Do pre-exposure prophylaxis (PrEP) users engaging in chemsex experience their participation as problematic and how can they best be supported? Findings from an online survey in Belgium.

BACKGROUND: Chemsex involves the use of psychoactive drugs in a sexual context and is a growing phenomenon among men who have sex with men (MSM) and pre-exposure prophylaxis (PrEP) users. Investigating how its negative consequences can be avoided is important. The objective of this study was to explore the perceived impact of chemsex, the willingness to reduce chemsex activities and associated risks and preferred interventions to do so among PrEP users. METHODS: We analysed data from an online survey among PrEP users in Belgium. Chemsex was assessed in two questionnaires distributed between September 2020 and January 2022. RESULTS: A total of 326 participants completed the baseline questionnaire, and 186 the follow-up questionnaire. About one in three participants (36.5%, 119/326) reported engaging in chemsex, and half of those (49.6%, 59/119) were willing to reduce chemsex-related risks. The most preferred strategies for reducing risks were online support via an app (37.3%, 22/59) and face-to-face counselling with a health care professional (30.5%, 18/59). Among those reporting recent chemsex in the follow-up questionnaire, about one in five (21.9%, 14/64) wanted to reduce or stop chemsex activities. About 23.4% (15/64) also reported experiencing negative consequences of chemsex on their health, social or professional life. CONCLUSION: Our findings show that one in four PrEP users engaging in chemsex experienced negative consequences of these activities and about one in five was willing to reduce or stop chemsex activities. We recommend embedding comprehensive chemsex support in the PrEP package of care and developing novel tools and interventions in order to reach maximum impact.

Digital chemsex support and care: The potential of just-in-time adaptive interventions.

Chemsex among gay, bisexual and other men who have sex with men (GBMSM) has received increasing attention as a public health concern in recent years. Chemsex can affect a variety of aspects of the lives of GBMSM and contribute to physical, social and emotional health burden. Starting from a continuum perspective of chemsex, rather than a binary view of problematic vs. non-problematic use, we argue that men engaging in chemsex at different points in their chemsex journey may benefit from tailored and personalized support to cope with the various and evolving challenges and concerns that may be related to their chemsex behavior. To date, interactive digital communication technologies are not much used to provide support and care for GBMSM engaging in chemsex, neither for community-based support and care nor by health services. This suggests potential for missed opportunities, as GBMSM are generally avid users of these technologies for social connections and hookups, including in relation to chemsex. Recent research has provided emerging evidence of the potential effects of so-called just in time adaptive interventions (JITAI) to provide effective support and care for a variety of health issues. JITAI hold much promise for the provision of appropriate, tailored support and care for GBMSM at different points in the chemsex journey. Co-designing JITAI with potential users and other stakeholders (co-design) is key to success. At the Institute for Tropical Medicine, in Antwerp (Belgium), we initiated the Chemified project to develop an innovative digital chemsex support and care tool for GBMSM. This project illustrates how current understanding of chemsex as a journey can be integrated with a JITAI approach and make use of co-design principles to advance the available support and care for GBMSM engaging in chemsex.

HIV testing for key populations in Europe: A decade of technological innovation and patient empowerment complement the role of health care professionals.

OBJECTIVES: With persisting high numbers of new HIV diagnoses in Europe, HIV testing remains an important aspect of HIV prevention. The traditional centralized and medicalized HIV testing approach has been complemented with newly developed and evaluated non-traditional approaches. Two important factors guided this process: technological innovation and empowerment of the patient. METHODS: We present a matrix to develop an HIV testing approach, and elaborate on three commonly used ones: community based testing, self-testing, and self-sampling. Despite non-traditional HIV testing approaches, barriers for testing remain. A potential disadvantage for users is the risk for false-reactive test results. As users receive an orientation test result, a reactive result should be confirmed. Another issue is the window phase, which is longer for some orientation tests compared to a traditional, laboratory-based test. RESULTS: Future implementation of non-traditional HIV testing approaches will depend on legal frameworks throughout Europe. Community testing centers may additionally improve empowerment of key populations by expanding their portfolio to testing and treatment for sexually transmitted infections. Community engagement and ownership may imply a shrinking role for health care providers, but they remain crucial actors for personalized information, counselling and referral to specialized HIV-care for many people. CONCLUSIONS: A highly effective HIV testing strategy to reduce undiagnosed people living with HIV in Europe is needed. Any approach, chosen according to the principles outlined in this paper, should reach the right people, diagnose them in the most accurate way, and optimize linkage to care.

The HepHIV 2017 Conference in Malta: joining forces for the earlier diagnosis of HIV and viral hepatitis.

