Transcript EABCTparis2007

10 year history serving the Substance Use needs of London’s
LGBT
(Lesbian, Gay, Bisexual & Transgender) community
8,000 contacts, 700+ people in various types of treatment each
year.
A National Training Programme
-----------------------In partnership with;
CNWL’s CLUB DRUG CLINIC
56 Dean St (CODE Clinic)
Mortimer Market PEP Clinic
Turning Point (SWDAS)
UKDPC: Drugs and diversity 2010
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Crystal
Methamphetamine
“Club Drugs” are Problematic Drugs
2005
2012
Crystal Meth
0%
40%
GHB GBL
3.2%
27%
0%
18%
Mephedrone
LGB&T people poly-using these 3 drugs now account for
85% of our presentations
(alcohol, marijuana, cocaine the remainder)
Referrals from GUM
clinics, A&E or
statutory drug
services
8%
63%
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(Unsubstantiated)
DRAMA!
MSM Chem-Sex is responsible for rising HIV/HCV numbers in London
Gay men are dying in saunas and bedrooms (in the pursuit of chem-sex)
2 gay men are sectioned each month (in the pursuit of chem-sex)
Gay men are flocking to GU clinics for PEP each week (as a result of chem-sex)
HIV infections amongst MSM are climbing for the first time in years, likely as a
result of Chem-sex
HCV infections (including re-infection) amongst MSM are rising fast, likely as
a result of increased injecting chem-sex by MSM.
NONE OF THIS IS BEING MONITORED
THIS IS WHERE WE START
2 Week Snapshot Survey;
Party-Drugs at 56 Dean st
285 MSM attending for a GUM screen
•
55% of drug using MSM agreed with the statement;
‘When I use drugs I do things sexually that I wouldn’t do sober’.
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Of concern, 34% agreed that they were more likely to have
unprotected anal sex when under the influence of drugs.
27 people reported using PEP in the last 6 months.
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Of these 11 (41%) reported this followed sex on drugs.
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Only 21% of these MSM expressed a preference to use current
generic drug services for advice regarding their drug use.
1. GUM Clinics were the most popular choice (40%),
2. Specialist LGBT drug service (33%),
3. GP (9%).
Discussion arising;
“MSM in London report high levels of recreational drug use with associated
increased HIV sexual risk behaviour. These users express a preference
for accessing help away from existing generic drug services.
GUM services are well placed to provide a holistic approach
combining risk reduction for both sexual behaviour and drug use.”
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ANTIDOTE DATA;
Sexual Health Consequences
Of the Crystal Meth, and Mephedrone users at Antidote;
•95% are using to facilitate sex
•80% are injecting
•70% report having shared needles to inject
•Prefer to use “Bareback” sites to find sexual partners
•Report an average of 5 sexual partners per “episode”
75% are HIV positive; of these,
•60% report not taking HIV medicines when on drugs
•90% attribute their HIV or Hep C diagnosis to the use of drugs or alcohol
Of the HIV Negative clients, more than half have had
two or more courses of PEP in the last year 7
LGBT reasons for drug use
HIV FEAR/STIGMA
Shame/judgment
Inappropriate/outdated
messages re HIV prevention
Bullying/Rejection
Gay sex =
•Sin
•Disease
•rejection
Managing Social Networking
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The popularity of “BareBacking”, PrEP
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“HIV prevention”
includes
sexually active HIV+ people.
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Are you confident disclosing your status?
Do you feel confident & sexy, or diseased and unclean?
Are you comfortable discussing HIV with friends/lovers?
Do you use Bareback sites to avoid the HIV topic?
Do you want support in writing your online profiles/setting
boundaries on line?
Do you care about your health and others… even when high?
Unsafe sex may be fine… but sharing needles?
Is compulsive sexual behaviour a result of HIV+ men being out of
work, benefit dependent, low self-esteemed, lonely, needing
affirmation, not at ease with their status?
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“Always use a condom”
“Know your status”
“Disclose your status”
“Get tested/treated more regularly”
Condoms distributed in bars/clubs
Interventions that offer;
‘How to put on a condom’
(and all the above)
NONE OF THESE INTERVENTIONS/MESSAGES SPEAK TO
THE BEHAVIOURS DEFINING THE MOST-AT-RISK GROUPS
The best way to address rising HIV/HCV
numbers… is to reduce MSM drug use;
By addressing stigma, sexual dysfunction
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Antidote carries most (all?) the weight of
this work at present; core funding is neither drug funds
or HIV prevention funds.
Are we prepared for the costs of PEP & ARV’s (HIV and HCV) if these
trends continue at this rate? (Can we project these costs?)
Can we afford to sit patiently in drug services waiting for clients to access support?
Are these standard GUM assessment questions sufficient?;
1. “Are you an injecting drug user?”
2. “Have you slept with an injecting drug user?”
If there are 33 PEP presentations following one Bank holiday weekend at Dean st
(100% of which result from chem-sex), how many are not presenting in time?
Is this a SEXUAL HEALTH issue, or a SUBSTANCE USE issue? (funding/treatment)
How does pan-London commissioning/current restructuring, affect these issues?
Who is training drug services in MSM sexual behavioral trends? (Who is not)?
Who is training GUM/HIV services in MSM drugs awareness? (Who is not)?
If this drug use data (Antidote, GU/HIV services) is not captured on NDTMS et al…
how are we to understand and monitor the problem?
What interventions WOULD be effective? Who is doing them?
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David Stuart
[email protected]
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