A Hegazi

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

How to assess gay, bisexual and other men who have sex with men for chemsex

Objectives Sexualised substance use, ‘chemsex’, is being increasingly reported by gay, bisexual and other men who have sex with men (GBMSM) in sexual health clinics. We aim to describe the evidence base and practical ways in which clinicians can assess and advise patients disclosing chemsex. Methods We review published literature on chemsex, discuss vulnerability to substance use, highlight the importance of clinical communication and discuss a management approach. Results GBMSM are vulnerable to substance use problems, which interplay with mental, physical and sexual health. Knowledge on sexualised drug use and related communication skills are essential to facilitating disclosure. Identifying sexual health and other consequences of harmful drug use may motivate patients to seek change. Conclusions Sexual health clinicians are well placed to make more holistic assessments of GBMSM accessing their services to promote broader sexual health and well-being beyond the management of HIV and sexually transmitted infections (STIs) alone.

HIV seroconversion in the third trimester of pregnancy: using raltegravir to prevent mother-to-child transmission.

We describe a case of acute HIV infection in the third trimester of pregnancy associated with an extremely high viral load and the use of raltegravir to prevent HIV mother-to-child transmission.

Gay, bisexual, and other men who have sex with men: time to end the fixation with HIV

Attention must shift to broader inequalities in health and wellbeing

Chemsex and New HIV Diagnosis in Gay, Bisexual and other Men who have Sex with Men attending Sexual Health Clinics

The aim of the study was to analyse associations between chemsex and new HIV and sexually transmitted infection (STI) diagnoses among gay, bisexual and other men who have sex with men (GBMSM) accessing sexual health clinics.

Testing the children of HIV-infected parents: 6 years on from ‘Don't forget the children’

The death of a 10-year-old child ‘SP’ in 2008, whose HIV infection was diagnosed only hours before death despite both parents being engaged in HIV care, prompted the British HIV Association, the Children’s HIV Association and the British Association for Sexual Health and HIV to organise a multidisciplinary conference titled ‘Don’t forget the children’ which took place later that year.1 The conference consensus document acknowledged a lack of robust protocols to identify and test children and recommended that ‘the HIV status of all the children of known HIV-positive adults in the UK be known as a matter of clinical urgency’. UNAIDS estimates that 240 000 children were newly infected with HIV in 2013, contributing to a global total of 3 200 000 children under 14 years living with the infection.2 The overwhelming majority of these children acquired their infection vertically and are living in sub-Saharan Africa. Without antiretroviral therapy (ART), most HIV-infected children die before their fifth birthday. Early HIV diagnosis is therefore critical, particularly in those aged under 2 years where starting ART may prevent up to 50% of deaths.3 Despite significant improvements in testing adults, only 35% of babies born to HIV-infected mothers worldwide are tested for HIV within 2 months of birth, resulting in many potentially preventable deaths.4 A small proportion of vertically infected children remain well into adolescence and are at risk of horizontally transmitting HIV if diagnosis takes place after sexual debut.5 A community based study in South Africa found that fewer than 41% of 244 surviving …

Seven years of teenage pregnancy in an inner London genitourinary medicine service - a retrospective cohort study.

Summary Young people attending genitourinary medicine services are at high risk of unplanned pregnancy. We performed a retrospective cohort study to identify characteristics of pregnant teenagers accessing an inner London genitourinary medicine service. There were 481 pregnancies in 458 teenagers with 54 previous pregnancies and 46 previous terminations of pregnancy. The under-18 and under-16 teenage pregnancy rates were 92.1 and 85.8 per 1000 age-matched clinic attendees, respectively. Median age was 17.1 years. ‘Black Other’ teenagers (‘Black British’, ‘Mixed White-Black Caribbean’ and ‘Mixed White-Black African’) were over-represented, compared to our clinic population, while those of White ethnicity were under-represented. Few pregnancies (1.5%) were planned with the majority (64%) intending terminations of pregnancy. Most teenagers did not use consistent contraception. Two-thirds of patients had attended genitourinary medicine services in the past and sexually transmitted infection prevalence at presentation was high. Effectively targeting the sexual and reproductive health needs of teenage genitourinary medicine clinic attendees may have a significant impact on reducing sexually transmitted infections, unplanned pregnancy and terminations of pregnancy in this group.

Teenage pregnancy in an inner London GUM service

Many young people attending genitourinary medicine (GUM) clinics are using inadequate contraception and are at high risk of unplanned pregnancy.1 Those attending for pregnancy testing or to request emergency contraception are a particularly high risk group, with the majority failing to return for contraceptive follow-up and continuing to use unreliable methods of contraception2 ,3 At 43.5 per 1000, the London Borough of Wandsworth has an under-18 teenage pregnancy rate (TPR) well above both the national average of 35.4 and that of London as a whole (37.1).4 Sixty-one percent of pregnancies in this age group end in termination (67% in Wandsworth).4 We carried out a cross-sectional study of all pregnant teenagers aged ≤18 years accessing the St Georges Hospital GUM service …