Risk behaviors for sexually transmitted infections in noninjecting drug users: A cross-sectional study

Who attends a free sexual health center in Paris for HIV/STI screening? an observational study

BACKGROUND

A key-population approach to sexually transmitted disease prevention does not fully take into account the multidimensional nature of sexual risk behavior. Visits to sexual health centers for HIV/STI screening provide an opportunity to spread prevention messages and tools, but few data are available on patients' sexual and prevention behaviors. This study aimed to identify the profile of patients consulting for HIV/STI testing in a Parisian sexual health center.

METHODS

This observational study included 5,130 patients who attended the center for HIV/STI testing from August 2017 through January 2020 and completed a self-administered electronic questionnaire. Data were obtained from the consultation database and the questionnaire. The data included STI results, sociodemographic characteristics, sexual and prevention behaviors, as well as HIV knowledge. To identify homogeneous groups of patients regarding sexual risky behavior, we conducted a mixed approach including both a priori classification and agglomerative hierarchical clustering (AHC) based on multiple correspondence analysis (MCA). Sexual behaviors and substance use were included in the MCA.

RESULTS

Median age of patients was 26 years [Q1-Q3:23-32]. Seven clusters of patients were identified. Two clusters had a high HIV/STI positivity rate (15-19%) with very different profiles: cluster 1 included socially disadvantaged patients who had no health insurance and cluster 5 included 89% of men who have sex with men. Two clusters had an HIV/STI positivity rate corresponding to that observed in the overall study population (10-11%) but exhibited risky behaviors (cluster 7 with a high frequency of unprotected sexual intercourse, substance use, cannabis use and weekly binge drinking) or lack of knowledge on HIV (cluster 6 including 100% of patients having transactional sex).

CONCLUSIONS

The multidimensional approach demonstrated that both key populations and lower-risk populations visit a sexual health center. While several groups could benefit from tailored interventions, knowledge of HIV and its treatment should be enhanced for every patient visiting a sexual health center. To provide a complete offer in sexual health, patients' profiles and expectations need to be taken into account.

Impact of a Community Empowerment Intervention on Sexually Transmitted Infections Among Female Sex Workers in Baltimore, Maryland

BACKGROUND

Female sex workers ( FSWs) are vulnerable to a number of health issues, but often delay seeking health care due to structural barriers. Multiservice drop-in centers have been shown to increase FSW access to health services globally, but their impact on FSW in the United States is lacking. This study seeks to evaluate the effect of a community-level empowerment intervention (the multiservice drop-in SPARC center) on cumulative sexually transmitted infections (STIs) among FSW in a city in the United States.

METHODS

Between September 2017 and January 2019, 385 FSWs were recruited in Baltimore. Participants from areas served by SPARC were recruited to the intervention; other areas of Baltimore were the control. Follow-up occurred at 6, 12, and 18 months. The primary outcome is cumulative STI (ie, positive gonorrhea or chlamydia test at any follow-up). We tested effect modification by condomless sex with paying clients reported at baseline. Logistic regressions with propensity score weighting were used to estimate intervention effect, accounting for loss to follow-up, with bootstrap confidence intervals.

RESULTS

Participants completed 713 follow-up study visits (73%, 70%, 64% retention at 6, 12, and 18 months, respectively). Baseline STI prevalence was 28% and cumulative STI prevalence across follow-ups was 26%; these both did not differ between control and intervention communities in bivariate analyses. After adjusting for covariates, FSW in the intervention had a borderline-significant decrease in odds of cumulative STI compared with control (odds ratio, 0.61, P = 0.09 ) . There was evidence of effect modification by baseline condomless sex, such that FSW in the intervention who reported condomless sex had lower odds of cumulative STI compared with FSW in the control community who also reported baseline condomless sex (odds ratio, 0.29; P = 0.04).

CONCLUSIONS

Results demonstrate the value of a low-barrier, multiservice model on reducing STIs among the highest-risk FSW.Clinical Trial Number: NCT04413591.

Sexual health services in community pharmacy for women on opioid substitution treatment: a qualitative study

BACKGROUND

Women on opioid substitution treatment (WOST) are at heightened risk for the sexual transmission of sexually transmitted infections and blood-borne viruses. This study aimed to explore the opportunities to promote their sexual health in community pharmacies in UK.

METHODS

Semi-structured interviews were conducted with 20 WOST and 14 community pharmacists (CPs). A focus group was run with three CPs. Participants were recruited in drug services and a service for sex workers (WOST), and in CP. Data collection took place between October 2016 and September 2017. Data were analyzed using Framework Analysis and directed Content Analysis.

RESULTS

CPs could play a role in promoting sexual health among WOST. Sexual health screening, treatment and condom supply were suggested as potential ways of delivering pharmacy-based sexual health services. These services should be actively offered to WOST, delivered in a private space and free of cost. We identified several challenges to overcome in order to design and implement sexual health services for WOST in community pharmacies.

CONCLUSIONS

This study highlights the potentially key role CPs can have promoting sexual health and addressing health inequities among WOST. Improvements in pharmacists' training are required in order to address stigma towards WOST, and promote trust and positive rapport. Structural changes are also needed to broaden the services available for this group of women and improve their access to healthcare.

Relationship between social capital and heroin use behaviors among patients in methadone maintenance treatment in Sichuan Province, China: A cross-sectional study

Covertly using heroin during methadone maintenance treatment (MMT) is very common among heroin-dependent patients, which has posed threats to the physical health of heroin-dependent patients and social safety. Covertly using heroin may be influenced by many factors, especially social capital. Therefore, we aimed to investigate the relationship between behaviors of covertly using heroin during MMT and social capital heroin-dependent patients in Sichuan Province, China. A cross-sectional study was conducted between October and November 2018, with a total of 581 heroin-dependent patients participating in the study. In addition to socio-demographic characteristics and heroin use related behaviors, the questionnaire also included the measures of social capital: social network (SN), social support (SP), community participation (CP) and social trust (ST). Multivariate logistic regression analyses were used to estimate the association between different measures of social capital and heroin use. The prevalence of covertly using heroin of heroin during MMT was 31.0% among our participants in the 6 months before the study. After adjusting for socio-demographic factors and heroin-use related variables, SN (OR = 0.85, 95% CI: 0.76-0.95), SP (OR = 0.89, 95% CI: 0.83-0.95), and ST (OR = 0.88, 95% CI: 0.81-0.95) were significantly associated with heroin use. Results suggest that social capital may have a protective effect on behavior of covertly using heroin during MMT, which should be consider in the interventions for heroin-dependent patients, in order to reduce the incidence of heroin use during MMT as well as improve the compliance of MMT.