outcome modeling, participants best assigned to Class 4 had the highest mean number of insertive (Mean = 9.70, 95% CI: 5.92 - 13.47) and receptive (Mean = 8.71, 95% CI: 6.75 - 10.66) condomless anal sex (CAS) partners in the prior three months. CONCLUSION The six heterogenous classes may indicate discrete typologies of use behavior corresponding to different settings or activities, which may themselves differ by regional HIV incidence trends and participant demographics. Programs seeking to address substance use among MSM may be well served to tailor toward these divergent clusters of substance use.
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Affiliation(s)
- Jesse L Goldshear
- Department of Population and Public Health Sciences, University of California Keck Medicine, 1845 N Soto St, Los Angeles, CA 90032, USA
| | - Drew A Westmoreland
- City University of New York (CUNY) Institute for Implementation Science in Population Health, 55 W 125th Street, New York, NY 10027, USA
| | - Adam W Carrico
- Department of Public Health Sciences, Miller School of Medicine, University of Miami. 1120 NW 14th St #905, 33136, Miami, FL, USA
| | - Christian Grov
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, 55 W 125th Street, New York, NY 10027, USA.
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15
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Zhao T, Chen G, Sun C, Gong X, Li H, Fu G. The epidemic of HIV and syphilis and the correlation with substance abuse among men who have sex with men in China: A systematic review and meta-analysis. Front Public Health 2023; 11:1082637. [PMID: 36875380 PMCID: PMC9982104 DOI: 10.3389/fpubh.2023.1082637] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/30/2023] [Indexed: 02/19/2023] Open
Abstract
Background In China, the HIV/AIDS epidemic among men who have sex with men (MSM) has been expanding in recent years. Substance abuse in MSM was not well studied as the independent risk factor for HIV and syphilis infection and other sexually transmitted diseases. The present review aimed to determine the correlation between HIV/Syphilis infections and substance abuse and other sexual risk behaviors among MSM. Methods We conducted a comprehensive search of PubMed, Web of Science, Embase, Scopus, Chinese National Knowledge Infrastructure, Chinese Wanfang Data, and VIP Chinese Journal Database for relevant articles of quantitative studies published between 2010 and May 31, 2022. Meta-analysis was performed using R software. Pooled estimated of the association-odds ratio, with 95% confidence intervals were calculated using random-effects models stratified by study design. Q statistics and I2 were used to measure the heterogeneity. Results Our meta-analysis included 61,719 Chinese MSM from 52 eligible studies. The pooled HIV prevalence rate among substance-abusing MSM was 10.0% (95% CI = 0.08-0.13). Substance abusers were more likely to have a higher prevalence of HIV (OR = 1.59) and syphilis (OR = 1.48) infections than non-substance abusers. Substance abusers were also more likely to seek sexual partners through the internet or social media applications (OR = 1.63), engage in unprotected anal intercourse (UAI) (OR = 1.69), group sex (OR = 2.78), and engage in commercial intercourse (OR = 2.04) compared to non-users. Regarding testing behaviors, substance abusers had a higher proportion of HIV or STI testing in their lifetime (OR = 1.70) compared with non-substance abusers (p < 0.05). They were also more likely to have had more sexual partners (≥2; OR = 2.31) and more likely to have consumed alcohol (OR = 1.49) in the past 6 months. Conclusions Our study shows the correlation between substance abuse and HIV/Syphilis infection. Eliminating disparities in HIV/Syphilis infection among substance abusing men who have sex with men (MSM) can be achieved if the Chinese government and public health sectors could provide targeted knowledge popularization and diagnosis interventions among high-risk populations.
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Affiliation(s)
- Tian Zhao
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Guohong Chen
- Jiangsu Provincial Center for Disease Control and Prevention, Institute for STI and HIV Control and Prevention, Nanjing, China
| | - Chengqing Sun
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Xiangdong Gong
- Department of Epidemiology, National Center for STD Control, Nanjing, China
| | - Huiyong Li
- Department of STI and HIV Control and Prevention, Jincheng Center for Disease Control and Prevention, Jincheng, China
| | - Gengfeng Fu
- School of Public Health, Nanjing Medical University, Nanjing, China
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16
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Nevendorff L, Schroeder SE, Pedrana A, Bourne A, Stoové M. Prevalence of sexualized drug use and risk of HIV among sexually active MSM in East and South Asian countries: systematic review and meta-analysis. J Int AIDS Soc 2023; 26:e26054. [PMID: 36600479 DOI: 10.1002/jia2.26054] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 12/05/2022] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Sexualized drug use (SDU), the use of psychoactive drugs in the context of sexual intercourse, has been identified as a risk factor for HIV among men who have sex with men (MSM) in Asia. Given the distinct social and cultural context of same-sex relationships and drug-using practice in Asia, we aimed to describe the prevalence of SDU in East and South Asian countries and its associations with condomless anal sex (CAI) and HIV status. Synthesizing SDU research in this region, including SDU definitions, prevalence and outcomes, provides insights to inform future research and improved programme planning, resourcing and advocacy. METHODS We systematically searched OVID Medline, OVID EMBASE, OVID Global Health, CINAHL, PsycINFO and SCOPUS publication databases for scientific articles published from 1990 to 2022 measuring SDU among MSM in East and South Asian countries. A narrative synthesis was utilized to describe key study attributes and findings, and meta-analyses using random pooled effect models were used to estimate SDU prevalence and its associations with CAI and HIV status. Subgroup meta-analyses, sensitivity analysis and assessment of publication bias examined potential sources of heterogeneity for the pooled SDU prevalence estimates. RESULTS AND DISCUSSION Of the 1788 publications screened, 49 publications met the selection criteria and 18 were suitable for meta-analyses. Findings highlight SDU definitions distinct from other regions but inconsistencies in the definition of SDU between studies that have been highlighted in research elsewhere. The pooled prevalence of recent SDU (past 12 months) was 13% (95% CI = 10-16%; I2 = 97.6) but higher when studies utilized self-administered surveys (15%; 95% CI = 12-19%; p<0.05). SDU was associated with greater odds of CAI (pooled odds ratio [OR] = 3.21; 95% CI = 1.82-5.66) and living with diagnosed HIV (OR = 4.73; 95% CI = 2.27-8.21). CONCLUSIONS SDU is common among MSM in East and South Asian countries, but varying SDU definitions limit between-study comparisons. Responses to SDU-related harms should consider local contexts, including specific drug types used and their relative risks.
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Affiliation(s)
- Laura Nevendorff
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- HIV AIDS Research Center, Atma Jaya Catholic University of Indonesia, South Jakarta, Indonesia
| | - Sophia E Schroeder
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Alisa Pedrana
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Stoové
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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17
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Maviglia F, Wickersham JA, Azwa I, Copenhaver N, Kennedy O, Kern M, Khati A, Lim SH, Gautam K, Shrestha R. Engagement in Chemsex among Men Who Have Sex with Men (MSM) in Malaysia: Prevalence and Associated Factors from an Online National Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:294. [PMID: 36612617 PMCID: PMC9819808 DOI: 10.3390/ijerph20010294] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/18/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
Background: Chemsex is the use of illicit drugs—particularly methamphetamine, gamma hydroxybutyrate (GHB), and gamma-butyrolactone (GBL)—to enhance sexual activity. Chemsex, which occurs primarily among communities of men who have sex with men (MSM), is associated with greater HIV risk behaviors, including multiple sex partners, group sex, condomless sex, and injection drug use. Despite evidence showing chemsex engagement among Malaysian MSM, there is a paucity of research on chemsex among MSM in Malaysia. Methods: This cross-sectional study was conducted through an online survey (August to September 2021) among 870 Malaysian MSM. Participants were recruited through targeted advertisements on social networks. We collected information regarding participants’ recent (<6 months) engagement in chemsex, demographic characteristics, psychosocial factors, pre-exposure prophylaxis (PrEP) knowledge and history, and recent sexual- and drug-related behavior. Multivariable logistic regression was used to identify factors associated with recent (<6 months) chemsex engagement. Results: Just under 1 in 10 (9.0%) of participants reported having engaged in chemsex in the previous six months. More than two-thirds of participants (69.1%) had not disclosed their sexual orientation to anyone in their family and 35.2% reported moderate to severe depressive symptoms. Multivariable analysis found that recent injection drug use (adjusted odds ratio: aOR = 6.61; 95% confidence interval: CI, 2.30−19.03), having shared pre-exposure prophylaxis (PrEP) with someone else (aOR = 5.60; 95% CI, 1.76−17.77), higher perceived HIV risk (aOR = 3.15; 95% CI, 1.25−7.93), knowing someone using PrEP (aOR = 2.93; 95% CI, 1.62−5.31), recent engagement in transactional sex (aOR = 2.38; 95% CI, 1.06−5.39), having a recent STI diagnosis (aOR = 2.36; 95% CI, 1.25−4.44), recent engagement in anal sex (aOR = 2.21; 95% CI, 1.07−4.57), and recent sexual intercourse with an HIV-positive partner (aOR = 2.09; 95% CI, 1.07−4.08) were associated with recent engagement in chemsex. Conclusions: Malaysian MSM who practice chemsex are vulnerable to several HIV risk factors, such as transactional sex, HIV-positive sexual partners, and injection drug use. There is an urgent need for programs that integrate drug, sexual health, and mental health services, with a focus on harm reduction (e.g., condoms, access to and utilization of HIV testing and PrEP services, drug knowledge, and safer drug use) tailored for MSM who practice chemsex.
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Affiliation(s)
- Francesca Maviglia
- Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, 135 College St., Suite 323, New Haven, CT 06510, USA
| | - Jeffrey A. Wickersham
- Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, 135 College St., Suite 323, New Haven, CT 06510, USA
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur 59100, Malaysia
| | - Iskandar Azwa
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur 59100, Malaysia
- Infectious Diseases Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 59100, Malaysia
| | - Nicholas Copenhaver
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT 06269, USA
| | - Olivia Kennedy
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT 06269, USA
| | - Monique Kern
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT 06269, USA
| | - Antoine Khati
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT 06269, USA
| | - Sin How Lim
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur 59100, Malaysia
- Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 59100, Malaysia
| | - Kamal Gautam
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT 06269, USA
| | - Roman Shrestha
- Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, 135 College St., Suite 323, New Haven, CT 06510, USA
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur 59100, Malaysia
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT 06269, USA
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18
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García-Pérez JN, Cañas-Ruano E, Navarro J, Raventós B, López L, Broto C, Arando M, Barberá MJ, Descalzo V, Suanzes P, Burgos J, Curran A, Falcó V. Sexual behavior and drug use impact in gay, bisexual, and other men who have sex with men. Med Clin (Barc) 2022; 159:563-568. [PMID: 35725636 DOI: 10.1016/j.medcli.2022.02.023] [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: 07/29/2021] [Revised: 02/21/2022] [Accepted: 02/23/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The emergence of chemsex has raised several concerns about gay, bisexual, and other men who have sex with men's (GBMSM) health. In this study we aim to analyze illicit drugs and chemsex use, sexual behavior and sexually transmitted infections (STI) in GBMSM who attended to a sexual health clinic and to explore any potential association between drug use and STI. METHODS We conducted an observational study between January and June 2019 among GBMSM population attending to a STI clinic in Barcelona, Spain. An anonymous self-administered questionnaire was given consecutively to all participants older than 18 years who accepted to participate. RESULTS A total of 514 GBMSM (median age of 34 years-old) were included. The median number of sexual partners in the last year was 20. Seventy-one percent did not use condoms consistently for receptive anal intercourse. Drug abuse prevalence in the preceding year was 64.2%, and 26.5% of the individuals practiced chemsex. Gamma-hydroxibutyrate/gammabutyrolactone, poppers and methamphetamine were the most common drugs in chemsex. Chemsex was associated to group sex (OR 9.8 [95 CI: 4-24]), HIV infection (OR 2.5 [95 CI: 1.1-5.8]), taking pre-exposure prophylaxis (OR 3.2 [95 CI: 1.5-7.1]), developing gonorrhea (OR 3.7 [95 CI: 1.5-8.8]) or syphilis (OR 6.7 [95 CI: 2.4-18.7]). CONCLUSIONS The prevalence of drug use and chemsex was high among GBMSM in Barcelona. Chemsex was associated with group sex, taking PrEP, and contracting syphilis, gonorrhea, and HIV.
