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Hanum N, Cambiano V, Sewell J, Rodger AJ, Asboe D, Whitlock G, Gilson R, Clarke A, Miltz AR, Collins S, Phillips AN, Lampe FC, for the AURAH2 Study Group. Transitions in sexual behaviour among gay, bisexual, and other men who have sex with men in England: Data from a prospective study. PLoS One 2025; 20:e0308238. [PMID: 40036238 PMCID: PMC11878903 DOI: 10.1371/journal.pone.0308238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 07/18/2024] [Indexed: 03/06/2025] Open
Abstract
The effectiveness of population-level intervention for HIV elimination is influenced by individual-level variation in sexual behaviour. We assess within-person changes in the frequency of condomless anal sex with two or more partners (CLS2+), estimate the transition probabilities and examine the predictors of transitions among a prospective cohort of HIV-negative gay, bisexual, and other men who have sex with men (GBMSM). Participants were recruited through one of three sexual health clinics in London and Brighton (July 2013 to April 2016) and self-completed a baseline paper questionnaire in the clinic. During follow-up, they were invited to complete four-monthly questionnaires twice a year and subsequent annual online questionnaires once a year (March 2015 to March 2018). We used Markov chain models to estimate transition probabilities from 'higher-risk' (CLS2+) to 'lower-risk' (no CLS2+) and vice versa, and to assess factors associated with transitions between different sexual risk levels. Among 1,162 men enrolled in the study, 622 (53.5%) completed at least one online questionnaire. Higher-risk behaviour was reported in 376/622 (60.4%) men during online follow-up. Overall, 1,665/3,277 (37.5%) baseline and follow-up questionnaires reported higher-risk behaviour. More than 60% of men (376/622) reported higher-risk behaviour at least one period during the follow-up, while 39.5% of men (246/622) never reported CLS2+ during the follow-up. In the next four months, the estimated probability of continuing higher-risk behaviour among men who reported higher-risk behaviour was 78%. Calendar time, recent HIV tests, PrEP and PEP use were the predictors of staying in higher-risk behaviour, while less stable housing status was associated with switching to lower-risk behaviour. Among men who reported lower-risk behaviour, the probability of engaging in the same behaviour was 88%. Recent HIV tests, PrEP and PEP use, recreational drugs, chemsex-associated drug and injection drugs, and bacterial STIs diagnosis were the predictors of switching to higher-risk behaviour. Our results indicate that at any one point in time, the majority of GBMSM are at low risk for HIV acquisition, although many experience short periods in which they are at higher risk. Markers of transitions can be utilized to identify which GBMSM are likely to increase or decrease their risk, thus helping the timing of HIV prevention interventions.
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Affiliation(s)
- Nadia Hanum
- UCL Institute for Global Health, London, United Kingdom
| | | | - Janey Sewell
- UCL Institute for Global Health, London, United Kingdom
| | | | - David Asboe
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Gary Whitlock
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Richard Gilson
- UCL Institute for Global Health, London, United Kingdom
- Central and North West London NHS Foundation Trust, London, United Kingdom
| | - Amanda Clarke
- Brighton and Sussex University Hospital NHS Trust, Brighton, United Kingdom
| | - Ada R. Miltz
- UCL Institute for Global Health, London, United Kingdom
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Hammond R, Cambiano V, Lampe FC, Asboe D, Clarke A, Gilson R, Hart GJ, Miltz AR, Nwokolo N, Johnson AM, Phillips AN, Speakman A, Whitlock G, Rodger A, Sewell J. Predictors of starting and stopping chemsex in men who have sex with men in England: findings from the AURAH2 prospective study. Sex Transm Infect 2023; 99:474-481. [PMID: 37321843 DOI: 10.1136/sextrans-2023-055774] [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: 01/30/2023] [Accepted: 05/20/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Chemsex (the use of psychoactive drugs in sexual contexts) has been associated with HIV acquisition and other STIs, so there is benefit in identifying those most likely to start chemsex to offer risk reduction interventions such as pre-exposure prophylaxis (PrEP). To date, there have been no data from a longitudinal study analysing factors most