Perceived need of, and interest in, HIV pre-exposure prophylaxis amongst men who have sex with men attending three sexual health clinics in London, UK

HIV pre-exposure prophylaxis (PrEP) has proven efficacy in reducing the risk of HIV infection in men who have sex with men (MSM), but has not yet been commissioned in the UK. The aim of this study was to investigate perceived need and benefit (or experience of) PrEP among HIV-negative MSM attending sexual health clinics. HIV-negative MSM attending three sexual health centres in London, UK were opportunistically invited to complete a questionnaire. Data collected comprised demographic data and sexual and drug use behaviours as well as questions regarding perceptions of risk and need for PrEP. Logistic regression analysis was undertaken to identify variables predicting acceptability of, and intention to use, PrEP. In addition, data were gathered in respondents already taking PrEP. Eight hundred and thirty-nine questionnaires were analysed. The median age of respondents was 35 years (IQR 28–41, range 18–78), 650 (77%) were of white ethnicity and 649 (77%) had a university education. Four hundred and fifty-six (54%) reported at least one episode of condomless anal sex in the preceding three months, 437 (52%) reported recreational drug use in the preceding three months and 311 (37%) had been diagnosed with a sexually transmitted infection within the preceding six months. Four hundred and sixty-three (64%) of 726 strongly agreed with the statement ‘I think I would benefit from PrEP’. Multivariate logistic regression analysis demonstrated that having receptive anal intercourse (RAI) without condoms, having an awareness of the risk of unprotected RAI and having belief in the effectiveness of PrEP were independent predictors for someone thinking they would benefit from taking PrEP. Eight percent of respondents (59/724) had already taken or were currently taking PrEP. The results suggest that individuals at risk are likely to perceive themselves as benefiting from PrEP. The majority perceived their risk of acquiring HIV and benefit from PrEP accurately. Overall they appeared to have little concern over the use of PrEP and generally positive attitudes. Further investigation is warranted to understand why those at risk do not perceive benefit from PrEP.

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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

International Journal of Drug Policy ◽

10.1016/j.drugpo.2017.01.001 ◽

2017 ◽

Vol 43 ◽

pp. 33-43 ◽

Cited By ~ 84

Author(s):

Janey Sewell ◽

Ada Miltz ◽

Fiona C. Lampe ◽

Valentina Cambiano ◽

Andrew Speakman ◽

...

Keyword(s):

Drug Use ◽

Sexual Health ◽

Sexual Risk ◽

Risk Behaviour ◽

Sexual Risk Behaviour ◽

Health Clinics ◽

Sex With Men ◽

Sexual Health Clinics ◽

Hiv Negative

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Fall in new HIV diagnoses among men who have sex with men (MSM) at selected London sexual health clinics since early 2015: testing or treatment or pre-exposure prophylaxis (PrEP)?

Eurosurveillance ◽

10.2807/1560-7917.es.2017.22.25.30553 ◽

2017 ◽

Vol 22 (25) ◽

Cited By ~ 53

Author(s):

Alison E Brown ◽

Hamish Mohammed ◽

Dana Ogaz ◽

Peter D Kirwan ◽

Mandy Yung ◽

...

Keyword(s):

High Risk ◽

Sexual Health ◽

Hiv Testing ◽

Health Clinics ◽

High Risk Populations ◽

Sex With Men ◽

Sexual Health Clinics ◽

Exposure Prophylaxis

Since October 2015 up to September 2016, HIV diagnoses fell by 32% compared with October 2014–September 2015 among men who have sex with men (MSM) attending selected London sexual health clinics. This coincided with high HIV testing volumes and rapid initiation of treatment on diagnosis. The fall was most apparent in new HIV testers. Intensified testing of high-risk populations, combined with immediately received anti-retroviral therapy and a pre-exposure prophylaxis (PrEP) programme, may make elimination of HIV achievable.

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Chemsex and the city: sexualised substance use in gay bisexual and other men who have sex with men attending sexual health clinics

International Journal of STD & AIDS ◽

10.1177/0956462416651229 ◽

2016 ◽

Vol 28 (4) ◽

pp. 362-366 ◽

Cited By ~ 89

Author(s):

A Hegazi ◽

MJ Lee ◽

W Whittaker ◽

S Green ◽

R Simms ◽

...