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Affiliation(s)
- Jorge N García-Pérez
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Esperanza Cañas-Ruano
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.
| | - Jordi Navarro
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Berta Raventós
- Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Luis López
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Claudia Broto
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Maider Arando
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - María Jesús Barberá
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Vicente Descalzo
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Paula Suanzes
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Joaquín Burgos
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Adrià Curran
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Vicenç Falcó
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
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De La Mora L, Nebot MJ, Martinez-Rebollar M, De Lazzari E, Tuset M, Laguno M, Ambrosioni J, Miquel L, Blanch J, Ugarte A, Torres B, González-Cordón A, Inciarte A, Chivite I, Short D, Salgado E, Martinez E, Blanco JL, Mallolas J. Do ART and Chemsex Drugs Get Along? Potential Drug-Drug Interactions in a Cohort of People Living with HIV Who Engaged in Chemsex: A Retrospective Observational Study. Infect Dis Ther 2022; 11:2111-2124. [PMID: 36173594 PMCID: PMC9669299 DOI: 10.1007/s40121-022-00694-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/05/2022] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION People living with HIV (PLWH) who engaged in chemsex are at risk of potential drug-drug interactions (pDDIs) with recreational drugs. This study aimed to characterize pDDIs between antiretroviral treatment (ART) and chemsex drugs and evaluate their association with unscheduled relevant hospital consultations. METHODS We conducted a single-center, retrospective, observational study in a series of gay, bisexual, and other men who have sex with men (gbMSM) living with HIV who engaged in chemsex and who attended a tertiary hospital in Barcelona, Spain, from February 2018 through August 2019. Associations between all recorded pDDIs and relevant unscheduled consultations were estimated using the incidence rate (IR) per 100 person-years of those events compared between patients with no pDDI (green flag) or moderate severity pDDI (orange flag) with patients with high severity pDDI (red flag) using the incidence rate ratio (IRR). RESULTS Among 172 PLWH engaged in chemsex, 249 ART regimens were prescribed: 44% based on integrase inhibitors, 30% on boosted ART, and 26% based on non-nucleoside reverse transcriptase inhibitors. The substances and recreational drugs most frequently used were erectile dysfunction agents (83%), methamphetamine (79%), GHB (77%), and alkyl nitrites (71%). Polydrug use was reported in 52%. We observed 2048 pDDIs. Of these, 23% were orange flag pDDIs; 88% related to boosted ARTs. The IR of the 285 unscheduled relevant episodes in patients with orange flag pDDIs was 64.67 (95% CI 40.07-89.28). The IRR of green flag pDDIs was 1.05 (95% CI 0.60-1.8; p = 0.876). CONCLUSION One in four pDDIs were of moderate severity but no significant increase in the incidence of unscheduled relevant consultations was observed. A high number of unscheduled consultations, predominantly for psychiatric events and intoxication, were observed. Beyond using non-boosted ART to minimize pDDIs, other factors related to the practice of chemsex must be addressed, in order to offer a better approach.
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Affiliation(s)
- Lorena De La Mora
- grid.5841.80000 0004 1937 0247HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS AIDS and HIV Research Group, Barcelona University, Villarroel 170, 08036 Barcelona, Spain
| | - María J. Nebot
- grid.5841.80000 0004 1937 0247HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS AIDS and HIV Research Group, Barcelona University, Villarroel 170, 08036 Barcelona, Spain
| | - Maria Martinez-Rebollar
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS AIDS and HIV Research Group, Barcelona University, Villarroel 170, 08036, Barcelona, Spain.
| | - Elisa De Lazzari
- grid.5841.80000 0004 1937 0247HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS AIDS and HIV Research Group, Barcelona University, Villarroel 170, 08036 Barcelona, Spain
| | - Montserrat Tuset
- grid.410458.c0000 0000 9635 9413Department of Pharmacy, Hospital Clinic, Barcelona, Spain
| | - Montserrat Laguno
- grid.5841.80000 0004 1937 0247HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS AIDS and HIV Research Group, Barcelona University, Villarroel 170, 08036 Barcelona, Spain
| | - Juan Ambrosioni
- grid.5841.80000 0004 1937 0247HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS AIDS and HIV Research Group, Barcelona University, Villarroel 170, 08036 Barcelona, Spain
| | - Laia Miquel
- grid.5841.80000 0004 1937 0247Addiction Unit (GRAC), Psychiatry and Psychology Department, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, Barcelona University, Barcelona, Spain
| | - Jordi Blanch
- grid.5841.80000 0004 1937 0247Addiction Unit (GRAC), Psychiatry and Psychology Department, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, Barcelona University, Barcelona, Spain
| | - Ainoa Ugarte
- grid.5841.80000 0004 1937 0247HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS AIDS and HIV Research Group, Barcelona University, Villarroel 170, 08036 Barcelona, Spain
| | - Berta Torres
- grid.5841.80000 0004 1937 0247HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS AIDS and HIV Research Group, Barcelona University, Villarroel 170, 08036 Barcelona, Spain
| | - Ana González-Cordón
- grid.5841.80000 0004 1937 0247HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS AIDS and HIV Research Group, Barcelona University, Villarroel 170, 08036 Barcelona, Spain
| | - Alexy Inciarte
- grid.5841.80000 0004 1937 0247HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS AIDS and HIV Research Group, Barcelona University, Villarroel 170, 08036 Barcelona, Spain
| | - Iván Chivite
- grid.5841.80000 0004 1937 0247HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS AIDS and HIV Research Group, Barcelona University, Villarroel 170, 08036 Barcelona, Spain
| | - Duncan Short
- grid.476798.30000 0004 1771 726XViiV Healthcare, Brentford, Middlesex UK
| | - Emilio Salgado
- grid.410458.c0000 0000 9635 9413Medical Toxicology Unit, Emergency Department, Hospital Clinic Barcelona, Barcelona, Spain
| | - Esteban Martinez
- grid.5841.80000 0004 1937 0247HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS AIDS and HIV Research Group, Barcelona University, Villarroel 170, 08036 Barcelona, Spain
| | - José L. Blanco
- grid.5841.80000 0004 1937 0247HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS AIDS and HIV Research Group, Barcelona University, Villarroel 170, 08036 Barcelona, Spain
| | - Josep Mallolas
- grid.5841.80000 0004 1937 0247HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS AIDS and HIV Research Group, Barcelona University, Villarroel 170, 08036 Barcelona, Spain
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Flores Anato JL, Panagiotoglou D, Greenwald ZR, Blanchette M, Trottier C, Vaziri M, Charest L, Szabo J, Thomas R, Maheu-Giroux M. Chemsex and incidence of sexually transmitted infections among Canadian pre-exposure prophylaxis (PrEP) users in the l'Actuel PrEP Cohort (2013-2020). Sex Transm Infect 2022; 98:549-556. [PMID: 35039437 PMCID: PMC9685712 DOI: 10.1136/sextrans-2021-055215] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 12/23/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Use of illicit substances during sex (chemsex) may increase transmission of HIV and other STIs. Pre-exposure prophylaxis (PrEP) is highly effective at preventing HIV transmission, providing an important prevention tool for those who practise chemsex. However, it does not prevent acquisition of other STIs. We aim to examine the impact of chemsex on STI incidence among gay, bisexual and other men who have sex with men (gbMSM), and transgender women using PrEP in Montréal, Canada. METHODS We linked baseline sociodemographic and behavioural data with follow-up STI testing from 2013 to 2020 among PrEP users in the l'Actuel PrEP Cohort (Canada). Focusing on the 24 months following PrEP initiation, we estimated the effect of chemsex reported at baseline on cumulative incidence of gonorrhoea and chlamydia using Kaplan-Meier curves and survival analyses. We investigated the role of polysubstance use and effect modification by sociodemographic factors. RESULTS There were 2086 clients (2079 cisgender gbMSM, 3 transgender gbMSM, 4 transgender women) who initiated PrEP, contributing 1477 years of follow-up. There were no incident HIV infections among clients on PrEP. Controlling for sociodemographic confounders, clients reporting chemsex at baseline had a 32% higher hazard of gonorrhoea/chlamydia diagnosis (adjusted HR=1.32; 95% CI: 1.10 to 1.57), equivalent to a risk increase of 8.9 percentage points (95% CI: 8.5 to 9.4) at 12 months. The effect was greater for clients who reported polysubstance use (adjusted HR=1.51; 95% CI: 1.21 to 1.89). The strength of the effect of chemsex on STI incidence varied by age, education and income. CONCLUSION Among PrEP users, chemsex at baseline was linked to increased incidence of gonorrhoea and chlamydia. This effect was stronger for people reporting multiple chemsex substances. The high STI incidence among gbMSM who report chemsex highlights the importance of PrEP for this population and the need for integrated services that address the complexities of sexualised substance use.
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Affiliation(s)
- Jorge Luis Flores Anato
- Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, Québec, Canada
| | - Dimitra Panagiotoglou
- Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, Québec, Canada
| | - Zoë R Greenwald
- Division of Epidemiology, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada,Epidemiology, L'Actuel Medical Clinic, Montréal, Québec, Canada
| | - Maxime Blanchette
- Unité d'enseignement et de recherche en sciences du développement humain et social, University of Québec in Abitibi Temiscamingue, Rouyn-Noranda, Québec, Canada
| | - Claire Trottier
- Epidemiology, L'Actuel Medical Clinic, Montréal, Québec, Canada
| | - Maliheh Vaziri
- Epidemiology, L'Actuel Medical Clinic, Montréal, Québec, Canada
| | - Louise Charest
- Clinical Department, L'Actuel Medical Clinic, Montréal, Québec, Canada
| | - Jason Szabo
- Clinical Department, L'Actuel Medical Clinic, Montréal, Québec, Canada
| | - Réjean Thomas
- Clinical Department, L'Actuel Medical Clinic, Montréal, Québec, Canada
| | - Mathieu Maheu-Giroux
- Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, Québec, Canada
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21
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Wang J, Zhao P, Xu W, Wang C. Sexual uses of drug and alcohol among men who have sex with men in China: implications for HIV prevention. BMC Infect Dis 2022; 22:895. [PMID: 36447161 PMCID: PMC9710115 DOI: 10.1186/s12879-022-07880-8] [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: 03/08/2022] [Accepted: 11/15/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Sexual uses of alcohol and drugs are pervasive among men who have sex with men (MSM) and associated with increased risk of HIV infection. However, there are limited studies related to sexual uses of alcohol and drugs among MSM in China. This study aims to describe the pattern of alcohol use, drug use, and multi-drug use during sex among Chinese MSM and to examine the association between condomless anal intercourse, group sex, commercial sex and HIV infection. METHODS We conducted an online cross-sectional survey in China. Characteristics on social-demographic, sexual behaviors, and sexual uses of alcohol and drugs were collected. The associations with high-risk sexual behaviors and HIV infection were analyzed with multivariable logistic regression. RESULTS A total of 699 MSM were included in this study. About 39.5% (230/582) of men reported sexual alcohol use in the past three months and 50.8% (355/699) reported sexual drug use. Of those reporting sexual drug use, around 10.7% (38/355) reported having multi-drug use. Factors associated with both sexual uses of alcohol and drugs included: reporting more male sexual partners (alcohol: adjusted odds ratio [aOR] = 1.77; drug: aOR = 2.12), reporting condomless anal intercourse in the past three months (alcohol: aOR = 2.08; drug: aOR = 2.08), having ever engaged in group sex (alcohol: aOR = 2.04; drug: aOR = 5.22; multi-drug: aOR = 3.52) and commercial sex (alcohol: aOR = 4.43; drug: aOR = 4.22 multi-drug: aOR = 5.07). Sexual drug use was also correlated with reported HIV-positive status (drug: aOR = 2.53, 95% CI:1.31-4.90). CONCLUSION Sexual uses of alcohol and drugs are prevalent among Chinese MSM. Interventions to reduce the sexual use of alcohol and other drugs may be warranted among MSM in China.
