The Experience of Safety, Harassment and Social Exclusion Among Male Clients of Sydney’s Medically Supervised Injecting Centre

Research on drug harm reduction services has found these operate as a safe haven from health harm. Less is known about the wider sense of security experienced by clients of such services as a counterbalance to social marginality in their daily lives. As part of a larger study of the experience of violence among Australian men, the authors completed 20 qualitative semi-structured interviews with male clients of Sydney’s Medically Supervised Injecting Centre (MSIC) in 2016–2020. These were conducted anonymously in a private clinical room inside the MSIC and focused on aspects of drug use and general life experiences of violence, law enforcement, safety and security. Interviews were analysed by thematic content through a combination of preliminary and second close readings. Our analysis found that the MSIC consistently acted as a reprieve from harassment and violence from police and members of the public, conflict in drug deals, and general social exclusion.

Dark skin, hourglass figure: The sexualisation of Black women in the Dutch sex industry

This article explores racial performance and the hypersexualisation of Black women in the Dutch sex industry. In the global sex trade, racialised women are constantly regarded as victims of sex trafficking without any agency, particularly migrant sex workers in European countries. While there is plenty of literature on how racial hierarchy affects Black women in the U.S. sex industry, such relevant research is lacking in Europe. In this explorative research, I deconstruct the images of Black women and set its narrative in the Netherlands. With semi-directive and in-depth interviews, I intend to highlight how Black sex workers perform images of Blackness and racial stereotypes when seducing male clients. My theoretical framework includes Patricia Hill Collins’s ‘controlling images’, Gloria Wekker’s ‘cultural archive’, Philomena Essed’s ‘everyday racism’, and Sunita Patel’s ‘racial performance’.

Characteristics of low-tier female sex workers who engage in commercial sex with old male clients in Zhejiang province, China: a cross-sectional study

ObjectivesTo characterise low-tier female sex workers (FSWs) who engage in commercial sex with old male clients (OMCs).DesignCross-sectional study.SettingTwenty-one counties in Zhejiang province, China.ParticipantsA total of 2647 low-tier FSWs who participated in our survey from September to November 2013, and responded to the question regarding whether they engaged in commercial sex with OMCs during the previous month.Main outcome measuresData on sociodemographic characteristics, sexual behaviours, risk perception of HIV/sexually transmitted infection (STI), ever exposure to an HIV prevention service and degree of self-efficacy regarding condom use were collected via a face-to-face questionnaire administered by trained interviewers.ResultsOf the 2647 participants, 1165 (44.0%) had engaged in commercial sex with OMCs in the previous month. Low-tier FSWs working out of roadside shops, those who had engaged in sex work for longer, those with a larger number of clients, those who had engaged in anal or oral sex during the previous month, those currently using contraception measures, those who had STI symptoms and those who had been exposed to HIV prevention services during the previous 6 months were more likely to engage in commercial sex with OMCs. FSWs with a high level of education; those working out of small venues other than streets, hair salons and roadside shops; those who charged more for commercial sex; those who had sex with young clients during the previous month and those who had seen a doctor during the previous 6 months were less likely to engage in commercial sex with OMCs.ConclusionsLow-tier FSWs who engaged in commercial sex with OMCs reported more risky behaviours than those who did not engage in this behaviour. Attention should be paid to these behaviours in future interventions targeting low-tier FSWs.

HIV-1 and Syphilis Prevalence Among Local Chinese and Cross-border Migrant Female Sex Workers in Sino-Vietnam Border Cities in Guangxi, China: a Nine-year Consecutive Cross-sectional Study

