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Miltz AR, Rodger AJ, Sewell J, Gilson R, Allan S, Scott C, Sadiq T, Farazmand P, McDonnell J, Speakman A, Sherr L, Phillips AN, Johnson AM, Collins S, Lampe FC. Recreational drug use and use of drugs associated with chemsex among HIV-negative and HIV-positive heterosexual men and women attending sexual health and HIV clinics in England. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 91:103101. [PMID: 33494013 PMCID: PMC8188422 DOI: 10.1016/j.drugpo.2020.103101] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 11/27/2020] [Accepted: 12/22/2020] [Indexed: 11/27/2022]
Abstract
Background There is little information on the prevalence of recreational drug use among UK heterosexual men and women, in particular on use of drugs associated with ‘chemsex’ within gay communities. The aim of this study was to examine among HIV-negative and HIV-positive heterosexual men and women in England: (i) the prevalence of recreational drug use (including use of drugs associated with chemsex), (ii) socio-economic/lifestyle correlates of drug use, and (iii) the association of drug use with sexual behavior measures and mental health symptoms. Methods Data are from the AURAH study of HIV-negative individuals attending sexual health clinics across England (2013–2014) and the ASTRA study of HIV-positive individuals attending HIV outpatient clinics in England (2011–2012). Prevalence of recreational drug use (past three months) and associations are presented separately among the four sample groups: HIV-negative (N = 470) and HIV-positive (N = 373) heterosexual men and HIV-negative (N = 676) and HIV-positive (N = 637) women. Results The age standardized prevalence of any drug use was 22.9%, 17.1%, 15.3%, and 7.1% in the four sample groups respectively. In all groups, cannabis was the drug most commonly used (range from 4.7% to 17.9%) followed by cocaine (1.6% to 8.5%). The prevalence of use of drugs associated with chemsex was very low among HIV-negative participants (1.0% heterosexual men, 0.2% women) and zero among HIV-positive men and women. In age-adjusted analysis, factors linked to drug use overall and/or to cannabis and cocaine use specifically in the four sample groups included Black/mixed Caribbean and white (vs. Black/mixed African) ethnicity, lower level of education , cigarette smoking, and higher risk alcohol consumption. Associations of recreational drug use with measures of condomless sex, depression, and anxiety were observed in the four groups, but were particularly strong/apparent among women. Conclusion Providers need to be aware of cannabis and cocaine use and its potential link with sexual risk behavior and symptoms of depression and anxiety among heterosexual men and women attending sexual health and HIV clinics.
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Affiliation(s)
- Ada R Miltz
- Institute for Global Health, University College London, London, UK.
| | - Alison J Rodger
- Institute for Global Health, University College London, London, UK
| | - Janey Sewell
- Institute for Global Health, University College London, London, UK
| | - Richard Gilson
- Institute for Global Health, University College London, London, UK
| | - Sris Allan
- City of Coventry Healthcare Centre, Coventry, UK
| | | | - Tariq Sadiq
- Courtyard Clinic, St George's Healthcare NHS Trust, London, UK
| | | | - Jeffrey McDonnell
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Andrew Speakman
- Institute for Global Health, University College London, London, UK
| | - Lorraine Sherr
- Institute for Global Health, University College London, London, UK
| | | | - Anne M Johnson
- Institute for Global Health, University College London, London, UK
| | | | - Fiona C Lampe
- Institute for Global Health, University College London, London, UK
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Miltz AR, Rodger AJ, Phillips AN, Sewell J, Edwards S, Allan S, Sherr L, Johnson AM, Burman WJ, Lampe FC. Opposing associations of depression with sexual behaviour: implications for epidemiological investigation among gay, bisexual and other men who have sex with men. Sex Transm Infect 2021; 97:613-618. [PMID: 33431606 PMCID: PMC8606445 DOI: 10.1136/sextrans-2020-054634] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 11/18/2020] [Accepted: 12/06/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The aim of this report is to investigate the nature of the relationship between depression and condomless sex (CLS) among gay, bisexual and other men who have sex with men (GBMSM). METHODS Data are from the Antiretrovirals, Sexual Transmission Risk and Attitude (ASTRA) study of people living with HIV and attending one of eight HIV outpatient clinics in England (2011-2012) and the Attitudes to and Understanding of Risk of Acquisition of HIV (AURAH) study of HIV-negative/unknown status individuals attending one of 20 genitourinary medicine clinics in England (2013-2014). This analysis included GBMSM only. For each study, the prevalence of depressive symptoms (Patient Health Questionnaire-9 score ≥10) was presented according to three categories of sex in the past 3 months (considering anal/vaginal sex with men/women and anal sex with men in separate definitions): (1) no sex, (2) condom-protected sex only and (3) CLS. Multinomial logistic regression with 'condom-protected sex only' as the reference group was used to adjust for age and (for ASTRA participants) time since HIV diagnosis. RESULTS There were opposing associations of depression with recent sexual behaviour: the prevalence of depression was higher among those who reported no sex and those who reported CLS, compared with those who reported condom-protected sex only. Among the 2170 HIV-positive GBMSM in ASTRA, considering anal/vaginal sex with men/women, the prevalence of depressive symptoms was 32%, 20% and 28%, respectively, among men reporting no sex (n=783), condom-protected sex only (n=551) and CLS (n=836) (global p<0.001). Among the 1477 HIV-negative GBMSM in AURAH, the prevalence of depressive symptoms was 12%, 8% and 13%, respectively, for no sex (n=137), condom-protected sex only (n=487) and CLS (n=853) (global p=0.017). Patterns were similar after adjustment and when only considering anal sex between men. CONCLUSIONS Depression may be linked both to lack of sexual activity and to sexual risk taking. When investigating associations between depression and CLS, it is important to separate out individuals reporting condom-protected sex only from those reporting no sex.