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Affiliation(s)
- Jinshen Wang
- grid.284723.80000 0000 8877 7471Present Address: Dermatology Hospital, Southern Medical University, 510095 Guangzhou, China ,grid.284723.80000 0000 8877 7471School of Public Health, Southern Medical University, 510515 Guangzhou, China ,grid.284723.80000 0000 8877 7471Southern Medical University Institute for Global Health, 510095 Guangzhou, China
| | - Peizhen Zhao
- grid.284723.80000 0000 8877 7471Present Address: Dermatology Hospital, Southern Medical University, 510095 Guangzhou, China ,grid.284723.80000 0000 8877 7471Southern Medical University Institute for Global Health, 510095 Guangzhou, China
| | - Wenqian Xu
- grid.284723.80000 0000 8877 7471Present Address: Dermatology Hospital, Southern Medical University, 510095 Guangzhou, China ,grid.284723.80000 0000 8877 7471School of Public Health, Southern Medical University, 510515 Guangzhou, China ,grid.284723.80000 0000 8877 7471Southern Medical University Institute for Global Health, 510095 Guangzhou, China
| | - Cheng Wang
- grid.284723.80000 0000 8877 7471Present Address: Dermatology Hospital, Southern Medical University, 510095 Guangzhou, China ,grid.284723.80000 0000 8877 7471Southern Medical University Institute for Global Health, 510095 Guangzhou, China
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Lee YG, Zhakupova G, Vinogradov V, Paine EA, Laughney CI, Reeder K, Davis A, Hunt T, Mergenova G, Primbetova S, Terlikbayeva A, Wu E. Polydrug Use, Sexual Risk, and HIV Testing Among Cisgender Gay, Bisexual, and Other Men and Transgender and Nonbinary Individuals Who Have Sex With Men in Kazakhstan. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2022; 34:413-426. [PMID: 36181500 PMCID: PMC10662254 DOI: 10.1521/aeap.2022.34.5.413] [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] [Indexed: 06/16/2023]
Abstract
This study examined substance use and sexual risk correlates of HIV testing among cisgender gay, bisexual, and other men (MSM) and transgender and nonbinary individuals (TSM) who have sex with men in Kazakhstan. We analyzed baseline data from an HIV prevention trial collected prior to intervention deployment (N = 304). Multivariable logistic regression analyses revealed that lifetime HIV testing was positively associated with poly-drug use (AOR = 4.4, 95% CI [2.0, 9.9]) and negatively with sexual risk (AOR = 0.4, 95% CI [0.2, 1.0]). Similarly, recent HIV testing was positively associated with polydrug use (AOR = 2.7, 95% CI [1.4, 5.2]) and negatively with sexual risk (AOR = 0.5, 95% CI [0.3, 0.9]). Current HIV testing was negatively associated with sexual risk (AOR = 0.6, 95% CI [0.3. 0.9]). Findings support the value of integrating drug treatment with HIV testing among MSM and TSM in Kazakhstan.
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Affiliation(s)
- Yong Gun Lee
- Social Intervention Group, Columbia University School of Social Work, New York, New York, USA
| | - Gulnara Zhakupova
- Columbia University Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Vitaliy Vinogradov
- Columbia University Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Emily Allen Paine
- HIV Center for Clinical and Behavioral Studies, Columbia University and the New York Psychiatric Institute, New York, New York, USA
| | | | - Kelsey Reeder
- Columbia University School of Social Work, New York, New York, USA
| | - Alissa Davis
- Social Intervention Group, Columbia University School of Social Work, New York, New York, USA
| | - Timothy Hunt
- Social Intervention Group, Columbia University School of Social Work, New York, New York, USA
| | - Gaukhar Mergenova
- Columbia University Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Sholpan Primbetova
- Columbia University Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Assel Terlikbayeva
- Columbia University Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Elwin Wu
- Social Intervention Group, Columbia University School of Social Work, New York, New York, USA
- Columbia University Global Health Research Center of Central Asia, Almaty, Kazakhstan
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Scheer JR, Edwards KM, Sheinfil AZ, Dalton MR, Firkey MK, Watson RJ. Interpersonal Victimization, Substance Use, and Mental Health Among Sexual and Gender Minority Youth: The Role of Self-concept Factors. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP18104-NP18129. [PMID: 34372724 PMCID: PMC8825891 DOI: 10.1177/08862605211035868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Reducing substance use and negative mental health outcomes of interpersonal victimization among sexual and gender minority youth (SGMY) represents a critical public health priority. Victimized individuals often develop cognitive schemas, or organized knowledge structures consisting of traits, values, and memories about the self, such as self-concept factors, in response to interpersonal victimization. Prior studies demonstrate the role of self-concept factors (e.g., mastery, control, and self-esteem) in explaining the relationship between victimization and substance use and mental health. However, mastery, control, and self-esteem have not been explored as mediators of interpersonal victimization and health among SGMY. This study is among the first to apply cognitive schema models of trauma-related health symptoms using a large sample of SGMY to examine (a) whether interpersonal victimization is associated with substance use (i.e., alcohol use, cannabis use, and cigarette use) and mental health problems (i.e., depressive symptoms, self-perceived stress, self-rated health issues) and (b) whether diminished sense of mastery and control and lower self-esteem can partially explain elevated rates of substance use and mental health problems in this population. We used the U.S.-based 2017 LGBTQ National Teen Survey (n = 17,112; Mage = 15.57, SD = 1.27); 6,401 (37.4%) identified as gay or lesbian, 7,396 (43.2%) as cisgender women, and 10,245 (59.9%) as White. Substance use and mental health variables were positively associated with interpersonal victimization variables and negatively associated with self-concept factors. Self-concept factors partially mediated the relationship between interpersonal victimization and mental health. This model explained 74.2% of the variance in mental health and 28.4% of the variance in substance use. Cognitive coping may represent an important modifiable factor that can be targeted by trauma-focused interventions in efforts to improve victimized SGMY's mental health. Findings call for the development of identity-affirmative, evidence-based, and trauma-focused interventions for SGMY to improve this populations' overall health.
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HIV, chemsex, and the need for harm-reduction interventions to support gay, bisexual, and other men who have sex with men. Lancet HIV 2022; 9:e717-e725. [PMID: 35926550 DOI: 10.1016/s2352-3018(22)00124-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/11/2022] [Accepted: 04/11/2022] [Indexed: 11/21/2022]
Abstract
Numerous studies have identified an association between the use of drugs in sexual contexts (chemsex) and HIV among gay, bisexual, and other men who have sex with men (GBMSM), although whether a causal relationship exists is contentious. An intricate relationship exists between chemsex, HIV treatment and prevention, harm reduction, and the provision of community-grounded health services. Furthermore, potential harms exist beyond HIV, such as intoxication and overdose. Community-engaged responses to chemsex involve social and cultural strategies of harm reduction and sexual health promotion before, during, and after a chemsex session. Ultimately, this Review calls for actions and collaborations aimed at developing a greater understanding of chemsex as a practice within different GBMSM subpopulations and to develop tailored harm-reduction models that can accommodate GBMSM who engage in chemsex in various ways and with varied effects.
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Marshall AD, Martinello M, Treloar C, Matthews GV. Perceptions of hepatitis C treatment and reinfection risk among HIV-positive men who have sex with men and engage in high risk behaviours for hepatitis C transmission: The CEASE qualitative study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 109:103828. [PMID: 35994937 DOI: 10.1016/j.drugpo.2022.103828] [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: 06/05/2022] [Revised: 08/07/2022] [Accepted: 08/08/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Globally, treatment uptake for hepatitis C virus (HCV) infection among HIV-HCV coinfected men who have sex with men (MSM) has substantially increased since the advent of interferon-free direct-acting antivirals (DAA). However, HIV-positive MSM who engage in high risk behaviours are at an increased risk of HCV reinfection post-treatment. The aim of this study was to investigate perceptions of HCV diagnosis, treatment and reinfection risk among HCV-HIV coinfected MSM who engage in drug use and/or high risk sexual behavior in Sydney, Australia. METHODS Participants were recruited from the Control and Elimination within AuStralia of HEpatitis C from people living with HIV (CEASE) cohort (n=402) who reported engaging in drug use and/or high risk sexual behavior for transmission of HCV infection. Participants were interviewed about their perceptions of HCV diagnosis, treatment, and reinfection risk. Interview data were transcribed, coded, and analyzed thematically. RESULTS Of 33 participants interviewed (mean age 49 years), many participants were 'shocked' by their HCV diagnosis. Participants who believed they acquired HCV infection through sexual exposure felt it was important that their healthcare practitioner agreed with their perspective to mitigate stigmatizing experiences. Overall, participants expressed high satisfaction with their treatment experience due to long-standing therapeutic relationships with their HIV physician. Many participants expressed knowledge of how to prevent HCV reinfection from injection drug use, yet other than condom usage, most were unsure how to reduce high risk sexual activity with such discussions occurring less frequently with healthcare practitioners. CONCLUSION Findings indicate that MSM who engage in drug use and high risk sexual activity would benefit from additional education on reducing reinfection risk through sexual activity and services to reduce substance use, if requested.
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Affiliation(s)
- Alison D Marshall
- The Kirby Institute, UNSW Sydney, Sydney, Australia; Centre for Social Research in Health, UNSW Sydney, Sydney, Australia.
| | | | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
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Shrestha R, Maviglia F, Altice FL, DiDomizio E, Khati A, Mistler C, Azwa I, Kamarulzaman A, Halim MAA, Wickersham JA. Mobile Health Technology Use and the Acceptability of an mHealth Platform for HIV Prevention Among Men Who Have Sex With Men in Malaysia: Cross-sectional Respondent-Driven Sampling Survey. J Med Internet Res 2022; 24:e36917. [PMID: 35877172 PMCID: PMC9361153 DOI: 10.2196/36917] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 04/14/2022] [Accepted: 05/08/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The growth in mobile technology access, utilization, and services holds great promise in facilitating HIV prevention efforts through mobile health (mHealth) interventions in Malaysia. Despite these promising trends, there is a dearth of evidence on the use of mHealth platforms that addresses HIV prevention among Malaysian men who have sex with men. OBJECTIVE The goal of this study was to gain insight into (1) access and utilization of communication technology (eg, landline phone, internet, mobile phone), (2) acceptability of mHealth-based interventions for HIV prevention services, and (3) preferences regarding the format and frequency of mHealth interventions among Malaysian men who have sex with men. METHODS We conducted a cross-sectional survey with Malaysian men who have sex with men between July 2018 and March 2020. Participants were recruited using respondent-driven sampling in the Greater Kuala Lumpur region of Malaysia. We collected information on demographic characteristics, HIV risk-related behaviors, access to and the frequency of use of communication technology, and acceptability of using mHealth for HIV prevention using a self-administered questionnaire with a 5-point scale (1, never; 2, rarely; 3, sometimes; 4, often; 5, all the time). RESULTS A total of 376 men participated in the survey. Almost all respondents owned or had access to a smartphone with internet access (368/376, 97.9%) and accessed the internet daily (373/376, 99.2%), mainly on a smartphone (334/376, 88.8%). Participants on average used smartphones primarily for social networking (mean 4.5, SD 0.8), followed by sending or receiving emails (mean 4.0, SD 1.0), and searching for health-related information (mean 3.5, SD 0.9). There was high acceptance of the use of mHealth for HIV prevention (mean 4.1, SD 1.5), including for receiving HIV prevention information (345/376, 91.8%), receiving medication reminders (336/376, 89.4%), screening and monitoring sexual activity (306/376, 81.4%) or illicit drug use (281/376, 74.7%), and monitoring drug cravings (280/376, 74.5%). Participants overwhelmingly preferred a smartphone app over other modalities (eg, text, phone call, email) for engaging in mHealth HIV prevention tools. Preference for app notifications ranged from 186/336 (53.9%), for receiving HIV prevention information, to 212/336 (69.3%), for screening and monitoring sexual activity. Acceptance of mHealth was higher for those who were university graduates (P=.003), living in a relationship with a partner (P=.04), engaged in sexualized drug use (P=.01), and engaged in receptive anal sex (P=.006). CONCLUSIONS Findings from this study provide support for developing and deploying mHealth strategies for HIV prevention using a smartphone app in men who have sex with men-a key population with suboptimal engagement in HIV prevention and treatment.