OBJECTIVES: The objective of the article is to provide an overview of the results of the HepHIV 2017 Conference organized by the HIV in Europe initiative under the Maltese EU Presidency in January 2017. METHODS: A thourough review of all conference presentations (oral and poster presentations) was performed to retrieve the key outcomes of the conference. RESULTS: The key result from the conference was a call to action summarising key priorities in HIV and viral hepatitis testing and linkage to care. This included improving monitoring of viral hepatitis and HIV, mixing testing strategies and ensuring policy support. The important contribution and outcomes of EU funded projects OptTEST and EuroHIVEdat was highlighted. CONCLUSION: An integrated approach to earlier testing and linkage to care across diseases is needed in Europe and the HepHIV conferences create an important forum to reach this aim.

Using conventional HIV tests on oral fluid.

There is need for more evaluations of non-invasive tests in order to broaden the reach of testing programs and to perform large scale epidemiological studies. In this study, three different human immunodeficiency virus (HIV) enzyme linked immunosorbent assays (ELISAs) and one line immunoassay were evaluated to detect HIV antibodies in oral fluid samples. Specimens were collected, after informed consent was obtained, with the Oracol (MMD, Worcester, England) device. A total IgG quantitation test was performed to demonstrate the quality of the sample. Assessment of a modified protocol of the Vironostika HIV Ag/Ab, Enzygnost Anti-HIV 1/2 Plus Genscreen HIV-1/2 Version 2 and a line immune confirmatory assay the INNO-LIA HIV I/II score was done, using oral fluid specimens of 325 HIV positive and negative individuals. For the ELISAs, the addition of an extra internal oral fluid control was evaluated as well as different cut-offs, time between sampling and testing and the effect of drinking water just before sampling. Finally, the confirmatory test and some testing algorithms and combination of tests were discussed. The results obtained from the oral fluid specimens were compared with the gold standard on paired serum specimens. Firstly, there was no significant difference observed between the use of the kit controls and the oral fluid controls. New protocols and calculation of cut-offs were defined for two of the three ELISAs. High sensitivities and specificities were obtained with all three ELISAs without any statistical difference between the three tests. Secondly, no statistically significant difference was observed when samples were stored for different time periods between sampling and testing, meaning that a period of seven days at room temperature before testing is still acceptable. Thirdly, drinking water before sample collection did not interfere with the testing, although lower optical densities were observed. None of the positive samples were missed. In addition, the line immunoassay INNO-LIA HIV I/II score test is a promising test for confirmation of reactive oral fluid specimen, but more samples need to be validated in order to adapt the interpretation rules specifically for oral fluid specimens. Different choices/algorithms adapted for the purpose of testing can be proposed. In conclusion, it can be said that the commercial ELISAs with adapted protocol and cut-off values are suitable tools for making HIV test performance accessible to people. With this non-invasive sampling method, more eligible individuals can and will be selected for further HIV test on blood.

Sexual and reproductive health services for people living with HIV/AIDS in Germany: are we up to the challenge?

PURPOSE: Germany is witnessing an increase in the number of new infections with human immunodeficiency virus (HIV). Enabling persons living with HIV (PLHIV) to adopt safer sex practices might contribute towards reducing the incidence of HIV infections. The aim of this study was to identify gaps in the sexual and reproductive health (SRH) services provided to PLHIV in Germany. METHODS: Within the framework of the European public health project Eurosupport 5, self-reported questionnaires were distributed to PLHIV and a survey of SRH-service providers was carried out. The completed questionnaires and survey results were analysed. RESULTS: Of the questionnaires distributed, 218 PLHIV (90 % men, 10 % women) returned a completed questionnaire. Of these, 74 % self-identified as men having sex with men (MSM) and 13 % as heterosexual men. MSM reported a median number of ten casual partners in the previous 6 months and unprotected sex in one-third of anal intercourses with casual partners, demonstrating that this group adopted more risky sexual behaviours than heterosexual PLHIV. Even though all PLHIV stated they would appreciate more support and service providers indicated that they provided a wide range of SRH services, SRH-relevant topics were rarely discussed between PLHIV and service providers. According to the patients' perception, shortage of time, lack of initiative by service providers and their own difficulty to address SRH-related topics were the most relevant obstacles to receiving satisfactory support. CONCLUSION: Many PLHIV consult their HIV-physician regularly for medical follow-up and also indicate that HIV-physicians should be the source of information concerning SRH counselling. HIV-physicians should take advantage of their key role in HIV care and strengthen their efforts to integrate SRH services in routine HIV care.

Voluntary outreach counselling and testing for HIV and STI among men who have sex with men in Antwerp.

