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Guerras JM, Hoyos J, Donat M, de la Fuente L, Palma Díaz D, Ayerdi O, García-Pérez JN, García de Olalla P, Belza MJ. Sexualized drug use among men who have sex with men in Madrid and Barcelona: The gateway to new drug use? Front Public Health 2022; 10:997730. [PMID: 36457321 PMCID: PMC9705339 DOI: 10.3389/fpubh.2022.997730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/25/2022] [Indexed: 11/17/2022] Open
Abstract
This original study compares the prevalences of drug use for any purpose and for sexualized drug use (SDU) among MSM. It also describes relevant characteristics of first SDU, analyzes to what extent SDU has been the first experience (the gateway) with different drugs by age and explores the correlates of SDU. Study participants included 2,919 HIV-negative MSM attending four HIV/STI diagnosis services in Madrid and Barcelona. They answered an online, self-administered questionnaire. Poisson regression models with robust variance were used. About 81.4% had ever used any drug, and 71.9% had done so in the last-12-months, while 56% had ever engaged in SDU, and 50% had done so in the last-12-months. Participants under 25 years old had the lowest prevalences of SDU, and the 25-39 age group the highest, except for Viagra, which was higher among those over age 40. The most frequently used drugs for first SDU were poppers (53.6%), cannabis (19.6%) and Viagra (12.2%). These drugs were also the most ever consumed for SDU. Among sexualized users, methamphetamine (78.3%) and Mephedrone (75.4%) were used always/most of the times for sex in the last-12-months. Around 72.2% of Mephedrone sexualized users and 69.6% of Methamphetamine vs 23.1% of ecstasy users' first consumption of these drugs involved use for sex. These drugs were provided to them free where they have sex for 66.8, 79.1, and 31.9%, respectively. On that occasion, 8.1% of Mephedrone, 6.8% of Methamphetamine and 18.4% of ecstasy users had sex only with steady partner; with 50.2, 56.2, and 26.2% respectively using a condom with any partner. SDU in the first use was associated with similar variables for recreational and chemsex drugs. The highest prevalence ratios were for having ever been penetrated by >20 men and having ever injected drugs. It can be concluded that the prevalence of SDU was more than half of the prevalence for any purpose. Thus SDU was the gateway to use for many drugs in an important proportion of users, who frequently consumed drugs that were free and had condomless anal sex with occasional and multiple partners. These circumstances were much more common for chemsex than for recreational drugs.
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Affiliation(s)
- Juan-Miguel Guerras
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, Spain,CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain
| | - Juan Hoyos
- Independent Researcher, Madrid, Spain,*Correspondence: Juan Hoyos
| | - Marta Donat
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, Spain,CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain
| | - Luis de la Fuente
- CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain,Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - David Palma Díaz
- CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain,Servicio de Epidemiología, Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - Oskar Ayerdi
- Centro Sanitario Sandoval, Instituto de Investigación Sanitaria San Carlos, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Patricia García de Olalla
- CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain,Servicio de Epidemiología, Agència de Salut Pública de Barcelona, Barcelona, Spain,Institut d'Investigació Biomèdica Sant Pau, Hospital Universitari Sant Pau, Barcelona, Spain
| | - María-José Belza
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, Spain,CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain
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Guerras JM, Hoyos J, de la Fuente L, Donat M, Pulido J, Sordo L, García de Olalla P, Belza MJ. Awareness and Use of HIV Self-Testing Among Men Who Have Sex With Men Remains Low in Spain 2 Years After Its Authorization. Front Public Health 2022; 10:888059. [PMID: 35784245 PMCID: PMC9247638 DOI: 10.3389/fpubh.2022.888059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/16/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives HIV self-testing has been available in Spain since 2017 as a diagnostic tool to promote earlier diagnosis. We aimed to assess awareness and previous use of HIV self-testing in a sample of men who have sex with men (MSM) recruited online more than 2 years after its legal authorization in Spain. Methods We analyzed 5,492 MSM recruited between May and July 2020 in gay dating apps/websites and other social networks. We estimated the proportion of participants who were aware of the existence of HIV self-testing and the proportion who reported previous use. To identify factors associated with both outcomes we built two Poisson regression models. Among those who reported previous use we described several aspects related to their last self-test. Results Awareness of HIV self-test was reported by 29.7% and its previous use by 5% of participants. Awareness was independently associated with recruitment in gay dating apps/websites, being ≥40 years old, born in Spain-other European countries, having higher educational level, living in medium-small municipalities and living sex life openly. Independent associations were also found with having received a sexually transmitted infection diagnosis (STI) or an HIV negative test in the last 12 months, and being HIV positive. Use was significantly higher among participants who were paid for sex or diagnosed with an STI in the last 12 months and who received their last HIV test in the preceding year. Self-testing occurred recently, with kits acquired at pharmacies and carried out alone. Conclusion Awareness and use probably have not increased sufficiently in order to make a relevant impact to the promotion of early HIV diagnosis. Additional efforts, mainly focused on less favored MSM, should be made to take better advantage of the possibilities offered by this testing option.
