Factors associated with reporting antibiotic use as STI prophylaxis among HIV PrEP users: findings from a cross-sectional online community survey, May–July 2019, UK

ObjectivesThe use of antibiotics as pre-exposure or postexposure prophylaxis for sexually transmitted infection (STI) prevention (STI prophylaxis) is not currently recommended in the UK, but there is evidence that self-prescribing occurs among those at greatest risk. We present the prevalence and factors associated with STI prophylaxis among a community sample of HIV pre-exposure prophylaxis (PrEP) users.MethodsThe 2019 online PrEP User Survey ran between 17 May and 1 July. Eligible participants included UK residents reporting HIV PrEP use or having tried to obtain HIV PrEP since January 2017. STI prophylaxis use was defined as reporting buying antibiotics to prevent STIs, either privately or through the internet; this question was only asked to HIV PrEP users. Factors associated with STI prophylaxis use were assessed using univariable and multivariable logistic regression.ResultsOverall, 9% (167/1856) of HIV PrEP users reported STI prophylaxis use; 97% were gay or bisexual men, 84% reported white ethnicity, 55% resided in London and 69% were aged ≥35 years. Factors associated with STI prophylaxis included: reporting ≥5 compared with 1–4 condomless sex partners in the past 6 months (12% vs 5.6%, adjusted odds ratio (aOR)=1.80; 95% CI 1.22 to 2.64), reporting chemsex drug use compared with no sexualised drug use in the past 12 months (13% vs 6.0%, aOR=1.88; 95% CI 1.20 to 2.93) and reporting an STI diagnosis in the past 12 months (12% vs 6.6%, aOR=1.54; 95% CI 1.08 to 2.18). Variables not significant in multivariable analyses included: ethnicity, age, residence and HIV PrEP sourcing.ConclusionsApproximately 1 in 10 HIV PrEP users from this community sample reported self-prescribed STI prophylaxis. STI prophylaxis was associated with sexual behaviour known to facilitate STI transmission and with a history of recent STIs acquisition. Given the potential risk of antimicrobial resistance, sexual health clinicians should consider asking attendees, especially HIV PrEP users, about the use of antibiotics as STI prophylaxis, to inform appropriate counselling, testing and management.

Download Full-text

Combination prevention and HIV: a cross-sectional community survey of gay and bisexual men in London, October to December 2016

Eurosurveillance ◽

10.2807/1560-7917.es.2019.24.25.1800312 ◽

2019 ◽

Vol 24 (25) ◽

Cited By ~ 4

Author(s):

Louise Logan ◽

Ibidun Fakoya ◽

Alison Howarth ◽

Gary Murphy ◽

Anne M Johnson ◽

...

Keyword(s):

Hiv Testing ◽

Gay And Bisexual Men ◽

Bisexual Men ◽

Transmitted Infection ◽

Cross Sectional ◽

Combination Prevention ◽

Factors Associated ◽

The Past ◽

Increased Risk ◽

And Bisexual

Background Men who have sex with men (MSM) are at risk of HIV and are an important population to monitor and ameliorate combination prevention efforts. Aim To estimate HIV prevalence and identify factors associated with frequent HIV testing (≥ 2 HIV tests in the last year) and pre-exposure prophylaxis (PrEP) use among MSM in London. Methods For this cross-sectional study, MSM recruited from 22 social venues provided oral-fluid samples for anonymous HIV antibody (Ab) testing and completed a questionnaire. Factors associated with frequent HIV testing and PrEP use were identified through logistic regression. Results Of 767 men recruited, 545 provided an eligible oral specimen. Among these, 38 MSM (7.0%) were anti-HIV positive including five (13.2%; 5/38) who reported their status as negative. Condomless anal sex within the previous 3 months was reported by 60.1% (412/685) men. Frequent HIV testing was associated with, in the past year, a reported sexually transmitted infection (adjusted odds ratio (AOR): 5.05; 95% confidence interval (CI): 2.66–9.58) or ≥ 2 casual condomless partners (AOR 2–4 partners: 3.65 (95% CI: 1.87–7.10); AOR 5–10 partners: 3.34 (95% CI: 1.32–8.49). Age ≥ 35 years was related to less frequent HIV testing (AOR 35–44 years: 0.34 (95% CI: 0.16–0.72); AOR ≥ 45 years: 0.29 (95% CI: 0.12–0.69). PrEP use in the past year was reported by 6.2% (46/744) of MSM and associated with ≥ 2 casual condomless sex partners (AOR: 2.86; 95% CI: 1.17–6.98) or chemsex (AOR: 2.31; 95% CI: 1.09–4.91). Conclusion This bio-behavioural study of MSM found high rates of behaviours associated with increased risk of HIV transmission. Combination prevention, including frequent HIV testing and use of PrEP, remains crucial in London.

