Maxwell Steven, Gafos Mitzy, Moncrieff Monty, Shahmanesh Maryam, Stirrup Oliver
School of Health in Social Science, University of Edinburgh, Edinburgh, UK.
London School of Hygiene and Tropical Medicine, London, UK.
Int J STD AIDS. 2020 Apr;31(5):474-480. doi: 10.1177/0956462420906927. Epub 2020 Feb 19.
Men who have sex with men (MSM) who experience problematic chemsex are at high risk of acquiring HIV due to combined drug use and sexual behaviours. Pre-exposure prophylaxis (PrEP) could substantially reduce the risk of HIV transmission in this group of men. The aim of this study was to examine the biopsychosocial characteristics associated with PrEP use among HIV-negative MSM who have experienced problematic chemsex. This was a cross-sectional analysis of secondary data collected during client assessments at a specialist alcohol and drug service based within the United Kingdom. We compared the socio-demographics, substance use, sexual behaviours and mental health of MSM who reported ever using PrEP to those who reported never using PrEP. Statistical analysis was conducted using the Mann–Whitney U-test for continuous variables and Fisher’s exact test for categorical variables. Between August 2016 and July 2018, 165 HIV-negative MSM who engaged in chemsex had an assessment completed. Thirty-four per cent (n = 50/145) had ever used PrEP. The median age was 36 years (IQR: 30–42), 92% identified as gay (n = 152/165) and 79% were of white ethnicity (n = 130/164). The use of crystal methamphetamine was associated with higher levels of men ever using PrEP (40% versus 21%) (p= 0.047). Men who had ever used PrEP had a higher median number of sexual partners in the previous three months (20 versus 10) (p= 0.004) and had lower level of condom use in their sex lives (median reported 5% versus 50%) (p= 0.010) in comparison to men who had never used PrEP. It is encouraging that men having higher-risk sex had been accessing PrEP. However, further research is required to explore PrEP uptake, retention and adherence in this high-risk group.
有药物滥用性性行为问题的男男性行为者（MSM），由于同时存在药物使用和性行为，感染艾滋病毒的风险很高。暴露前预防（PrEP）可大幅降低该群体中艾滋病毒传播的风险。本研究的目的是调查有药物滥用性性行为问题的艾滋病毒阴性男男性行为者中与使用PrEP相关的生物心理社会特征。这是一项对在英国一家专业酒精和药物服务机构进行客户评估期间收集的二手数据的横断面分析。我们比较了报告曾使用PrEP的男男性行为者与报告从未使用过PrEP的男男性行为者的社会人口统计学、物质使用、性行为和心理健康情况。对连续变量使用曼-惠特尼U检验，对分类变量使用费舍尔精确检验进行统计分析。在2016年8月至2018年7月期间，165名有药物滥用性性行为的艾滋病毒阴性男男性行为者完成了评估。34%（n = 50/145）曾使用过PrEP。中位年龄为36岁（四分位间距：30 - 42岁），92%的人认定为同性恋（n = 152/165），79%为白人（n = 130/164）。使用冰毒与曾使用PrEP的男性比例较高有关（40%对21%）（p = 0.047）。与从未使用过PrEP的男性相比，曾使用过PrEP的男性在过去三个月中的性伴侣中位数较高（20对10）（p = 0.004），且其性生活中避孕套的使用比例较低（报告的中位数为5%对50%）（p = 0.010）。高危性行为的男性能够获取PrEP，这令人鼓舞。然而，需要进一步研究来探索该高危群体中PrEP的接受、持续使用和依从情况。
