Exploring adolescents' experiences of continuing to wear face masks during COVID-19: A qualitative descriptive study in Barcelona (Spain).

BACKGROUND: The COVID-19 pandemic prompted the use of face masks as a social distancing measure. Although evidence supports their effectiveness in preventing infection, it remains unclear why some adolescents choose to continue wearing them postpandemic, even when it is no longer mandatory. This study aims to explore adolescents' experiences of wearing face masks during the COVID-19 pandemic when their use was no longer mandatory. METHOD: In this exploratory qualitative study, data were collected from 16 adolescents through face-to-face semistructured interviews. The participants were asked about the reasons and feelings associated with continuing to wear masks, as well as the contexts in which they felt safe without a mask. The collected data were analysed using Braun and Clarke's thematic analysis. RESULTS: Three main themes were identified: (1) Navigating complex decision-making: balancing safety and self-image, (2) peer influence dynamics and (3) managing the future: weather dynamics and pandemic evolution. DISCUSSION: The potential implications of withdrawing COVID-19 preventive measures, such as mask-wearing, beyond the pandemic remain understudied. It is crucial to further investigate the perceptions related to wearing masks and its cessation, especially amongst vulnerable individuals. PATIENT OR PUBLIC CONTRIBUTION: Due to methodological constraints associated with participants' age, they were not engaged in the design, data analysis, data interpretation or manuscript preparation phases of the study.

Egocentric sexual network analysis among gay and bisexual men who have sex with men with and without mpox infection.

OBJECTIVES: Recent outbreaks of the mpox (monkeypox) virus have been detected in dense sexual networks of gay and bisexual men who have sex with men (GBMSM). The objective of this study is to describe and compare the epidemiological and behavioural characteristics, as well as the sexual networks, of GBMSM diagnosed with mild mpox in Spain. METHODS: A prospective case-control study was conducted in Spain from July 2022 to February 2023. The study targeted a key population of GBMSM aged 18 years or older. Study participants were categorised into cases, those who were diagnosed with mpox virus infection; and controls, those who were not diagnosed. We examined and compared the sexual network characteristics of the two groups-mpox-positive (mpox-P) and mpox-negative (mpox-N) egos-using χ2, t-test and Wilcoxon test to examine the differences between the two groups in each section. Finally, we conducted univariable and multivariable logistic regressions to determine the factors associated with mpox infection. RESULTS: Among the 105 participants, 35 (33.3%) were mpox-P. Compared with mpox-N, mpox-P respondents more frequently reported syphilis (mpox-P: 31.4%; mpox-N: 12.9%) and HIV (mpox-P: 45.7%; mpox-N: 18.6%), and mpox-P individuals to have had at least one sexual contact with a confirmed mpox case (mpox-P: 62.5%; mpox-N: 8.3%). In the egocentric network analysis, mpox-P respondents had a higher prevalence of group sex with alters (mpox-P: 18.5%; mpox-N: 8.9%) and one-time sexual partners (mpox-P: 46.1%; mpox-N: 31.7%). Multivariable logistic regressions showed that reporting stranger/client ties (adjusted OR (aOR)=10.3, 95% CI 1.39 to 76.6) with alters, being vaccinated for mpox (aOR=0.07, 95% CI 0.02 to 0.24) and tie strength heterogeneity (aOR=0.01, 95% CI 0.00 to 0.42) were associated with mpox infection. CONCLUSIONS: Our findings highlight the role of demographic, epidemiological and sexual network characteristics in the transmission of mpox virus during the outbreak in Spain. These findings have important implications for future prevention efforts.

Factors associated with PrEP knowledge and intention to use PrEP among HIV-negative men and trans women sex workers in Spain.

Lack of data regarding knowledge and intention to use pre-exposure prophylaxis (PrEP) among sex workers exists in Spain. We conducted a cross-sectional analysis based on data from SexCohort study, which included male (MSW) and trans women sex workers (TWSW), aged ≥18 and recruited in two community-based centres in Barcelona, Spain. Of 116 TWSW and 79 MSW, 49.1% and 58.2% had factual knowledge of PrEP, and 40.3% and 70.1% had the intention to use PrEP, respectively. In the multivariable analyses, we found that education and condomless anal sex with stable partners were associated with PrEP knowledge. Regarding intention to use PrEP, TWSW were less likely than MSW to report an intention to use it (aOR = 0.35, 95% CI: 0.16-0.74). Furthermore, intention to use PrEP was associated with being foreign-born, practicing chemsex, and visiting a medical service in the last 12 months. The results of this study inform future trans-specific guidance for PrEP to be effectively implemented in Spain.

