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

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.

Download Full-text

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

Download Full-text

Patterns of sexualised recreational drug use and its association with risk behaviours and sexual health outcomes in men who have sex with men in London, UK: a comparison of cross-sectional studies conducted in 2013 and 2016

Sexually Transmitted Infections ◽

10.1136/sextrans-2019-054139 ◽

2019 ◽

Vol 96 (3) ◽

pp. 197-203 ◽

Cited By ~ 2

Author(s):

Tyrone J Curtis ◽

Alison J Rodger ◽

Fiona Burns ◽

Anthony Nardone ◽

Andrew Copas ◽

...

Keyword(s):

Sexual Health ◽

Hiv Positive ◽

Risk Behaviours ◽

Hiv Status ◽

Cross Sectional ◽

The Past ◽

Unknown Status ◽

Sex With Men ◽

Hiv Negative ◽

Hiv Positive Men

ObjectiveLondon has one of the highest identified prevalence of chemsex (sexualised recreational drug use) among men who have sex with men (MSM) in Europe. We examine MSM’s patterns of chemsex and its association with HIV/STI risk behaviours, STI diagnoses and sexual healthcare-seeking behaviours, including if HIV testing behaviour met UK national guidelines (three monthly if engaging in chemsex).MethodsCross-sectional survey data from 2013 (n=905) and 2016 (n=739) were collected using anonymous, self-administered questionnaires from MSM recruited in commercial gay venues in London, UK. Descriptive and multivariable analyses, stratified by self-reported HIV status, were conducted. Adjusted prevalence ratios (aPR) with 95% CIs were calculated.ResultsComparing the 2013 and 2016 surveys, chemsex prevalence in the past year remained stable, in both HIV-negative/unknown-status MSM (20.9% in 2013 vs 18.7% in 2016, p=0.301) and HIV-positive MSM (41.6% in 2013 vs 41.7% in 2016, p=0.992). Combined 2013–2016 data showed that compared with other MSM, those reporting chemsex were more likely to report HIV/STI risk behaviours, including condomless anal intercourse with serodifferent HIV-status partners (HIV-negative/unknown-status men: aPR 2.36, 95% CI 1.68 to 3.30; HIV-positive men: aPR 4.19, 95% CI 1.85 to 9.50), and STI diagnoses in the past year (HIV-negative/unknown-status men: aPR 2.10, 95% CI 1.64 to 2.69; HIV-positive men: aPR 2.56, 95% CI 1.57 to 4.20). 68.6% of HIV-negative/unknown-status men reporting chemsex attended sexual health clinics and 47.6% had tested for HIV more than once in the past year.ConclusionsChemsex in London MSM remained stable but high, particularly among HIV-positive men. Irrespective of HIV status, chemsex was associated with engagement in HIV/STI risk behaviours. Frequency of HIV testing in the past year among HIV-negative/unknown-status men was below national recommendations. Promoting combination prevention strategies, including three monthly HIV/STI testing, access to pre-exposure prophylaxis/antiretroviral treatment and behavioural interventions among MSM reporting chemsex, remains vital to address sexual health inequalities in MSM.

Download Full-text

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.

Download Full-text

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

International Journal of STD & AIDS ◽

10.1177/0956462417730259 ◽

2017 ◽

Vol 29 (5) ◽

pp. 435-442 ◽

Cited By ~ 7

Author(s):

Lauren Bull ◽

Pavle Dimitrijevic ◽

Sophie Beverley ◽

Alex Scarborough ◽

Sundhiya Mandalia ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Drug Use ◽

Sexual Health ◽

Perceived Need ◽

Health Clinics ◽

Sex With Men ◽

Sexual Health Clinics ◽

Exposure Prophylaxis ◽

Hiv Negative

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.

Download Full-text

Epidemiology of herpes simplex virus types 2 and 1 amongst men who have sex with men attending sexual health clinics in England and Wales: implications for HIV prevention and management

Eurosurveillance ◽

10.2807/ese.14.47.19418-en ◽

2009 ◽

Vol 14 (47) ◽

Cited By ~ 12

Author(s):

C Hill ◽

E McKinney ◽

C M Lowndes ◽

H Munro ◽

G Murphy ◽

...

Keyword(s):

