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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.

In the USA, one in four sexually active adolescents has an STI,1 and yet sexual health education and screening in this population is inadequate.2 Factors impacting adolescent women’s access to sexual healthcare include a misunderstanding of the symptoms, stigma and fear of embarrassment, issues around cost, and conflicting clinic and school schedule.2 The purpose of our study was to identify the perceived barriers to …

Background National guidance recommends targeted behavioural interventions and frequent HIV testing for men who have sex with men (MSM). We reviewed current policy and practice for HIV testing and behavioural interventions (BI) in England to determine adherence to guidance. Methods 25 sexual health clinics were surveyed using a semistructured audit asking about risk ascertainment for MSM, HIV testing and behavioural intervention policies. Practice was assessed by reviewing the notes of the first 40 HIV-negative MSM aged over 16 who attended from 1 June 2010, in a subset of 15 clinics. Results 24 clinics completed the survey: 18 (75%) defined risk for MSM and 17 used unprotected anal intercourse (UAI) as an indication of high risk. 21 (88%) offered one or more structured BI. Of 598 notes reviewed, 199 (33%) MSM reported any UAI. BI, including safer sex advice, was offered to and accepted by 251/598 (42%) men. A low proportion of all MSM (52/251: 21%) accepted a structured one-to-one BI as recommended by national guidance and uptake was still low among higher risk MSM (29/107: 27%). 92% (552/598) of men had one or more HIV test over a 1-year period. Conclusions In 2010, the number of HIV tests performed met the national minimum standard but structured behavioural interventions were being offered to and accepted by only a small proportion of MSM, including those at a higher risk of infection. Reasons for not offering behavioural interventions to higher risk MSM, whether due to patient choice, a lack of staff training or resource shortage, need to be investigated and addressed.

In Brighton, we have exceptionally high rates of party drug use including chemsex among men who have sex with men (MSM) including injection drug use (slamming).1 The ever-changing landscape of drugs and legal highs pose challenges to healthcare professionals to keep up to date with current ‘trends’ and subsequently to engage in meaningful discussion to support and …

There is an urgent need for well designed randomised trials to assess the impact of behavioural interventions at both individual and community levels in developed and developing countries. The relative lack of such studies partly reflects the particular challenges of applying randomised trials in this area. Although there are obvious differences between clinical and behavioural interventions, the principles underlying successful evaluation are not fundamentally different. Experience gained from clinical trial methodology over the past two decades should be applied and further developed to tackle the demands and challenges of evaluating behavioural interventions in HIV/STI prevention.

Background In Nicaragua, 9,739 HIV cases have been reported during 1987–2014. Two Central American Behavioural Surveillance Survey (BSS) among people living with HIV (PLHIV) to estimate prevalence of STI and risk behaviour have been conducted. Since 2012, the STI Sentinel Surveillance Strategy (VICITS) has offered STI diagnosis/treatment and behavioural intervention for PLHIV in public health sites. We present socio-demographic/behavioural and STI prevalence among PLHIV from BSS (2009 and 2014) and VICITS databases. Methods For the BSS, we used a convenience sample of PLHIV seeking HIV services at Roberto Calderon Hospital (RCH) in Managua, from September–December 2009 and January–March 2014. For VICITS, PLHIV seeking services at RCH during 2014 were included. BSS information was obtained through Audio Computer-Assisted Self-Interview. VICITS data were abstracted from VICITS information system. Blood samples were collected for Syphilis testing according to national guidelines. Data were analysed using STATA v13.0. Results Each BSS survey recruited 200 PLHIV (male 53.5% BSS-2009; 74.0% BSS-2014). VICITS recruited 146 PLHIV (85.7% male). Median age was 34 years old for all three data sources. One-third reported being married/living together in BSS-2009 and VICITS (44%, BSS-2014). Alcohol use in the last month was reported by 33.2% in BSS-2009 and 50% in BSS-2014 and VICITS. Condom use in the last sex with any partner was 60.0% in BSS-2009 and 75.5% in BSS-2014 and VICITS. Prevalence of syphilis was 11.6% (95% CI: 7.5–16.8) in BSS-2009, 10.0% (95% CI: 6.2–15.0) in BSS-2014 and 16.7% (95% CI: 8.1–19.8) in VICITS. Conclusion Although socio-demographic/behavioural data of PLHIV in BSS and VICITS were similar, syphilis prevalence was higher among PLHIV enrolled in VICITS. Our results indicate that VICITS strategy can provide valuable information about sexual behaviour of PLHIV. Our findings suggest the use of programmatic data in lieu of complex and expensive surveys to monitor trends in STI prevalence and sexual behaviour. Disclosure of interest We declare that we have no conflicts of interest.