Syndemic conditions and quality of life in the PISCIS Cohort of people living with HIV in Catalonia and the Balearic Islands: a cross sectional study.

BACKGROUND: People living with HIV (PLWH) face structural and psychosocial factors that affect health-related quality of life (HRQoL). We aimed to evaluate how syndemic conditions affected HRQoL in PLWH. METHODS: A cross-sectional survey was conducted among 861 PLWH, to determine whether syndemic conditions (monthly income; sexual satisfaction; depressive symptoms; social role satisfaction; social isolation; cognitive function; nicotine dependence; perception of stigma) have an effect on HRQoL. A linear regression model and measures of Additive Interaction (AI) were used to determine the effects of syndemic conditions on HRQoL, controlling for other risk factors. RESULTS: Overall, the most frequently observed were stigma perception (56.9%), poor cognitive function (50.6%) and the perception of social isolation (51.6%). The presence of depressive symptoms was the risk factor most associated with worse Physical Health (PH) (B 3.93, 2.71-5.15) and Mental Health (MH) (B 5.08, 3.81-6.34) in linear regression model. Specifically, an interaction was observed between poor cognitive function and poor satisfaction with social role on worse PH and MH (AI 2.08, 0.14-4.02; AI 2.69, 0.15-5.22, respectively); and low income and perception of stigma (AI 2.98, 0.26-5.71), low income and perception of social isolation (AI 2.79, 0.27-5.32), and low income and poor satisfaction with social role (AI 3.45, 0.99-5.91) on MH. CONCLUSION: These findings provide evidence that syndemic factors impact HRQoL. HIV prevention programs should screen and address co-occurring health problems to improve patient-centered health care and outcomes.

Impact of the COVID-19 Health Crisis on Trans Women and Cis Men Sex Workers in Spain.

The objective of the study was to describe the impact of the COVID-19 pandemic on sex workers in accessing health and social services. A qualitative study was conducted using semi-structured interviews with 29 participants in Barcelona, Spain. Data were analyzed using thematic analysis. Four themes were identified: (1) impact of COVID-19 on physical/mental health, (2) barriers and facilitators to health/social service access, (3) health decision-making, and (4) suggestions for future pandemic situations. Barriers to accessing health services were structural. Non-governmental organization support was the main facilitating factor. A person-centered, intersectional approach is suggested for future practice, considering co-occurring syndemic factors.

Syndemic Conditions and Their Association with HIV/STI Sexual Risk Behaviors Among Transgender Women and Cisgender Men Sex Workers in Catalonia: The SexCohort Project.

BACKGROUND: Transgender women and cisgender men sex workers are vulnerable to HIV and sexually transmitted infections (STIs). This study aimed to explore in depth the prevalence of syndemic conditions and their association with the sexual risk behaviors for HIV/STI acquisition in cis men and trans women sex workers in Barcelona (Catalonia, Spain). METHOD: We conducted a study between 2014 and 2018 to determine whether syndemic conditions (frequent alcohol consumption and polydrug use (> 2) during sex with clients; experience of violence; and lack of healthcare access) are associated with HIV/STI sexual risk behaviors. A "syndemic index" was calculated based on the cumulative number of syndemic conditions (0 to 4). RESULTS: In the last year (2018), 78.8% of cisgender men and 68.1% of transgender women reported at least one syndemic condition. The most prevalent syndemic factor in both cisgender men and transgender women was violence (38.8% and 43.6% respectively). In multivariable analysis, an association was found between condomless anal sex and violence (aOR = 1.81), and frequent alcohol consumption and violence with reporting > 10 clients/week (aOR = 2.73 and 1.88, respectively). The higher the number of syndemic factors, the greater probability of having > 10 clients/week and reporting condomless anal sex with clients. CONCLUSION: Psychosocial conditions have a syndemic effect on risky sexual behaviors highlighting the need for a more holistic approach to HIV/STI prevention targeting these populations.

