High-risk drug practices tighten grip on London gay scene

Kirby, Tony; Thornber-Dunwell, Michelle

doi:10.1016/s0140-6736(13)60032-x

Cited by 118 publications

(109 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…As we observed an increase in requests for GHB analysis, the drug was incorporated into the GC-MS urine illicit drugs screen in May 2012. This screen is performed on approximately half of all cases received (A total of 709 cases received in 2011, 8 Femoral blood samples from individuals with detectable GHB in their urine were subsequently analysed for GHB. If no urine was received, blood analysis was determined based on the history received with the case.…”

Section: Methodsmentioning

confidence: 99%

“…[6,7] The mainstream media are becoming increasingly aware of the issue and drug treatment centres report being overwhelmed by the number of men seeking help. [8] However, it is difficult to know how harmful chemsex is. The Chemsex Study (2014) reported that whilst chemsex has received significant media attention, evidence on the extent of the issue and potential harms was limited.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

An observed rise in γ-hydroxybutyrate-associated deaths in London: Evidence to suggest a possible link with concomitant rise in chemsex

Hockenhull

Murphy

Paterson

2017

Forensic Science International

View full text Add to dashboard Cite

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

An observed rise in γ-hydroxybutyrate-associated deaths in London: Evidence to suggest a possible link with concomitant rise in chemsex

Hockenhull

Murphy

Paterson

2017

Forensic Science International

View full text Add to dashboard Cite

“…A programme of work on sexual behaviour among HIV-diagnosed MSM provided insight into the levels of different types of CLS and use of recreational drugs in relation to sexual behaviour, an issue that has been increasingly highlighted as a current concern. 28,29 The ASTRA study questionnaire included an inquiry on recent drug use, asking about a comprehensive list of 19 drugs, including those commonly used in party/club and 'chemsex' contexts. Of all 2189 MSM in the ASTRA study diagnosed with a HIV infection for at least 3 months, 38.3% had CLS, 16.3% had CLS with a serodifferent partner and 21.9% had CLS with only HIV-positive partners, 25.4% reported condom-protected sex only, and 36.4% reported no anal or vaginal sex in the past 3 months.…”

Section: Synopsismentioning

confidence: 99%

Implications for a policy of initiating antiretroviral therapy in people diagnosed with human immunodeficiency virus: the CAPRA research programme

Miltz

Phillips

Speakman

et al. 2017

Programme Grants Appl Res

View full text Add to dashboard Cite

BackgroundMore than 100,000 people in the UK are living with a human immunodeficiency virus (HIV) infection. There are currently estimated to be around 4000 people newly infected in the UK per year, mostly men who have sex with men (MSM). It has become increasingly clear that antiretroviral therapy (ART) used to treat people infected with HIV also has a profound effect on infectivity. At the initiation of the programme, it was the policy in the UK to initiate ART in people when their cluster of differentiation 4 (CD4) count was approaching 350/µl.ObjectivesTo assess what would be the effectiveness and cost-effectiveness of a policy of immediate initiation of ART at diagnosis among MSM, taking into account the potential reductions in new infections.DesignWe calibrated an individual-based model of HIV transmission, progression and the effect of ART in MSM, informed by a series of studies on sexual behaviour in relation to ART use and the transmission risk in people with viral suppression on ART, and by surveillance data collected by Public Health England.Setting, participants and interventionsThe series of studies used to inform the model included (1) the Antiretrovirals, Sexual Transmission Risk and Attitudes (ASTRA) study, a cross-sectional self-administered questionnaire study of people diagnosed with HIV attending eight HIV outpatient clinics in the UK (2011–12); (2) the Cognitive Impairment in People with HIV in the European Region (CIPHER) study, a study of levels of neurocognitive impairment in HIV-positive ASTRA participants and people from HIV clinics in Rome, Copenhagen and Minsk; (3) the Attitudes to, and Understanding of, Risk of Acquisition of HIV (AURAH) study, a cross-sectional self-administered questionnaire study of individuals who have not been diagnosed as HIV-positive attending 20 genitourinary medicine clinics across the UK (2013–14); (4) a substudy of sexual behaviour among individuals enrolled in an open-label multicentre international randomised trial (from 2013) of immediate versus deferred ART (to CD4 cell counts of 350/µl) in people with CD4 cell counts of > 500/µl [the Strategic Timing of Antiretroviral Therapy (START) trial]; and (5) Partners of People on ART: a new Evaluation of the Risks (PARTNER), an observational multicentre longitudinal study of HIV serodifferent heterosexual and MSM couples, in which the HIV-positive partner is on ART (2010–14).Main outcome measuresThe main outcome measures were the clinical effectiveness and cost-effectiveness of a policy of immediate initiation of ART at diagnosis.ResultsBased on data from studies (i)–(v), we estimated from our modelling work that increases in condomless sex (CLS) among MSM as a whole may explain the increase in HIV infection incidence in MSM epidemics over a time when ART coverage and viral suppression increased, demonstrating the limiting effects of non-condom use on the HIV epidemic among MSM. Accordingly, an increase in the overall proportion of MSM living with HIV who are virally suppressed on ART from the current level of < 60% to 90% without increases in CLS was required to achieve a reduction in the incidence of HIV among MSM to < 1 per 1000 person-years. The incremental cost-effectiveness ratio associated with the fourfold increase in levels of HIV testing and ART at diagnosis required to provide this increase from < 60% to 90% was £20,000 if we assumed continuation of current ART prices. However, this value falls to £3500 if we assume that ART prices will fall to 20% of their current cost as a result of the introduction of generic drugs. Therefore, our evaluation suggests that ART initiation at diagnosis is likely to be highly cost-effective in MSM at a population level, particularly accounting for future lower ART costs as generic drugs are used. The impact will be much greater if levels of HIV testing can be enhanced.LimitationsIt was necessary to make some assumptions beyond the available data in order to extrapolate cost-effectiveness through modelling.ConclusionsOur findings suggest that ART initiation at diagnosis is likely to be cost-effective in MSM. Of note, after this programme of work was completed, results from the main START trial demonstrated benefit in ART initiation even in people with CD4 cell counts of > 500/µl, supporting ART initiation in people diagnosed with a HIV infection.Future workThere is a need for future research into the means of increasing the frequency with which MSM test for HIV.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

