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.

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.

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 contribution of HIV point-of-care tests in early HIV diagnosis: community-based HIV testing monitoring in Catalonia, 1995 to 2018.

BackgroundCommunity-based HIV testing services combined with the use of point-of-care tests (POCT) have the potential to improve early diagnosis through increasing availability, accessibility and uptake of HIV testing.AimTo describe community-based HIV testing activity in Catalonia, Spain, from 1995 to 2018, and to evaluate the impact of HIV POCT on the HIV continuum of care.MethodsA community-based network of voluntary counselling and testing services in Catalonia, Spain has been collecting systematic data on activity, process and results since 1995. A descriptive analysis was performed on pooled data, describing the data in terms of people tested and reactive screening test results.ResultsBetween 1995 and 2018, 125,876 HIV tests were performed (2.1% reactive). Since the introduction of HIV POCT in 2007, a large increase in the number of tests performed was observed, reaching 14,537 tests alone in 2018 (1.3% reactive). Men who have sex with men (MSM), as a proportion of all people tested, has increased greatly over time reaching 74.7% in 2018. The highest percentage of reactive tests was found in people who inject drugs followed by MSM. The contribution of community-based HIV testing to the overall total notified cases in the Catalonia HIV registry has gradually increased, reaching 37.9% in 2018, and 70% of all MSM cases. In 2018, the percentage of individuals with a reactive screening test who were linked to care was 89.0%.ConclusionOur study reinforces the important role that community-based HIV POCT has on the diagnosis of HIV in key populations.

High Prevalence and Incidence of HIV and HCV Among New Injecting Drug Users With a Large Proportion of Migrants--Is Prevention Failing?

OBJECTIVES: The aim of this study was to assess differences in the prevalence of HIV and HCV infection and associated risk factors between new (injecting for ≤5 years) and long-term injectors and to estimate HIV/HCV incidence among new injectors. METHODS: Cross-sectional study among people who inject drugs (PWID) who attended harm reduction centers in Catalonia in 2010-11. Anonymous questionnaires and oral fluid samples were collected. Poisson regression models were applied to determine the association between HIV/HCV infection and risk factors. RESULTS: Of the 761 participants, 21.4% were new injectors. New injectors were younger than long-term injectors (mean age = 31.6 vs. 37.8) and were more likely to be immigrants (59.0% vs. 33.4%). HIV and HCV prevalence was 20.6% and 59.4% among new injectors, and estimated HIV and HCV incidence 8.7 and 25.1 /100 person-years, respectively. Among new injectors, HIV infection was associated with homelessness (PR = 3.10) and reporting a previous sexually transmitted infection (PR = 1.79). Reporting front/backloading (PR = 1.33) and daily injection (PR = 1.35) were risk-factors for HCV infection. For long-term injectors, HIV risk factors were: having shared syringes (PR = 1.85), having injected cocaine (PR = 1.38), reporting front/backloading (PR = 1.30) and ever having been in prison (PR = 2.03). CONCLUSION: A large proportion of PWID in Catalonia are new injectors, a subgroup with a high level of both sexual and parenteral exposure and a high incidence rate of HIV/ HCV infections. It is important to improve early diagnosis of these infections among this group, in particular among migrants. To identify and address risk factors for homelessness PWID should be a priority.

Differences in illegal drug consumption between native and immigrants in a large sample of injected drug users in Catalonia (Spain).

The aims of this study were to describe illegal drug abuse patterns in relation to the migration process and use of drug treatment centers among immigrant injected drug users (IDUs) involved in harm reduction programs, and to compare the characteristics of immigrant and native IDUs. Cross-sectional study of 748 IDUs aged ≥18 years attending harm reduction centers between 2008 and 2009. We explored differences in socio-economic status, illegal drug consumption, health status and use of treatment centers in native versus immigrant IDUs. We also described whether immigrant IDUs started using injected drugs before or after entering the host country. Immigrant IDUs tend to live alone more frequently, start injection at later ages, use heroin and inject it more frequently and use drug treatment centers less frequently than native IDUs. Seventy-six percent of immigrants began using illegal drugs before arriving at the host country. Those who started in other countries were residing in the host country for 5 years or less (63.9%). Overall, immigrant IDUs attended drug treatment centers (36.9%) less frequently than native IDUs (71.8%). In conclusion, migration could be a risk factor for illegal drug abuse initiation or increase in consumption, often with the adoption of local consumption patterns and aggravated due to a lower access to drug treatment centers.

High Hepatitis B Prevalence and Vaccination Needs Among Transgender Women and Men Sex Workers in Barcelona, Spain.