The Impact of COVID-19 on Adolescents' Mental Health in Catalonia (Spain): A Qualitative Study.

This study aimed to understand the experiences of adolescents regarding the perceived impact of COVID-19 on their mental health in Catalonia (Spain). A qualitative exploratory methodology was used with a purposive sample of 30 high-school students regarding their experiences of the self-perceived impact of COVID-19 on their mental health. Data were thematically analyzed using Braun and Clarke method. Three main themes emerged from the data: (a) the challenge of living confined, (b) the footprint of COVID-19 on adolescents' mental health, and (c) school dynamics during the lockdown. The COVID-19 pandemic negatively impacted adolescents' mental health, and adolescents perceived a lack of emotional support from educational centers. Therefore, incorporating emotional support in educational centers and offering emotional self-management tools to young students should be a priority. School nurses can play an essential role in recognizing and managing emotional needs and being the natural link between educational and primary care centers.

Chemsex in Barcelona: A qualitative study of factors associated with the practice, the perception of the impact on health and prevention needs. / Chemsex en Barcelona: Estudio cualitativo sobre factores asociados a la práctica, percepción del impacto en salud y necesidades de prevención.

Chemsex is defined as use of psychoactive drugs with the aim of having sexual relations between gay men, bisexuals and men who have sex with men for a long period of time. To study this phenomenon, this qualitative descriptive study was proposed with the objective of describing the practice of chemsex from the perspective of users, to determine the main factors associated with its practice, the perception of the impact on their health and to establish prevention needs. Data were obtained using conversational techniques: 12 semi-structured interviews and 3 focus groups. The purposive sample was made up of GBMSM with a mean age of 40.1 years, 78% born in Spain, and 68% with completed university studies. The qualitative analysis focused on three thematic areas: factors associated with the practice of chemsex, the impact of chemsex on health, and prevention and risk reduction needs. It is concluded that the practice of chemsex should be understood as multifactorial and multicausal, associated with the sociocultural context. Sexual satisfaction, increased libido and the search for more intense pleasure are identified as key factors among people who practice it. These men are still scared of being judged, even by specialists who may lack knowledge or training. A reanalysis and rethinking of the interventions and policies directed towards this population is necessary, putting the focus of action on shared decision-making, self-care, cultural competence and the humanization of care.

El chemsex se define como el uso de drogas psicoactivas con el objetivo de mantener relaciones sexuales entre hombres gay, bisexuales y otros hombres que tienen sexo con hombres (GBHSH), por un largo periodo de tiempo. El objetivo de este estudio cualitativo exploratorio es describir la práctica del chemsex desde la perspectiva de los usuarios, determinar los principales factores asociados a su práctica, la percepción del impacto en su salud y establecer necesidades de prevención. Se obtuvieron los datos mediante técnicas conversacionales: 12 entrevistas semiestructuradas y 3 grupos focales. El análisis cualitativo se centró en tres áreas temáticas: factores asociados a la práctica de chemsex, impacto del chemsex en la salud y necesidades prevención y reducción de riesgos. La muestra intencionada fue conformada por hombres GBHSH con una edad media de 40,1 años, 78% nacidos en España, y 68% con estudios universitarios finalizados. Los resultados del estudio ponen de manifiesto que la práctica de chemsex debe comprenderse como multifactorial y multicausal, y asociada al contexto sociocultural. La satisfacción sexual, del aumento de la libido y de la búsqueda de placer más intenso se identifican como factores clave entre las personas que lo practican. Sigue existiendo miedo en estos hombres a ser juzgados, incluso por los especialistas que pueden carecer de conocimiento o formación. Es necesario un reanálisis y replanteamiento de las intervenciones y políticas dirigidas hacia esta población, poniendo el foco de acción en la toma de decisiones compartidas, el autocuidado, la competencia cultural y la humanización del cuidado.

Characterization of Acute HCV Infection and Transmission Networks in People Who Currently Inject Drugs in Catalonia: Usefulness of Dried Blood Spots.

