Mental health of Covid-19 risk groups during the first Covid-19 lockdown in Germany: a cross-sectional study.

BACKGROUND: The ongoing Covid-19 pandemic not only threatens physical health, but also affects the mental health of people. Yet, health consequences of the pandemic do not affect all members of society equally. We therefore assessed the mental health burden of individuals who are at increased risk of severe illness from Covid-19 compared to individuals who are at low risk of severe illness during the first lockdown (March, 2020) in Germany. Furthermore, we investigated variables mediating the effect of being an individual at increased risk of serve illness on depression. METHODS: Adult German residents (n = 2.369) provided responses to a cross-sectional online survey about risk factors for of severe illness from Covid-19 and various aspects of mental health during the first lockdown in Germany. For data collection, standardized and validated self-report measures were used and for data analysis Mann-Whitney U-tests as well as regression and mediation analyses were performed. RESULTS: The results clearly show that the mental health burden is higher among individuals at increased risk of severe illness from Covid-19 compared to individuals at low risk of severe illness from Covid-19. Moreover, our findings indicate that the association between Covid-19 risk status and depressive symptoms is mediated by concerns about mental health, anxiety and loneliness in a causal effect chain. CONCLUSIONS: Individuals at increased risk of severe illness from Covid-19 have an increased need for psychosocial support during times of lockdown. Future public health policies should pay special attention to these individuals and support them by targeted offers. More research, however, is needed on possible long-term consequences of social distancing on mental health.

Health Outcomes for Clients of Needle and Syringe Programs in Prisons.

High levels of drug dependence have been observed in the prison population globally, and the sharing of injecting drug equipment in prisons has contributed to higher prevalence of bloodborne diseases in prisoners than in the general population. Few prison needle and syringe programs (PNSPs) exist. We conducted a systematic review to assess evidence regarding health outcomes of PNSPs. We searched peer-reviewed databases for data relating to needle and syringe programs in prisons. The search methodology was conducted in accordance with accepted guidelines. Five studies met review inclusion criteria, and all presented evidence associating PNSPs with one or more health benefits, but the strength of the evidence was low. The outcomes for which the studies collectively demonstrated the strongest evidence were prevention of human immunodeficiency virus and viral hepatitis. Few negative consequences from PNSPs were observed, consistent with previous evidence assessments. More research is needed on PNSP effectiveness, and innovative study designs are needed to overcome methodological limitations of previous research. Until stronger evidence becomes available, policymakers are urged to recognize that not implementing PNSPs has the potential to cause considerable harm, in light of what is currently known about the risks and benefits of needle and syringe programs and PNSPs and about the high prevalence of human immunodeficiency virus and viral hepatitis in prisons.

Drug use and health behaviour among German men who have sex with men: Results of a qualitative, multi-centre study.

BACKGROUND: Men who have sex with men (MSM) are a risk group for new HIV infections. Drug use among men who have sex with men is often accompanied by risky sexual behaviours. Local AIDS help centres and gay advice centres are recording an increase in drug use among MSM clients in Germany. This study examines reasons for drug use and drug use contexts for MSM, including syndemic factors and experiences of social support. METHODS: The study is based on a qualitative research approach. We conducted 14 structured, in-depth interviews with substance-using MSM in three German cities. An interview guidance document was used that was developed on the basis of the syndemic approach. Data analysis was based on structured analysis of content. RESULTS: The MSM interviewed had extensive experience of drug use, in particular amyl nitrate, amphetamines, methamphetamine, ketamine, cocaine and cannabis. The drugs were used both at parties and in connection with sexual experiences (chemsex). Twelve men said that they had an existing HIV infection at the time of the interview. The men also reported experiences of violence and discrimination because of their sexual orientation. The social networks of the MSM and dating apps are highly relevant for experiencing chemsex. Certain places in the MSM community also have an impact on drug purchase, drug consumption and chemsex sessions. CONCLUSIONS: MSM are a group that is vulnerable to psychological problems, in particular problematic drug use. This group requires specific help from drug services and AIDS support services that are orientated towards the life situation and substance use contexts of the clients. Both support systems should work together more closely and network. Furthermore, specific prevention strategies, aimed at both mental and physical well-being, should be developed for substance-using MSM.

Chemsex among men who have sex with men in Germany: motives, consequences and the response of the support system.

Background In Germany, drug use in sexual settings (i.e. chemsex) among men who have sex with men (MSM) has increasingly been the subject of discussion for considerable time. At the same time, however, little is known about this practice. It is against this background that what is currently known about chemsex among MSM in Germany is discussed. METHODS: The present study observations are essentially based on the results of two research projects of a qualitative-explorative nature. In-depth interviews with drug-using MSM (n=14), as well as qualitative, problem-centred interviews with drug-using MSM (n=75) and expert interviews (n=27) were conducted within these research projects. RESULTS: Chemsex is a minority behaviour among MSM in Germany. The reasons for using drugs in sexual settings are manifold. For the most part, the effects of the drugs are used to intensify sexual feelings and to achieve greater intimacy. Men who consider their consumption to be problematic, in particular, report a range of negative consequences, such as sexually transmissible infections. Even though chemsex is a minority behaviour, suitable offers of support are, hence, necessary, especially for these men. However, such offers are not yet available in most German cities. CONCLUSIONS: In order to close this gap in provision of support services, tangible practical steps, such as further training of people who work at drug and gay advisory services, are necessary, along with further research into the backgrounds and contexts of chemsex.