Download Full-text

Sexually transmitted infection diagnoses, sexualised drug use and associations with pre-exposure prophylaxis use among men who have sex with men in the UK

International Journal of STD & AIDS ◽

10.1177/0956462419897222 ◽

2020 ◽

Vol 31 (3) ◽

pp. 254-263

Author(s):

Matthew P Hibbert ◽

Caroline E Brett ◽

Lorna A Porcellato ◽

Vivian D Hope

Keyword(s):

Drug Use ◽

Sexually Transmitted Infection ◽

Transmitted Infection ◽

Cross Sectional ◽

Sexually Transmitted ◽

Factors Associated ◽

Hiv Test ◽

Condomless Anal Intercourse ◽

Sex With Men ◽

Exposure Prophylaxis

Previous research has focused on acceptability of pre-exposure prophylaxis (PrEP) use, but few community-based studies have been conducted regarding actual use, and PrEP use in the context of sexualised drug use remains understudied. A national online cross-sectional study recruited men who have sex with men (MSM) via social media (April–June 2018). Multivariable logistic regression was used to investigate factors associated with PrEP use. Bivariate analyses compared engaging in condomless anal intercourse (CAI) under the influence of specific drugs and recent sexually transmitted infection (STI) diagnoses (past 12 months) between MSM taking PrEP and those not. Overall, 6% (99/1581) MSM reported current PrEP use. Factors associated with PrEP use were increasing age, recent genitourinary medicine (GUM) attendance (95% versus 45%, aOR = 6.25, 95%CI 2.05, 19.03), an HIV test in the past three months (89% versus 23%, aOR = 14.22, 95%CI 6.76, 29.90), and recent engagement in chemsex (21% versus 4%, aOR = 3.56, 95%CI 1.78, 7.11). MSM taking PrEP were more likely to have had an STI diagnosis (42% versus 8%), most commonly chlamydia (26% versus 3%) and gonorrhoea (25% versus 4%). Considering the elevated levels of self-reported STI diagnoses among those on PrEP, there was a high level of engagement with sexual health services, which may help reduce onward STI transmission.

Download Full-text

Food access among people who inject drugs in West Virginia

Harm Reduction Journal ◽

10.1186/s12954-021-00536-x ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Saba Rouhani ◽

Sean T. Allen ◽

Sara Whaley ◽

Rebecca Hamilton White ◽

Allison O’Rourke ◽

...

Keyword(s):