BACKGROUND AND AIMS: Accurate identification of recent HCV infections is critical for tracing the extent and mechanisms of ongoing transmission. We aimed to validate dried blood spot (DBS) samples for the assessment of Hepatitis C virus (HCV) genetic diversity and to determine epidemiological parameters including incidence, determinants of acute infection, and phylogenetic clustering in people who inject drugs (PWID). APPROACH AND RESULTS: HCV nonstructural protein 5B next-generation sequencing was performed from plasma and/or DBS in 220 viremic PWID from the HepCdetect II study. No significant differences were found in consensus sequences or Shannon entropy (SE) intrahost diversity estimate between paired plasma/DBS specimens. SE values were used to identify acute infections with 93.3% sensitivity (95% CI, 0.81-1.06) and 95.0% specificity (95% CI, 0.88-1.02) in a set of well-defined controls. An acute HCV infection (either primary infection or reinfection) was detected in 13.5% of viremic participants and was associated with age ≤30 years (OR, 8.09), injecting less than daily (OR, 4.35), ≤5 years of injected drug use (OR, 3.43), sharing cocaine snorting straws (OR, 2.89), and being unaware of their HCV status (OR, 3.62). Annualized HCV incidence was estimated between 31 and 59/100 person-years. On phylogenetic analysis, 46.8% of viremic cases were part of a transmission pair or cluster; age ≤30 years (OR, 6.16), acute infection (OR, 5.73), and infection with subtype 1a (OR, 4.78) were independently associated with this condition. CONCLUSIONS: The results obtained from plasma and DBS characterize PWID with acute infection and those involved in ongoing HCV transmission and allow estimating incidence from cross-sectional data. This information is critical for the design and assessment of targeted harm reduction programs and test-and-treat interventions and to facilitate monitoring of HCV elimination in this key population.

Factors associated with low levels of HIV testing among young men who have sex with men (MSM) participating in EMIS-2017 in Spain.

PURPOSE: The European Men who have sex with men Internet Survey looked over the characteristics and needs of men who have sex with men (MSM) across Europe. Our objective was to estimate the prevalence of HIV testing and its associated factors among MSM younger than 25 years old participating in the EMIS-2017 in Spain. METHODS: Multivariable regression model was used to compare those who had been tested for HIV within the last 12 months and those that had not. RESULTS: Of 2313 participants, 1070 (46.3%) had been tested for HIV in the past 12 months. Increased age (age 19-21 years, aOR=3.38 (95% CI 2.57 to 4.44); age 22-24 years, aOR=5.26 (4.06 to 6.92) compared with age 16-18 years); being migrant (Latin America: aOR=1.34 (0.98 to 1.84); Europe, North America and Mediterranean countries (aOR=1.56 (0.98 to 2.51) compared with those from Spain); living more openly with one's sexuality (out to some people (aOR=1.53 (1.19 to 1.96)); out to all or almost all people (aOR=2.24 (1.75 to 2.87) compared with those out to none or a few people); having had one condomless steady partners in the las year ((aOR=1.59 (1.26 to 2.02)); having had condomless non-steady partners in the last year (one: aOR=1.76 (1.35 to 2.29)); two or more partners: aOR=2.37 (1.84 to 3.04)); and having practised sex work in the past year (aOR=1.52 (1.07 to 2.13)) were associated with increased odds of HIV testing. Living in a smaller city was associated with less likelihood of HIV testing (<1 00 000 inhabitants: aOR=0.51 (95% CI 0.41 to 0.64); 100 000-500 000: aOR=0.68 (95% CI 0.54 to 0.86) compared with more than 500 000). CONCLUSION: Young MSM showed low HIV testing rate. Future programming specifically targeting this population, especially those middle adolescents, living in a medium-small city and having less 'outness', can help increase HIV testing and prevent access barriers.

Would eligible gay, bisexual and other men who have sex with men use PrEP? Awareness, knowledge, eligibility and intention to use PrEP among EMIS-2017 participants in Spain.