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Affiliation(s)
- Ada R Miltz
- Institute for Global Health, University College London, London, UK
| | - Alison J Rodger
- Institute for Global Health, University College London, London, UK
| | | | - Janey Sewell
- Institute for Global Health, University College London, London, UK
| | - Simon Edwards
- Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK
| | - Sris Allan
- City of Coventry NHS Healthcare Centre, Coventry, UK
| | - Lorraine Sherr
- Institute for Global Health, University College London, London, UK
| | - Anne M Johnson
- Institute for Global Health, University College London, London, UK
| | | | - Fiona C Lampe
- Institute for Global Health, University College London, London, UK
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Miltz AR, Rodger AJ, Lepri AC, Sewell J, Nwokolo NC, Allan S, Scott C, Ivens D, Lascar M, Speakman A, Phillips AN, Sherr L, Collins S, Elford J, Lampe FC. Investigating Conceptual Models for the Relationship Between Depression and Condomless Sex Among Gay, Bisexual, and Other Men Who have Sex with Men: Using Structural Equation Modelling to Assess Mediation. AIDS Behav 2020; 24:1793-1806. [PMID: 31782068 PMCID: PMC7220884 DOI: 10.1007/s10461-019-02724-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study is to investigate five hypothesized mechanisms of causation between depression and condomless sex with ≥ 2 partners (CLS2+) among gay, bisexual, and other men who have sex with men (GBMSM), involving alternative roles of self-efficacy for sexual safety and recreational drug use. Data were from the AURAH cross-sectional study of 1340 GBMSM attending genitourinary medicine clinics in England (2013–2014). Structural equation modelling (SEM) was used to investigate which conceptual model was more consistent with the data. Twelve percent of men reported depression (PHQ-9 ≥ 10) and 32% reported CLS2+ in the past 3 months. AURAH data were more consistent with the model in which depression was considered to lead to CLS2+ indirectly via low self-efficacy for sexual safety (indirect Beta = 0.158; p < 0.001) as well as indirectly via higher levels of recreational drug use (indirect Beta = 0.158; p < 0.001). SEM assists in understanding the relationship between depression and CLS among GBMSM.
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Affiliation(s)
- A R Miltz
- Institute for Global Health, University College London, London, UK.
| | - A J Rodger
- Institute for Global Health, University College London, London, UK
| | - A Cozzi Lepri
- Institute for Global Health, University College London, London, UK
| | - J Sewell
- Institute for Global Health, University College London, London, UK
| | | | - S Allan
- City of Coventry Healthcare Centre, Coventry, UK
| | - C Scott
- West London Centre for Sexual Health, London, UK
| | - D Ivens
- Royal Free Hospital, London, UK
| | - M Lascar
- Whipps Cross Hospital, London, UK
| | - A Speakman
- Institute for Global Health, University College London, London, UK
| | - A N Phillips
- Institute for Global Health, University College London, London, UK
| | - L Sherr
- Institute for Global Health, University College London, London, UK
| | | | - J Elford
- City, University of London, London, UK
| | - F C Lampe
- Institute for Global Health, University College London, London, UK
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Mitchell HD, Desai S, Mohammed H, Ong KJ, Furegato M, Hall V, Desai M, Saunders JM, Hughes G, Field N, Gill ON. Preparing for PrEP: estimating the size of the population eligible for HIV pre-exposure prophylaxis among men who have sex with men in England. Sex Transm Infect 2019; 95:484-487. [PMID: 31010953 DOI: 10.1136/sextrans-2019-054009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 03/27/2019] [Accepted: 04/02/2019] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The size of the population of men who have sex with men (MSM) who may be eligible for HIV pre-exposure prophylaxis (HIV-PrEP) in England remains unknown. To plan for a national PrEP implementation trial, we estimated the number of MSM attending sexual health clinics (SHCs) that may be eligible for HIV-PrEP in England. METHODS Sexually transmitted infection (STI) surveillance data from 2010 to 2015 from the GUMCAD surveillance system were used to estimate the annual number of HIV-negative MSM who may be eligible for HIV-PrEP in England. Based on national eligibility criteria, we identified HIV-negative MSM attending SHCs with a HIV-negative test in the past year and used diagnosed bacterial STI (past year) in this group as a proxy for condomless sex and eligibility for HIV-PrEP. We estimated HIV incidence per 100 person-years (py) in these groups in 2014. RESULTS During 2010-2015, the number of HIV-negative MSM attending SHCs with a HIV-negative test in the past year doubled from 14 643 to 29 023, and HIV incidence in this group was 1.9 (95% CI 1.6 to 2.2) per 100 py in 2014. In the same period, the subgroup with a bacterial STI diagnosis (past year), and therefore considered potentially eligible for HIV-PrEP in this analysis, increased from 4365 (30%) to 10 276 (35%). HIV incidence in this subgroup was 3.3 (95% CI 2.7 to 4.0) per 100 py in 2014. CONCLUSIONS In 2015, approximately 10 000 HIV-negative MSM were considered potentially eligible for HIV-PrEP based on clinic history in GUMCAD. These data were used to inform the initial recruitment target for the PrEP Impact Trial and will inform future evaluations at a population level.