Background To analyze the trends of HIV-1 and syphilis prevalence as well as associated factors among local Chinese female sex workers (LCFSWs) and cross-border migrant female sex workers (CMFSWs) in Sino-Vietnam border cities in Guangxi, China. Methods A consecutive cross-sectional study was conducted from 2010 to 2018 in three border cities in Guangxi. The survey was conducted through face-to-face interview with a structured questionnaire. HIV-1 and syphilis infections were tested simultaneously. Cochran-Armitage analysis was used to assess the trends of HIV-1, syphilis and HCV prevalence, as well as the trend of risk behaviors, HIV/AIDS knowledge and prevention services. Multivariate logistics regression analysis was used to identify factors associated with HIV-1 and syphilis infection.Results Totally, 19873 LCFSWs and 1723 CMFSWs were enrolled. The overall prevalence of HIV-1 and syphilis infection was 0.91% and 5.14%, respectively. The HIV-1 prevalence among CMFSWs was higher than that among LCFSWs, without a declined trend. However, a downward trend was observed among LCFSWs. Overall, the main associated factors of HIV-1 infection among CMFSWs shifted from age >35 years old, staying in current residence for >12 months, self-reporting sexually transmitted infections (STIs) in the last year during 2010-2015 to inconsistent condoms use in commercial sex in last month, not receiving peer education and self-reporting STIs in the last year during 2016-2018. The main correlated factors of syphilis infection among CMFSWs changed from history of illicit drug use, staying in current residence for more than 12 months, self-reporting of STIs and inconsistent condoms use in commercial sex in the past month during 2010-2015 to working in low-tier venues, self-reporting of STIs in the last year, and sexing with commercial male clients who used aphrodisiac drugs during 2016-2018. For LCFSWs, the relative strong associated factors of HIV-1 infection shifted from receiving less than 6 years of education, illicit drugs use, and self-reporting STIs in the last year during 2010-2015 to sexing with commercial male clients who use aphrodisiac drugs and self-reporting of STIs during 2016-2018, while the main factors of syphilis infection changed from self-reporting STIs in the last year, history of illicit drug use and receiving less than 9 years of education during 2010-2015 to self-reporting of STIs in the last year, sexing with commercial male clients who use aphrodisiac drugs, and history of illicit drugs use during 2016-2018.Conclusions The relatively higher prevalence of HIV-1 infection and frequent risk behaviours among CMFSWs in border cities in Guangxi, indicating that CMFSWs is the high-risk population for HIV-1 infection and transmission in the region, and is the key population of HIV/AIDS prevention and control. Meanwhile, the change of HIV infection-associated risk factors over time suggests that HIV intervention strategies need to be changed accordingly.

Abstract 53: Results Of The Nashville Barber-pharmacist Hypertension Management Pilot Study

Background: The Los Angeles Barbershop Blood Pressure Study (LABBPS) demonstrated that collaboration between barbers and pharmacists delivering hypertension management could significantly improve blood pressure as well as access to care. It is unknown if this model can be translated to other locations. This single-arm, proof-of-concept pilot study tested the development and implementation of a similar protocol in Nashville, TN (NCT04232124). Methods: Between 2019 and 2021, community stakeholders, clinicians, investigators, and the LABBPS team convened to adapt the study design and protocol. Established barbershops with barbers willing to be trained on study procedures were recruited as study sites. Non-Hispanic Black male clients, aged 35-79 years with systolic blood pressure (SBP) > 140 mmHg on two screening days were eligible for participation. Enrolled participants met with a pharmacist for lifestyle and medication management at least once monthly for a six-month period. Barbers measured blood pressure during haircuts for additional monitoring. Results: Eight barbershops in business for an average of 20 (± 5) years participated in the trial. Barbers from each shop (range: 1-4) were trained. A total of 419 clients completed screening visit 1, 82 were eligible and 52 (12%) completed visit 2. We enrolled 36, with 30 completing the initial clinical visit and 27 had complete data at 6-months. Participants were on average age 50 (± 10) years, had a body mass index 33 (± 6), 44% were currently smoking, 52% with high school or less education, and 56% reported current primary care. Baseline BP 157.7±17.1/ 95.1±13.9 mmHg improved to 125.7±11.9/75.6±9.5, a change of -32.1±21.6/ -19.5±14.1, respectively. At 6-months 85% of the group had a BP<140/90, 74% BP<135/85, and 67% BP<130/80. At baseline 15% of participants reported health as excellent/very good and this increased to 56% at 6-months (p=0.002). Adverse reactions reported were minimal. Conclusion: Implementation of the barber-pharmacist model of hypertension management and care delivery improved BP control among hypertensive Black men in Nashville. Lessons learned regarding adaptation overcoming unforeseen barriers will inform expansion into additional naïve locations for future research.

