scholarly journals Chemsex and diagnoses of syphilis, gonorrhoea and chlamydia among men who have sex with men in the UK: a multivariable prediction model using causal inference methodology

2021 ◽  
pp. sextrans-2020-054629
Author(s):  
Louis MacGregor ◽  
Manik Kohli ◽  
Katharine J Looker ◽  
Ford Hickson ◽  
Peter Weatherburn ◽  
...  
Keyword(s):  
Causal Inference ◽  
Significant Proportion ◽  
Internet Survey ◽  
Hiv Diagnosis ◽  
Inference Models ◽  
Stimulant Use ◽  
Sex With Men ◽  
The Uk ◽  
Exposure Prophylaxis

IntroductionIn the last decade diagnoses of most STIs have risen among men who have sex with men (MSM). Although a significant proportion of this is likely due to increased STI screening, understanding the role of behavioural drivers remains critical. We measure the associations between stimulant use to enhance and prolong sexual experiences (chemsex) and bacterial STI diagnoses in UK MSM, individually considering HIV-diagnosed MSM, pre-exposure prophylaxis (PrEP) users and other MSM.MethodsWe used the UK 2017–2018 European MSM Internet Survey data (n=9375). We constructed causal inference models using multivariable logistic regression, calculating adjusted OR (aOR) and 95% CI of the associations between participation in recent (≤12 months) exclusively dyadic or multipartner chemsex versus no chemsex and recent self-reported diagnoses of syphilis, gonorrhoea and chlamydia.ResultsAmong MSM with an HIV diagnosis, 25% of users indicated recent multipartner chemsex, vs 28% of PrEP users and 5% of other MSM. Adjusting for age, ethnicity, UK birth, cis-trans status, sexual identity, education, settlement size and relationship status, participation in recent multipartner chemsex versus no chemsex was associated with greater odds of recent syphilis, gonorrhoea and chlamydia diagnosis. aORs for recent syphilis, gonorrhoea and chlamydia diagnoses were 2.6 (95% CI 1.7 to 4.1), 3.9 (95% CI 2.6 to 5.8) and 2.9 (95% CI 1.9 to 4.3), respectively, in HIV-diagnosed MSM; 1.9 (95% CI 1.1 to 3.3), 2.9 (95% CI 2.0 to 4.2) and 1.9 (95% CI 1.3 to 2.8), respectively, in PrEP users; and 4.0 (95% CI 2.3 to 6.9), 2.7 (95% CI 1.9 to 3.8) and 2.3 (95% CI 1.6 to 3.4), respectively, in other MSM. Conversely, exclusively dyadic chemsex had no significant associations with bacterial STI diagnoses among HIV-diagnosed MSM, only gonorrhoea (aOR 2.4, 95% CI 1.2 to 4.7) among PrEP users and syphilis (aOR 2.8, 95% CI 1.4 to 5.6) among other MSM.DiscussionMultipartner chemsex may drive the association between chemsex and bacterial STI diagnoses and thus should be the focus of future tailored chemsex interventions. Additionally, PrEP acceptability among MSM and particularly chemsex participants has generated an emergent group suitable for such interventions.

scholarly journals Characteristics and consequences of medical care interruptions in HIV-infected patients in France

2016 ◽  
Vol 144 (11) ◽  
pp. 2363-2370 ◽  
Author(s):  
L. CUZIN ◽  
P. DELLAMONICA ◽  
Y. YAZDANPANAH ◽  
S. BOUCHEZ ◽  
D. REY ◽  
...  
Keyword(s):  
Medical Care ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Time Interval ◽  
Hiv Diagnosis ◽  
Viral Loads ◽  
Treatment Benefits ◽  
Cox Proportional Hazards Models ◽  
Sex With Men