Introduction Persons with acute HIV infection (AHI) contribute disproportionately to transmission. In a pilot study, we evaluated a short-term, behavioural and biomedical intervention among persons with AHI in Malawi. Methods We enrolled persons with AHI. AHI was defined as negative or discordant antibody test (s) with detectable virus. Persons were randomised 1:2:2 to standard counselling (SC), a four-session behavioural intervention (BI), or behavioural intervention plus 12 weeks of antiretrovirals (BIA), and followed 26–52 weeks. ARV resistance was assessed at baseline and after therapy. Participants were asked to refer partners for testing. Follow-up was completed in August 2014; phylogenetic analyses were completed in May 2015. Results We identified 59 persons with AHI and enrolled 46 (9 [SC], 18 [BI], 19 [BIA]). Average age was 25; 61% were male. Median viral load (VL) was 5.9 log copies/ml (6.7 [SC]; 5.1 [BI]; 6.1 [BIA]). At week four, 64% (11/17) of BIA participants were suppressed ( Conclusion ARV quickly reduced viremia below transmissible levels and did not induce resistance; however, patients experienced rapid virological rebound after discontinuation. Sexual risk decreased rapidly in all arms. Most referred partners with available sequences were linked transmissions with the AHI index. Early diagnosis with standard AHI counselling and early ARV referral may be sufficient to reduce transmission risk. Disclosure of interest statement This study was supported by the National Institutes of Health, USA; ARVs donated by Merck and Gilead.

Behavioural interventions for HIV prevention work by encouraging people to change behaviours that may make them more susceptible to HIV infection, or more likely to infect another person. There is some evidence that such interventions have led to reductions in HIV risk behaviours, such as having multiple partners, and improvements in other outcomes, such as increased condom use, increased testing, and improved treatment adherence. Behaviour is influenced heavily by socio-cultural contexts and as such, behavioural interventions must be sensitive to these contexts in order to be effective. Examples of behavioural interventions include individual and group level counselling, and providing information and guidelines through community outreach and mass media campaigns. This paper will provide a synthesis of the evidence on the effectiveness of behavioural interventions for HIV prevention. A review of reviews methodology will be followed to identify relevant primary studies. The strength of the evidence from these reviews will be evaluated and recommendations will be made.

Objectives Rates of sexually transmitted infections (STIs) in UK young people remain high in men and women. However, the National Chlamydia Screening Programme has had limited success in reaching men. The authors explored the acceptability of various medical, recreational and sports venues as settings to access self-collected testing kits for STIs and HIV among men in the general population and those who participate in sport. Methods A stratified random probability survey of 411 (weighted n=632) men in Great Britain aged 18–35 years using computer-assisted personal and self-interviews. Results Young men engaged well with healthcare with 93.5% registered with, and 75.3% having seen, a general practitioner in the last year. 28.7% and 19.8% had previously screened for STIs and HIV, respectively. Willingness to access self-collected tests for STIs (85.1%) and HIV (86.9%) was high. The most acceptable pick-up points for testing kits were general practice 79.9%, GUM 66.8% and pharmacy 65.4%. There was a low acceptability of sport venues as pick-up points in men as a whole (11.7%), but this was greater among those who participated in sport (53.9%). Conclusions Healthcare settings were the most acceptable places for accessing STI and HIV self-testing kits. Although young men frequently access general practice, currently little STI screening occurs in this setting. There is considerable potential to screen large numbers of men and find high rates of infection through screening in general practice. While non-clinical settings are acceptable to a minority of men, more research is needed to understand how these venues could be used most effectively.