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Affiliation(s)
- Juan-Miguel Guerras
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
- CIBER Epidemiologia y Salud Pública, Madrid, Spain
| | - Juan Hoyos
- Independent Researcher, Madrid, Spain
- *Correspondence: Juan Hoyos
| | - Luis de la Fuente
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
- CIBER Epidemiologia y Salud Pública, Madrid, Spain
| | - Marta Donat
- CIBER Epidemiologia y Salud Pública, Madrid, Spain
- Departamento de epidemiología y bioestadística, Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, Spain
| | - José Pulido
- CIBER Epidemiologia y Salud Pública, Madrid, Spain
- Departamento de Salud Pública y Materno-Infantil, Universidad Complutense de Madrid, Madrid, Spain
| | - Luis Sordo
- CIBER Epidemiologia y Salud Pública, Madrid, Spain
- Departamento de Salud Pública y Materno-Infantil, Universidad Complutense de Madrid, Madrid, Spain
| | - Patricia García de Olalla
- CIBER Epidemiologia y Salud Pública, Madrid, Spain
- Servicio de Epidemiología, Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - María-José Belza
- CIBER Epidemiologia y Salud Pública, Madrid, Spain
- Departamento de epidemiología y bioestadística, Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, Spain
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Guerras JM, Belza MJ, Fuster MJ, de la Fuente L, García de Olalla P, Palma D, García-Pérez JN, Hoyos J. Knowledge and Prior Use of HIV Self-Testing in Madrid and Barcelona among Men Who Have Sex with Men More than One Year after Its Legal Authorization in Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031096. [PMID: 35162118 PMCID: PMC8834423 DOI: 10.3390/ijerph19031096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 01/25/2023]
Abstract
This study assessed the knowledge and prior use of HIV self-testing in a sample of men who have sex with men (MSM) recruited in a sexual health clinic and two community-based testing sites in Madrid and Barcelona, >12 months after its legal authorization. Between March 2019 and December 2020, we recruited 2044 MSM. Participants completed a self-administered questionnaire while waiting to be tested for HIV and other STIs. We built two Poisson regression models to assess factors associated with prior knowledge and with use. Among those who had used self-testing in the past we assessed frequency of use and several aspects related to the last testing episode. The proportion of participants that knew about the existence of self-testing and had already used it was of 26.3% and 5.1% respectively. Both, knowledge and use were independently associated with being born in Spain or other western European countries, university education and more recent HIV testing. Additionally, knowledge was associated with older age, having a more favorable economic situation, and not living sexuality in total secrecy. Use was also associated with having received money in exchange for sex. Most (69.5%) reported having self-tested once, 64.8% had self-tested <12 months ago, 63.8% self-tested alone and 71.4% acquired the kit at a pharmacy over the counter. In spite of its authorization and becoming legally available, knowledge and use of HIV self-testing remain low among MSM attending sites specialized in the diagnosis of HIV and other STIs. When designing scale-up strategies, lower levels of knowledge and use in less favored subgroups of MSM need to be factored in.
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Affiliation(s)
- Juan-Miguel Guerras
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.-M.G.); (L.d.l.F.)
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (P.G.d.O.); (D.P.)
| | - María-José Belza
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (P.G.d.O.); (D.P.)
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence:
| | - María-José Fuster
- Sociedad Española Interdisciplinaria del SIDA, SEISIDA, 28036 Madrid, Spain;
- Departamento de Psicología Social y de las Organizaciones, Universidad Nacional de Educación a Distancia, 28040 Madrid, Spain
| | - Luis de la Fuente
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.-M.G.); (L.d.l.F.)
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (P.G.d.O.); (D.P.)
| | - Patricia García de Olalla
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (P.G.d.O.); (D.P.)
- Servicio de Epidemiología, Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain
| | - David Palma
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (P.G.d.O.); (D.P.)