SUMMARYTo describe the consequences of medical care interruptions (MCIs) we selected patients with at least two medical encounters between January 2006 and June 2013 in the Dat'AIDS cohort. Patients with any time interval >15 months between two visits were defined as having a MCI, as opposed to uninterrupted follow-up (UFU). Patients’ characteristics at the time of HIV diagnosis and at the censoring date were compared between groups. Cox proportional hazards models were built to assess the role of interruptions on survival (total and AIDS-free). Of 11 116 patients, 824 had at least one MCI. These patients were younger at the time of HIV diagnosis (30vs. 33 years,P< 0·0001). MCI was less frequent in men having sex with menvs.heterosexual patients [odds ratio (OR) 0·81, 95% confidence interval (CI) 0·69–0·96)], and a centre effect was described. MCI was independently associated with AIDS (OR 2·54, 95% CI 2·10–3·09) and death (OR 2·65, 95% CI 1·94–3·61). At the censoring date, 52·2% of patients with at least one MCI had viral load below detectionvs.85·3% of the UFU group (P< 0·0001). In conclusion, MCIs were associated with patients’ survival and with the proportion of viral loads below detection in our cohort, compromising individual and collective treatment benefits.

Evaluating the extent of potential resistance to pre-exposure prophylaxis within the UK HIV-1-infectious population of men who have sex with men

HIV Medicine ◽  
2011 ◽  
Vol 13 (5) ◽  
pp. 309-314 ◽  
Author(s):  
D Dolling ◽  
AN Phillips ◽  
V Delpech ◽  
D Pillay ◽  
PA Cane ◽  
...  
Keyword(s):  
Sex With Men ◽  
The Uk ◽  
Exposure Prophylaxis ◽  
Hiv 1

Experience in the UK

2009 ◽  
Vol 20 (1_suppl) ◽  
pp. 7-14 ◽  
Author(s):  
M Fisher ◽  
V Delpech
Keyword(s):  
Hiv Testing ◽  
Significant Proportion ◽  
National Guidelines ◽  
Black African ◽  
Opt Out ◽  
Hiv Test ◽  
Undiagnosed Hiv ◽  
Sex With Men ◽  
The Uk ◽  
Prompt Diagnosis

The number of new diagnoses of HIV in the UK is increasing, with most new diagnoses reported in men who have sex with men (MSM) and black African heterosexuals the later of whom usually acquire their infection abroad. Around 31 % of people infected with HIV in the UK are unaware of their diagnosis, and one in three are diagnosed for the first time with a CD4 count <200 cells/mm3 or with AIDS. Late diagnosis is the most important factor that explains most HIV-related causes of death in the UK. Strategies to increase HIV-testing include universal approaches in antenatal and STD clinics (known as genitourinary [GU] medicine clinics), but other opportunities for prompt diagnosis are often missed during secondary and primary consultations - even when patients present with HIV-related illnesses. Furthermore, a significant proportion of people with undiagnosed HIV who attend GU medicine clinics leave without being offered an HIV test or a diagnosis of HIV. Universal offer (opt-out testing) policies seem to work well - such as in the successful antenatal testing programme - but local strategies to increase HIV-testing and prompt diagnosis, such as training courses and rapid HIV-testing initiatives have met with varied success. New national guidelines for the UK have been published and, if successfully implemented, should help to address some of these issues.

Comparing non-occupational post-exposure prophylaxis drug regimens for HIV: insights from a linked HIV surveillance system

Sexual Health ◽  
2017 ◽  
Vol 14 (2) ◽  
pp. 179 ◽  
Author(s):  
Anna B. Pierce ◽  
Carol El-Hayek ◽  
Damien McCarthy ◽  
Jude Armishaw ◽  
Kerrie Watson ◽  
...  
Keyword(s):  
Anal Intercourse ◽  
Post Exposure Prophylaxis ◽  
Receptive Anal Intercourse ◽  
Hiv Diagnosis ◽  
Hiv Surveillance ◽  
Post Exposure ◽  
Hiv Serostatus ◽  
Drug Regimens ◽  
Sex With Men ◽  
Exposure Prophylaxis