associated with starting and stopping chemsex. METHODS The prospective cohort study, Attitudes to and Understanding Risk of Acquisition of HIV over Time (AURAH2), collected 4 monthly and annual online questionnaire data from men who have sex with men (MSM) from 2015 to 2018. We investigate the association of sociodemographic factors, sexual behaviours and drug use with starting and stopping chemsex among 622 men who completed at least one follow-up questionnaire. Poisson models with generalised estimating equations were used to produce risk ratios (RRs) accounting for multiple starting or stopping episodes from the same individual. Multivariable analysis was adjusted for age group, ethnicity, sexual identity and university education. FINDINGS In the multivariable analysis, the under 40 age group was significantly more likely to start chemsex by the next assessment (RR 1.79, 95% CI 1.12 to 2.86). Other factors which showed significant association with starting chemsex were unemployment (RR 2.10, 95% CI 1.02 to 4.35), smoking (RR 2.49, 95% CI 1.63 to 3.79), recent condomless sex (CLS), recent STI and postexposure prophylaxis (PEP) use in the past year (RR 2.10, 95% CI 1.33 to 3.30). Age over 40 (RR 0.71, 95% CI 0.51 to 0.99), CLS, and use of PEP (RR 0.64, 95% CI 0.47 to 0.86) and PrEP (RR 0.47, 95% CI 0.29 to 0.78) were associated with lower likelihood of stopping chemsex by the next assessment. INTERPRETATION Knowledge of these results allows us to identify men most likely to start chemsex, thus providing an opportunity for sexual health services to intervene with a package of risk mitigation measures, especially PrEP use.
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Affiliation(s)
- Robbie Hammond
- Department of Infectious Diseases, Royal Free London NHS Foundation Trust, London, UK
| | | | - Fiona C Lampe
- Institute for Global Health, University College London, London, UK
| | - David Asboe
- St Stephen's Centre, Chelsea and Westminster Healthcare NHS Trust, London, UK
| | - Amanda Clarke
- Department of Sexual Health, University Hospitals Sussex NHS Foundation Trust, Worthing, UK
| | - Richard Gilson
- Institute for Global Health, University College London, London, UK
| | - Graham J Hart
- Institute for Global Health, University College London, London, UK
| | - Ada Rose Miltz
- Institute for Global Health, University College London, London, UK
| | - Nneka Nwokolo
- St Stephen's Centre, Chelsea and Westminster Healthcare NHS Trust, London, UK
| | - Anne M Johnson
- Institute for Global Health, University College London, London, UK
| | | | - Andrew Speakman
- Institute for Global Health, University College London, London, UK
| | - Gary Whitlock
- 56 Dean Street, Chelsea and Westminster Healthcare NHS Trust, London, UK
| | - Alison Rodger
- Department of Infectious Diseases, Royal Free London NHS Foundation Trust, London, UK
- Institute for Global Health, University College London, London, UK
| | - Janey Sewell
- Institute for Global Health, University College London, London, UK
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Trends in HIV incidence between 2013-2019 and association of baseline factors with subsequent incident HIV among gay, bisexual, and other men who have sex with men attending sexual health clinics in England: A prospective cohort study. PLoS Med 2021; 18:e1003677. [PMID: 34143781 PMCID: PMC8253400 DOI: 10.1371/journal.pmed.1003677] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 07/02/2021] [Accepted: 06/01/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Prospective cohort studies of incident HIV and associated factors among gay, bisexual, and other men who have sex with men (GBMSM) in the United Kingdom are lacking. We report time trends in and factors associated with HIV incidence between 2013 and 2019 among a cohort of GBMSM: the AURAH2 prospective study. METHODS AND FINDINGS Participants were recruited through 1 of 3 sexual health clinics in London and Brighton (July 2013 to April 2016) and self-completed a baseline paper questionnaire and subsequent 4-monthly and annual online questionnaires (March 2015 to March 2018), including information on sociodemographics, lifestyle, health and well-being, HIV status, sexual/HIV-related behaviours, and preexposure prophylaxis and postexposure prophylaxis (PrEP/PEP). Incident HIV was ascertained by linkage with national HIV surveillance data from Public Health England (PHE). We investigated the associations of HIV incidence with (1) baseline factors using mixed-effects Weibull proportional hazard models, unadjusted and