Drug Use ◽

West Virginia ◽

Disease Transmission ◽

Food Access ◽

People Who Inject Drugs ◽

The United States ◽

Cross Sectional ◽

Factors Associated ◽

The Past ◽

Adequate Food

Abstract Background The substance use epidemic in the United States continues to drive high levels of morbidity and mortality, particularly among people who inject drugs (PWID). Poor access to food often co-occurs with drug use and contributes to associated sequelae, such as risks for HIV and diabetes. The objective of this study was to examine factors associated with adequate food access among PWID in a rural Appalachian community. Methods Cross-sectional surveys were used to collect data among PWID aged 18 and older in Cabell County, West Virginia. Frequency of hunger and sociodemographic, structural and drug use characteristics were measured. Adequate food access was defined as reporting ‘never’ going to bed hungry at night in the past six months. Pearson’s χ2 and t-tests and multivariable logistic regression were used to identify factors associated with food access. Results Only 71 individuals (17%) reported never going to bed hungry at night in the past six months. Adjusted odds of having adequate food access were higher among PWID who completed high school (aOR 2.94; P = 0.010) and usually used drugs alone (aOR 1.97; P = 0.025), and lower among PWID who were female (aOR 0.51; P = 0.037), experienced homelessness (aOR 0.23, P < 0.001), were recently arrested (aOR 0.50 P = 0.047), and engaged in receptive sharing of injection equipment (aOR 0.52, P = 0.035). Conclusions We found extremely low food access in a population of PWID in Appalachia who are vulnerable to overdose and infectious disease transmission. Integrated interventions promoting food access are needed to improve the public health and wellbeing of people who inject drugs in Appalachia.

Download Full-text

Clinically significant depressive symptoms and sexual behaviour among men who have sex with men

BJPsych Open ◽

10.1192/bjpo.bp.116.003574 ◽

2017 ◽

Vol 3 (3) ◽

pp. 127-137 ◽

Cited By ~ 12

Author(s):

Ada R. Miltz ◽

Alison J. Rodger ◽

Janey Sewell ◽

Andrew Speakman ◽

Andrew N. Phillips ◽

...

Keyword(s):

Depressive Symptoms ◽

Sexual Behaviour ◽

Prevalence Ratio ◽

Post Exposure Prophylaxis ◽

Transmitted Infection ◽

Cross Sectional ◽

Sti Prevention ◽

The Past ◽

Sex With Men ◽

The Relationship

BackgroundThe relationship between depression and sexual behaviour among men who have sex with men (MSM) is poorly understood.AimsTo 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.MethodThe 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).ResultsAmong 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).ConclusionsManagement of mental health may play a role in HIV and STI prevention.

Download Full-text

Sexually transmitted infection testing awareness, uptake and diagnosis among urban refugee and displaced youth living in informal settlements in Kampala, Uganda: a cross-sectional study

BMJ Sexual & Reproductive Health ◽

10.1136/bmjsrh-2019-200392 ◽

2019 ◽

Vol 46 (3) ◽

pp. 192-199 ◽

Cited By ~ 1

Author(s):

Carmen Helen Logie ◽

Moses Okumu ◽

Simon Mwima ◽

Peter Kyambadde ◽

Robert Hakiza ◽

...

Keyword(s):

Young Women ◽

Sex Partners ◽

Transmitted Infection ◽

Cross Sectional ◽

Sti Prevention ◽

Sexually Transmitted ◽

Factors Associated ◽

Sti Testing ◽

Social Ecological ◽

Related Stigma

BackgroundSexually transmitted infection (STI) prevention needs among urban refugee and displaced youth are understudied. The study objective was to explore factors associated with the STI prevention cascade (STI services awareness, testing, diagnosis) among urban refugee and displaced youth in Kampala, Uganda.MethodsWe implemented a cross-sectional survey with youth aged 16–24 years in informal settlements in Kampala. We conducted bivariate and multivariable logistic regression analyses to identify social ecological (intrapersonal, interpersonal, community) level factors associated with STI testing services awareness, lifetime STI testing, and lifetime STI diagnosis.ResultsParticipants (n=445; mean age 19.3, SD 2.6, years) included young women (n=333, 74.8%) and young men (n=112, 25.2%). Less than half (43.8%) were aware of community STI services. One-quarter (26.1%) reported lifetime STI testing. Of these, 39.5% reported a lifetime STI diagnosis. In multivariable analyses among young women, age, lifetime sex partners, and lower adolescent sexual and reproductive health (SRH)-related stigma were associated with STI services awareness; and age, lower adolescent SRH-related stigma, and food security were associated with STI testing. Among young men, time in Uganda and lower HIV-related stigma were associated with STI services awareness; and age, condom self-efficacy, and increased adolescent SRH-related stigma were associated with testing. Lifetime sex partners, lower condom self-efficacy, and lower adolescent SRH-related stigma were associated with lifetime STI diagnosis.ConclusionsSocial ecological factors including stigma (adolescent SRH-related, HIV-related) were associated with STI testing and diagnosis among young urban refugees. Gender, age and stigma-tailored strategies can advance the STI prevention cascade among urban young refugees.

