PAUSA: Resultados de un programa de proximidad dirigido a personas con prácticas de chemsex en la ciudad de Madrid / PAUSA: Results of an outreach programme aimed at people with chemsex practices in the city of Madrid

Introducción: El Instituto de Adicciones de Madrid Salud (Ayuntamiento de Madrid) utiliza habitualmenteestrategias de acercamiento orientadas a diferentes grupos de población. En 2020 se impulsó un nuevoprograma de acercamiento dirigido a usuarios con prácticas de chemsex, cuyo diseño y resultadosiniciales se presentan en este trabajo. Objetivos: El programa de acercamiento PAUSA se proponeacceder a usuarios de chemsex que todavía no han demandado atención profesional, ofreciéndolesapoyo desde fases más tempranas para: reducir los riesgos de estas prácticas, programar un descansode las mismas, o facilitar un mejor acceso y enlace a los servicios públicos y comunitarios especializadosen chemsex en la ciudad de Madrid. Materiales y métodos: El diseño del programa exploró diferentesopciones de acercamiento a usuarios de chemsex en activo, incluyendo estrategias de difusión onliney a través de tarjetas y cartelería. Se ofrecieron a los usuarios dos tipos de intervenciones, breves yestructuradas. Las primeras se desarrollaron vía chat. Las segundas mediante cita programada presencialo por Skype/Zoom. Resultados: Durante el periodo de actividad analizado se realizaron un total de 739intervenciones breves por chat, beneficiando a un total de 442 usuarios. Se realizaron además un totalde 190 citas estructuradas, presenciales u online, de una hora de duración. Un total de 115 usuariosfueron derivados a centros de atención a las adicciones. La atención recibida por parte del programarecibió excelentes evaluaciones. Conclusiones: El modelo de intervención implementado en el programaPAUSA resultó efectivo para contactar con usuarios de chemsex en fases más tempranas. La captaciónonline en aplicaciones de contactos gais fue la estrategia de acercamento de mayor éxito. Los usuariosatendidos mostraron una alta aceptabilidad de este formato de intervención. (AU)

Introduction: The Institute of Addictions of Madrid Health (City Council of Madrid) routinely employsoutreach strategies aimed at different population groups. In 2020, a new outreach programme wasinitiated targeting individuals engaged in chemsex practices. This paper presents the design and initialoutcomes of this programme. Objectives: The PAUSE outreach programme aims to engage chemsexusers who have not yet sought professional help, providing them support at earlier stages to mitigatethe risks associated with these practices, introduce breaks from them, or facilitate better access andlinkage to public and community services specialised in chemsex within the city of Madrid. Materialsand Methods: The programme’s design explored various approaches to engage active chemsex users,including online dissemination strategies and through cards and posters. Users were offered twotypes of interventions: brief and structured. The former were conducted via chat, while the latterwere scheduled either for in-person meetings or through Skype/Zoom. Results: During the analysedactivity period, a total of 739 brief interventions were conducted via chat, benefiting 442 users in total.Additionally, 190 structured sessions, either in-person or online, lasting an hour each were carriedout. A total of 115 users were referred to addiction care centres. The programme’s services receivedexcellent evaluations. Conclusions: The intervention model implemented in the PAUSE programmeproved effective in reaching users engaged in chemsex during early stages. Online outreach throughgay contact apps emerged as the most successful engagement strategy. Users served demonstrated ahigh acceptability of this intervention format. (AU)

Alto consumo de drogas recreativas y conductas sexuales de riesgo en hombres que tienen relaciones sexuales con hombres / High prevalence of drug consumption and sexual risk behaviors in men who have sex with men

Fundamento y objetivo: Describir el patrón de uso de drogas en hombres que tienen relaciones sexuales con hombres (HSH) residentes en España y su asociación con las prácticas de riesgo sexual. Material y método: La Encuesta Europea por Internet para HSH se implementó en 2010 en 38 países europeos y recogió información sociodemográfica y sobre conducta y salud sexual, entre otras. Mediante modelos de regresión logística multivariante se evaluó la asociación entre la variable penetración anal desprotegida (PANP) con parejas ocasionales y el consumo de drogas. Resultados: Entre los 13.111 HSH encuestados, el cannabis fue la droga consumida con más frecuencia en los últimos 12 meses (30,1%), seguido del popper (28,4%) y la cocaína (18,7%). Los modelos de regresión logística ajustados mostraron un riesgo de PANP de 1,5 entre los consumidores de drogas en relación con los que no las habían consumido. El 2,5% de los HSH se había inyectado drogas alguna vez en la vida, y el 1,4%, en los últimos 12 meses. La prevalencia de PANP con parejas ocasionales (53,4%), de infección por el virus de la inmunodeficiencia humana (VIH) (23%), de hepatitis C (8,2%) y de infecciones de transmisión sexual (ITS) (15,8%) fue superior en HSH inyectores con respecto al resto de los participantes (p < 0,05). Conclusiones: Se confirma una elevada prevalencia de consumo de drogas en HSH y su asociación con las conductas sexuales de riesgo. Aunque el uso de la vía inyectada en HSH es minoritario, el subgrupo de HSH inyectores presenta una mayor prevalencia de conductas sexuales de riesgo, VIH, hepatitis C y otras ITS (AU)