Pre-exposure prophylaxis (PrEP) is an efficacious strategy for reducing the incidence of HIV infection. It has been available in Spain since 2019. We aim to report on awareness, knowledge of, intention to use, and eligibility for PrEP and related factors among participants in the European Men-Who-Have-Sex-With-Men Internet Survey (EMIS-2017) in Spain. We used Spanish data from EMIS-2017, a cross-sectional study performed among gay, bisexual, and other men who have sex with mean (GBMSM) from 50 countries. We found that 65.3% of the 10,634 participants were aware of PrEP, some 30.1% of those HIV-negative and ≥ 18 years were eligible and 52.7% of those eligible intended to use it. Regarding knowledge about PrEP, only 15.4% of the participants knew 3 statement with true information about that PrEP meant. Older age, being born in Western Europe (WE) and greater outness were associated with greater awareness. Older age, being born in Latin America or Caribbean or WE, sex work, and living in a large city were associated with greater eligibility. A greater degree of outness was associated with reduced intention to use. Our study point to possible barriers in the implementation of PrEP in Spain and similar countries.

What is the empirical basis for converting banded ordinal data on numbers of sex partners among MSM into a continuous scale level variable? A secondary analysis of 13 surveys across 17 countries.

BACKGROUND: To provide empirically based guidance for substituting partner number categories in large MSM surveys with mean numbers of sexual and condomless anal intercourse (CAI) partners in a secondary analysis of survey data. METHODS: We collated data on numbers of sexual and CAI partners reported in a continuous scale (write-in number) in thirteen MSM surveys on sexual health and behaviour across 17 countries. Pooled descriptive statistics for the number of sexual and CAI partners during the last twelve (N = 55,180) and 6 months (N = 31,759) were calculated for two sets of categories commonly used in reporting numbers of sexual partners in sexual behaviour surveys. RESULTS: The pooled mean number of partners in the previous 12 months for the total sample was 15.8 partners (SD = 36.6), while the median number of partners was 5 (IQR = 2-15). Means for number of partners in the previous 12 months for the first set of categories were: 16.4 for 11-20 partners (SD = 3.3); 27.8 for 21-30 (SD = 2.8); 38.6 for 31-40 (SD = 2.4); 49.6 for 41-50 (SD = 1.5); and 128.2 for 'more than 50' (SD = 98.1). Alternative upper cut-offs: 43.4 for 'more than 10' (SD = 57.7); 65.3 for 'more than 20' (SD = 70.3). Self-reported partner numbers for both time frames consistently exceeded 200 or 300. While there was substantial variation of overall means across surveys, the means for all chosen categories were very similar. Partner numbers above nine mainly clustered at multiples of tens, regardless of the selected time frame. The overall means for CAI partners were lower than those for sexual partners; however, such difference was completely absent from all categories beyond ten sexual and CAI partners. CONCLUSIONS: Clustering of reported partner numbers confirm common MSM sexual behaviour surveys' questionnaire piloting feedback indicating that responses to numbers of sexual partners beyond 10 are best guesses rather than precise counts, but large partner numbers above typical upper cut-offs are common.

Nursing students' perceptions of the efficacy of narrative photography as a learning method: A cross-sectional study.

Although active learning methodologies promote students' creativity and motivation regarding learning objectives, traditional unidirectional teaching methods remain more common. The objective of this study was to determine nursing students' perceptions regarding the efficacy of narrative photography as a learning method, including self-perceived satisfaction. Narrative photography is an art-based technique inspired by Photovoice that promotes empathy, creativity, and reflection. A cross-sectional study was conducted using a nonprobabilistic sample of 66 nursing students from a public university in Barcelona, Spain. Quantitative and qualitative data were collected anonymously using an electronic tool. Descriptive statistics and thematic analyses were used to analyze the data. Sixty valid questionnaires were returned. The respondents found narrative photography's ability to promote creativity and assist understanding of theory to be its most satisfying aspect (>95% somewhat/totally agree). Narrative photography's usefulness, ability to foster self-criticism, and the associated workload was the least satisfactory aspect (>55% somewhat/totally agree). Significant differences regarding satisfaction levels were found for both age and sex. Narrative photography is a helpful and satisfactory learning method, especially for promoting creativity and understanding theoretical concepts.

Polydrug use of tobacco and cannabis: Relationship with self-perceived health and mood state in adolescents in Central Catalonia- DESKcohort Project. / Policonsumo de tabaco y cannabis: Relación con la salud autopercibida y el estado de ánimo en adolescentes de la Catalunya Central-Proyecto DESKcohort.