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Affiliation(s)
- Holly D Mitchell
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Service, National Infection Service, Public Health England, London, UK
| | - Sarika Desai
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Service, National Infection Service, Public Health England, London, UK
| | - Hamish Mohammed
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Service, National Infection Service, Public Health England, London, UK
| | - Koh Jun Ong
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Service, National Infection Service, Public Health England, London, UK
| | - Martina Furegato
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Service, National Infection Service, Public Health England, London, UK
| | - Victoria Hall
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Service, National Infection Service, Public Health England, London, UK
| | - Monica Desai
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Service, National Infection Service, Public Health England, London, UK
| | - John Michael Saunders
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Service, National Infection Service, Public Health England, London, UK.,Centre for Clinical Research in Infection and Sexual Health, Institute for Global Health, University College London, London, UK
| | - Gwenda Hughes
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Service, National Infection Service, Public Health England, London, UK
| | - Nigel Field
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Service, National Infection Service, Public Health England, London, UK.,Centre for Molecular Epidemiology and Translational Research, Institute for Global Health, University College London, London, UK
| | - O Noel Gill
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Service, National Infection Service, Public Health England, London, UK
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Coyle RM, Lampe FC, Miltz AR, Sewell J, Anderson J, Apea V, Collins S, Dhairyawan R, Johnson AM, Lascar M, Mann S, O'Connell R, Sherr L, Speakman A, Tang A, Phillips AN, Rodger A. Associations of depression and anxiety symptoms with sexual behaviour in women and heterosexual men attending sexual health clinics: a cross-sectional study. Sex Transm Infect 2019; 95:254-261. [PMID: 30814165 PMCID: PMC6585278 DOI: 10.1136/sextrans-2018-053689] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 11/30/2018] [Accepted: 12/27/2018] [Indexed: 11/21/2022] Open
Abstract
Objective To assess the association of symptoms of depression and anxiety with sexual risk behaviour and history, among women and heterosexual men attending genitourinary medicine (GUM) clinics. Methods Attitudes to and Understanding of Risk of Acquisition of HIV (AURAH) was a cross-sectional, self-administered questionnaire study recruited from 20 GUM clinics in England, 2013–2014. This analysis included women and heterosexual men. The prevalence of depression and anxiety symptoms was assessed. Modified Poisson regression was used to produce adjusted prevalence ratios (aPR) for the association of t demographic, socioeconomic and lifestyle factors with depression and anxiety, adjusted for gender, age, ethnicity, education level and study region. Among individuals reporting sex in the past 3 months, associations of depression and anxiety with sexual risk behaviour and history were assessed separately by gender, adjusted for age, ethnicity, study region, education and relationship status. Results Questionnaires were completed by 676 women and 470 heterosexual men. Depression symptoms were reported by 100 (14.8%) women and 33 men (7.0%). Anxiety symptoms were reported by 79 women (11.7%) and 21 men (4.5%). Among women reporting recent sex, those with depression symptoms were more likely to report condomless sex with a non-regular partner, aPR 1.38 (1.07–1.77) and recent condomless sex with two or more partners, 1.80 (1.25–2.59). Women with anxiety symptoms more likely to report recent condomless sex with two or more partners, 1.68 (1.13–2.50), low self-efficacy for condom use, 1.54 (1.02–2.31) and STI diagnosis in the last year 1.51 (1.04–2.20). Among heterosexual men reporting recent sex, depression and anxiety symptoms were associated with low self-efficacy with condom use, 2.32 (1.29–4.19) for depression and 2.23 (1.26–3.94) for anxiety, but not with measures of condomless sex. Discussion The associations between psychological symptoms and sexual risk behaviours highlight the importance of holistic assessment of need by both general and sexual health clinicians. We highlight the challenge in delivering holistic care associated with fragmentation of sexual health services.