Background International non-occupational post-exposure prophylaxis (NPEP) guidelines recommend routine use of three drug NPEP regimens, despite absence of evidence for greater prevention efficacy compared with two drug regimens. This study examines the potential for excess HIV seroconversions among high-risk men who have sex with men (MSM) reporting receptive anal intercourse with a source of unknown HIV serostatus (RAIU) following a two-drug versus a three-drug NPEP regimen. Methods: Data for MSM in the Victorian NPEP service database between 10 August 2005 and 31 December 2012 were linked with all Victorian HIV notifications up to 31 December 2013. The primary outcome was NPEP failure following NPEP presentation among MSM reporting RAIU, stratified by the number of drugs prescribed. Results: Among 1482 MSM reporting 2002 episodes of RAIU and prescribed two- or three-drug NPEP, 70 seroconverted to HIV, but only 19 were considered possible NPEP failures. HIV diagnosis incidence among men reporting RAIU was 1.2/100 person years (PY) (95%CI = 1.0–1.6); 1.1/100 PY (95%CI = 0.8–1.4) among MSM prescribed two drugs and 2.2/100 PY (95%CI = 1.4–3.7) among MSM prescribed three drugs (P < 0.01). Of the 19 possible NPEP failures, 13 (0.7%) were prescribed two drugs and six (2.7%) three drugs (P < 0.001). Conclusions: This study suggests that two-drug NPEP regimens do not result in excess seroconversions compared with three-drug regimens when used following RAIU. Clinical services should carefully consider their use of three drug NPEP and whether resources might be better invested in other prevention strategies, particularly pre-exposure prophylaxis (PrEP).

scholarly journals 1287. PrEP-Engaged or PrEP Curious?: A Characterization and Comparison of Initial PrEP Appointment Attenders vs. Nonattenders

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S463-S464
Author(s):  
Deborah A Kahal ◽  
Neal Goldstein ◽  
Susan Szabo
Keyword(s):  
Demographic Data ◽  
Significant Proportion ◽  
White Men ◽  
Published Data ◽  
Effective Prevention ◽  
Younger Age ◽  
Immunodeficiency Virus ◽  
Chi Squared ◽  
Sex With Men ◽  
Exposure Prophylaxis

Abstract Background Human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP), with adequate adherence, is highly effective prevention of HIV-1 infection amongst high-risk individuals. While over 1 million individuals are PrEP-eligible in the U.S., those at highest risk for HIV, specifically young non-white men who have sex with men (MSM), represent some of the least penetrated groups to benefit from PrEP. No published data exists to characterize individuals with unattended initial PrEP appointments. Methods Our program, a Ryan White funded HIV clinic that also provides Hepatitis C and PrEP care, prospectively collected demographic data on all patients with an attended initial PrEP appointment between November 2015 and March 2019. We retrospectively abstracted the same data for individuals with unattended initial PrEP appointments (including cancelations and no shows) during the same period. Descriptive statistical analyses used rank-sum tests for skewed data (age) and Chi-squared tests for categorical data (all other variables). Results 33% (34/103) of all individuals did not attend an initial appointment (table). Younger age and nonprivate insurance were the 2 sociodemographic variables that were significantly associated with unattended vs. attended initial appointments. Amongst those whose HIV risk factors were known, MSM were more likely to attend their appointment compared with non-MSM. 77% (26/34) of individuals with unattended initial appointments did not reschedule (figure). Notably, 12% (4/34) PrEP-eligible individuals previously presented to the clinic yet did not re-present for dedicated PrEP evaluation. Conclusion A significant proportion of individuals schedule but do not attend initial PrEP appointments. This cohort, particularly younger patients and those with nonprivate insurance, represents a distinct population - with a “near” yet incomplete engagement in care – for whom HIV prevention efforts and concerted outreach should be focused. Same day, rapid PrEP starts deserve serious consideration in order to capitalize on patient engagement when the opportunity presents. The paucity of data highlights the need for research of those who are PrEP-interested but not fully PrEP-engaged. Disclosures All authors: No reported disclosures.

What is the extent of repeat prescriptions for post-exposure prophylaxis for HIV after sexual exposure among men who have sex with men in the UK?

Sexual Health ◽  
2016 ◽  
Vol 13 (6) ◽  
pp. 595 ◽  
Author(s):  
Carrie Llewellyn ◽  
Harriet Martin ◽  
Eileen Nixon
Keyword(s):  
High Risk ◽  
Hiv Positive ◽  
Post Exposure Prophylaxis ◽  
Post Exposure ◽  
Genitourinary Medicine ◽  
Sex With Men ◽  
The Uk ◽  
Exposure Prophylaxis ◽  
Prevention Of Hiv ◽  
Repeat Prescriptions

People who repeatedly present for post-exposure prophylaxis (PEP) for prevention of HIV following a high-risk sexual exposure are of concern according to the British HIV Association PEP guidelines. The aim of this audit was to determine the extent of repeat PEP prescriptions for men who have sex with men (MSM) by conducting a retrospective review of patient notes from a 5-year period at one genitourinary medicine clinic. Over the 5 years, 107 of 929 MSM (11.5%; 95% confidence interval: 9.45–13.55) received more than one PEP prescription (repeat range 1–8; mean = 3.3, s.d. = 1.44). Forty percent of these had received three or more PEP prescriptions. Seven of the 107 became HIV positive. Patients need to be offered and encouraged to take up behavioural risk reduction interventions at the time of each PEP prescription.