The objective was to estimate the prevalence of polydrug use of tobacco and cannabis and to see its relationship with self-perceived health and mood state in adolescents from Central Catalonia in the 2019-2020 academic year. A cross-sectional study was carried out with a sample of 7,319 students, who answered a self-administered questionnaire. The dependent variables were the polydrug use of tobacco and cannabis and polydrug use of tobacco and high-risk cannabis. The main independent variables were self-perceived health status and mood state. Frequencies and percentages were analyzed for the prevalence analysis, and the Chi-square test was used. Poisson regression models were adjusted with robust variance, obtaining Prevalence Ratios. The prevalence of polydrug use of tobacco and cannabis was 3.5% and polydrug use of tobacco and high-risk cannabis was 2.5%. In boys, attending higher academic courses (4th of ESO (aPR: 3.88; 95% CI: 2.14-7.05) vs. CFGM (aPR: 8.67; CI95%: 4.51-16.67), having worse self-perceived health (aPR: 4.79; CI95%: 3.24-7.08) and worse mood state (aPR: 1.47; CI95%: 1.05-2.08) act as factors associated with polydrug use of tobacco and cannabis. The results for girls, and risky use of cannabis follow a similar pattern. Among the main conclusions we observe is that there are no differences in self-perceived health and mood state when comparing polydrug use of tobacco and cannabis and polydrug use of tobacco and high-risk cannabis, so risk reduction strategies must be applied whether the use of cannabis is occasional or problematic.

El objetivo fue estimar la prevalencia del policonsumo de tabaco y cannabis y ver su relación con la salud autopercibida y el estado de ánimo en los adolescentes escolarizados de la Catalunya Central en el curso 2019-2020. Estudio transversal con una muestra de 7.319 estudiantes, que contestaron un cuestionario auto administrado. Las variables dependientes fueron el policonsumo de tabaco y cannabis y policonsumo de tabaco y cannabis de riesgo. Las variables independientes principales fueron la salud autopercibida y el estado de ánimo. Para el análisis de prevalencia se analizaron frecuencias y porcentajes, y se usó la prueba de Chi-cuadrado. Se ajustaron modelos de regresión de Poisson con varianza robusta, obteniendo Razones de Prevalencia. La prevalencia del policonsumo de tabaco y cannabis fue de 3,5% y del policonsumo de tabaco y cannabis de riesgo 2,5%. En los chicos, cursar un curso académico superior (4º de ESO (RPa: 3,88; IC95%:2,14-7,05) vs. CFGM (RPa: 8,67; IC95%:4,51-16,67), tener peor salud autopercibida (RPa: 4,79; IC95%:3,24-7,08) y un peor estado de ánimo (RPa: 1,47; IC95%:1,05-2,08) actúan como factores asociados con el policonsumo de tabaco y cannabis. En chicas y por consumo de riesgo de cannabis siguen un patrón similar. Entre las principales conclusiones observamos que no hay diferencias en la salud autopercibida y el estado de ánimo en el policonsumo de tabaco con cannabis y con cannabis de riesgo, por lo que deben existir estrategias de reducción de riesgos tanto si el consumo de cannabis es puntual como si el consumo de cannabis es problemático.

Estimating the percentage of European MSM eligible for PrEP: insights from a bio-behavioural survey in thirteen cities.

OBJECTIVES: This paper aims to estimate the percentage of European men who have sex with men (MSM) who may benefit from pre-exposure prophylaxis (PrEP), applying the three most widely used HIV risk indices for MSM (MSM Risk Index, Menza score, San Diego Early Test (SDET) score) and drawing on a large-scale multisite bio-behavioural survey (Sialon II). METHODS: The Sialon II study was a bio-behavioural survey among MSM implemented in 13 European cities using either time-location sampling or respondent-driven sampling. Biological and behavioural data from 4901 MSM were collected. Only behavioural data of HIV-negative individuals were considered. Three widely used risk indices to assess HIV acquisition risk among MSM were used to estimate individual HIV risk scores and PrEP eligibility criteria. RESULTS: 4219 HIV-negative MSM were considered. Regardless the HIV risk score used and the city, percentages of MSM eligible for PrEP were found to range between 5.19% and 73.84%. Overall, the MSM Risk Index and the Menza score yielded broadly similar percentages, whereas the SDET Index provided estimates constantly lower across all cities. Although all the three scores correlated positively (r>0.6), their concordance was highly variable (0.01

The Role of Community Health Workers Within the Continuum of Services for HIV, Viral Hepatitis, and Other STIs Amongst Men Who Have Sex with Men in Europe.