Keyword(s):

Substance Use ◽

Hepatitis C ◽

Drug Use ◽

Sexual Health ◽

Clinical Pathways ◽

Post Exposure Prophylaxis ◽

Hiv Incidence ◽

Health Clinics ◽

Sex With Men ◽

Sexual Health Clinics

The objective of this study was to analyse associations between sexualised substance use (chemsex), STI diagnoses and sexual behaviour among gay bisexual and other men who have sex with men accessing sexual health clinics to better inform clinical pathways. A retrospective case notes review was undertaken following the introduction of more detailed and holistic profomas for all gay bisexual and other men who have sex with men attending two London sexual health clinics between 1 June 2014 and 31 January 2015. Chemsex status was documented for 655/818. Overall, 30% disclosed recreational drug use of whom 113 (57%) disclosed chemsex and 27 (13.5%) injecting drugs. HIV-positive gay bisexual and other men who have sex with men were more likely to disclose chemsex (AOR 6.68; 95% CI 3.91–11.42; p < 0.001). Those disclosing chemsex had a higher incidence of acute bacterial STIs (AOR 2.83 CI 1.79–4.47; p < 0.001), rectal STIs (AOR 3.10 CI 1.81–5.32; p < 0.001) or hepatitis C (AOR 15.41 CI 1.50–158.17; p = 0.021). HIV incidence in the study period was 1.8% (chemsex) vs. 0.9% (no chemsex) (p = 0.61). Chemsex was associated with having more sexual partners, transactional sex, group sex, fisting, sharing sex toys, injecting drug use, higher alcohol consumption and the use of ‘bareback’ sexual networking applications (p < 0.004). Chemsex participants were also more likely to have accessed post-exposure prophylaxis for HIV in the study period and report sex with a discordant HIV or hepatitis C-infected partner (p < 0.001). Chemsex disclosure is associated with higher risk-taking behaviours, acute bacterial STIs, rectal STIs and hepatitis C incidence. HIV incidence was higher but not significantly so in the study period. Chemsex disclosure in sexual health clinics should prompt an opportunity for prevention, health promotion and wellbeing interventions.

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Identifying the Prevalence of Recreational Drug Use in Men Who Have Sex With Men Attending Sexual Health Clinics in Greater Manchester.

10.26226/morressier.5731a408d462b8028d88c9db ◽

2016 ◽

Author(s):

Andrew Tomkins

Keyword(s):

Drug Use ◽

Sexual Health ◽

Recreational Drug ◽

Health Clinics ◽

Recreational Drug Use ◽

Sex With Men ◽

Sexual Health Clinics

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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

Sexually Transmitted Infections ◽

10.1136/sextrans-2017-053439 ◽

2018 ◽

Vol 94 (7) ◽

pp. 494-501 ◽

Cited By ~ 27

Author(s):

Janey Sewell ◽

Valentina Cambiano ◽

Ada Miltz ◽

Andrew Speakman ◽

Fiona C Lampe ◽

...

Keyword(s):

Drug Use ◽

Sexual Health ◽

Sociodemographic Factors ◽

Post Exposure Prophylaxis ◽

Specific Drug ◽

Cross Sectional ◽

Polydrug Use ◽

Sex With Men ◽

Exposure Prophylaxis ◽

Hiv Negative

ObjectivesThe 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.MethodsData 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.ResultsIn 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).ConclusionsThere 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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P138 Identifying the Prevalence of Recreational Drug Use in Men Who Have Sex With Men Attending Sexual Health Clinics in Greater Manchester

Sexually Transmitted Infections ◽

10.1136/sextrans-2016-052718.192 ◽

2016 ◽

Vol 92 (Suppl 1) ◽

pp. A67.3-A68

Author(s):

Andrew Tomkins ◽

Sameena Ahmad ◽

Luke Cannon ◽

Stephen P Higgins ◽

Merav Kilner ◽

...