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Affiliation(s)
- Rachel Margaret Coyle
- Institute for Global Health, University College London, Royal Free Hospital, London, UK
| | - Fiona C Lampe
- Institute for Global Health, University College London, Royal Free Hospital, London, UK
| | - Ada Rose Miltz
- Institute for Global Health, University College London, Royal Free Hospital, London, UK
| | - Janey Sewell
- Institute for Global Health, University College London, Royal Free Hospital, London, UK
| | - Jane Anderson
- Centre for the Study of Sexual Health and HIV, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Vanessa Apea
- Ambrose King Centre, Barts Health NHS Trust, London, UK
| | | | - Rageshri Dhairyawan
- Outpatients East, Barking, Havering and Redbridge University Hospitals NHS Trust, London, UK
| | - Anne M Johnson
- Institute for Global Health, University College London, Royal Free Hospital, London, UK
| | - Monica Lascar
- Ambrose King Centre, Barts Health NHS Trust, London, UK
| | - Sue Mann
- Camberwell Sexual Health Centre, King's College Hospital, London, UK
| | | | - Lorraine Sherr
- Institute for Global Health, University College London, Royal Free Hospital, London, UK
| | - Andrew Speakman
- Institute for Global Health, University College London, Royal Free Hospital, London, UK
| | - Alan Tang
- Royal Berkshire Hospital NHS Foundation Trust, Reading, UK
| | - Andrew N Phillips
- Institute for Global Health, University College London, Royal Free Hospital, London, UK
| | - Alison Rodger
- Institute for Global Health, University College London, Royal Free Hospital, London, UK
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Sewell J, Cambiano V, Miltz A, Speakman A, Lampe FC, Phillips A, Stuart D, Gilson R, Asboe D, Nwokolo N, Clarke A, Hart G, Rodger A. Changes in recreational drug use, drug use associated with chemsex, and HIV-related behaviours, among HIV-negative men who have sex with men in London and Brighton, 2013-2016. Sex Transm Infect 2018; 94:494-501. [PMID: 29700052 PMCID: PMC6227813 DOI: 10.1136/sextrans-2017-053439] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 03/05/2018] [Accepted: 03/18/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The objective of this study was to compare the prevalence of polydrug use, use of drugs associated with chemsex, specific drug use, and HIV-related behaviours, between two time periods, using two groups of HIV-negative men who have sex with men (MSM) attending the same sexual health clinics in London and Brighton, in two consecutive periods of time from 2013 to 2016. METHODS Data from MSM in the cross-sectional Attitudes to and Understanding Risk of Acquisition of HIV (AURAH) study (June 2013 to September 2014) were compared with baseline data from different MSM in the prospective cohort study Attitudes to and Understanding Risk of Acquisition of HIV over Time (AURAH2) (November 2014 to April 2016). Prevalence of polydrug use, drug use associated with chemsex and specific drug use, and 10 measures of HIV-related behaviours including condomless sex, post-exposure prophylaxis (PEP) use, pre-exposure prophylaxis (PrEP) use, and HIV testing, were compared. Prevalence ratios (PRs) for the association of the study (time period) with drug use and HIV-related behaviour measures were estimated using modified Poisson regression analysis, unadjusted and adjusted for sociodemographic factors. RESULTS In total, 991 MSM were included from AURAH and 1031 MSM from AURAH2. After adjustment for sociodemographic factors, use of drugs associated with chemsex had increased (adjusted PR (aPR) 1.30, 95% CI 1.11 to 1.53) and there were prominent increases in specific drug use; in particular, mephedrone (aPR 1.32, 95% CI 1.10 to 1.57), γ-hydroxybutyric/γ-butryolactone (aPR 1.47, 95% CI 1.15 to 1.87) and methamphetamine (aPR 1.42, 95% CI 1.01 to 2.01). Use of ketamine had decreased (aPR 0.54, 95% CI 0.38 to 0.78). Certain measures of HIV-related behaviours had also increased, most notably PEP use (aPR 1.50, 95% CI 1.21 to 1.88) and number of self-reported bacterial STI diagnoses (aPR 1.24, 95% CI 1.08 to 1.43). CONCLUSIONS There have been significant increases in drug use associated with chemsex and some measures of HIV-related behaviours among HIV-negative MSM in the last few years. Changing patterns of drug use and associated behaviours should be monitored to enable sexual health services to plan for the increasingly complex needs of some clients.