Download Full-text

Food Security among People who Inject Drugs in West Virginia

10.21203/rs.3.rs-151915/v1 ◽

2021 ◽

Author(s):

Saba Rouhani ◽

Sean T Allen ◽

Sarah Whaley ◽

Rebecca H White ◽

Allison O'Rourke ◽

...

Keyword(s):

Food Security ◽

Drug Use ◽

West Virginia ◽

Disease Transmission ◽

People Who Inject Drugs ◽

The United States ◽

Cross Sectional ◽

Factors Associated ◽

The Past ◽

Poor Access

Abstract Background. The substance use epidemic in the United States continues to drive high levels of morbidity and mortality, particularly among people who inject drugs (PWID). Poor access to food co-occurs with illicit drug use and contributes to associated sequelae, such as HIV and diabetes. The objective of this study was to examine factors associated with food security among PWID in a rural Appalachian community. Methods. Cross-sectional surveys were used to collect data in a sample of 420 PWID aged 18 and older Cabell County, West Virginia. Frequency of food access and sociodemographic, structural and drug use characteristics were measured. Food security was defined as reporting ‘never’ going to bed hungry at night in the past six months. Pearson’s χ2 and t-tests were used to identify factors associated with food security. Multivariable logistic regression was employed to estimate adjusted odds of being food secure.Results. Only 71 individuals (17%) reported never going to bed hungry night in the past six months. Adjusted odds of being food secure were higher among PWID who completed high school (aOR 2.94; P=0.010) and usually using drugs alone (aOR 1.97; P=0.025), and lower among PWID who were female (aOR 0.51; P=0.037), experienced homelessness (aOR 0.23, P<0.001), were recently arrested (aOR 0.50 P=0.049), and engaged in receptive sharing of injection equipment (aOR 0.52, P=0.035).Conclusions. We found extremely low levels of food security in a population of PWID in Appalachia who are vulnerable to overdose and infectious disease transmission. Integrated interventions that approach food provision as harm reduction are needed to address the overlapping factors that jeopardize the health and wellbeing of people who inject drugs.

Download Full-text

Violence and discrimination among Ugandan residents during the COVID-19 lockdown

BMC Public Health ◽

10.1186/s12889-021-10532-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Elizabeth Katana ◽

Bob Omoda Amodan ◽

Lilian Bulage ◽

Alex R. Ario ◽

Joseph Nelson Siewe Fodjo ◽

...

Keyword(s):

