Condomerie, Amsterdam, the Netherlands.
Department of Research, Cluster of Infectious Diseases, Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, the Netherlands.
BMC Infect Dis. 2019 Mar 4;19(1):222. doi: 10.1186/s12879-019-3839-0.
HIV and other sexually transmitted infections remain a burden on men who have sex with men in the era of effective combination antiretroviral therapy. New prevention efforts are therefore needed. One of these approaches is the current country-wide free condom distribution at gay bars with darkrooms and gay saunas in the Netherlands. This study assessed the effects of free condom distribution on incidence and burden of disease of HIV and other sexually transmitted infections.
A static model was constructed to calculate the impact of free condom distribution on HIV, hepatitis C, chlamydia, gonorrhoea, and syphilis among men who have sex with men visiting these venues. Outcomes included new infections averted and disability-adjusted life years averted. Scenario studies were performed to predict the effects of a further increase of condom use, condom effectiveness and coverage. Lastly, cost-effectiveness and sensitivity analyses were performed.
Our model showed that condom use at public sex venues increased after the intervention. Annual incidence risk decreased, ranging from 5.73% for gonorrhoea to 7.62% for HIV. The annual number of new infections averted was largest for chlamydia and gonorrhoea (261 and 394 infections, respectively), but 42 new HIV infections were averted as well. In scenarios where condom use and condom effectiveness were further increased, the number of infections reduced more extensively. Over 99% of the decrease in burden of disease was due to HIV. The intervention was cost-effective and cost-saving (for every €1 spent on condom distribution, €5.51 was saved) and remained this in all sensitivity analyses.
Free condoms at public sex venues could reduce the transmission of HIV and other sexually transmitted infections. Condom distribution is an affordable and easily implemented intervention that could reduce the burden of disease in men who have sex with men substantially.
在有效的联合抗逆转录病毒疗法时代，艾滋病毒和其他性传播感染仍然是男男性行为者面临的一个负担。因此，需要采取新的预防措施。其中一种方法是目前在荷兰全国范围内的同性恋酒吧、暗室和同性恋桑拿浴室免费发放避孕套。本研究评估了免费发放避孕套对男男性行为者感染艾滋病毒和其他性传播感染的发病率和疾病负担的影响。
构建了一个静态模型，以计算在这些场所光顾的男男性行为者中，免费发放避孕套对艾滋病毒、丙型肝炎、衣原体、淋病和梅毒的影响。结果包括避免的新感染和避免的残疾调整生命年。进行了情景研究，以预测进一步增加避孕套使用率、避孕套有效性和覆盖率的效果。最后，进行了成本效益和敏感性分析。
我们的模型表明，干预后公共性场所的避孕套使用增加。年度发病风险降低，淋病的发病率风险从 5.73%降至艾滋病毒的 7.62%。避免的新感染人数最多的是衣原体和淋病（分别为 261 和 394 例感染），但也避免了 42 例新的艾滋病毒感染。在避孕套使用和避孕套有效性进一步提高的情况下，感染人数减少更多。疾病负担减少的 99%以上归因于艾滋病毒。该干预措施具有成本效益且节省成本（每支出 1 欧元用于发放避孕套，可节省 5.51 欧元），在所有敏感性分析中均保持这种情况。
在公共性场所发放免费避孕套可以减少艾滋病毒和其他性传播感染的传播。避孕套发放是一种负担得起且易于实施的干预措施，可以大大减少男男性行为者的疾病负担。