BACKGROUND: High risk settings for transmission of HIV and sexually transmitted infections (STI) offer an opportunity for screening of difficult to reach risk groups. METHODS: Free, anonymous counselling and testing for HIV, syphilis, Chlamydia and hepatitis B/C were offered to visitors in two selected gay venues in Antwerp, by a multidisciplinary team. Participants completed an anonymous questionnaire. The STI-test results were communicated by cell phone using standardised text messages. RESULTS: In total, 137 MSM were tested. Facilitators of risky sexual behaviour (alcohol and drug use) were reported by 34 and 21%, respectively. Four men (3%) were newly diagnosed with HIV; 25 men (18%) had an active, transmittable STI. Infected MSM were significantly less often registered with a fixed general practitioner (GP). CONCLUSIONS: Outreach testing in gay venues is a suitable method to detect MSM at risk for HIV/STI. Although the outreach approach is very labour intensive, it shows a high yield of new STI-diagnoses that are not detected in the regular health system.

Sexual satisfaction among men living with HIV in Europe.

This study determined risk factors for decreased sexual satisfaction among men living with HIV (MLHIV). Self-administered questionnaires were distributed consecutively to all MLHIV attending 17 European HIV treatment centres. The sample included 1,017 MLHIV, among whom 79.2% self-identified as homosexual or bisexual. Sexual satisfaction was measured for five domains of sexual functioning and 33.2% reported low satisfaction in at least one domain. Decreased sexual satisfaction was associated with psychosocial factors, i.e. depression (OR 2.77, P < 0.001), anxiety (OR 1.77, P < 0.001), stress (OR 2.27, P < 0.001) and social factors, such as low partner support (OR 2.28, P < 0.001) and experiences of HIV related discrimination (OR 1.69, P < 0.001). Discussing satisfaction with sexuality should be integrated in regular HIV care, considering patients' personal and relationship-related resources next to medical treatment if indicated.

Mirror, mirror on the wall: the face of HIV + women in Europe today.

Sexual and reproductive health (SRH) and rights are important components of quality of life. This cross-sectional study describes HIV-positive women's SRH aspirations and needs and the predictive value of selected SRH factors on condom use with steady sexual partners. Data were collected in a European multi-centre study in 17 HIV centres in 14 European countries by a standardised anonymous self-administered questionnaire. Descriptive statistics and hierarchical regression analysis were carried out and qualitative data from related formative research illustrated the findings. Among 387 HIV-positive women, 57% had children and 35% had become pregnant since their HIV-diagnosis. Contraceptive needs were largely unmet: 14% had undergone a pregnancy termination. About 83% changed their sexual behaviour after HIV-diagnosis in some ways. Sixty-two percent had at least one sexual encounter with a steady partner during the past six months and 51% used condoms consistently. Significant correlations with condom use were identified for childbearing since HIV-diagnosis (r=-0.21, p<0.01), miscarriage since HIV-diagnosis (r=-0.24, p<0.01), the use of contraception (r=0.47, p<0.001) and changes in sexual behaviour after HIV-diagnosis (r=0.20, p<0.01). Hierarchical regression analysis controlled for education, migration background, age, undetectable viral load and partners' serostatus. The following significant predictors for condom use were established: the use of contraceptives (beta=0.33, p<0.001); miscarriage since HIV-diagnosis (beta=-0.16, p<0.01); childbearing since HIV-diagnosis (beta=-0.12, p<0.05); and having an HIV-positive partner (beta=-0.13, p<0.05). For study population, consistent condom use performed a challenge. Selected SRH-issues predicted condom use. Sexual risk reduction and positive prevention should be discussed in the context of family planning and integrate SRH perspectives in routine HIV care.

Receiving a positive HIV test result: the experience of patients in Europe.

OBJECTIVE: To describe HIV-infected people's experience of the HIV test procedure in Europe. METHODS: Between August 1996 and September 1997, anonymous self-administered questionnaires were distributed to HIV-infected people in 11 European countries. RESULTS: A total of 1366 people completed the questionnaire (50% response rate). Of these, 194 (16%) had more than five negative HIV tests before being diagnosed as HIV positive, 179 (14%) were tested without consent and 192 (15%) were informed about the HIV positive test result by mail or by telephone. Of the 963 people who received a positive test result during a consultation, 247 (26%) reported that this visit lasted less than 10 min, 336 (35%) between 10 and 20 min, and 289 (30%) more than 20 min. Over half the total respondents (591, 54%) felt they did not receive adequate support when they were informed about being HIV positive, with 249 (19%) experiencing feelings of rejection. People who were diagnosed as HIV positive after 1994 reported more frequently receiving adequate support, information and understanding when the positive test result was revealed compared with those diagnosed before 1990. CONCLUSION: A large number of our study participants did not endorse the way HIV tests were conducted and positive test results revealed. Although there was an improvement over time in the way HIV tests were conducted, they often did not conform to international guidelines.