Little is known about Community Health Workers (CHWs) who work in non-clinical settings to provide sexual health support around HIV, viral hepatitis, and other sexually transmitted infections (STIs) to men who have sex with men (MSM) in Europe and neighbouring countries. This article describes for the first time, who CHWs are, and how they contribute to the continuum of services for HIV, viral hepatitis, and other STIs amongst MSM. The first European Community Health Worker Online Survey (ECHOES) developed in the framework of the EU-funded ESTICOM project ( www.esticom.eu ), was available in 16 languages (October 2017-January 2018). Amongst the 1035 persons aged 18 and older reporting CHW activities in the previous 12 months, 28.2% were women, 30.7% were volunteers, 59.2% were men self-defining as gay/homosexual, bisexual or queer ('peer CHWs'), and most CHWs worked/volunteered in private not-for-profit organisations (86.4%). CHWs involvement in the continuum of services for HIV, viral hepatitis and other STIs was as follows: primary prevention (88.6%), consultation and counselling (58.0%), testing provision (50.6%), linkage to care (49.8%), and treatment and support activities (51.3%). CHWs were also involved in cross-cutting activities such as developing interventions, advocacy, and engaging in research (46.3%). CHWs as a public health workforce contribute to all steps of the continuum of services for HIV, viral hepatitis, and other STIs amongst MSM in Europe. National governments should recognise and support CHWs better in order to make their activities more visible and sustainable, and increase their impact on the continuum of services.

Women who inject drugs and violence: Need for an integrated response. / Mujeres que usan drogas inyectadas y violencia: Necesidad de una respuesta integrada.

The aim of this study was to describe the prevalence of physical and/or sexual violence experienced by women who inject drugs (WWID) and identify associated factors. A cross-sectional study was conducted among 120 WWID in a network of harm reduction centres using an anonymous questionnaire. Oral fluid samples were also collected to estimate the prevalence of HIV and hepatitis C. Univariate and multivariate Poisson regression models with robust variance were performed to identify the factors associated with experiencing violence, obtaining prevalence ratios (PR) and their 95% confidence intervals. The results showed that the prevalence of violence reported by WWID in the last 12 months was 45.8% (42.2% physical and 11.9% sexual aggression). In multivariate analysis, variables associated with experiencing violence were homelessness (PR = 1.59; CI: 1.07-2.38), reporting exchanges of sex for money or drugs (PR = 1.65; CI: 1.19-2.29), reporting a previous sexually transmitted infection (PR = 1.49; CI: 1.04-2.15) and/or injecting drugs less frequently than daily (RP = 2.29; CI: 1.49-3.54). This study highlights the importance of establishing detection protocols and systems of referral to the network of attention to women suffering violence, within the centres of the drug addiction care network, as well as the development of multilevel strategies that take into account not only individual factors but also other social and/or structural aspects that may be playing a relevant role in addressing this problem.