Keyword(s):

Drug Use ◽

Sexual Health ◽

Recreational Drug ◽

Health Clinics ◽

Recreational Drug Use ◽

Sex With Men ◽

Sexual Health Clinics

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Enhanced surveillance of syphilis cases among men who have sex with men in London, October 2016–January 2017

International Journal of STD & AIDS ◽

10.1177/0956462418814998 ◽

2019 ◽

Vol 30 (5) ◽

pp. 422-429 ◽

Cited By ~ 2

Author(s):

Sangeeta Rana ◽

Neil Macdonald ◽

Patrick French ◽

Jay Jarman ◽

Sheel Patel ◽

...

Keyword(s):

Health Promotion ◽

Sexual Health ◽

Risk Behaviour ◽

Hiv Positive ◽

Health Clinics ◽

Sex With Men ◽

Group Sex ◽

Sexual Health Clinics ◽

Hiv Negative ◽

Hiv Positive Men

Syphilis rates have been increasing in men who have sex with men (MSM) in London. To describe risk behaviour and refine public health interventions, we conducted prospective enhanced surveillance of new syphilis cases in MSM attending selected London sexual health clinics (SHCs) between October 2016 and January 2017. Sexual health advisors (SHAs) completed 107 questionnaires. Eighteen per cent of respondents reported always using condoms, with lower use in HIV-positive (8%, 4/53) than HIV-negative men (33%, 14/52). Almost half of respondents reported condomless sero-discordant sex (46%, 33/72). The most frequent means of meeting new partners reported were venues (80%, 76/95), particularly bars or clubs (34%, 32/95), and apps or websites (79%, 75/95). Nearly a third of respondents reported engaging in group sex (32%, 30/95). Almost half reported drug use during sex (47%, 46/98), with HIV-positive men more likely to report use of the three main ‘chemsex’ drugs. The majority of respondents preferred health promotion information from SHAs (63%, 58/92) compared to other sources such as Google/Wikipedia and apps. Prevention activity should continue to focus on condomless sex, serosorting, multiple and overlapping partners, and chemsex. SHCs, particularly those serving HIV-positive men, are important sources for sexual health promotion advice.

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Prevalence of recreational drug use reported by men who have sex with men attending sexual health clinics in Manchester, UK

International Journal of STD & AIDS ◽

10.1177/0956462417725638 ◽

2017 ◽

Vol 29 (4) ◽

pp. 350-356 ◽

Cited By ~ 13

Author(s):

A Tomkins ◽

S Ahmad ◽

L Cannon ◽

SP Higgins ◽

M Kliner ◽

...

Keyword(s):

Drug Use ◽

Sexual Health ◽

Drug Users ◽

Anal Intercourse ◽

Sexual Practices ◽

Health Clinics ◽

Significant Difference ◽

Sex With Men ◽

Group Sex ◽

Sexual Health Clinics

Recreational drug use (RDU) has been reported to be disproportionately higher in men who have sex with men (MSM) when compared to their heterosexual counterparts. To identify RDU, links to risky sexual practices and infections for MSM attending three sexual health clinics across Manchester, United Kingdom, a retrospective case note review was conducted using a random powered sample of service users attending three sites during 2014. Three hundred and fifty-seven case notes were reviewed across three sites. Eighteen per cent of service users reported any type of RDU. Use of at least one of the three drugs associated with chemsex (crystal methamphetamine, mephedrone, gamma hydroxybutyrate/gamma butyrolactone) was reported by 3.6%. A statistically significant difference was identified between non-drug users and any-drug users reporting: group sex (odds ratio [OR] 5.88, p = 0.013), condomless receptive anal intercourse (CRAI) (OR 2.77, p = 0.003) and condomless oral intercourse (OR 2.52, p = 0.016). A statistically significant difference was identified between chemsex-related drug user and non-drug user groups reporting: group sex (OR 13.05, p = 0.023), CRAI (OR 3.69, p = 0.029) and condomless insertive anal intercourse (OR 1.27, p = 0.039). There was also a statistically higher incidence of gonorrhoea infection in chemsex-related drug use compared with those not using drugs (p = 0.002, OR 6.88). This study identifies that substance use is common in MSM attending sexual health clinics in Manchester. High-risk sexual practices and certain sexually transmitted infections are more common in MSM reporting RDU.

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