show abstract

“…The subsequent emergence of the injection of synthetic cathinones, including mephedrone, has caused particular concerns in Europe [9], with the injection of these drugs having been associated with increases in human immunodeficiency virus (HIV) infections and risk behaviours among people who inject drugs (PWID) in several central European countries [10,11]. The use, and in particular the injection, of mephedrone by some populations of men who have sex with men (MSM), particularly during sex, has also recently been reported in Europe and elsewhere [12][13][14], often in settings where unsafe sex and sharing of injecting equipment occur [12,13].…”

Section: Introductionmentioning

confidence: 99%

Is the recent emergence of mephedrone injecting in the United Kingdom associated with elevated risk behaviours and blood borne virus infection?

et al. 2016

View full text Add to dashboard Cite

The recent, and rapid, emergence of injection of the short-acting stimulant mephedrone (4-methylmethcathione) has resulted in concerns about increased infection risks among people who inject drugs (PWID). Data from the bio-behavioural surveillance of PWID in the United Kingdom were analysed to examine the impact of mephedrone injection on infections among PWID. During the year preceding the survey, 8.0% of PWID (163/2,047) had injected mephedrone. In multivariable analyses, those injecting mephedrone were younger, less likely to have injected opiates, and more likely to have injected cocaine or amphetamines, used needle/syringe programmes or sexual health clinics, been recruited in Wales and Northern Ireland or shared needles/syringes. There were no differences in sexual risks. Those injecting mephedrone more often had hepatitis C antibodies (adjusted odds ratio (AOR) = 1.51; 95% confidence interval (CI): 1.08–2.12), human immunodeficiency virus (AOR = 5.43; 95% CI: 1.90–15.5) and overdosed (AOR = 1.70; 95% CI: 1.12–2.57). There were no differences in the frequency of injecting site infections or prevalence of hepatitis B. The elevated levels of risk and infections are a concern considering its recent emergence. Mephedrone injection may currently be focused among higher-risk or more vulnerable groups. Targeted responses are needed to prevent an increase in harm.

show abstract

High-risk drug practices tighten grip on London gay scene

Cited by 118 publications

References 0 publications

An observed rise in γ-hydroxybutyrate-associated deaths in London: Evidence to suggest a possible link with concomitant rise in chemsex

An observed rise in γ-hydroxybutyrate-associated deaths in London: Evidence to suggest a possible link with concomitant rise in chemsex

Implications for a policy of initiating antiretroviral therapy in people diagnosed with human immunodeficiency virus: the CAPRA research programme

Is the recent emergence of mephedrone injecting in the United Kingdom associated with elevated risk behaviours and blood borne virus infection?

Contact Info

Product

Resources

About