adjusted for age, country of birth and ethnicity, sexuality, and education level; and (2) time-updated factors, using mixed-effects Poisson regression models. In total, 1,162 men (mean age 34 years, 82% white, 94% gay, 74% university-educated) were enrolled in the study. Thirty-three HIV seroconversions occurred over 4,618.9 person-years (PY) of follow-up: an overall HIV incidence rate (IR) of 0.71 (95% confidence interval (CI) 0.51 to 1.00) per 100 PY. Incidence declined from 1.47 (95% CI 0.48 to 4.57) per 100 PY in 2013/2014 to 0.25 (95% CI 0.08 to 0.78) per 100 PY in 2018/2019; average annual decline was 0.85-fold (p < 0.001). Baseline factors associated with HIV acquisition included the following: injection drug use (6/38 men who reported injection drug-acquired HIV; unadjusted conditional hazard ratio (HR) 27.96, 95% CI 6.99 to 111.85, p < 0.001), noninjection chemsex-related drug use (13/321; HR 6.45, 95% CI 1.84 to 22.64, p < 0.001), condomless anal sex (CLS) (26/741; HR 3.75, 95% CI 1.31 to 10·74, p = 0.014); higher number of CLS partners (HRs >10 partners [7/57]; 5 to 10 partners [5/60]; and 2 to 4 partners [11/293]: 14.04, 95% CI 4.11 to 47.98; 9.60, 95% CI 2.58 to 35.76; and 4.05, 95% CI 1.29 to 12.72, respectively, p < 0.001); CLS with HIV-positive partners (14/147; HR 6.45, 95% CI 3.15 to 13.22, p < 0.001), versatile CLS role (21/362; HR 6.35, 95% CI 2.18 to 18.51, p < 0.001), group sex (64/500; HR 8.81, 95% CI 3.07 to 25.24, p < 0.001), sex for drugs/money (4/55, HR 3.27, 95% CI 1.14 to 9.38, p = 0.027) (all in previous 3 months); previous 12-month report of a bacterial sexually transmitted infection (STI) diagnoses (21/440; HR 3.95, 95% CI 1.81 to 8.63, p < 0.001), and more than 10 new sexual partners (21/471, HRs 11 to 49, 50 to 99, and >100 new partners: 3.17, 95% CI 1.39 to 7.26; 4.40, 95% CI 1.35 to 14.29; and 4.84, 95% CI 1.05 to 22.4, respectively, p < 0.001). Results were broadly consistent for time-updated analysis (n = 622 men). The study's main limitation is that men may not be representative of the broader GBMSM population in England. CONCLUSIONS We observed a substantial decline in HIV incidence from 2013 to 2019 among GBMSM attending sexual health clinics. Injection drug use, chemsex use, and measures of high-risk sexual behaviour were strongly associated with incident HIV. Progress towards zero new infections could be achieved if combination HIV prevention including Test and Treat strategies and routine commissioning of a PrEP programme continues across the UK and reaches all at-risk populations.
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Hanum N, Cambiano V, Sewell J, Phillips AN, Rodger AJ, Speakman A, Nwokolo N, Asboe D, Gilson R, Clarke A, Miltz AR, Collins S, Lampe FC. Use of HIV pre-exposure prophylaxis among men who have sex with men in England: data from the AURAH2 prospective study. LANCET PUBLIC HEALTH 2020; 5:e501-e511. [PMID: 32888443 PMCID: PMC7462627 DOI: 10.1016/s2468-2667(20)30186-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 07/19/2020] [Accepted: 07/31/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Since October, 2017 (and until October, 2020), pre-exposure prophylaxis (PrEP) has only been available in England, UK, through the PrEP Impact Trial, by purchasing it from some genitourinary medicine clinics, or via online sources. Here we report changes from 2013 to 2018 in PrEP and postexposure prophylaxis (PEP) awareness and use among HIV-negative gay, bisexual, and other men who have sex with men (MSM) and assess predictors of PrEP initiation. METHODS In the prospective cohort study Attitudes to, and Understanding of Risk of Acquisition of HIV 2 (AURAH2), MSM were recruited from three sexual health clinics in England: two in London and one in Brighton, UK. Men were eligible if they were aged 18 years or older and HIV-negative or of unknown HIV status. Participants self-completed a baseline paper questionnaire at one of the three clinics between July 30, 2013, and April 30, 2016, and were subsequently able to complete 4-monthly and annual online questionnaires, which were available between March 1, 2015, and March 31, 2018, and collected information on sociodemographics, health and wellbeing, HIV status, and sexual behaviours. PrEP and PEP use in the previous 12 months was obtained at baseline and in annual questionnaires. We assessed trends over calendar time in 3-month periods from first enrolment to the end of the study period (July-December, 2013, was counted as one period) in use of PrEP and PEP using generalised estimating equation logistic models. We used age-adjusted Poisson models to assess factors associated with PrEP initiation among participants who reported never having used PrEP at baseline. FINDINGS 1162 men completed a baseline questionnaire, among whom the mean age was 34 years (SD 10·4), and of those with available data, 942 (82%) of 1150 were white, 1076 (94%) of 1150 were gay, and 857 (74%) of 1159 were university educated. 