Herpes Simplex ◽

Hiv Positive ◽

Health Clinics ◽

Hiv Progression ◽

High Prevalence ◽

Sex With Men ◽

Sexual Health Clinics ◽

Simplex Virus ◽

Hiv Negative ◽

Hsv 1

The objective was to investigate herpes simplex virus (HSV) epidemiology amongst HIV-positive and HIV-negative men who have sex with men (MSM) in England and Wales. Unlinked anonymous sera from 3,968 MSM attending 12 sexual health clinics in 2003 were tested for HIV, HSV-2 and HSV-1 antibodies. Fifty-five percent of HIV-positive MSM were HSV-2-seropositive, compared to 17% of HIV-negative MSM (Adj RR: 2.14 [CI: 1.92-2.37]). Amongst HIV-positive individuals, there was no significant difference in HSV-2 seroprevalence by knowledge of HIV status or whether the HIV infection was recently acquired (determined through STARHS). HIV infection was also independently associated with HSV-1 serostatus (Adj RR 1.19 [CI: 1.14-1.24)]). Four of the twelve attendees who received a diagnosis of recurrent anogenital herpes at the clinic visit were HSV-1-seropositive but not HSV-2-seropositive at the time, although no cultures or PCR results were available to type the cause of the ano-genital presenting disease. It is of concern that one in two HIV-positive MSM and one in six HIV-negative MSM may be infected with HSV-2, given increasing evidence of its impact on HIV progression, onward transmission and acquisition. To date results have been disappointing from trials aimed at reducing HIV onward transmission and HIV acquisition using HSV antiviral medication. However, recent research in an African context demonstrates the efficacy of HSV antivirals in delaying HIV progression. The high prevalence of HSV-2 amongst HIV-positive MSM suggests that an increased focus on HSV control in the management of HIV amongst MSM in the United Kingdom (UK) may be warranted. Given this and existing research on the high prevalence of genitally acquired HSV-1 amongst MSM in the UK, further research is also warranted into the role of HSV-1 in the HIV epidemic in this context.

Download Full-text

Should we change the focus of health promotion in sexual health clinics?

Sexual Health ◽

10.1071/sh09107 ◽

2010 ◽

Vol 7 (4) ◽

pp. 407 ◽

Cited By ~ 6

Author(s):

Rudiger Pittrof ◽

Elizabeth Goodburn

Keyword(s):

Risk Factors ◽

Health Promotion ◽

Cost Effectiveness ◽

Reproductive Health ◽

Sexual Health ◽

Sexual And Reproductive Health ◽

Health Clinics ◽

Unknown Risk ◽

Sexual Health Clinics ◽

The Cost

The effectiveness of sexual behaviour change interventions in sexual health clinics is unknown. Risk factors for poor sexual and reproductive health such as depression, violence, alcohol and smoking in sexual health clinics are all common and can be identified easily in sexual health services. Targeting these risk factors could be as effective as traditional sexual health promotion and could have additional benefits. The authors propose a pilot to assess the cost-effectiveness and acceptability of incorporating screening and interventions for these risk factors.

Download Full-text

Is it time to move to nucleic acid amplification tests screening for pharyngeal and rectal gonorrhoea in men who have sex with men to improve gonorrhoea control?

Sexual Health ◽

10.1071/sh10134 ◽

2011 ◽

Vol 8 (1) ◽

pp. 9 ◽

Cited By ~ 20

Author(s):

Christopher K. Fairley ◽

Marcus Y. Chen ◽

Catriona S. Bradshaw ◽

Sepehr N. Tabrizi

Keyword(s):

Nucleic Acid ◽

Antimicrobial Resistance ◽

Sexual Health ◽

Nucleic Acid Amplification ◽

Nucleic Acid Amplification Tests ◽

Health Clinics ◽

Sex With Men ◽

Sexual Health Clinics

The use of nucleic acid amplification tests (NAAT), as well as or in preference to culture for non-genital sites is now recommended both in Australia and overseas because of their greater sensitivity and improved specificity. A survey of 22 Australian sexual health clinics who each year test over 14 500 men who have sex with men (MSM) show that culture remains the predominate method for detecting gonorrhoea at pharyngeal (64%) and rectal (73%) sites. This editorial discusses the potential disadvantages of using culture over NAAT in relation to optimal gonorrhoea control among MSM and advocates that significantly improved control would be achieved by moving to NAAT with the proviso that culture samples are taken wherever possible on NAAT-positive samples and from clients with urethritis to ensure continued surveillance for antimicrobial resistance.

Download Full-text

HIV-Related Attitudes and Intentions for High-Risk, Substance-Using Men Who Have Sex With Men: Associations and Clinical Implications for HIV-Positive and HIV-Negative MSM

Journal of Cognitive Psychotherapy ◽

10.1891/0889-8391.24.4.281 ◽

2010 ◽

Vol 24 (4) ◽

pp. 281-293 ◽

Cited By ~ 6

Author(s):

Gordon Mansergh ◽

David J. McKirnan ◽

Stephen A. Flores ◽

Sharon M. Hudson ◽

Beryl A. Koblin ◽

...

Keyword(s):

Substance Use ◽

Risk Behavior ◽

Self Efficacy ◽

Safer Sex ◽

Hiv Positive ◽

Hiv Status ◽

Anal Sex ◽

Sex With Men ◽

Hiv Negative ◽

Hiv Positive Men

This study compared HIV-related attitudes and intentions by respondent HIV-status in a large sample of substance-using men who have sex with men (MSM) in the United States. Attitudes and intentions included self-efficacy for safer sex; difficulty communicating with sex partners about safer sex; intent to use condoms consistently and to not use substances before sex in the next 3 months; and less concern for HIV given effective antiviral treatments. Differences were found for behavior during the most recent anal sex encounter by HIV-status, including (a) insertive and (b) receptive anal sex risk behavior, and (c) substance use before or during the encounter. Self-efficacy for safer sex was associated with less risk behavior among HIV-negative men but not among HIV-positive men, suggesting that self-efficacy for safer sex continues to be a relevant issue to address in counseling uninfected MSM. HIV-positive men who reported less concern for HIV given treatments were more likely to report receptive risk behavior, as were HIV-negative men who reported difficulty communicating about safer sex. Implications are discussed for potentially heightened client desire and therapeutic opportunity to reduce future substance use during sex for clients who report recent substance use during sex.

Download Full-text