Law Enforcement ◽

Control Measures ◽

Sub Saharan Africa ◽

World Health ◽

Vulnerable Groups ◽

Transport Systems ◽

Outcome Variable ◽

Cross Sectional ◽

Factors Associated ◽

The Past

Abstract Background In March 2020, the World Health Organization (WHO) declared COVID-19 a pandemic. Many countries in Sub-Saharan Africa, Uganda inclusive, implemented lockdowns, curfew, banning of both private and public transport systems, and mass gatherings to minimize spread. Social control measures for COVID-19 are reported to increase violence and discrimination globally, including in Uganda as some may be difficult to implement resulting in the heavy deployment of law enforcement. Media reports indicated that cases of violence and discrimination had increased in Uganda’s communities following the lockdown. We estimated the incidence and factors associated with experiencing violence and discrimination among Ugandans during the COVID-19 lockdown to inform control and prevention measures. Methods In April 2020, we conducted a secondary analysis of cross-sectional data under the International Citizen Project (ICP) to assess adherence to public health measures and their impact on the COVID-19 outbreak in Uganda. We analyzed data on violence and discrimination from the ICP study. We performed descriptive statistics for all the participants’ characteristics and created a binary outcome variable called experiencing violence and/or discrimination. We performed logistic regression analysis to identify the factors associated with experiencing violence and discrimination. Results Of the 1726 ICP study participants, 1051 (58.8%) were males, 841 (48.7%) were currently living with a spouse or partner, and 376 (21.8%) had physically attended work for more than 3 days in the past week. Overall, 145 (8.4%) experienced any form of violence and/or discrimination by any perpetrator, and 46 (31.7%) of the 145 reported that it was perpetrated by a law enforcement officer. Factors associated with experiencing violence or discrimination were: being male (AOR = 1.60 CI:1.10–2.33), having attended work physically for more than 3 days in the past week (AOR = 1.52 CI:1.03–2.23), and inability to access social or essential health services since the epidemic started (AOR = 3.10 CI:2.14–4.50). Conclusion A substantial proportion of Ugandan residents experienced violence and/or discrimination during the COVID-19 lockdown, mostly perpetrated by law enforcement officers. We recommend mitigation of the collateral impact of lockdowns with interventions that focus on improving policing quality, ensuring continuity of essential services, and strengthening support systems for vulnerable groups including males.

Download Full-text

Use of illicit drugs by adolescents and young adults of an urban settlement in Brazil

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.64.02.114 ◽

2018 ◽

Vol 64 (2) ◽

pp. 114-118

Author(s):

Rafael Alves Guimarães ◽

Márcia Maria de Souza ◽

Karlla Antonieta Amorim Caetano ◽

Sheila Araujo Teles ◽

Marcos André de Matos

Keyword(s):

Young Adults ◽

Drug Use ◽

Illicit Drugs ◽

Illicit Drug ◽

Illicit Drug Use ◽

Self Report ◽

Adolescents And Young Adults ◽

Cross Sectional ◽

Urban Settlement ◽

Factors Associated

Summary Objective: To estimate the prevalence and factors associated with illicit drug use by adolescents and young adults of a formal urban settlement. Method: Cross-sectional study including adolescents and young adults 12-24 years of an urban settlement in the Midwest Region of Brazil. Data were collected using a structured questionnaire and analyzed using Stata, version 12.0. We used Poisson regression model to estimate the factors associated with illicit drug use. Results: Of the total participants (n=105), 27.6% (95CI 20.0-36.9%) had used illicit drugs such as marijuana, cocaine, crack, LSD and inhalants. The consumption of these substances was associated with male gender, use of body piercing and/or tattoos, licit drug use and self-report of signs and/or symptoms of sexually transmitted infections. Conclusion: High prevalence of illicit drug use was found in the individuals investigated, ratifying the presence of risk factors to the vulnerability of the settlers to use these substances in the urban settlement population.

Download Full-text

Study Of Depression in Elderly: Prevalence and Factors Associated

Journal of Psychiatrists Association of Nepal ◽

10.3126/jpan.v7i2.24609 ◽

2018 ◽

Vol 7 (2) ◽

pp. 16-23

Author(s):

S. Subedi ◽

P. Shrestha ◽

D.K. Thapa

Keyword(s):