622 (54%) of 1162 men completed at least one follow-up online questionnaire, of whom 483 (78%) completed at least one annual questionnaire. Overall, PrEP use in the past year increased from 0% (none of 28 respondents) in July to December, 2013, to 43% (23 of 53) in January to March, 2018. The corresponding increase in PrEP use among men who reported condomless sex with two or more partners was from 0% (none of 13 respondents) to 78% (21 of 27). PEP use peaked in April to June, 2016, at 28% (41 of 147 respondents), but decreased thereafter to 8% (four of 53) in January to March, 2018. Among 460 men who had never used PrEP at baseline, predictors of initiating PrEP included age 40-44 years (incidence rate ratio [IRR] 4·25, 95% CI 1·14-15·79) and 45 years and older (3·59, 1·08-11·97) versus younger than 25 years; and after adjustment for age, recent HIV test (5·17, 1·89-14·08), condomless sex (5·01, 2·16-11·63), condomless sex with two or more partners (5·43, 2·99-9·86), group sex (1·69, 1·01-2·84), and non-injection chemsex-related drugs use (2·86, 1·67-4·91) in the past 3 months, PEP use (4·69, 2·83-7·79) in the past 12 months, and calendar year (Jan 1, 2017, to March 31, 2018 vs July 30, 2013, to Dec 31, 2015: 21·19, 9·48-47·35). Non-employment (0·35, 0·14-0·91) and unstable or no housing (vs homeowner 0·13, 0·02-0·95) were associated with reduced rates of PrEP initiation after adjustment for age. About half of PrEP was obtained via the internet, even after the PrEP Impact trial had started (11 [48%] of 23 respondents in January to March, 2018). INTERPRETATION PrEP awareness and use increased substantially from 2013 to 2018 among a cohort of MSM in England. Improving access to PrEP by routine commissioning by National Health Service England could increase PrEP use among all eligible MSM, but should include public health strategies to target socioeconomic and demographic disparities in knowledge and use of PrEP. FUNDING National Institute for Health Research.
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Affiliation(s)
- Nadia Hanum
- Institute for Global Health, University College London, London, UK.
| | | | - Janey Sewell
- Institute for Global Health, University College London, London, UK
| | | | - Alison J Rodger
- Institute for Global Health, University College London, London, UK
| | - Andrew Speakman
- Institute for Global Health, University College London, London, UK
| | - Nneka Nwokolo
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - David Asboe
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Richard Gilson
- Institute for Global Health, University College London, London, UK; Central and North West London NHS Foundation Trust, London, UK
| | - Amanda Clarke
- Brighton & Sussex University Hospitals NHS Trust, Brighton, UK; Brighton & Sussex Medical School, Brighton, UK
| | - Ada R Miltz
- 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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Sewell J, Cambiano V, Speakman A, Lampe FC, Phillips A, Stuart D, Gilson R, Asboe D, Nwokolo N, Clarke A, Rodger AJ. Changes in chemsex and sexual behaviour over time, among a cohort of MSM in London and Brighton: Findings from the AURAH2 study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 68:54-61. [PMID: 30999243 DOI: 10.1016/j.drugpo.2019.03.021] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 03/21/2019] [Accepted: 03/24/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Recent evidence has suggested that chemsex (the use of mephedrone, crystal methamphetamine and γ -hydroxybutyrate/ γ -butryolactone (GHB/GBL) to enable, enhance and prolong sexual interactions) has increased among men having sex with men (MSM) attending sexual health clinics in large UK cities. To date there has been no data from the UK or Europe that describes changes in chemsex over time within a cohort of MSM. METHODS The prospective cohort study, Attitudes to and Understanding Risk of Acquisition of HIV over Time (AURAH2), collected online questionnaire data from HIV negative or undiagnosed MSM (at enrolment) from 2015 to 2018, recruited from sexual health clinics. We aim to investigate