Background HIV infection continues to disproportionately affect MSM in the UK. The 2011 HPA report “Sexually Transmitted Infections in MSM in the UK” highlights the need for one-to-one behavioural interventions. Thus, identifying those at highest risk is essential. Aims To profile the sexual behaviour of younger MSM attending a dedicated clinic. To establish how MSM perceive their sexual risk and explore the use of a simple HIV Risk Assessment Tool (HIVRAT). Methods MSM attending a weekly clinic offering HIV testing self-complete a 6 question HIVRAT in addition to standard history. The HIVRAT records number of male partners in previous 12 months, and number of unprotected anal intercourse (UPAI) partners (previous 3 and 12 months). It also contains a Likert scale of perceived sexual risk. Data was collected over 6 months from June 2011. Statistical analysis was performed in Excel and correlated using Spearman9s Rank methodology. Results 138 men completed the HIVRAT (aged 18–35). Median number of sexual partners in preceding 12 months = 8 (range 1–250, 42% reported >10 partners). Median number of UPAI partners in preceding 3 months =0 (range 0–5) and 12 months =1 (range 0–8). Perceived risk was scored as 1= Very low (20.4%), 2 (44.5%), 3 (28.5%), 4 (4.4%) and 5= Very high (2.2%). There was poor correlation between sexual behaviour and perceived risk. For MSM who had UPAI with one or more partners in the previous 3 and 12 months, there was a moderately positive correlation between actual risk and perceived risk (SRCC 0.517 and 0.544 respectively). Conclusions Only 6.6% of MSM judged their personal HIV risk as high in a cohort where 36% reported UPAI with two or more partners in 12 months. Tools like HIVRAT provide valuable information which is not routinely collected. Asking about UPAI during the 12-month period prior to testing showed the strongest correlation between actual and perceived risk, and could help identify MSM who would benefit most from behavioural intervention.

Over the last two and a half decades, researchers and public health agencies have invested substantial resources in developing and implementing counselling and behavioural interventions to decrease HIV transmission among men who have sex with men (MSM) in higher-income nations. Meanwhile, MSM have substantially altered their sexual risk behaviour, adapting to the HIV epidemic, as well as the technological revolution fuelled by the Internet. This presentation will review the evidence supporting the efficacy of behavioural interventions in MSM, discuss the challenges posed in bringing those interventions to scale, and suggest future research and prevention directions designed to move behavioural interventions from an efficacy to an effectiveness focus.