Elderly People ◽

Short Form ◽

Demographic Data ◽

Community Sample ◽

Depression Scale ◽

Structured Interview ◽

Mild Depression ◽

Cross Sectional ◽

Factors Associated ◽

Prevalence Of Depression

Introduction: Ageing is a normal phenomenon. Various studies shows that there is a sharp rise in the elderly population in the last few years. Prevalence of depression in elderly is found to around 13% in the community sample in various countries. There is a dearth of study related to psychiatric illness in elderly in Nepal. This study was aimed to find the prevalence of depression in elderly and see for various factors associated with elderly depression. Material And Method: This was a cross-sectional study conducted at Siddharthnagar Municipality, Bhairahawa, Rupandehi. 316 elderly were selected by using systematic random sampling technique. A Semi- structured interview schedule was developed to collect Socio-demographic data. The Short Form Geriatric Depression Scale (SF-GDS) was used to find out the prevalence of depression among elderly people. Ethical Approval was obtained from the Institutional Review Committee, Chitwan Medical College and permission was obtained from Siddharthnagar Municipality, Bhairahawa, Rupandehi. The collected data was entered in Epidata 3.1 and the data was exported and analyzed in IBM SPSS 20. Results: There were a total of 316 samples in this study. The mean age of respondents was 68.47 years of age. Majority of the respondents (54.1%) were female and living in joint Family (72.2%). Almost 45.9% respondents were from upper caste groups, 90.5% of respondents were Hindus. Among the married (100%) respondents, 54.6% of respondents were living with spouse and 3.2% were divorced and separated from spouse. Depression was present in 49.4% of respondents were depressed. Among depressed respondents, 46.7% of respondents were having mild depression, 39.2% moderate depression and 14.1% severe depression. Conclusion: The finding of this study concluded that depression among elderly people was a substantial problem in Siddharthnagar Municipality, Bhairahawa, Rupandehi.

Download Full-text

Drug Use Changes at the Individual Level: Results from a Longitudinal, Multisite Survey in Young Europeans Frequenting the Nightlife Scene

European Addiction Research ◽

10.1159/000520118 ◽

2021 ◽

pp. 1-6

Author(s):

Meryem Grabski ◽

Jon Waldron ◽

Tom P. Freeman ◽

Claire Mokrysz ◽

Ruben J.J. van Beek ◽

...

Keyword(s):

Drug Use ◽

Online Survey ◽

Prescription Opioids ◽

Alkyl Nitrates ◽

Cross Sectional ◽

Individual Level ◽

The Past ◽

Frequency Of Use ◽

The Individual

Background: Monitoring emerging trends in the increasingly dynamic European drug market is vital; however, information on change at the individual level is scarce. In the current study, we investigated changes in drug use over 12 months in European nightlife attendees. Method: In this longitudinal online survey, changes in substances used, use frequency in continued users, and relative initiation of use at follow-up were assessed for 20 different substances. To take part, participants had to be aged 18–34 years; be from Belgium, Italy, the Netherlands, Sweden, or the UK; and have attended at least 6 electronic music events in the past 12 months at baseline. Of 8,045 volunteers at baseline, 2,897 completed the survey at both time points (36% follow-up rate), in 2017 and 2018. Results: The number of people using ketamine increased by 21% (p < 0.001), and logarithmized frequency of use in those continuing use increased by 15% (p < 0.001; 95% CI: 0.07–0.23). 4-Fluoroamphetamine use decreased by 27% (p < 0.001), and logarithmized frequency of use in continuing users decreased by 15% (p < 0.001, 95% CI: −0.48 to −0.23). The drugs with the greatest proportion of relative initiation at follow-up were synthetic cannabinoids (73%, N = 30), mephedrone (44%, N = 18), alkyl nitrites (42%, N = 147), synthetic dissociatives (41%, N = 15), and prescription opioids (40%, N = 48). Conclusions: In this European nightlife sample, ketamine was found to have the biggest increase in the past 12 months, which occurred alongside an increase in frequency of use in continuing users. The patterns of uptake and discontinuation of alkyl nitrates, novel psychoactive substances, and prescription opioids provide new information that has not been captured by existing cross-sectional surveys. These findings demonstrate the importance of longitudinal assessments of drug use and highlight the dynamic nature of the European drug landscape.

Download Full-text