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Affiliation(s)
- Roman Shrestha
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
| | - Francesca Maviglia
- Section of Infectious Diseases, Yale University, New Haven, CT, United States
| | - Frederick L Altice
- Section of Infectious Diseases, Yale University, New Haven, CT, United States
| | - Elizabeth DiDomizio
- Section of Infectious Diseases, Yale University, New Haven, CT, United States
| | - Antoine Khati
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
| | - Colleen Mistler
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
| | - Iskandar Azwa
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Latent Class Analysis of Polysubstance Use and Sexual Risk Behaviors among Men Who Have Sex with Men Attending Sexual Health Clinics in Mexico City. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148847. [PMID: 35886704 PMCID: PMC9323409 DOI: 10.3390/ijerph19148847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/12/2022] [Accepted: 07/15/2022] [Indexed: 12/10/2022]
Abstract
Men who have sex with men (MSM) are more likely to use drugs and other substances compared to their heterosexual peers. No studies have evaluated patterns of substance use among MSM adults in Mexico. We used latent class analysis (LCA) to identify MSM subgroups with specific substance use patterns and their associations with sexual behaviors. Methods: Data from 1850 adult MSM were collected at HIV clinics in Mexico City between September 2018 and December 2019. The structural equation modeling approach was used to estimate a LC model to identify patterns of substance use by self-report of substance use (i.e., cigarette smoking, alcohol, and drugs). To evaluate LC membership, we included HIV status, condomless anal sex (CAS), and serosorting, while controlling for demographic variables. Results: 30.3% were under the age of 22. Alcohol use in last 30 days (76.2%), binge drinking (29.2%), marijuana (29.4%), sex-drugs (23.9%), stimulants (13.7%), and depressants (6.3%). MSM reported engaging in CAS (55.9%) and serosorting (13.5%) behaviors, and 40% reported being HIV positive. LCA indicated three general categories of MSM substance users: Class 1 (49.0%), Class 2 (29.8%), and Class 3 (20.4%). Members of Class 3 were younger: 23–28 age years (aOR = 1.86) and 29–33 age years (aOR = 1.86), more educated: completed graduate studies (aOR = 1.60), had a high probability of polysubstance use and were more likely to engage in CAS and serosorting. Conclusions: Attempts to detect alcohol and problematic use of substances are needed for MSM followed by culturally competent approaches that address alcohol and drug use disorders.
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Stephenson R, Sullivan SP, Pitter RA, Hunter AS, Chavanduka TMD. Are We Still Having Sex? Results of Round Two of the Love and Sex in the Time of COVID Survey with Gay, Bisexual and Other Men Who Have Sex with Men. AIDS Behav 2022; 26:2338-2348. [PMID: 35044555 PMCID: PMC8767038 DOI: 10.1007/s10461-022-03580-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2022] [Indexed: 11/25/2022]
Abstract
This paper presents data from the Love and Sex in the Time of COVID survey, an online survey with US gay, bisexual and other men who have sex with men. The first round of the Love and Sex in the Time of COVID-19 survey was conducted online from April to May, 2020: the second round was collected November 2020 to January 2021. GBMSM were recruited through advertisements featured on social networking platforms. Analysis examines changes in self-reported measures of sexual behavior (number of sex partners, number of anal sex partners and number of anal sex partners not protected by pre-exposure prophylaxis (PrEP) or condoms) between those with complete data for round one and round two of the surveys (n = 280). While in round one, men reported a moderate willingness to have sex during COVID-19 (3.5 on a scale from 1 to 5), this had reduced significantly to 2.1 by round two. Men reported declines in the number of unprotected anal sex partners since pre-COVID. Perceptions of a longer time until the end of the COVID-19 pandemic were associated with increases in the number of sex partners and UAI partners. The results illustrate some significant declines in sexual behavior among GBMSM as the COVID-19 pandemic progressed. As vaccine programs continue to roll out across the U.S, as lockdowns ease and as we return to some normalcy, it will be important to continue to think critically about ways to re-engage men in HIV prevention.
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Affiliation(s)
- Rob Stephenson
- Department of Systems, Population and Leadership, School of Nursing, University of Michigan, Ann Arbor, USA.
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, USA.
| | - Stephen P Sullivan
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, USA
| | - Renée A Pitter
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, USA
| | - Alexis S Hunter
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, USA
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De La Mora L, Ugarte A, Martínez-Rebollar M, De Lazzari E, García-Hernández D, Font G, De Loredo N, Solbes E, Miquel L, Blanch J, Torres B, Riera J, Chivite I, Ambrosioni J, Inciarte A, González-Cordón A, Martínez E, Blanco JL, Mallolas J, Laguno M. Chemsex Practices in PrEP: Beyond Addiction and Risk Toward a Healthy Sex Life-Baseline Experiences from a Hospital-Based PrEP Program in Barcelona, Spain. AIDS Behav 2022; 26:4055-4062. [PMID: 35732910 DOI: 10.1007/s10461-022-03730-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2022] [Indexed: 11/26/2022]
Abstract
Pre-exposure prophylaxis (PrEP) is a biomedical intervention that has demonstrated efficacy in HIV prevention in individuals at high-risk, among them chemsex users. Out of 190 PrEP users followed at Hospital Clinic of Barcelona until October 2020, 89% reported drug use, and 63% disclosed that they had engaged in chemsex practices, initiated in 64% of cases within the past year. Twenty-one percent used 3 or more drugs simultaneously, being GHB/GBL, nitrites, sildenafil, and methamphetamine the most prevalent combination. Eight percent reported slamming. Forty-one percent described having had negative experiences and 8% did not remember the last time they had sober sex. Methamphetamine, mephedrone, GHB/GBL, and having had open relationships, group sex, double penetration, and fisting were significantly more prevalent. Forty-nine percent admitted being worried about chemsex use, and 18% said they needed help. A comprehensive, interdisciplinary approach is mandatory to enable the attainment of a healthy approach to one's sex life.
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Affiliation(s)
- Lorena De La Mora
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Ainoa Ugarte
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Maria Martínez-Rebollar
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain.
| | - Elisa De Lazzari
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - David García-Hernández
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Guillermo Font
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Nicolás De Loredo
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Estela Solbes
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Laia Miquel
- Addiction Unit (GRAC). Psychiatry and Psychology Department, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, Barcelona University, Barcelona, Spain
| | - Jordi Blanch
- Addiction Unit (GRAC). Psychiatry and Psychology Department, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, Barcelona University, Barcelona, Spain
| | - Berta Torres
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Josep Riera
- Dermatology Service, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Iván Chivite
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Juan Ambrosioni
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Alexy Inciarte
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Ana González-Cordón
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Esteban Martínez
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - José Luis Blanco
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Josep Mallolas
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Montserrat Laguno
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
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Uholyeva X, Pitoňák M. Chemsex users in Czechia: EMIS survey. Cent Eur J Public Health 2022; 30:86-92. [PMID: 35876596 DOI: 10.21101/cejph.a6923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 05/13/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Chemsex is a phenomenon highly relevant to public health concerns. Our primary aim is to describe the Czech chemsex scene regarding substances used, sexual behaviour, mental health, sexual life satisfaction, internalization of homonegative attitudes, and prevalent chemsex patterns. METHODS The data from the European Men Who Have Sex With Men Internet Survey (EMIS) 2017 were used. The mental health of chemsex users was assessed by the Patient Health Questionnaire 4 (PHQ4), internalized homonegativity was measured using the Short Internalized Homonegativity Scale. A sample of 87 men who have sex with men (MSM) chemsex users and a comparison group of 261 MSM were selected from the total sample of 1,688 respondents. Mann-Whitney and χ2 tests were used to compare groups. RESULTS Active chemsex users made up 5% of the sample (87 of 1,688), with an average age of 37 years. Chemsex users were more likely to engage in condomless sex with non-steady partners (χ2 = 46.8, p < 0.001), and had dramatically more STIs, such as HIV (χ2 = 52.9, p < 0.001), HCV (χ2 = 25.9, p < 0.001), and syphilis (χ2 = 41.5, p < 0.001). Chemsex users frequently injected drugs (n = 19, 20%). More than half (n = 48; 55%) of chemsex users had sober sex in the last 4 weeks. Chemsex culture was associated with riskier substance use, both in terms of mode and frequency. The mental health of chemsex users in our sample did not differ significantly from the comparison group (χ2 = 0.2, p < 0.7). Chemsex users did not conceal their sexual identity more often than the comparison group, on the contrary, 69% (n = 59) of them were out to most significant others, compared to 53% (n = 134) in the comparison group (χ2 = 8.8, p < 0.05). In addition, we did not find differences in the degree of internalized homonegativity (χ2 = 0.9, p < 0.4). Chemsex users were clearly and significantly more satisfied with their sex life than the comparison group (Mann-Whitney U test, p < 0.001). CONCLUSIONS In our sample, chemsex use was not associated with a negative impact on health or wellbeing. Our results suggest that chemsex is not a homogeneous phenomenon. Many different patterns and subcultures exist, some of them are riskier, some safer than others.
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Affiliation(s)
| | - Michal Pitoňák
- National Institute of Mental Health, Klecany, Czech Republic
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Krings A, Schmidt D, Meixenberger K, Bannert N, Münstermann D, Tiemann C, Kollan C, Gunsenheimer-Bartmeyer B. Decreasing prevalence and stagnating incidence of Hepatitis C-co-infection among a cohort of HIV-1-positive patients, with a majority of men who have sex with men, in Germany, 1996-2019. J Viral Hepat 2022; 29:465-473. [PMID: 35302675 DOI: 10.1111/jvh.13670] [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] [Received: 11/17/2021] [Revised: 02/08/2022] [Accepted: 02/16/2022] [Indexed: 12/09/2022]
Abstract
Co-infection with Hepatitis C virus (HCV) among HIV-positive patients leads to accelerated progression of liver disease and AIDS. Due to increased HCV prevalence and incidence, co-infection requires monitoring trends among HIV-positive individuals. This will help target prevention strategies and support to reach the global goals of eliminating viral hepatitis as a public health threat. In this analysis HCV prevalence and incidence were determined for the years 1996-2019 from yearly blood samples and questionnaire details among HIV-1-positive patients, with a majority of men who have sex with men, belonging to a nationwide, multicentre observational, prospective cohort study. The results show that HCV prevalence for acute/chronic and resolved infection increased until 2014 to 12%. Since then, prevalence of acute/chronic HCV infection rapidly decreased and prevalence of resolved infections showed a steady increase. HCV incidence was highest in 2010 and lowest in 2017; however, no significant change in HCV incidence could be seen over the years. Therefore, the introduction of directly-acting antiviral agents for HCV treatment notably decreased prevalence and potentially incidence of acute/chronic HCV infection. Nevertheless, prevalence and incidence of HCV among these HIV-1-positive study participants remain high compared with the general population and justify the need for continuous HCV prevention and treatment efforts among HIV-positive individuals.
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Affiliation(s)
- Amrei Krings
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.,Postgraduate Training for Applied Epidemiology, Robert Koch Institute, Berlin, Germany.,European Program for Intervention Epidemiology Training, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Daniel Schmidt
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | | | - Norbert Bannert
- Department of Infectious Diseases, Robert Koch Institute, Berlin, Germany
| | | | | | - Christian Kollan
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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Risky Sexual Practices, Sexually Transmitted Infections, Motivations, and Mental Health among Heterosexual Women and Men Who Practice Sexualized Drug Use in Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116387. [PMID: 35681972 PMCID: PMC9180103 DOI: 10.3390/ijerph19116387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/18/2022] [Accepted: 05/21/2022] [Indexed: 12/10/2022]
Abstract
Sexualized drug use (SDU) has been poorly studied among heterosexuals. The purpose of the present study was to analyze the prevalence of and gender differences in types of substances, risky sexual practices, sexually transmitted infections (STIs), motivations, and psychological adjustment among heterosexual women and men who engage in SDU. The study sample consisted of 1181 heterosexuals (795 women) between 18 and 78 years old (mean age = 24.4, SD = 7.4). Approximately 12% of the participants had engaged in SDU. No differences were found in the prevalence of SDU between men and women. Alcohol, cannabis, and 3,4-methylenedioxy-methamphetamine (MDMA) were the substances most frequently used for sexual purposes. Men were significantly more likely to use MDMA, ecstasy, cocaine, and erectile dysfunction (ED) drugs, and they tended to have more sexual partners than women. Likewise, SDU was related to have more sexual partners, penetrative sex without a condom, practice a fetish, be diagnosed with syphilis, chlamydia, and others STIs, and present more depression symptoms (but not with more anxiety). In conclusion, SDU was associated with poorer physical and mental health. It is, therefore, necessary to design programs aimed at reducing the incidence of the consequences of SDU on the physical and mental health of both men and women. Moreover, programs that seek to understand why these individuals engage in SDU should be undertaken.