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Affiliation(s)
- Janey Sewell
- Research Department of Infection and Population Health, Institute for Global Health, UCL, London, UK
| | - Valentina Cambiano
- Research Department of Infection and Population Health, Institute for Global Health, UCL, London, UK
| | - Ada Miltz
- Research Department of Infection and Population Health, Institute for Global Health, UCL, London, UK
| | - Andrew Speakman
- Research Department of Infection and Population Health, Institute for Global Health, UCL, London, UK
| | - Fiona C Lampe
- Research Department of Infection and Population Health, Institute for Global Health, UCL, London, UK
| | - Andrew Phillips
- Research Department of Infection and Population Health, Institute for Global Health, UCL, London, UK
| | - David Stuart
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Richard Gilson
- Research Department of Infection and Population Health, Institute for Global Health, UCL, London, UK
| | - David Asboe
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Nneka Nwokolo
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Amanda Clarke
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Graham Hart
- Research Department of Infection and Population Health, Institute for Global Health, UCL, London, UK
| | - Alison Rodger
- Research Department of Infection and Population Health, Institute for Global Health, UCL, London, UK
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Coyle RM, Miltz AR, Lampe FC, Sewell J, Phillips AN, Speakman A, Dhar J, Sherr L, Sadiq ST, Taylor S, Ivens DR, Collins S, Elford J, Anderson J, Rodger A. Ethnicity and sexual risk in heterosexual people attending sexual health clinics in England: a cross-sectional, self-administered questionnaire study. Sex Transm Infect 2018. [PMID: 29519911 PMCID: PMC6204969 DOI: 10.1136/sextrans-2017-053308] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Objectives In the UK, people of black ethnicity experience a disproportionate burden of HIV and STI. We aimed to assess the association of ethnicity with sexual behaviour and sexual health among women and heterosexual men attending genitourinary medicine (GUM) clinics in England. Methods The Attitudes to and Understanding of Risk of Acquisition of HIV is a cross-sectional, self-administered questionnaire study of HIV negative people recruited from 20 GUM clinics in England, 2013–2014. Modified Poisson regression with robust SEs was used to calculate adjusted prevalence ratios (aPR) for the association between ethnicity and various sexual risk behaviours, adjusted for age, study region, education and relationship status. Results Questionnaires were completed by 1146 individuals, 676 women and 470 heterosexual men. Ethnicity was recorded for 1131 (98.8%) participants: 550 (48.6%) black/mixed African, 168 (14.9%) black/mixed Caribbean, 308 (27.2%) white ethnic groups, 105 (9.3%) other ethnicity. Compared with women from white ethnic groups, black/mixed African women were less likely to report condomless sex with a non-regular partner (aPR (95% CI) 0.67 (0.51 to 0.88)), black/mixed African and black/mixed Caribbean women were less likely to report two or more new partners (0.42 (0.32 to 0.55) and 0.44 (0.29 to 0.65), respectively), and black/mixed Caribbean women were more likely to report an STI diagnosis (1.56 (1.00 to 2.42)). Compared with men from white ethnic groups, black/mixed Caribbean men were more likely to report an STI diagnosis (1.91 (1.20 to 3.04)), but did not report risk behaviours more frequently. Men and women of black/mixed Caribbean ethnicity remained more likely to report STI history after adjustment for sexual risk behaviours. Discussion Risk behaviours were reported less frequently by women of black ethnicity; however, history of STI was more prevalent among black/mixed Caribbean women. In black/mixed Caribbean men, higher STI history was not explained by ethnic variation in reported risk behaviours. The association between STI and black/mixed Caribbean ethnicity remained after adjustment for risk behaviours.
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Affiliation(s)
- Rachel Margaret Coyle
- Research Department of Infection and Population Health, University College London, Royal Free Hospital, London, UK
| | - Ada Rose Miltz
- Research Department of Infection and Population Health, University College London, Royal Free Hospital, London, UK
| | - Fiona C Lampe
- Research Department of Infection and Population Health, University College London, Royal Free Hospital, London, UK
| | - Janey Sewell
- Research Department of Infection and Population Health, University College London, Royal Free Hospital, London, UK
| | - Andrew N Phillips
- Research Department of Infection and Population Health, University College London, Royal Free Hospital, London, UK
| | - Andrew Speakman
- Research Department of Infection and Population Health, University College London, Royal Free Hospital, London, UK
| | - Jyoti Dhar
- Staffordshire and Stoke on Trent Partnership NHS Trust, Leicester, UK
| | - Lorraine Sherr
- Research Department of Infection and Population Health, University College London, Royal Free Hospital, London, UK
| | - S Tariq Sadiq
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Stephen Taylor
- Birmingham Heartlands Hospital, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Daniel R Ivens
- Marlborough Department of Sexual Health, Royal Free Hospital, London, UK
| | | | - Jonathan Elford
- School of Health Sciences, City University London, London, UK
| | - Jane Anderson
- Centre for the Study of Sexual Health and HIV, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Alison Rodger
- Research Department of Infection and Population Health, University College London, Royal Free Hospital, London, UK
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Miltz AR, Cambiano V, Lampe FC, Sewell J, Speakman A, Phillips AN, Ivens DR, Asboe D, Collins S, Brady M, Nwokolo NC, Rodger AJ. Eligibility for PrEP among MSM attending GUM clinics in the UK. Sex Transm Infect 2017; 93:571. [DOI: 10.1136/sextrans-2017-053268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 05/29/2017] [Accepted: 07/09/2017] [Indexed: 11/04/2022] Open