Background Approximately 1.1 million persons in the United States are living with HIV and for 18.5% their infections are attributable to injection drug use. In 2009 there were an estimated 5063 new HIV diagnoses attributed to injection drug use. In 2002, CDC developed the National HIV Behavioural Surveillance System (NHBS) to help state and local health departments in areas with high AIDS prevalence monitor behaviours and use of prevention services in groups at highest risk for HIV infection, including injection drug users (IDU). NHBS uses a sampling method most appropriate for each group; respondent-driven sampling (RDS) was chosen as the method for NHBS-IDU. We describe implementation and key monitoring indicators from the first two rounds of NHBS-IDU. Methods NHBS-IDU is implemented in more than 20 cities every 3 years using a standardised protocol for conducting surveys and HIV testing among persons who had injected drugs within the 12 months prior to interview. Data are analysed for each city independently and then aggregated and weighted to form national estimates. Results During the first IDU cycle (NHBS-IDU1, conducted 2005–2006), a total of 13 519 persons in 23 cities were recruited to participate, which resulted in 11 471 persons included in the final dataset. A total of 10 901 persons received 34 038 coupons to recruit others; 13 115 (62%) coupons were returned (range by city: 52.2%–75.3%). Challenges to the underlying assumptions of RDS included a somewhat high (5%) proportion of participants who reported their recruiter was “a stranger” and limited geographic cross-recruitment, suggesting IDU networks were not linked. These issues were found for some cities and were addressed in the operational guidance for NHBS-IDU2, conducted during 2009. Data from NHBS are used to monitor national progress in HIV prevention for IDU; in NHBS-IDU1, an estimated 32.8% of IDU shared syringes, and 63.4% had unprotected vaginal sex; 66.3% had been tested for HIV, and 29.7% had participated in an HIV behavioural intervention. Conclusions Use of RDS for NHBS-IDU has identified challenges in implementation and analysis that continue to further the development of this method for conducting behavioural surveillance among IDU in order to characterise the HIV epidemic in the USA.

Background To implement a randomised trial of a risk-reduction intervention consisting of small group sessions, individual counselling and support groups for African- and Mexican-American adolescent women with STI and abuse history and evaluate the effects of the intervention model vs enhanced counselling for this group on STI at 6 and 12 month follow-up. Methods Mexican- and African-American adolescent women (n=409, 13–18 years) with STI and a history of abuse (physical, psychological, sexual) were recruited from public-health clinics in a metropolitan area of the USA. Following enrolment participants received targeted physical exams including contraception counselling and interviews including assessments for abuse, sexual risk behaviour, substance use, contraceptive use and STI. Participants were encouraged to return for unscheduled visits as needed for counselling or suspected STI or pregnancy. Scheduled follow-up rates at 6 (93%) and 12 (93%) months were high Participation in risk-reduction interventions was also high (92%). Surveillance for STI and pregnancy at off-site clinic visits was conducted and documented throughout the study. Results At study entry, participants reported sexual (58.9%), physical (76.8%) and psychological (82.4%) abuse histories, ever pregnant (45%), currently pregnant (18.7%), ever used birth control (29.9%), currently in school (63.2%), previous arrest (56.2%), home runaway (54.5%), any substance use (94.1%) including marijuana (82.6%), heroin (13.4%), cigarettes (74.6%), alcohol (77.5%), cocaine (41.1%) and benzodiazepine (45%); forced sex (29.1%), sex when high/out of control (13.9%), sex with friends for benefits (36.2%), steady partner in last 3 months (77.4%) however off and on (31.4%). More workshop vs control group participants reported physical abuse (82.9% vs 71.0%), home runaway (63.1% vs 46.4%), cigarettes (78.9% vs 70.5%) and alcohol use (81.4% vs 73.8%). More control group participants were currently in school (68.1% vs 58.1%) and had used condoms (95.3% vs 86.4%). These variables plus age/ethnicity were initially included in the regression model for analysis of data from 0 to 6 and 0–12 month follow-ups. Fewer STI re-infections for intervention vs control group participants at each study interval were identified; physical abuse and substance use remained in the model. Conclusions Behavioral interventions may reduce of STI among African-and Mexican-American adolescent women with STI and a history of abuse.

Randomised controlled trials that test biomedical interventions to reduce sexually transmitted infections (STIs) have had very mixed results,1 2 as have behavioural trials.3 4 It is only in the past 10 years that the field has recognised that chlamydia resolves itself without treatment in 50% of the cases,4 although the estimates range from 13% to 60%.5–7 The length of time to clear chlamydia infection varies from 60 days in women to up to 15 months in men.5 The speed of resolution is also subject …

Edited by Aral SO, Douglas JM. Published by Springer, 2007, pp 578, hardcover, £53.50. ISBN 978-0-387-47863-0