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Poulios A, Apostolidou A, Triantafyllidou S, Protopapas K, Tapeinos A, Papadopetrakis G, Papadopoulou M, Antoniadou A, Psichogiou M, Canellopoulos L. Sexualized Drug Use and Chemsex: Their Association with Sexual Health Among Men who have Sex with Men Living in Greece. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2022; 34:450-461. [PMID: 38596273 PMCID: PMC10903580 DOI: 10.1080/19317611.2022.2045417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 01/12/2022] [Accepted: 02/15/2022] [Indexed: 04/11/2024]
Abstract
Objectives: The study aims to investigate rates of sexualized drug use (SDU) and chemsex, a type of SDU involving specifically the use of crystal methamphetamine, mephedrone, or GHB/GBL and their association with the rates of negative sexual health outcomes among men who have sex with men (MSM) in Greece. Methods: Survey of 485 MSM in internal disease departments and community testing centers. Results: Twenty-eight percent of participants were involved in SDU and 20.4% in chemsex. HIV positive status and recent STI diagnoses were associated with SDU involvement. Conclusion: SDU and chemsex rates and their impact on health reveal the need for informed community-based services.
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Affiliation(s)
- Antonios Poulios
- Laboratory of Clinical Research “Subjectivity and Social Bond”, Department of Psychology, School of Philosophy, National and Kapodistrian University of Athens, Athens, Greece
- Greek Association of People Living with HIV – Positive Voice, Athens, Greece
| | - Anna Apostolidou
- Laboratory of Clinical Research “Subjectivity and Social Bond”, Department of Psychology, School of Philosophy, National and Kapodistrian University of Athens, Athens, Greece
- Greek Association of People Living with HIV – Positive Voice, Athens, Greece
| | | | | | - Athanasios Tapeinos
- Greek Association of People Living with HIV – Positive Voice, Athens, Greece
| | | | - Martha Papadopoulou
- First Department of Internal Medicine, “Laiko” General Hospital, Athens, Greece
| | - Anastasia Antoniadou
- Fourth Department of Internal Medicine, “Attikon” University Hospital, Chaidari, Greece
| | - Mina Psichogiou
- First Department of Internal Medicine, “Laiko” General Hospital, Athens, Greece
| | - Lissy Canellopoulos
- Laboratory of Clinical Research “Subjectivity and Social Bond”, Department of Psychology, School of Philosophy, National and Kapodistrian University of Athens, Athens, Greece
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Meiksin R, Melendez-Torres GJ, Miners A, Falconer J, Witzel TC, Weatherburn P, Bonell C. E-health interventions targeting STIs, sexual risk, substance use and mental health among men who have sex with men: four systematic reviews. PUBLIC HEALTH RESEARCH 2022. [DOI: 10.3310/brwr6308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background
Human immunodeficiency virus/sexually transmitted infections, sexual risk, substance (alcohol and other legal and illegal drugs) use and mental ill health constitute a ‘syndemic’ of mutually reinforcing epidemics among men who have sex with men. Electronic health (e-health) interventions addressing these epidemics among men who have sex with men might have multiplicative effects. To our knowledge, no systematic review has examined the effectiveness of such interventions on these epidemics among men who have sex with men.
Objective
The objective was to synthesise evidence addressing the following: (1) What approaches and theories of change do existing e-health interventions employ to prevent human immunodeficiency virus/sexually transmitted infections, sexual risk, alcohol/drug use or mental ill health among men who have sex with men? (2) What factors influence implementation? (3) What are the effects of such interventions on the aforementioned epidemics? (4) Are such interventions cost-effective?
Data sources
A total of 24 information sources were searched initially (October–November 2018) [the following sources were searched: ProQuest Applied Social Sciences Index and Abstracts; Campbell Library; EBSCO Cumulative Index to Nursing and Allied Health Literature Plus, Wiley Online Library The Cochrane Library; Centre for Reviews and Dissemination databases (the Database of Abstracts of Reviews of Effects and the NHS Economic Evaluation Database); the Health Technology Assessment database; Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre) database of health promotion research (Bibliomap); ProQuest Dissertations & Theses Global; OvidSP EconLit; OvidSP EMBASE; OvidSP Global Health; OvidSP Health Management Information Consortium; ProQuest International Bibliography of the Social Sciences; Ovid MEDLINE ALL; OvidSP PsycINFO; Web of Science Science Citation Index Expanded; Elsevier Scopus; OvidSP Social Policy & Practice; Web of Science Social Sciences Citation Index Expanded; ProQuest Sociological Abstracts; ClinicalTrials.gov; World Health Organization International Clinical Trials Registry Platform; EPPI-Centre Trials Register of Promoting Health Interventions; and the OpenGrey database], and an updated search of 19 of these was conducted in April 2020. Reference lists of included reports were searched and experts were contacted.
Review methods
Eligible reports presented theories of change and/or process, outcome and/or economic evaluations of e-health interventions offering ongoing support to men who have sex with men to prevent human immunodeficiency virus/sexually transmitted infections, sexual risk behaviour, alcohol/drug use and/or common mental illnesses. References were screened by title/abstract, then by full text. Data extraction and quality assessments used existing tools. Theory and process reports were synthesised using qualitative methods. Outcome and economic data were synthesised narratively; outcome data were meta-analysed.
Results
Original searches retrieved 27 eligible reports. Updated searches retrieved 10 eligible reports. Thirty-seven reports on 28 studies of 23 interventions were included: 33 on theories of change, 12 on process evaluations, 16 on outcome evaluations and one on an economic evaluation. Research question 1: five intervention types were identified – ‘online modular’, ‘computer games’ and ‘non-interactive’ time-limited/modular interventions, and open-ended interventions with ‘content organised by assessment’ and ‘general content’. Three broad types of intervention theories of change were identified, focusing on ‘cognitive/skills’, ‘self-monitoring’ and ‘cognitive therapy’. Research question 2: individual tailoring based on participant characteristics was particularly acceptable, and participants valued intervention content reflecting their experiences. Research question 3: little evidence was available of effects on human immunodeficiency virus or sexually transmitted infections. The analysis did not suggest that interventions were effective in reducing instances of human immunodeficiency virus or sexually transmitted infections. The overall meta-analysis for sexually transmitted infections reported a small non-significant increase in sexually transmitted infections in the intervention group, compared with the control group. Meta-analyses found a significant impact on sexual risk behaviour. The findings for drug use could not be meta-analysed because of study heterogeneity. Studies addressing this outcome did not present consistent evidence of effectiveness. Trials did not report effects on alcohol use or mental health. Research question 4: evidence on cost-effectiveness was limited.
Limitations
The quality of the eligible reports was variable and the economic synthesis was limited to one eligible study.
Conclusions
There is commonality in intervention theories of change and factors affecting receipt of e-health interventions. Evidence on effectiveness is limited.
Future work
Future trials should assess the impact of interventions on multiple syndemic factors, among them sexual risk, substance use and mental health; incorporate sufficient follow-up and sample sizes to detect the impact on human immunodeficiency virus/sexually transmitted infections; and incorporate rigorous process and economic evaluations.
Study registration
This study is registered as PROSPERO CRD42018110317.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 10, No. 4. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Rebecca Meiksin
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Alec Miners
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Jane Falconer
- Library, Archive and Open Research Services, London School of Hygiene & Tropical Medicine, London, UK
| | - T Charles Witzel
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Peter Weatherburn
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Chris Bonell
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
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Coyer L, Boyd A, Davidovich U, van Bilsen WPH, Prins M, Matser A. Increase in recreational drug use between 2008 and 2018: results from a prospective cohort study among HIV-negative men who have sex with men. Addiction 2022; 117:656-665. [PMID: 34402120 PMCID: PMC9292014 DOI: 10.1111/add.15666] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 08/04/2021] [Indexed: 11/28/2022]
Abstract
AIMS To test whether recreational drug use (RDU) and sexualized drug use (SDU) changed in the Amsterdam area between 2008 and 2018 and quantify associations of SDU with condomless anal sex (CAS), recent human immunodeficiency virus (HIV) or sexually transmitted infections (STI) among human immunodeficiency virus (HIV)-negative men who have sex with men (MSM). DESIGN Open prospective cohort study. SETTING Public Health Service of Amsterdam, the Netherlands. PARTICIPANTS A total of 976 HIV-negative MSM, aged ≥ 18 years. MEASUREMENTS Self-reported RDU and sexual behaviour in the past 6 months. Laboratory-confirmed HIV and STI (chlamydia, gonorrhoea and syphilis). We studied: any RDU; any SDU (i.e. any RDU during sex); specific SDU (i.e. use of mephedrone, methamphetamine, gamma-hydroxybutyric acid/gamma-butyrolactone, ketamine, amphetamine, cocaine and/or ecstasy during sex); use of individual drugs; and use of individual drugs during sex. We evaluated changes over calendar years in the proportion of individuals with these end-points [using logistic regression with generalized estimating equations (GEE)] and number of drugs (using negative binomial regression with GEE), adjusted for current age, country of birth and education level. FINDINGS Median age of participants in 2008 was 33.2 years (interquartile range = 27.8-40.1); 83.1% were born in the Netherlands. The proportion of any RDU increased from 67.2% in 2008 to 69.5% in 2018 [adjusted odds ratio (aOR) = 1.25; 95% confidence interval (CI) = 1.03-1.51]. Any SDU increased from 53.8% in 2008 to 59.8% in 2013 (aOR = 1.23; 95% CI = 1.07-1.42) and remained stable afterwards. Specific SDU increased from 25.0% in 2008 to 36.1% in 2018 (aOR = 2.10; 95% CI = 1.71-2.58). The average number of drugs used increased for those reporting any RDU, any SDU and specific SDU (all P < 0.05. Among those engaging in sex, any SDU was associated with CAS (aOR = 1.36; 95% CI = 1.19-1.55), HIV (aOR = 5.86; 95% CI = 2.39-14.4) and STI (aOR = 2.31; 95% CI = 1.95-2.73). Specific SDU was associated with CAS (aOR = 1.58; 95% CI = 1.37-1.81), HIV (aOR = 6.30; 95% CI = 3.28-12.1) and STI (aOR = 2.15; 95% CI = 1.81-2.55). CONCLUSIONS Among human immunodeficiency virus (HIV)-negative men who have sex with men in Amsterdam, recreational drug use, including sexualized drug use, increased between 2008 and 2018. Sexualized drug use was strongly associated with condomless anal sex, HIV and sexually transmitted infections.
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Affiliation(s)
- Liza Coyer
- Department of Infectious DiseasesPublic Health Service of AmsterdamAmsterdamthe Netherlands
| | - Anders Boyd
- Department of Infectious DiseasesPublic Health Service of AmsterdamAmsterdamthe Netherlands,Stichting HIV MonitoringAmsterdamthe Netherlands
| | - Udi Davidovich
- Department of Infectious DiseasesPublic Health Service of AmsterdamAmsterdamthe Netherlands,Department of Social PsychologyUniversity of AmsterdamAmsterdamthe Netherlands
| | - Ward P. H. van Bilsen
- Department of Infectious DiseasesPublic Health Service of AmsterdamAmsterdamthe Netherlands
| | - Maria Prins
- Department of Infectious DiseasesPublic Health Service of AmsterdamAmsterdamthe Netherlands,Department of Internal Medicine, Division of Infectious Diseases, Amsterdam Infection and Immunity (AII), Amsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - Amy Matser
- Department of Infectious DiseasesPublic Health Service of AmsterdamAmsterdamthe Netherlands
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Cheng CY, Ku SY, Lin YC, Chen CP, Cheng SH, Lin IF. Incidence and Risk Factors of Reinfection with HCV after Treatment in People Living with HIV. Viruses 2022; 14:v14020439. [PMID: 35216032 PMCID: PMC8874599 DOI: 10.3390/v14020439] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/08/2022] [Accepted: 02/17/2022] [Indexed: 02/04/2023] Open
Abstract
Infection with hepatitis C virus (HCV) does not induce protective immunity, and re-exposure to HCV can reinfect the population engaging in high-risk behavior. An increasing incidence of acute hepatitis C infection in people living with HIV (PLWH) has been described in recent years. This retrospective cohort study was conducted in PLWH who completed HCV therapy between June 2009 and June 2020 at an HIV care hospital, to analyze their basic characteristics and risky behavior. Of 2419 patients, 639 were diagnosed with HCV infection and 516 completed the HCV therapy with a sustained virologic response. In total, 59 patients (11.4%) were reinfected with acute hepatitis C, and the median time to reinfection was 85.3 weeks (IQR: 57–150). The incidence of reinfection was 6.7 cases/100 person-years. The factors associated with reinfection were being male (AHR, 8.02; 95% CI 1.08–59.49), DAA (direct-acting antiviral) treatment (AHR, 2.23; 95% CI 1.04–4.79), liver cirrhosis (AHR, 3.94; 95% CI 1.09–14.22), heroin dependency (AHR: 7.41; 95% CI 3.37–14.3), and HIV viral loads <50 copies/mL at the follow-up (AHR: 0.47, 95% CI 0.24–0.93) in the subgroup of people who inject drugs (PWID). Amphetamine abuse (AHR: 20.17; 95% CI 2.36–172.52) was the dominant factor in the subgroup of men who have sex with men (MSM). Our study suggests that education and behavioral interventions are needed in this population to prevent reinfection.