Men who have sex with men who are born abroad and diagnosed with HIV in England and Wales: an epidemiological perspective

2005 ◽  
Vol 16 (9) ◽  
pp. 618-621 ◽  
Author(s):  
S Dougan ◽  
J Elford ◽  
K Sinka ◽  
K A Fenton ◽  
B G Evans
Keyword(s):  
Sexual Health ◽  
Significant Proportion ◽  
Health Needs ◽  
Country Of Birth ◽  
England And Wales ◽  
Black African ◽  
South Central ◽  
Black Caribbean ◽  
Sex With Men ◽  
The Uk

Relatively little is known about the sexual health needs of men who have sex with men (MSM) born abroad who reside in the UK. We describe here the epidemiology of HIV among MSM born outside the UK and diagnosed with HIV in England and Wales. Reports of HIV diagnoses in England and Wales received at the Health Protection Agency Centre for Infections were analysed. Between 2000 and 2003, 6386 MSM were diagnosed with HIV in England and Wales. Country of birth was recorded for 3571 (56%). Of those with country of birth reported, 2598 (73%) were born in the UK and 973 (27%) abroad. Of those born abroad (973), 424 (44%) were born in Europe, 141 (15%) in Africa, 104 (11%) in South/Central America and the remainder in other regions. Where reported (949), 69% of MSM born abroad were White, 12% other/mixed, 9% Black Caribbean and 7% Black African. Probable country of infection was reported for 612 MSM born abroad: 52% were infected in the UK, 43% in their region of birth and 5% in another region. Men born abroad represent a significant proportion of HIV diagnoses among MSM in England and Wales. More than half probably acquired their HIV infection in the UK, strengthening the call for targeted HIV prevention and sexual health promotion among MSM who are not born in England and Wales.

scholarly journals Key Findings from the European Men-Who-Have-Sex-With-Men Internet Survey in Greece

Epidemiologia ◽  
2021 ◽  
Vol 2 (1) ◽  
pp. 114-123
Author(s):  
Katerina Pantavou ◽  
Georgios Tsiakalakis ◽  
Sophocles Chanos ◽  
Georgios Polkas ◽  
Georgios Papageorgiou ◽  
...  
Keyword(s):  
Policy Making ◽  
Hepatitis A ◽  
Descriptive Analysis ◽  
Internet Survey ◽  
Anxiety And Depression ◽  
Inclusion Criteria ◽  
Four Dimensions ◽  
Sex With Men ◽  
Exposure Prophylaxis ◽  
Severe Anxiety

The European Men-Who-Have-Sex-With-Men Internet Survey (EMIS-2017) is an international survey for men who have sex with men (MSM) designed to measure the level and distribution of four dimensions: (a) sexual health outcomes, (b) risk and precaution behaviors, (c) health promotion needs, and (d) coverage/uptake of interventions. The aim of the current work is to provide an overview of key demographics and findings for MSM in Greece covering the abovementioned dimensions of EMIS-2017, especially regarding HIV. Overall, 2909 men met the inclusion criteria for the analysis. The participants’ age ranged between 15 and 74 years old (median 35 years). According to the descriptive analysis, 14.4% of the participants reported moderate and 8.9% severe anxiety and depression. The self-reported HIV prevalence was 11%. A high number of participants had non-steady male partners (74%, n = 2153). The number of non-steady intercourse partners in the last 12 months was over two for about 61.5% (n = 1321) of the participants. A very small number of participants had ever tried to get pre-exposure prophylaxis (PrEP) (2.2%, n = 63), and 41.2% of the participants (n = 1199) were unaware of PrEP. About half of the participants (51.6%, n = 1501) did not know that vaccination against both hepatitis A and B viruses is recommended for MSM. The results of EMIS-2017 identify important needs and can help policy making and prevention planning.

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