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Miltz A, Phillips AN, Speakman A, Cambiano V, Rodger A, Lampe FC. Implications for a policy of initiating antiretroviral therapy in people diagnosed with human immunodeficiency virus: the CAPRA research programme. PROGRAMME GRANTS FOR APPLIED RESEARCH 2017. [DOI: 10.3310/pgfar05180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BackgroundMore than 100,000 people in the UK are living with a human immunodeficiency virus (HIV) infection. There are currently estimated to be around 4000 people newly infected in the UK per year, mostly men who have sex with men (MSM). It has become increasingly clear that antiretroviral therapy (ART) used to treat people infected with HIV also has a profound effect on infectivity. At the initiation of the programme, it was the policy in the UK to initiate ART in people when their cluster of differentiation 4 (CD4) count was approaching 350/µl.ObjectivesTo assess what would be the effectiveness and cost-effectiveness of a policy of immediate initiation of ART at diagnosis among MSM, taking into account the potential reductions in new infections.DesignWe calibrated an individual-based model of HIV transmission, progression and the effect of ART in MSM, informed by a series of studies on sexual behaviour in relation to ART use and the transmission risk in people with viral suppression on ART, and by surveillance data collected by Public Health England.Setting, participants and interventionsThe series of studies used to inform the model included (1) the Antiretrovirals, Sexual Transmission Risk and Attitudes (ASTRA) study, a cross-sectional self-administered questionnaire study of people diagnosed with HIV attending eight HIV outpatient clinics in the UK (2011–12); (2) the Cognitive Impairment in People with HIV in the European Region (CIPHER) study, a study of levels of neurocognitive impairment in HIV-positive ASTRA participants and people from HIV clinics in Rome, Copenhagen and Minsk; (3) the Attitudes to, and Understanding of, Risk of Acquisition of HIV (AURAH) study, a cross-sectional self-administered questionnaire study of individuals who have not been diagnosed as HIV-positive attending 20 genitourinary medicine clinics across the UK (2013–14); (4) a substudy of sexual behaviour among individuals enrolled in an open-label multicentre international randomised trial (from 2013) of immediate versus deferred ART (to CD4 cell counts of 350/µl) in people with CD4 cell counts of > 500/µl [the Strategic Timing of Antiretroviral Therapy (START) trial]; and (5) Partners of People on ART: a new Evaluation of the Risks (PARTNER), an observational multicentre longitudinal study of HIV serodifferent heterosexual and MSM couples, in which the HIV-positive partner is on ART (2010–14).Main outcome measuresThe main outcome measures were the clinical effectiveness and cost-effectiveness of a policy of immediate initiation of ART at diagnosis.ResultsBased on data from studies (i)–(v), we estimated from our modelling work that increases in condomless sex (CLS) among MSM as a whole may explain the increase in HIV infection incidence in MSM epidemics over a time when ART coverage and viral suppression increased, demonstrating the limiting effects of non-condom use on the HIV epidemic among MSM. Accordingly, an increase in the overall proportion of MSM living with HIV who are virally suppressed on ART from the current level of < 60% to 90% without increases in CLS was required to achieve a reduction in the incidence of HIV among MSM to < 1 per 1000 person-years. The incremental cost-effectiveness ratio associated with the fourfold increase in levels of HIV testing and ART at diagnosis required to provide this increase from < 60% to 90% was £20,000 if we assumed continuation of current ART prices. However, this value falls to £3500 if we assume that ART prices will fall to 20% of their current cost as a result of the introduction of generic drugs. Therefore, our evaluation suggests that ART initiation at diagnosis is likely to be highly cost-effective in MSM at a population level, particularly accounting for future lower ART costs as generic drugs are used. The impact will be much greater if levels of HIV testing can be enhanced.LimitationsIt was necessary to make some assumptions beyond the available data in order to extrapolate cost-effectiveness through modelling.ConclusionsOur findings suggest that ART initiation at diagnosis is likely to be cost-effective in MSM. Of note, after this programme of work was completed, results from the main START trial demonstrated benefit in ART initiation even in people with CD4 cell counts of > 500/µl, supporting ART initiation in people diagnosed with a HIV infection.Future workThere is a need for future research into the means of increasing the frequency with which MSM test for HIV.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
- Ada Miltz
- Research Department of Infection and Population Health, University College London, London, UK
| | - Andrew N Phillips
- Research Department of Infection and Population Health, University College London, London, UK
| | - Andrew Speakman
- Research Department of Infection and Population Health, University College London, London, UK
| | - Valentina Cambiano
- Research Department of Infection and Population Health, University College London, London, UK
| | - Alison Rodger
- Research Department of Infection and Population Health, University College London, London, UK
| | - Fiona C Lampe
- Research Department of Infection and Population Health, University College London, London, UK
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Miltz AR, Rodger AJ, Sewell J, Speakman A, Phillips AN, Sherr L, Gilson RJ, Asboe D, Nwokolo NC, Clarke A, Gompels MM, Allan S, Collins S, Lampe FC. Clinically significant depressive symptoms and sexual behaviour among men who have sex with men. BJPsych Open 2017; 3:127-137. [PMID: 28507772 PMCID: PMC5421094 DOI: 10.1192/bjpo.bp.116.003574] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 01/13/2017] [Accepted: 03/06/2017] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The relationship between depression and sexual behaviour among men who have sex with men (MSM) is poorly understood. AIMS To investigate prevalence and correlates of depressive symptoms (Patient Health Questionnaire-9 score ≥10) and the relationship between depressive symptoms and sexual behaviour among MSM reporting recent sex. METHOD The Attitudes to and Understanding of Risk of Acquisition of HIV (AURAH) is a cross-sectional study of UK genitourinary medicine clinic attendees without diagnosed HIV (2013-2014). RESULTS Among 1340 MSM, depressive symptoms (12.4%) were strongly associated with socioeconomic disadvantage and lower supportive network. Adjusted for key sociodemographic factors, depressive symptoms were associated with measures of condomless sex partners in the past 3 months (≥2 (prevalence ratio (PR) 1.42, 95% CI 1.17-1.74; P=0.001), unknown or HIV-positive status (PR 1.43, 95% CI 1.20-1.71; P<0.001)), sexually transmitted infection (STI) diagnosis (PR 1.46, 95% CI 1.19-1.79; P<0.001) and post-exposure prophylaxis use in the past year (PR 1.83, 95% CI 1.33-2.50; P<0.001). CONCLUSIONS Management of mental health may play a role in HIV and STI prevention. DECLARATION OF INTEREST A.N.P. has received payments for presentations made at meetings sponsored by Gilead in spring 2015. N.C.N. has received support for attendance at conferences, speaker fees and payments for attendance at advisory boards from Gilead Sciences, Viiv Healthcare, Janssen Pharmaceuticals and Bristol-Myers Squibb and a research grant from Gilead Sciences. D.A. served on the advisory board for Gilead in January 2016. M.M.G. has had sponsorship to attend conferences by Bristol-Myers Squibb, been on the BioCryst advisory board and run trials for Merck, Gilead, SSAT, BioCryst and Novartis. COPYRIGHT AND USAGE © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.