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Affiliation(s)
- Chien-Yu Cheng
- Department of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan City 330, Taiwan; (C.-Y.C.); (Y.-C.L.); (C.-P.C.); (S.-H.C.)
- Institute of Public Health, School of Medicine, National Yang-Ming Chiao Tung University, Taipei City 112, Taiwan
| | - Shin-Yen Ku
- Department of Nursing, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan City 330, Taiwan;
| | - Yi-Chun Lin
- Department of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan City 330, Taiwan; (C.-Y.C.); (Y.-C.L.); (C.-P.C.); (S.-H.C.)
| | - Cheng-Pin Chen
- Department of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan City 330, Taiwan; (C.-Y.C.); (Y.-C.L.); (C.-P.C.); (S.-H.C.)
- School of Clinical Medicine, National Yang-Ming Chiao Tung University, Taipei City 112, Taiwan
| | - Shu-Hsing Cheng
- Department of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan City 330, Taiwan; (C.-Y.C.); (Y.-C.L.); (C.-P.C.); (S.-H.C.)
- School of Public Health, Taipei Medical University, Taipei City 110, Taiwan
| | - I-Feng Lin
- Institute of Public Health, School of Medicine, National Yang-Ming Chiao Tung University, Taipei City 112, Taiwan
- Correspondence:
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Adler Z, Fitzpatrick C, Broadwell N, Churchill D, Richardson D. Chemsex and antiretroviral prescribing in an HIV cohort in Brighton, UK. HIV Med 2022; 23:797-800. [PMID: 35048490 DOI: 10.1111/hiv.13239] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 12/27/2021] [Accepted: 01/06/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Chemsex has been reported among men who have sex with men (MSM) living with HIV. There have been concerns about potentially harmful drug-drug interactions between chemsex drugs and antiretroviral therapy (ritonavir and cobicistat). We aimed to describe the prevalence and patterns of chemsex users in our HIV clinic population and to evaluate antiretroviral prescribing among chemsex users. METHODS We undertook a cross-sectional study of patients attending our HIV clinic between January 2019 and December 2020. We collected data on patients who disclosed recent recreational drug use including chemsex in the previous 3 months. RESULTS In all, 2202/2501 (88%) patients were asked about recreational drug use and 514 (23%) disclosed recreational drug use. Eighty-two (4%) of these disclosed recent chemsex; 73 (89%) used crystal methamphetamine, 51 (62%) used gamma-hydroxybutyrate (GHB)/gamma-butyrolactone (GBL), 55 (67%) reported poly-drug use and 63 (76%) reported injecting drug use. The chemsex users were all cis-male MSM and were significantly older (53 vs. 46 years, p < 0.0001), and more likely to have had previous syphilis (73% vs. 28%, p < 0.0001) than patients reporting non-chemsex drug use. All chemsex users were prescribed antiretrovirals and 74 (90%) had an undetectable HIV viral load; 31 (38%) patients were taking either ritonavir (N = 12) or cobicistat (N = 19) as part of their antiretroviral regimen and this was similar to other patients attending for HIV care [31/82 (38%) vs. 768/2419 (31%), p = 0.25]. CONCLUSIONS The prevalence of chemsex users among our HIV clinic attendants is 4%, and 38% of these were prescribed either ritonavir or cobicistat. Chemsex use should be a factor in antiretroviral therapy decision-making to avoid potential harm.
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Affiliation(s)
- Zoe Adler
- Unversity Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | | | | | | | - Daniel Richardson
- Unversity Hospitals Sussex NHS Foundation Trust, Brighton, UK.,Brighton & Sussex Medical School, Brighton, UK
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Smiles C, O’Donnell A, Jackson K. Needle exchange practitioners accounts of delivering harm reduction advice for chemsex: implications for policy and practice. DRUGS: EDUCATION, PREVENTION AND POLICY 2022. [DOI: 10.1080/09687637.2022.2027345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Claire Smiles
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Amy O’Donnell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Katherine Jackson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Ye X, Li FR, Pan Q, Li Z, Yu GQ, Liu H, Liu J, Huai PC, Zhang FR. Prevalence and associated factors of sexually transmitted infections among methamphetamine users in Eastern China: a cross-sectional study. BMC Infect Dis 2022; 22:7. [PMID: 34983422 PMCID: PMC8725376 DOI: 10.1186/s12879-021-06987-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 12/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The reported incidence of sexually transmitted infections (STIs) in China has been increasing over the last decades, especially among drug users, which has become one of the main burdens of public health in China. This study was conducted to estimate the prevalence and associated factors of STIs among non-injecting methamphetamine (MA) users in Eastern China. METHODS A cross-sectional survey was conducted among 632 MA users in Eastern China in 2017. Demographic characteristics, sexual behaviors, behaviors of MA use and sexual health knowledge were collected through questionnaire. First pass urine specimens were collected and detected for deoxyribonucleic acid (DNA) of Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) with Nucleic Acid Amplification Technology (NAAT), while blood specimens were collected and detected for antibodies of Human immunodeficiency virus (HIV), Herpes simplex virus type-2 (HSV-2), and syphilis with enzyme-linked immune sorbent assay (ELISA). RESULTS Among the 632 MA users, 464 (73.42%) were males, 60.92% were < 35 years of age, 546 (86.39%) were Shandong residents. 317 (50.16%, 95% CI 46.26-54.06%) participants were tested positive for at least one kind of STIs, including 242 (38.29%, 95% CI 34.50-42.08%) for HSV-2, 107 (16.93%, 95% CI 14.01-19.85%) for active syphilis, 46 (7.28%, 95% CI 5.25-9.31%) for treated syphilis, 40 (6.33%, 95% CI 4.43-8.23%) for CT, 6 (0.95%, 95% CI 0.19-1.71%) for HIV, and 3 (0.47%, 95% CI 0.06-1.00%) for NG infection. 99 (15.66%, 95% CI 12.83-18.49%) participants were co-infected with two kinds of STIs, including 91 (14.40%, 95% CI 11.66-17.14%) participants were co-infected with HSV-2 and syphilis. 14 (2.22%, 95% CI 1.07-3.37%) participants were co-infected with three kinds of STIs, and 4 HIV positive participants were co-infected with both syphilis and HSV-2. In the multiple logistic regression analysis, the results showed that females (adjusted OR [AOR] = 7.30, 95% CI 4.34-12.30) and individuals ≥ 35 years of age (AOR = 2.97, 95% CI 2.04-4.32) were more likely to test positive for STIs among MA users, whereas participants who acquired sexual health knowledge primarily from the Internet (AOR = 0.57, 95% CI 0.40-0.82) and those whose regular partners did not use drugs (AOR = 0.59, 95% CI 0.37-0.94) were less likely. CONCLUSIONS This study found that the prevalence of HSV-2 and syphilis are alarming high among non-injecting MA users in Shandong Province in Eastern China. The prevention and control intervention of STIs among MA users in Shandong were needed, especially on females and MA users ≥ 35 years of age.
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Affiliation(s)
- Xing Ye
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, Shandong, China
| | - Fu-Rong Li
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, Shandong, China
| | - Qing Pan
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, Shandong, China
| | - Zhen Li
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, Shandong, China
| | - Gong-Qi Yu
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, Shandong, China
| | - Hong Liu
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, Shandong, China
| | - Jian Liu
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, Shandong, China
| | - Peng-Cheng Huai
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, Shandong, China.
| | - Fu-Ren Zhang
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, Shandong, China
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Shrestha R, Fisher C, Wickersham JA, Khati A, Kim R, Azwa I, Mistler C, Goldsamt L. Privacy and Confidentiality Concerns Related to the Use of mHealth Apps for HIV Prevention Efforts Among Malaysian Men Who Have Sex With Men: Cross-sectional Survey Study. JMIR Form Res 2021; 5:e28311. [PMID: 34924355 PMCID: PMC8726055 DOI: 10.2196/28311] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 07/19/2021] [Accepted: 11/21/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The use of mobile health (mHealth), including smartphone apps, can improve the HIV prevention cascade for key populations such as men who have sex with men (MSM). In Malaysia, where stigma and discrimination toward MSM are high, the mHealth platform has the potential to open new frontiers for HIV prevention efforts. However, little guidance is available to inform researchers about privacy and confidentiality concerns unique to the development and implementation of app-based HIV prevention programs. OBJECTIVE Given the lack of empirical data in this area, we aim to understand the privacy and confidentiality concerns associated with participation in a hypothetical app-based research study for HIV prevention efforts. METHODS A cross-sectional, web-based survey was conducted between June and July 2020 among 355 Malaysian MSM. The survey included demographic and sexual health questions and a series of short videos describing a hypothetical app-based HIV prevention program, followed by questions related to privacy and confidentiality concerns in each step of the app-based program (ie, recruitment, clinical interaction, risk assessment, and weekly reminder). Multivariable logistic regression models were used to identify the correlates of willingness to use such an app-based program. RESULTS Most of the participants (266/355, 74.9%) indicated their willingness to participate in a hypothetical mHealth app-based HIV prevention program. Participants expressed concerns about privacy, confidentiality, data security, and risks and benefits of participating in all stages of the app-based HIV research process. Multivariate analyses indicated that participants who had a higher degree of perceived participation benefits (adjusted odds ratio [aOR] 1.873; 95% CI 1.274-2.755; P=.001) were more willing to participate. In contrast, participants who had increased concerns about app-based clinical interaction and e-prescription (aOR 0.610; 95% CI 0.445-0.838; P=.002) and those who had a higher degree of perceived risks of participating (aOR 0.731; 95% CI 0.594-0.899; P=.003) were less willing to participate. CONCLUSIONS Overall, our results indicate that mHealth app-based HIV prevention programs are acceptable for future research on Malaysian MSM. The findings further highlighted the role of privacy and confidentiality, as well as the associated risks and benefits associated with participation in such a program. Given the ever-evolving nature of such technological platforms and the complex ethical-legal landscape, such platforms must be safe and secure to ensure widespread public trust and uptake.
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Affiliation(s)
- Roman Shrestha
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
| | - Celia Fisher
- Center for Ethics Education, Fordham University, New York, NY, United States
| | | | - Antoine Khati
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
| | - Rayne Kim
- Department of Internal Medicine, Yale University, New Haven, CT, United States
| | - Iskandar Azwa
- Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Colleen Mistler
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
| | - Lloyd Goldsamt
- Rory Meyers School of Nursing, New York University, New York, NY, United States
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Castro-Granell V, Garin N, Jaén Á, Casado JL, Leal L, Cenoz S, Fuster-RuizdeApodaca MJ. Recreational Drug Use in People Living with HIV in Spain: Factors Associated with Drug Use and the Impact on Clinical Outcomes. AIDS Behav 2021; 25:3883-3897. [PMID: 33932187 PMCID: PMC8602223 DOI: 10.1007/s10461-021-03271-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2021] [Indexed: 01/28/2023]
Abstract
We analysed the impact of recreational drug use (RDU) on different outcomes in people living with HIV (PLHIV). A multicentre retrospective cohort study was performed with two cohorts of PLHIV included: people using recreational drugs (PURD) vs. people not using recreational drugs (PNURD). Overall, 275 PLHIV were included. RDU was associated with men having sex with men (OR 4.14, 95% CI [1.14, 5.19]), previous sexually transmitted infections (OR 4.00, 95% CI [1.97, 8.13]), and current smoking (OR 2.74, 95% CI [1.44, 5.19]). While the CD4/CD8 ratio increased amongst PNURD during the follow-up year, it decreased amongst PURD (p = 0.050). PURD presented lower scores of self-reported and multi-interval antiretroviral adherence (p = 0.017, and p = 0.006, respectively), emotional well-being (p < 0.0001), and regular follow-up (p = 0.059), but paid more visits to the emergency unit (p = 0.046). RDU worsens clinical, immunological, and mental health outcomes amongst PLHIV.