El objetivo de este estudio fue describir la prevalencia de violencia física y/o sexual experimentada por mujeres que usan drogas por vía inyectada (MUDVI) e identificar factores asociados. Se realizó un estudio transversal en 120 MUDVI usuarias de centros de reducción de daños mediante un cuestionario anónimo y recogida de muestras de fluido oral para estimar la prevalencia del VIH y de la hepatitis C. Los factores asociados a la presencia de violencia se analizaron mediante un modelo de regresión de Poisson con varianza robusta univariante y multivariante, obteniendo razones de prevalencia (RP) y sus intervalos de confianza al 95%. Los resultados muestran que la prevalencia de  agresiones en los últimos 12 meses fue del 45,8% (42,2% agresiones físicas y 11,9% agresiones sexuales). A nivel multivariante, las variables asociadas a la presencia de violencia fueron estar sin domicilio fijo (RP=1,59; IC: 1,07-2,38), ejercer el trabajo sexual (RP=1,65; IC: 1,19-2,29), haber sufrido alguna infección de transmisión sexual (RP=1,49; IC: 1,04-2,15) y/o inyectarse drogas no de forma diaria (RP=2,29; IC: 1,49-3,54). Este estudio pone de manifiesto la importancia de establecer protocolos de detección, y derivación a la red de atención a la violencia de género, dentro de los centros de la red de atención a las drogodependencias, así como el desarrollo de estrategias multinivel que tengan en cuenta no solamente factores individuales sino también otros aspectos sociales y/o estructurales que pueden estar jugando un papel relevante a la hora de abordar este problema.

The Role of Gay-Related Stigma in HIV-Risk Behavior Among Sexual Minority Men in Europe.

Sexual orientation stigma stems from discriminatory social contexts and may ultimately impact the behavioral health of stigmatized individuals through stress-related pathways. Sexual minority stigma is of particular concern in Europe given the diversity of social contexts on the continent and sexual minority men's rapidly increasing risk of HIV infection, especially in Central and Eastern Europe, potentially rooted in stigma. This study assesses whether stigma in the ubiquitous social contexts surrounding sexual minority men (e.g., family, workplace, government) may place them at higher risk for HIV contraction across six countries. We utilized a large cross-sectional survey sample of HIV-negative sexual minority men (N = 2087; mean age = 31.6, SD = 9.7) from six European countries to test whether those who reported sexual orientation stigma also engaged in more HIV risk-related behaviors, including condomless sex with casual partners (in the absence of PrEP) and substance use before and during sex. Regression analyses were performed in Mplus. We found that a one standard deviation increase in reported sexual orientation stigma was significantly associated with the following during the last sexual encounter: a 19% increase in odds of sex under the influence of alcohol, 27% increase in odds of sex under the influence of cannabis, 49% increase in odds of sex under the influence of illicit drugs, an 11% increase in odds of condomless sex with casual partners in the past 6 months, and a 26% increase in odds of knowing where to receive an HIV test. Sexual minority men who reported perceiving greater sexual orientation-related stigma within their ubiquitous social contexts were significantly more likely to report sexual risk and alcohol and drug use during their last sexual encounter, yet reported more knowledge of preventive services. Contextual stigma might serve as a precursor to behavioral risks of HIV infection, generating maladaptive stress responses capable of being modified through individually-focused interventions. Structural interventions are also needed to ultimately reduce stigma at its source.

Measurement of sexual health outcomes among people who inject drugs: pilot study in Catalonia, Spain and Barnaul, Russia.

BACKGROUND: The main objective of this study was to test some of the draft sexual health indicators developed by the World Health Organization as part of a comprehensive indicator framework to monitor progress in universal access to reproductive health. METHODS: Cross-sectional studies among people who inject drugs were conducted in Catalonia (n = 734) and Barnaul (n = 500). 'Sexual competency' was measured using three indicators: sexual satisfaction, sexual safety, and sexual autonomy. Individual social norms on sexuality were also collected. The construct validity of the sexual safety and sexual autonomy items were assessed. Multivariate logistic regression models explored factors associated with sexual dissatisfaction. RESULTS: In Catalonia, sexual competency was higher among males than females who inject drugs (60.4% versus 33.3%). In both Catalonia and Barnaul, differences by sex in social norms on sexuality were seen. Mean scores on sexual safety (4.15 in Catalonia and 3.54 in Barnaul) were lower among participants who reported not using condoms. Mean scores on sexual autonomy (4.42 in Catalonia and 3.97 in Barnaul) were lower among those who had experienced some form of sexual assault. Perceived sexual safety, sexual autonomy, and social norms on sexuality were associated with sexual dissatisfaction. CONCLUSIONS: The sexual health indicators tested are valid, feasible, and reliable tools to monitor and evaluate sexual health programs and activities. The results confirm that sexual satisfaction depends on safe sexual experiences, free from coercion and violence. Social norms and individual perceptions about sexual health need to be considered when developing national disease prevention programs.