Background: Transgender women sex workers (TWSWs) and men sex workers (MSWs) are especially vulnerable to acquiring hepatitis B virus (HBV) infection. We aimed to describe HBV prevalence (hepatitis B surface antigen [HBsAg] and core antibody [HBcAb]) and associated risk factors for HBV exposure (HBcAb), to assess vaccination status and risk factors for no prior vaccination, and to compare HBV prevalence and vaccination status between TWSWs and MSWs. Methods: The SexCohort study was advertised to TWSWs and MSWs through several communication channels. At cohort entry through 2 community-based organizations in Barcelona, the study population was screened for HBV and other sexually transmitted infections, and an epidemiological questionnaire was administered (n = 271). Results: Overall, 93.0% of participants were migrants, mostly from South and Central American countries. HBsAg prevalence was 1.9% (TWSWs, 2.4%; vs MSWs, 0.9%; P = .42), and previous exposure to HBV was 31.8% (TWSWs, 38.5%; vs MSWs, 20.8%; P = .002). Over 5 years of sex work (adjusted odds ratio [aOR], 9.35), prior exposure to Treponema pallidum (aOR, 3.49), and treatment with anxiolytic drugs (aOR, 3.23) were associated with HBV exposure. Overall, 33.7% of participants exhibited immunity from vaccination (TWSWs, 30.8%; vs MSWs, 38.61%; P < .001), while 34.4% were candidates to HBV vaccination (TWSWs, 30.8%; vs MSWs, 40.6%; P < .001). Never having been on pre-exposure prophylaxis for HIV (odds ratio [OR], 4.23) and non-Spanish origin (OR, 5.00) were associated with no prior HBV vaccination. Conclusions: There is a need to reinforce screening and vaccination programs aimed at TWSWs and MSWs as integrated services offered at the community centers commonly accessed by these populations.

High HIV/STI prevalence among cisgender men and transgender women sex workers attending community-based centres in Barcelona, Spain: The Sweetie Project.

BACKGROUND: The aim of this study was to describe the socio-demographics, and the sexual and health-seeking behaviours of cisgender men and transgender women sex workers (M & TWSW) attending community-based organisations (CBOs) in Barcelona, Spain, as well as to estimate the prevalence of HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), Chlamydia Trachomatis (CT) and Neisseria gonorrhoeae (NG) among them at different anatomical sites. METHODS: The Sweetie Project was a community-based cross-sectional study of 147 M & TWSW recruited in two CBOs in Barcelona between 2017 and 2018. A nurse collected biological samples from rectum, pharynx and urethra from the subjects at each CBO and the participants self-completed an epidemiological questionnaire. RESULTS: The highest prevalence observed was for HIV infection (25.3%) followed by bacterial STIs (NG 19.2% and CT 10.3%). The most prevalent anatomical site was pharyngeal (17.7%) followed by rectal (13.8%). More than half of participants who had a pharyngeal infection presented an isolated pharyngeal infection (57.7%) and half of those who had a rectal or urethral infection presented an isolated infection respectively. The seroprevalence of HCV and HBV was 2.4% and 34.2% respectively. There was a poor but statistically significant correlation between HIV and rectal CT infection (r = 0.31), previous exposure to HCV (r = 0.27) or self-reported STI (r = 0.23), as well as between previous exposure to HCV and rectal CT (r = 0.21) or self-reported STI (r = 0.20). DISCUSSION: The Sweetie Project confirms the high burden of HIV and bacterial STIs among a sample of M&TWSW recruited in CBOs and reinforces the need to routinely screen them at all exposed anatomical sites.

Sexually transmitted infections and sexual practices among injecting drug users in harm reduction centers in Catalonia.

BACKGROUND: The objectives of the study were to estimate the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae and sexual risk practices, and to identify factors associated with infection by C. trachomatis/N. gonorrhoeae. METHODS: Injecting drug users were interviewed at harm reduction centers and biological samples were collected to estimate the prevalence of C. trachomatis and N. gonorrhoeae. RESULTS: The prevalence of C. trachomatis was 2.3%, and this was higher among immigrants (3.6%); the prevalence of N. gonorrhoeae was 0.7% (no differences between Spanish-born and immigrants). Respondents aged ≤25 years had a higher risk of sexually transmitted infections (STIs) (OR 3.39), as did women (OR 3.08). Also associated with having an STI were not having registered employment (OR 4.70), injecting drugs daily (OR 4.21), and having unprotected sex with a stable partner (OR 3.37). CONCLUSION: Although the prevalence of STIs observed is low, scant condom use makes it necessary for prevention programs to include messages related to sexual risk practices, especially among young people and women.

Outreach HIV testing using oral fluid and online consultation of the results: Pilot intervention in Catalonia. / Oferta de la prueba del VIH en fluido oral en actividades de acercamiento y consulta de los resultados online: intervención piloto en Cataluña.

INTRODUCTION: The aim of the intervention was to describe the feasibility and cost-effectiveness of offering HIV testing in outreach interventions and subsequent consultation of the results through a secure web page. METHODS: The HIV test was offered "in situ" to men who have sex with men (MSM), migrant sex workers and trans women recruited in places of leisure and sex. Four collaborating NGOs recruited the participants and assisted them to register on the study website (www.swab2know.eu) through a tablet or the smartphone of the same participant. The samples were sent to the reference laboratory and the results were published on the website. RESULTS: 834 participants (612 MSMs, 203 women sex workers and 19 trans women) were recruited. In total 22 reagent results (2.6%) were detected: 21 among MSMs (3.4%) and 1 in a trans women (5.3%). While 82.6% of MSMs consulted their outcome, only 39.9% and 26.3% of women sex workers and trans women respectively consulted their outcome CONCLUSIONS: Providing self-sampling in outreach activities, dispatch and analysis in a reference laboratory as well as online communication of test results is feasible. A high proportion of participants with a HIV reactive result were detected among MSMs and trans women.