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Affiliation(s)
- Ada R. Miltz
- Ada R. Miltz, MSc, HIV Epidemiology and Biostatistics Group, Research Department of Infection and Population Health, University College London, London, UK
| | - Alison J. Rodger
- Alison J. Rodger, MD, HIV Epidemiology and Biostatistics Group, Research Department of Infection and Population Health, University College London, London, UK
| | - Janey Sewell
- Janey Sewell, BNurs, HIV Epidemiology and Biostatistics Group, Research Department of Infection and Population Health, University College London, London, UK
| | - Andrew Speakman
- Andrew Speakman, PhD, HIV Epidemiology and Biostatistics Group, Research Department of Infection and Population Health, University College London, London, UK
| | - Andrew N. Phillips
- Andrew N. Phillips, PhD, HIV Epidemiology and Biostatistics Group, Research Department of Infection and Population Health, University College London, London, UK
| | - Lorraine Sherr
- Lorraine Sherr, PhD, HIV Epidemiology and Biostatistics Group, Research Department of Infection and Population Health, University College London, London, UK
| | - Richard J. Gilson
- Richard J. Gilson, MBBS, Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, Mortimer Market Centre, University College London, London, UK
| | - David Asboe
- David Asboe, MBBS, John Hunter Clinic, London, UK
| | | | - Amanda Clarke
- Amanda Clarke, BM, Royal Sussex County Hospital, Brighton, UK
| | | | - Sris Allan
- Sris Allan, MBBS, City of Coventry Healthcare Centre, Coventry, UK
| | | | - Fiona C. Lampe
- Fiona C. Lampe, PhD, HIV Epidemiology and Biostatistics Group, Research Department of Infection and Population Health, University College London, London, UK, for the AURAH Study Group
| | - for the AURAH Study Group
- Ada R. Miltz, MSc, HIV Epidemiology and Biostatistics Group, Research Department of Infection and Population Health, University College London, London, UK
- Alison J. Rodger, MD, HIV Epidemiology and Biostatistics Group, Research Department of Infection and Population Health, University College London, London, UK
- Janey Sewell, BNurs, HIV Epidemiology and Biostatistics Group, Research Department of Infection and Population Health, University College London, London, UK
- Andrew Speakman, PhD, HIV Epidemiology and Biostatistics Group, Research Department of Infection and Population Health, University College London, London, UK
- Andrew N. Phillips, PhD, HIV Epidemiology and Biostatistics Group, Research Department of Infection and Population Health, University College London, London, UK
- Lorraine Sherr, PhD, HIV Epidemiology and Biostatistics Group, Research Department of Infection and Population Health, University College London, London, UK
- Richard J. Gilson, MBBS, Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, Mortimer Market Centre, University College London, London, UK
- David Asboe, MBBS, John Hunter Clinic, London, UK
- Nneka C. Nwokolo, MBBS, 56 Dean Street, London, UK
- Amanda Clarke, BM, Royal Sussex County Hospital, Brighton, UK
- Mark M. Gompels, MBBS, Southmead Hospital, Bristol, UK
- Sris Allan, MBBS, City of Coventry Healthcare Centre, Coventry, UK
- Simon Collins, advocate, HIV i-Base, London, UK
- Fiona C. Lampe, PhD, HIV Epidemiology and Biostatistics Group, Research Department of Infection and Population Health, University College London, London, UK, for the AURAH Study Group
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Sewell J, Miltz A, Lampe FC, Cambiano V, Speakman A, Phillips AN, Stuart D, Gilson R, Asboe D, Nwokolo N, Clarke A, Collins S, Hart G, Elford J, Rodger AJ. Poly drug use, chemsex drug use, and associations with sexual risk behaviour in HIV-negative men who have sex with men attending sexual health clinics. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 43:33-43. [PMID: 28189979 DOI: 10.1016/j.drugpo.2017.01.001] [Citation(s) in RCA: 133] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 11/20/2016] [Accepted: 01/03/2017] [Indexed: 10/24/2022]
Abstract
BACKGROUND Recreational drug use and associated harms continue to be of significant concern in men who have sex with men (MSM) particularly in the context of HIV and STI transmission. METHODS Data from 1484 HIV-negative or undiagnosed MSM included in the AURAH study, a cross-sectional, self-completed questionnaire study of 2630 individuals from 20 sexual health clinics in the United Kingdom in 2013-2014, was analysed. Two measures of recreational drug use in the previous three months were defined; (i) polydrug use (use of 3 or more recreational drugs) and (ii) chemsex drug use (use of mephedrone, crystal methamphetamine or GHB/GBL). Associations of socio-demographic, health and lifestyle factors with drug use, and associations of drug use with sexual behaviour, were investigated. RESULTS Of the 1484 MSM, 350 (23.6%) reported polydrug use and 