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Affiliation(s)
- Vanessa Castro-Granell
- Doctoral Programme in Pharmacy, Granada University, Granada, Spain
- Department of Pharmacy, Hospital Marina Baixa, Av. Alcalde En Jaume Botella Mayor, 7, 03570 Villajoyosa, Alicante Spain
| | - Noé Garin
- Department of Pharmacy, Hospital Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- School of Health Science Blanquerna, Universitat Ramon Llull, Barcelona, Spain
| | - Ángeles Jaén
- Research Unit, Fundació Docència i Recerca mutua Terrassa. Universidad de Barcelona, Terrassa, Barcelona Spain
| | - José Luis Casado
- Department of Infectious Diseases, Hospital Ramón y Cajal, Madrid, Spain
| | - Lorna Leal
- Infectious Diseases-HIV Unit, Hospital Clínic Barcelona- IDIBAPS, Barcelona, Spain
| | - Santiago Cenoz
- Medical Department, ViiV Healthcare, Tres Cantos, Madrid Spain
| | - María José Fuster-RuizdeApodaca
- Spanish Interdisciplinary AIDS Society (Sociedad Española Interdisciplinaria del Sida, SEISIDA), Madrid, Spain
- Department of Social and Organizational Psychology, Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
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Castro-Granell V, Garin N, Jaén Á, Cenoz S, Galindo MJ, Fuster-RuizdeApodaca MJ. Prevalence, beliefs and impact of drug-drug interactions between antiretroviral therapy and illicit drugs among people living with HIV in Spain. PLoS One 2021; 16:e0260334. [PMID: 34797882 PMCID: PMC8604370 DOI: 10.1371/journal.pone.0260334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 11/08/2021] [Indexed: 11/28/2022] Open
Abstract
Drug use implies important challenges related to HIV management, particularly due to an increased risk of potential interactions between antiretroviral therapy (ART) and illicit drugs (pDDIs). This study analyses the prevalence and severity of pDDIs among people living with HIV (PLHIV). It also explores their awareness of pDDIs and their beliefs about the toxicity that they may cause, as well as the impact of pDDIs on selected health variables. We conducted an on-line cross-sectional survey across 33 Spanish hospitals and NGOs to collect demographics and clinical data. pDDIs were checked against the Interaction Checker developed by Liverpool University. The sample of the present study was composed of 694 PLHIV who used illicit drugs. They represented 49.5% of the 1,401 PLHIV that participated in the survey. After excluding 38 participants due to lack of information on their ART or illicit drug use, 335 (51.1%) participants consuming drugs presented with some potentially significant pDDIs between their ART and illicit drugs, with a mean of 2.1±1.7 (1–10) pDDIs per patient. The drugs most frequently involved in pDDIs were cocaine, cannabis, MDMA and nitrates ("poppers"). The prevalence of pDDIs across ART regimens was: protease inhibitors (41.7%); integrase inhibitor-boosted regimens (32.1%), and non-nucleoside reverse transcriptase inhibitors (26.3%). An awareness of pDDIs and beliefs about their potential toxicity correlated positively with intentional non-adherence (p<0.0001). Participants with pDDIs exhibited a higher prevalence of intentional non-adherence (2.19±1.04 vs. 1.93±0.94; p = 0.001). The presence of pDDIs was not associated with poorer results in the clinical variables analysed. A significant proportion of PLHIV who use drugs experience pDDIs, thereby requiring close monitoring. pDDIs should be considered in the clinical management of HIV patients. Adequate information about pDDIs and indicators about how to manage ART when PLHIV use drugs could improve ART non-adherence.
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Affiliation(s)
- Vanessa Castro-Granell
- Doctoral Programme in Pharmacy, Granada University, Granada, Spain
- Department of Pharmacy, Hospital Marina Baixa, Villajoyosa, Alicante, Spain
- * E-mail: ,
| | - Noé Garin
- Department of Pharmacy, Hospital Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de salud Mental (CIBERSAM), Madrid, Spain
- School of Health Science Blanquerna, Universitat Ramon Llull, Barcelona, Spain
| | - Ángeles Jaén
- Research Unit, Fundació Docència i Recerca Mutua Terrassa, Terrassa, Universidad de Barcelona, Barcelona, Spain
| | - Santiago Cenoz
- Medical Department, ViiV Healthcare, Tres Cantos, Madrid, Spain
| | - María José Galindo
- Spanish Interdisciplinary AIDS Society (Sociedad Española Interdisciplinaria del Sida, SEISIDA), Madrid, Spain
- Department of Infectious Diseases, Hospital Clínico Universitario, Valencia, Spain
| | - María José Fuster-RuizdeApodaca
- Spanish Interdisciplinary AIDS Society (Sociedad Española Interdisciplinaria del Sida, SEISIDA), Madrid, Spain
- Department of Social and Organizational Psychology, Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
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Norman T, Bourne A, Power J, Meléndez-Torres GJ. Non-prescription drug use among HIV positive gay and bisexual men in Australia: A latent class analysis and comparison of health and well-being. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 100:103526. [PMID: 34801816 DOI: 10.1016/j.drugpo.2021.103526] [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: 07/16/2021] [Revised: 10/01/2021] [Accepted: 10/29/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Establishing typologies of drug use among gay and bisexual men who have sex with men (GBMSM) who are living with HIV, as well as differences in health outcomes between them, is important in addressing health inequalities within this population. We sought to determine how use of non-prescription drugs is clustered for these individuals and to establish differences in their broader health and well-being, including STI diagnosis, mental health, and physical health. METHOD We examined past-year drug use reported by 747 GBMSM in Australia as part of the HIV Futures 8 survey, a large cross-sectional survey of people living with HIV. We tested between two and five latent class models of specific drug use and conducted cross-class comparisons of past-year STI diagnosis and self-reported mental and physical health. RESULTS We identified four distinct drug use typologies: 'chemsex-related use', 'minimal use', 'analgesic and sedative use', and 'diverse use'. The 'chemsex use' and 'diverse use' classes had a markedly higher likelihood of STI diagnosis relative to the other two classes, while the 'analgesic and sedative use' class reported markedly poorer physical and mental health scores than the other classes. CONCLUSIONS While GBMSM living with HIV in Australia have higher rates of drug use compared to other GBMSM, and the general population, our analysis indicates that patterns of drug use are not uniform within this group. Specific patterns of drug use are related to distinct health inequalities, and this should be accounted for when addressing the needs of men who use drugs differently.
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Affiliation(s)
- Thomas Norman
- Australian Research Centre in Sex, Health and Society, La Trobe University, Victoria, Australia; Centre for Alcohol Policy Research, La Trobe University, Victoria, Australia.
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Victoria, Australia; Kirby Institute, UNSW Sydney, Australia
| | - Jennifer Power
- Australian Research Centre in Sex, Health and Society, La Trobe University, Victoria, Australia
| | - G J Meléndez-Torres
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
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Firkey M, Sheinfil A, Ramos J, Woolf-King SE. Cannabis and Alcohol Co-Use and Condomless Anal Sex Among Men Who have Sex with Men Living with HIV: An Event-Level Analysis. AIDS Behav 2021; 25:3770-3781. [PMID: 33733310 DOI: 10.1007/s10461-021-03228-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
Men who have sex with men (MSM) account for more than two thirds of new HIV diagnoses annually. Sexual behavior that increases risk for onward transmission of HIV is associated with both alcohol and cannabis use. However, little is known about the influence of cannabis and alcohol co-use on engagement in condomless anal sex (CAS). The current study explored daily associations between substance use and CAS among HIV-positive MSM using a 42-day timeline followback interview (N = 101). Generalized estimating equation (GEE) logistic regression models were used to examine the association between cannabis and alcohol co-use and CAS at the sexual event while controlling for study site, condition, adherence to antiretroviral therapy, sex-related alcohol expectancies, and partner type. Participants provided data for 1052 sexual activity days, 60.7% of which involved CAS. Of 638 CAS days, 9.1% involved no substances, 72.0% involved either cannabis or alcohol use, and 18.9% involved cannabis and alcohol co-use. Results indicated that the odds of engaging in CAS were higher for sexual events in which cannabis and alcohol co-use occurred (aOR 2.98; 95% CI 1.27, 6.97) compared to events in which no substance use occurred (p = 0.012), but this relationship was no longer significant when cannabis and alcohol co-use was compared to single substance use (aOR 1.57; 95% CI 0.85, 2.90; p = 0.15). Future research should identify specific substance use (e.g., quantity) and partner characteristics (e.g., level of intoxication) that may uniquely influence the relationship between cannabis and alcohol co-use and condomless sex.
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Comorbid Communicable Diseases of Substance Abuse in Thailand: A 5-Year Retrospective Study. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2021. [DOI: 10.1097/ipc.0000000000001010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cain D, Samrock S, Jones SS, Jimenez RH, Dilones R, Tanney M, Outlaw A, Friedman L, Naar S, Starks TJ. Marijuana and illicit drugs: Correlates of condomless anal sex among adolescent and emerging adult sexual minority men. Addict Behav 2021; 122:107018. [PMID: 34171584 DOI: 10.1016/j.addbeh.2021.107018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/26/2021] [Accepted: 06/09/2021] [Indexed: 11/28/2022]
Abstract
The association between "illicit drugs" (e.g., cocaine/crack, methamphetamine, gamma-hydroxybutyrate-GHB, ketamine, and ecstasy) and condomless anal sex (CAS) with casual partners is well established for sexual minority men (SMM). Recent evidence from adult SMM has indicated that marijuana is associated with the occurrence of CAS with casual partners above and beyond illicit drug use. The purpose of the current study was to evaluate associations between CAS and the use of marijuana and illicit drugs in a sample of young SMM (aged 15-24). Participants (n = 578) completed an online survey assessing demographics, current PrEP prescription, age, marijuana use, as well as drug use and sexual behavior in the past 90 days. A hurdle model simultaneously predicted the occurrence of CAS as well as the frequency of CAS among those reporting it. Illicit drug use was associated with both the occurrence (OR = 2.26; p = .01) and frequency of CAS (RR = 1.63; p = .02). In contrast, marijuana use was associated with the occurrence (OR = 1.69; p = .01), but not the frequency of CAS (RR = 1.07; p = .74). Findings mirror recent observations in large samples of adult SMM. While the effect size of marijuana is more modest than illicit drug use, marijuana does have significant and unique associations with the occurrence of CAS. HIV prevention services for young SMM may therefore benefit from assessing and addressing marijuana use in the context of HIV sexual behavior.
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Affiliation(s)
- Demetria Cain
- Department of Psychology, Hunter College of the City University of New York (CUNY), 142 W. 36th Street, New York, NY 10018, USA.
| | - Steven Samrock
- Department of Psychology, Hunter College of the City University of New York (CUNY), 142 W. 36th Street, New York, NY 10018, USA.
| | - S Scott Jones
- Department of Psychology, Hunter College of the City University of New York (CUNY), 142 W. 36th Street, New York, NY 10018, USA.
| | - Ruben H Jimenez
- Department of Psychology, Hunter College of the City University of New York (CUNY), 142 W. 36th Street, New York, NY 10018, USA.
| | - Rafael Dilones
- Department of Psychology, Hunter College of the City University of New York (CUNY), 142 W. 36th Street, New York, NY 10018, USA.
| | - Mary Tanney
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA.
| | - Angulique Outlaw
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, 60 West Hancock, Detroit, MI 48201 USA.
| | - Lawrence Friedman
- Department of Pediatrics, University of Miami, 1580 Northwest 10th Avenue, Miami, FL 33136, USA.
| | - Sylvie Naar
- Center for Translational Behavioral Science, 12236 Florida State University (FSU) College of Medicine, Tallahassee, FL, USA.
| | - Tyrel J Starks
- Department of Psychology, Hunter College of the City University of New York (CUNY), 142 W. 36th Street, New York, NY 10018, USA; Doctoral Program in Health Psychology and Clinical Science, Graduate Center of CUNY, 695 Park Avenue, New York, NY 10065, USA.