changes in chemsex, three individual drugs associated with chemsex, frequency of chemsex sessions and measures of sexual behaviour, among the cohort of MSM over the study's 3 year follow-up period. RESULTS In total 622 MSM completed at least one online questionnaire for the AURAH2 study, of which 400 (64.3%) were still engaged with the study within the last six months of follow-up. Prevalence of chemsex significantly declined during the follow-up from 31.8% (198/622) at the first online questionnaire, to 11.1% (8/72; p < 0.001) at the 9th. This decline was reflected in the proportion of MSM reporting use of two of the three individual chemsex drugs: mephedrone use had significantly declined from 25.2% at the first online questionnaire to 9.7% (p < 0.001) at the 9th, GHB/GBL use had also declined from 19.9% to 8.3% (p = 0.001). While crystal methamphetamine use declined, but not significantly (11.1%-6.9% [p = 0.289]). Most measures of sexual behaviour (any anal sex, group sex, recent HIV test and bacterial STI) also tended to decline over the follow-up period, with the exception of CLAI with more than one and more than two partners. CONCLUSIONS Chemsex and use of two individual chemsex drugs (mephedrone and GHB/GBL) significantly declined over time among individuals in the study, alongside most measures of sexual behaviour with the exception of those related to CLAI. Focusing health promotion and HIV prevention, such as awareness of post-exposure prophylaxis (PEP) and access to pre-exposure prophylaxis (PrEP), on MSM that report chemsex, and in particular problematic chemsex, would be highly beneficial, potentially only necessary for a relatively short period of time for individuals, and could have long term benefits for HIV and STI prevention.
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Affiliation(s)
- Janey Sewell
- UCL Institute for Global Health, UCL, London, United Kingdom
| | | | - Andrew Speakman
- UCL Institute for Global Health, UCL, London, United Kingdom
| | - Fiona C Lampe
- UCL Institute for Global Health, UCL, London, United Kingdom
| | - Andrew Phillips
- UCL Institute for Global Health, UCL, London, United Kingdom
| | - David Stuart
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Richard Gilson
- UCL Institute for Global Health, UCL, 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
| | - Alison J Rodger
- UCL Institute for Global Health, UCL, London, United Kingdom.
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Cortopassi AC, Driver R, Eaton LA, Kalichman SC. A New Era of HIV Risk: It's Not What You Know, It's Who You Know (and How Infectious). Annu Rev Psychol 2018; 70:673-701. [PMID: 30256719 DOI: 10.1146/annurev-psych-010418-102927] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
HIV is transmitted in social and sexual relationships, and HIV transmission risks, as well as protective actions, are evolving as HIV epidemics unfold. The current focus of HIV prevention is centered on antiretroviral medications used to reduce HIV infectiousness in persons already infected with HIV [treatment as prevention (TasP)]. The same medications used to treat infected persons can also be used by uninfected persons as pre-exposure prophylaxis (PrEP) to reduce the infectivity of HIV. Both PrEP and TasP are effective when adherence is high and individuals do not have co-occurring sexually transmitted infections. HIV prevention is most effective and efficient when delivered within sexual networks with high HIV prevalence. Specific network characteristics are recognized as important facilitators of HIV transmission; these characteristics include the degree of similarity among network members (homophily), gender role norms, and belief systems. Since 2011, HIV risk has been redefined based on infectiousness and infectivity, ushering in a new era of HIV prevention with the potential to end HIV epidemics.
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Affiliation(s)
- Andrew C Cortopassi
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut 06269, USA;
| | - Redd Driver
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut 06269, USA;
| | - Lisa A Eaton
- Department of Human Development and Family Studies, University of Connecticut, Storrs, Connecticut 06269, USA
| | - Seth C Kalichman
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut 06269, USA;
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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: 7.9] [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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