- Servicio de Epidemiología, Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain
| | | | - Juan Hoyos
- Independent Researcher, 28013 Madrid, Spain;
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Comparison of Polydrug Use Prevalences and Typologies between Men Who Have Sex with Men and General Population Men, in Madrid and Barcelona. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111609. [PMID: 34770122 PMCID: PMC8583212 DOI: 10.3390/ijerph182111609] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 10/27/2021] [Accepted: 11/03/2021] [Indexed: 12/22/2022]
Abstract
This study compares the prevalence of drug use and the typologies of polydrug use (PDU) in men who have sex with men (MSM) and general population men (GPM). Participants were men aged 16–64, living in the provinces of Madrid and Barcelona: 1720 were recruited in a GPM survey, and 2658 were HIV-negative MSM from HIV/STIs diagnosis services. Lifetime and last-year prevalence of drug use and prevalence ratios (PRs) of MSM to GPM for the different drugs were calculated using Poisson regression. Latent class analysis (LCA) was performed to identify typologies of PDU. Lifetime use of the drugs considered was higher in MSM, and even higher for drug use in the last-year: PRs for cannabis, hallucinogens and cocaine ranged from 2–5; for amphetamine, ecstasy and methamphetamine 12–16; and above 60 for ketamine, GHB/GBL, inhalants and mephedrone. In the LCA for lifetime PDU four classes arose from the GPM (No-PDU (79.6%); Conventional PDU (13.8%); Intensive conventional PDU (4.9%); Heavy PDU (1.8%)) and four among MSM (No-PDU (57.7%); Conventional PDU plus poppers (18.8%); PDU preferring chemsex drugs (6.4%); Heavy PDU (17.2%)). For PDU during the last-year, three classes arose in the GPM: No-PDU (94.7%); Conventional PDU (4.3%); Heavy PDU (0.9%). For MSM, we identified four classes: No-PDU (64.7%); Conventional PDU plus poppers (15.6%); PDU preferring chemsex drugs (6.2%); Heavy PDU (13.5%). MSM should be considered a priority group for the prevention of the use of all drugs but the heterogeneity of PDU typologies regarding users’ preference towards conventional and/or sexualised drugs needs to be taken into account.
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Guerras JM, García de Olalla P, Belza MJ, de la Fuente L, Palma D, Del Romero J, García-Pérez JN, Hoyos J. Sexualized drug injection among men who have sex with men in Madrid and Barcelona as the first episode of drug injecting. Harm Reduct J 2021; 18:86. [PMID: 34362402 PMCID: PMC8344139 DOI: 10.1186/s12954-021-00531-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/27/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND We estimate the prevalence of drug injection, the variables associated with having ever injected and the proportion of ever injectors whose first drug injection was for having sex; we describe the first drug injection episode, analyze the drugs most frequently injected and estimate the prevalence of risky injecting behaviors. METHODS The participants were 3387 MSM without a previous HIV diagnosis attending four HIV/STI diagnosis services in Madrid and Barcelona. Lifetime prevalence and prevalence ratios (PRs) by different factors were calculated using Poisson regression models with robust variance. We compared the characteristics of first drug injection episode, lifetime injection and risky injecting behaviors of those whose first injection was for sex (FIS) with those whose was not (non-FIS). RESULTS Lifetime prevalence of injection was 2.1% (CI 1.7-2.7). In the multivariate analysis, it was strongly associated with having been penetrated by more than five men in the last 12 months (aPR = 10.4; CI 2.5-43.4) and having met most of their partners at private parties (aPR = 7.5; CI 4.5-12.3), and less strongly with other factors. Of those who had ever injected drugs, 81.9% injected for sex the first time they injected drugs (FIS). At first injection, FIS participants had a mean age of 31 years, 62.7% used mephedrone and 32.2% methamphetamine on that occasion. Of this FIS group 39.0% had ever shared drugs or equipment and 82.6% had always shared for sex. Some 30.8% of non-FIS reported having also injected drugs for sex later on. CONCLUSIONS Only two out of a hundred had ever injected, most to have sex and with frequent drug or injecting equipment sharing. Injecting for sex is the most common first episode of drug injection and is the most efficient risky behavior for the transmission of HIV, hepatitis B or C and other blood-borne infections. MSM participating in private parties should be considered a priority group for prevention policies.
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Affiliation(s)
- Juan-Miguel Guerras
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
- CIBER Epidemiologia Y Salud Pública (CIBERESP), Madrid, Spain
| | - Patricia García de Olalla
- CIBER Epidemiologia Y Salud Pública (CIBERESP), Madrid, Spain
- Servicio de Epidemiología, Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - María José Belza
- CIBER Epidemiologia Y Salud Pública (CIBERESP), Madrid, Spain.
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Monforte de Lemos 5, 28029, Madrid, Spain.
| | - Luis de la Fuente
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
- CIBER Epidemiologia Y Salud Pública (CIBERESP), Madrid, Spain
| | - David Palma
- CIBER Epidemiologia Y Salud Pública (CIBERESP), Madrid, Spain
- Servicio de Epidemiología, Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - Jorge Del Romero
- Centro Sanitario Sandoval, Instituto de Investigación Sanitaria San Carlos, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Juan Hoyos
- Departamento de Salud Pública Y Materno-Infantil, Universidad Complutense de Madrid, Madrid, Spain
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