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Jones TPW, Lampe FC, Arenas-Pinto A, Smith C, McDonnell J, Haddow L, Johnson M, Yousef E, Lascar M, Maria Geretti A, Sherr L, Collins S, Phillips AN, Rodger AJ. Alcohol, smoking, recreational drug use and association with virological outcomes among people living with HIV: cross-sectional and longitudinal analyses. HIV Med 2021; 23:209-226. [PMID: 34634176 PMCID: PMC9293433 DOI: 10.1111/hiv.13156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 07/23/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVES There is increasing evidence to suggest that people living with HIV (PLWH) have significant morbidity from alcohol, recreational drug use and cigarette smoking. Our aim was to report associations of these factors with antiretroviral therapy (ART) non-adherence, viral non-suppression and subsequent viral rebound in PLWH. METHODS The Antiretroviral Sexual Transmission Risk and Attitudes (ASTRA) study recruited PLWH attending eight outpatient clinics in England between February 2011 and December 2012. Data included self-reported excessive drinking (estimated consumption of > 20 units of alcohol/week), alcohol dependency (CAGE score ≥ 2 with current alcohol consumption), recreational drug use (including injection drug use in the past 3 months), and smoking status. Among participants established on ART, cross-sectional associations with ART non-adherence [missing ≥2 consecutive days of ART on ≥2 occasions in the past three months] and viral-non suppression [viral load (VL) > 50 copies/mL] were assessed using logistic regression. In participants from one centre, longitudinal associations with subsequent viral rebound (first VL > 200 copies/mL) in those on ART with VL ≤ 50 copies/mL at baseline were assessed using Cox regression during a 7-year follow-up. RESULTS Among 3258 PLWH, 2248 (69.0%) were men who have sex with men, 373 (11.4%) were heterosexual men, and 637 (19.6%) were women. A CAGE score ≥ 2 was found in 568 (17.6%) participants, 325 (10.1%) drank > 20 units/week, 1011 (31.5%) currently smoked, 1242 (38.1%) used recreational drugs and 74 (2.3%) reported injection drug use. In each case, prevalence was much more common among men than among women. Among 2459 people on ART who started at least 6 months previously, a CAGE score ≥ 2, drinking > 20 units per week, current smoking, injection and non-injection drug use were all associated with ART non-adherence. After adjusting for demographic and socioeconomic factors, CAGE score ≥ 2 [adjusted odds ratio (aOR) = 1.52, 95% confidence interval (CI): 1.09-2.13], current smoking (aOR = 1.58, 95% CI: 1.10-2.17) and injection drug use (aOR = 2.11, 95% CI: 1.00-4.47) were associated with viral non-suppression. During follow-up of a subset of 592 people virally suppressed at recruitment, a CAGE score ≥ 2 [adjusted hazard ratio (aHR) = 1.66, 95% CI: 1.03-2.74], use of 3 or more non-injection drugs (aHR = 1.82, 95% CI: 1.12-3.57) and injection drug use (aHR = 2.73, 95% CI: 1.08-6.89) were associated with viral rebound. CONCLUSIONS Screening and treatment for alcohol, cigarette and drug use should be integrated into HIV outpatient clinics, while clinicians should be alert to the potential for poorer virological outcomes.
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Affiliation(s)
| | - Fiona C Lampe
- Research Department of Infection & Population, University College London, London, UK
| | | | - Colette Smith
- Research Department of Infection & Population, University College London, London, UK
| | - Jeff McDonnell
- Research Department of Infection & Population, University College London, London, UK
| | - Lewis Haddow
- Research Department of Infection & Population, University College London, London, UK
| | | | - Elaney Yousef
- Brighton and Sussex University Hospitals, Brighton, UK
| | | | - Anna Maria Geretti
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Lorraine Sherr
- Research Department of Infection & Population, University College London, London, UK
| | | | - Andrew N Phillips
- Research Department of Infection & Population, University College London, London, UK
| | - Alison J Rodger
- Research Department of Infection & Population, University College London, London, UK
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Scheer JR, Clark KA, Maiolatesi AJ, Pachankis JE. Syndemic Profiles and Sexual Minority Men's HIV-Risk Behavior: A Latent Class Analysis. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:2825-2841. [PMID: 33483851 PMCID: PMC8295412 DOI: 10.1007/s10508-020-01850-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 09/14/2020] [Accepted: 09/23/2020] [Indexed: 05/10/2023]
Abstract
Syndemic theory posits that "syndemic conditions" (e.g., alcohol misuse, polydrug use, suicidality) co-occur among sexual minority men and influence HIV-risk behavior, namely HIV acquisition and transmission risk. To examine how four syndemic conditions cluster among sexual minority men and contribute to HIV-risk behavior, we conducted latent class analysis (LCA) to: (1) classify sexual minority men (n = 937) into subgroups based on their probability of experiencing each syndemic condition; (2) examine the demographic (e.g., race/ethnicity) and social status (e.g., level of socioeconomic distress) characteristics of the most optimally fitting four syndemic classes; (3) examine between-group differences in HIV-risk behavior across classes; and (4) use syndemic class membership to predict HIV-risk behavior with sexual minority men reporting no syndemic conditions as the reference group. The four classes were: (1) no syndemic, (2) alcohol misuse and polydrug use syndemic, (3) polydrug use and HIV syndemic, and (4) alcohol misuse. HIV-risk behavior differed across these latent classes. Demographic and social status characteristics predicted class membership, suggesting that syndemic conditions disproportionately co-occur in vulnerable subpopulations of sexual minority men, such as those experiencing high socioeconomic distress. When predicting HIV-risk behavior, men in the polydrug use and HIV syndemic class were more likely (Adjusted Risk Ratio [ARR] = 2.93, 95% CI: 1.05, 8.21) and men in the alcohol misuse class were less likely (ARR = 0.17, 95% CI: 0.07, 0.44) to report HIV-risk behavior than were men in the no syndemic class. LCA represents a promising methodology to inform the development and delivery of tailored interventions targeting distinct combinations of syndemic conditions to reduce sexual minority men's HIV-risk behavior.
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Affiliation(s)
- Jillian R Scheer
- Department of Psychology, Syracuse University, 414 Huntington Hall, Syracuse, NY, 13244, USA.
| | - Kirsty A Clark
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT, USA
| | - Anthony J Maiolatesi
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, USA
| | - John E Pachankis
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, USA
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Moltó J, Bailón L, Pérez-Mañá C, Papaseit E, Miranda C, Martín S, Mothe B, Farré M. Absence of drug-drug interactions between γ-hydroxybutyric acid (GHB) and cobicistat. J Antimicrob Chemother 2021; 77:181-184. [PMID: 34561695 DOI: 10.1093/jac/dkab359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/02/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Potential interactions between CYP3A4 inhibitors and γ-hydroxybutyric acid (GHB) have been suggested as a possible explanation for cases of GHB overdose in recent years among people living with HIV engaged in chemsex. Our objective was to assess the effect of cobicistat on the pharmacokinetics of GHB. METHODS Fifteen healthy adults were enrolled in this randomized, double-blind, placebo-controlled, two-arm, crossover clinical trial. Participants underwent two 5 day treatment periods with at least a 1 week washout period between them. In each treatment period, participants received cobicistat (150 mg q24h orally) or matched placebo. On day 5 of each treatment period, participants were given a single oral dose of GHB (25 mg/kg). Plasma concentrations of GHB, subjective effects, blood pressure, heart rate and oxygen saturation were monitored for 5 h after dosing. GHB pharmacokinetic and pharmacodynamic parameters were calculated for each participant during each study period by non-compartmental analysis and were compared using linear mixed-effects models. The study was registered at https://www.clinicaltrialsregister.eu (Eudra-CT number 2019-002122-71) and at https://clinicaltrials.gov (NCT04322214). RESULTS Ten participants completed the two study periods. No drug-related adverse events that necessitated subject withdrawal or medical intervention occurred during the study. Compared with placebo, none of the primary pharmacokinetic parameters of GHB was substantially changed by the administration of GHB with cobicistat. Similarly, no differences regarding subjective or physiological effects were observed when GHB was administered alone or with cobicistat. CONCLUSIONS Neither pharmacokinetic nor pharmacodynamic drug-drug interactions between cobicistat and GHB were identified in this study.
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Affiliation(s)
- José Moltó
- Department of Infectious Diseases, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Fundació Lluita contra la Sida, Badalona, Spain
| | - Lucía Bailón
- Department of Infectious Diseases, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Fundació Lluita contra la Sida, Badalona, Spain
| | - Clara Pérez-Mañá
- Department of Clinical Pharmacology, Hospital Universitari Germans Trias i Pujol and Institut de Recerca Germans Trias i Pujol (HUGTiP-IGTP), Badalona, Spain.,Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona (UAB), Cerdanyola del Vallés, Spain
| | - Ester Papaseit
- Department of Clinical Pharmacology, Hospital Universitari Germans Trias i Pujol and Institut de Recerca Germans Trias i Pujol (HUGTiP-IGTP), Badalona, Spain.,Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona (UAB), Cerdanyola del Vallés, Spain
| | | | - Soraya Martín
- Department of Clinical Pharmacology, Hospital Universitari Germans Trias i Pujol and Institut de Recerca Germans Trias i Pujol (HUGTiP-IGTP), Badalona, Spain
| | - Beatriz Mothe
- Department of Infectious Diseases, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Fundació Lluita contra la Sida, Badalona, Spain.,IrsiCaixa AIDS Research Institute-HIVACAT, Badalona, Spain.,Faculty of Medicine, University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain
| | - Magí Farré
- Department of Clinical Pharmacology, Hospital Universitari Germans Trias i Pujol and Institut de Recerca Germans Trias i Pujol (HUGTiP-IGTP), Badalona, Spain.,Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona (UAB), Cerdanyola del Vallés, Spain
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50
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Mizuno S, Ono S, Yasunaga H, Iwase H. Factors associated with methamphetamine use in Japanese people who died of unnatural causes: Analysis using forensic autopsy reports. Forensic Sci Int 2021; 327:110946. [PMID: 34464922 DOI: 10.1016/j.forsciint.2021.110946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/02/2021] [Accepted: 08/15/2021] [Indexed: 11/27/2022]
Abstract
This study aimed to examine factors related to methamphetamine use in Japanese people who died of unnatural causes. This study used a cross-sectional design. A total of 3343 forensic autopsy reports were obtained from two forensic medicine departments in the Kanto region of Japan. We classified the decedents who underwent forensic autopsies into methamphetamine/amphetamine (MA) and undetected (comparison) groups based on toxicological examination. We matched the decedents in the MA group with those in the comparison group at a 1:4 ratio based on sex and age. The variables, including gang members, criminal records, tattoos, body mass index, infections, concurrent psychotropic drug use, and cause of death, were compared between the groups. Of the 3343 decedents, we matched 109 in the MA group with 436 in the comparison group. Methamphetamine use was significantly associated with gang membership (13.8% vs. 3%, p < 0.001), criminal records unrelated to methamphetamine (47.7% vs. 13.8%, p < 0.001), tattoos (29.2% vs. 6.4%, p < 0.001), and hepatitis C virus infection (48.0% vs. 3.6%, p < 0.001). One-third of the patients in the MA group died from poisoning. This is the first study to show the physical and social characteristics associated with methamphetamine use in Japanese people who died of unnatural causes. Our results could be extended to people with methamphetamine use disorder at risk of death and enable the development of policies and practices to provide necessary intervention in a timely manner.
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Affiliation(s)
- Satomi Mizuno
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-0033, Japan.
| | - Sachiko Ono
- Department of Eat-loss Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-0033, Japan.
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-0033, Japan.
| | - Hirotaro Iwase
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-0033, Japan; Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba, Chiba Prefecture 260-8670, Japan.
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