324 (21.8%) reported chemsex drug use in the past three months. Overall 852 (57.5%) men reported condomless sex in the past three months; 430 (29.0%) had CLS with ≥2 partners, 474 (31.9%) had CLS with unknown/HIV+ partner(s); 187 (12.6%) had receptive CLS with an unknown status partner. For polydrug use, prevalence ratios (95% confidence interval) for association with CLS measures, adjusted for socio-demographic factors were: 1.38 (1.26, 1.51) for CLS; 2.11 (1.80, 2.47) for CLS with ≥2 partners; 1.89 (1.63, 2.19) for CLS with unknown/HIV+ partner(s); 1.36 (1.00, 1.83) for receptive CLS with an unknown status partner. Corresponding adjusted prevalence ratios for chemsex drug use were: 1.38 (1.26, 1.52); 2.07 (1.76, 2.43); 1.88 (1.62, 2.19); 1.49 (1.10, 2.02). Polydrug and chemsex drug use were also strongly associated with previous STI, PEP use, group sex and high number of new sexual partners. Associations remained with little attenuation after further adjustment for depressive symptoms and alcohol intake. CONCLUSION There was a high prevalence of polydrug use and chemsex drug use among HIV negative MSM attending UK sexual health clinics. Drug use was strongly associated with sexual behaviours linked to risk of acquisition of STIs and HIV.
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Affiliation(s)
- Janey Sewell
- Research Department of Infection & Population Health, University College London, London, United Kingdom
| | - Ada Miltz
- Research Department of Infection & Population Health, University College London, London, United Kingdom
| | - Fiona C Lampe
- Research Department of Infection & Population Health, University College London, London, United Kingdom
| | - Valentina Cambiano
- Research Department of Infection & Population Health, University College London, London, United Kingdom
| | - Andrew Speakman
- Research Department of Infection & Population Health, University College London, London, United Kingdom
| | - Andrew N Phillips
- Research Department of Infection & Population Health, University College London, London, United Kingdom
| | - David Stuart
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Richard Gilson
- Research Department of Infection & Population Health, University College London, London, United Kingdom
| | - David Asboe
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Nneka Nwokolo
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Amanda Clarke
- Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | | | - Graham Hart
- Research Department of Infection & Population Health, University College London, London, United Kingdom
| | | | - Alison J Rodger
- Research Department of Infection & Population Health, University College London, London, United Kingdom.
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Sewell J, Speakman A, Phillips AN, Cambiano V, Lampe FC, Gilson R, Asboe D, Nwokolo N, Clarke A, Ogilvy A, Collins S, Rodger AJ. Attitudes to and Understanding of Risk of Acquisition of HIV Over Time: Design and Methods for an Internet-based Prospective Cohort Study Among UK Men Who Have Sex With Men (the AURAH2 Study). JMIR Res Protoc 2016; 5:e128. [PMID: 27307218 PMCID: PMC4927873 DOI: 10.2196/resprot.5582] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 02/29/2016] [Accepted: 03/16/2016] [Indexed: 11/18/2022] Open
Abstract
Background The annual number of new human immunodeficiency virus (HIV) infections among men who have sex with men (MSM) has risen in the United Kingdom and, of those who are HIV positive, the proportion undiagnosed is high. Objective The prospective AURAH2 study aims to assess factors associated with HIV acquisition among MSM in the United Kingdom and to investigate changes over time within individuals in sexual behavior and HIV-testing practices. Methods AURAH2 is a prospective study among MSM without diagnosed HIV, aiming to recruit up to 1000 sexually active MSM attending sexual health clinics in London and Brighton in the United Kingdom. Participants complete an initial paper-based questionnaire, followed by online follow-up questionnaires every 4 months collecting sociodemographic, health and behavioral data, including sexual behavior, recreational and other drug use, HIV testing practices, and pre-exposure prophylaxis use, over a planned 3-year period. Results The study is ongoing. Conclusions The results from AURAH2 study will provide important insight into established and emerging risk behaviors that may be associated with acquisition of HIV in MSM in the United Kingdom, changes over time within individuals in sexual behavior, and information on HIV testing practices. These data will be crucial to inform future HIV prevention strategies.
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Affiliation(s)
- Janey Sewell
- Department of Infection and Population Health, UCL, London, United Kingdom.
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