The Weekend Drug; Recreational Use of Sildenafil Citrate and Concomitant Factors: A Cross-Sectional Study

Background: Men who use erectile dysfunction medications for recreational purposes may be at increased risk of becoming psychologically dependent, which in turn could lead to psychogenic-based erectile dysfunction symptoms. Sildenafil has become one of the most commonly prescribed and abused drugs available today.Objectives: This study aimed to describe the utilization pattern and associated factors of sildenafil citrate among its users visiting community pharmacies in Gondar, Ethiopia.Methods: A facility-based cross-sectional study was conducted from March 20, 2017 to May 10, 2017, among male clients who visited community pharmacies in Gondar town, North West Ethiopia. A self-administered, structured questionnaire was used to collect data from Sildenafil users older than 18 years, that started using the drug (Sildenafil) for at least 6 months before the data collection period. A regression analysis was conducted to determine the association between study variables, and a P-value of &lt;0.05 was considered to declare statistical significance.Results: A total of 65 men participated in the study. Of the total study participants, 33.8% were aged 25–34 years and about 40% of them had multiple sexual partners. The use of sildenafil for recreational purposes was 66.2% and was found to be higher than its use for medical purposes 33.8%. Use of the drug for &lt;1-year duration (AOR = 34.086, 95% CI [2.90, 401.37]) and 2 years duration (AOR = 21.42: 95% CI [2.10, 218.82]) were significantly associated with its use for recreational purpose. Non-recreational use of sildenafil includes erectile problems associated with diabetes mellitus (27.1%), heart disease (9.2%), hyperlipidemia (4.2%), and relationship problems due to stress and poor communication (3.1%).Conclusion: Most men who use sildenafil citrate do so for recreational purposes, and use of sildenafil citrate for 2 years or less was associated with recreational use. There should be a collaborative effort among pharmacists, health professionals, and policymakers to improve the rational use of sildenafil.

Teaching Gender Competency with Men in Mind: Foundations of an Online Training Program for Mental Health Practitioners

Recognition of the importance of mental health practitioners’ enactment of ‘gender competency’ when working with men is growing. This article describes the development and theoretical background to a novel online training program for practitioners, called Men in Mind. The training focuses on men’s gender socialization, engaging male clients in therapy, and responding effectively to men’s depression and suicidality. The content of the training was derived from a comprehensive review of available literature, structured into modules with measurable learning outcomes via learning design principles. The training employed a range of andragogic principles and tools (e.g., character vignettes, reflective exercises). Plans for evaluation via a controlled trial, alongside scaling, and implementation are described.

Changes in Violence and Clinical Distress Among Men in Individual Psychotherapy for Violence Against Their Female Partner: An Explorative Study

Most interventions for men who have acted violently toward their partner have been conducted as group interventions within a criminal justice context. Therefore, few studies have examined individual psychotherapy and how such interventions may reduce partner violence. In this study, we aimed to describe changes in violence, and changes in clinical distress in men undergoing individual psychotherapy targeting their use of partner violence, at a clinic organized within a psychosocial health care context. This is a naturalistic prospective study of men voluntarily receiving individual psychotherapy for their use of violence against their female partner. Participants were 84 male clients, and data on their use of physical violence, physical controlling violence, property violence and psychological violence were collected pretreatment, posttreatment and at follow-up 1.5 years after treatment from both the men, and their partners (n = 58). The percentage of use of all types of violence during a typical month the last year decreased from pretreatment to follow-up, according to both the men, and their partners. Over the course of treatment, use of all types of self-reported violence during the last month was reduced, however, this was only partially confirmed by their partners. Number of sessions was associated with a lower risk of having used physical and physically controlling violence 1.5 years after treatment. Alcohol abuse or dependency, or qualifying for one or more psychiatric diagnoses, were not associated with levels or change in use of violence. On average, the men's clinical distress declined over the course of psychotherapy. The findings suggest that individual psychotherapy may be a promising and worthwhile intervention for intimate partner violence. Studies with more elaborate designs are needed to identify the core mechanisms of psychotherapy for violence, and to corroborate these results with higher levels of evidence.

Overlapping Key Populations and HIV Transmission in Tijuana, Mexico: A Modelling Analysis of Epidemic Drivers

Tijuana, Mexico, has a concentrated HIV epidemic among overlapping key populations (KPs) including people who inject drugs (PWID), female sex workers (FSW), their male clients, and men who have sex with men (MSM). We developed a dynamic HIV transmission model among these KPs to determine the extent to which their unmet prevention and treatment needs is driving HIV transmission. Over 2020–2029 we estimated the proportion of new infections acquired in each KP, and the proportion due to their unprotected risk behaviours. We estimate that 43.7% and 55.3% of new infections are among MSM and PWID, respectively, with FSW and their clients making-up < 10% of new infections. Projections suggest 93.8% of new infections over 2020–2029 will be due to unprotected sex between MSM or unsafe injecting drug use. Prioritizing interventions addressing sexual and injecting risks among MSM and PWID are critical to controlling HIV in Tijuana.