Basis and objective: To describe the pattern of drug use among men who have sex with men (MSM) living in Spain and its association with sexual risk practices. Material and method. The European MSM Internet Survey was implemented in 2010 in 38 European countries on websites for MSM and collected data on sociodemographics, sexual behavior, and other sexual health variables. The association between unprotected anal intercourse (UAI) with casual partners and drug consumption was evaluated using multivariate logistic regression models. Results: Among the 13,111 participants, most consumed drugs were cannabis (30.1%), popper (28.4%) and cocaine (18.7%). The risk of UAI with casual partners was 1.5 among those who had used drugs in relation to the other participants. The proportion of MSM who had injected drugs at least once in life was 2.5%, and 1.4% in the last 12 months. The prevalence of UAI with casual partners (53.4%), human immunodeficiency virus (HIV) (23%), hepatitis C (8.2%) and sexually transmitted infections (STI) (15.8%) was higher in MSM injectors related to those who had not used injected drugs (P < .05). Conclusions: The results of this study confirm a high prevalence of drug use in MSM and their relationship to sexual risk behavior. Although the use of injected drugs in MSM is a minority, this group reported a higher level of sexual risk behaviors, self-reported HIV, hepatitis C and other STI (AU)

Hepatitis C virus infection and its relationship to certain sexual practices in men-who-have-sex-with-men in Spain: Results from the European MSM internet survey (EMIS) / La infección por el virus de la hepatitis C y su relación con ciertas prácticas sexuales en hombres-que-tienen- sexo-con-hombres en España: resultados de la European MSM internet survey (EMIS)

OBJECTIVES: To compare sexual practices and risk behaviours between MSM who were first diagnosed with hepatitis C (HCV) in the previous 12 months and those who were never diagnosed; and, to identify factors associated with a diagnosis of HCV. METHODS: The European-MSM-Internet-Survey (EMIS) was implemented for 3 months during 2010, mainly on websites for MSM. Data on socio-demographic characteristics, sexual behaviour, drug use, STI history, and other sexual health variables were collected. The Chi-square test and logistic regression analysis were used to analyse the data. RESULTS: Data from 13,111 respondents were analysed. The proportion of MSM who had ever been diagnosed with HCV infection was 1.9% (n = 250), and of those currently infected with the virus was 0.6% (n = 78). The percentage of those first diagnosed in the last 12 months was 0.4% (n = 46), of whom 70% were HIV-negative and 22% had HIV coinfection. Having a first diagnosis of HCV in the last 12 months was more common among HIV-positive than among HIV-negative MSM (0.9% vs 0.4%) and among MSM born abroad than among Spanish-born (0.7% vs 0.3%). MSM diagnosed with HCV in the last 12 months were more likely to have had: more than 10 sexual partners, sex abroad, receptive anal intercourse, insertive/receptive fisting, and unprotected anal intercourse with non-steady partners of unknown or discordant HIV-status. Likewise, they reported more frequent visits to sex-focused venues, higher drug use, as well as a higher proportion of STI diagnosis. In the multivariate model, visiting a public sex-focused venue, practicing receptive fisting, using erection enhancing medication and having a diagnosis of syphilis were independently associated with a first diagnosis of HCV in the last 12 months. CONCLUSIONS: HCV infection does not seem to be restricted to HIV-infected MSM. Certain sexual behaviour (fisting, visiting sex-focused venues), drug use, and ulcerative STI seem to be associated with a diagnosis of HCV

OBJETIVOS: Comparar las prácticas sexuales y otras conductas de riesgo entre los HSH diagnosticados por primera vez con el virus de la hepatitis C (VHC) en los últimos 12 meses y los nunca diagnosticados; y, determinar factores asociados al diagnóstico del VHC. MÉTODO: La European MSM Internet Survey (EMIS) fue implementada en el 2010, durante 3 meses, principalmente en páginas de contacto gay. Se recogió información sobre conductas sexuales de riesgo, consumo de drogas, historia de ITS, prevalencia del VIH, entre otros temas. Para analizar los datos se utilizó la prueba chi-cuadrado y análisis de regresión logística. RESULTADOS: Datos de 13.111 participantes fueron analizados. El 1,9% de la muestra (n = 250) había recibido un diagnóstico del VHC, el 0,6% (n = 78) estaba actualmente infectado y un 0,4% (n = 46) recibió por primera vez su diagnóstico en los últimos 12 meses. Entre estos últimos, el 70% fueron VIH-negativos y el 22% tenía coinfección con el VIH. Tener un primer diagnóstico del VHC en los últimos 12 meses fue más común entre VIH-positivos que entre VIH-negativos (0,9% frente a 0,4%) y entre extranjeros que entre españoles (0,7% frente a 0,3%). En una significativa proporción (p < 0,05), los HSH diagnosticados del VHC en los últimos 12 meses tuvieron más: parejas sexuales, sexo en el extranjero, penetración anal receptiva, fisting insertivo/receptivo y penetración anal sin condón con parejas sexuales ocasionales de seroestatus desconocido o discordante frente al VIH. Asimismo indicaron frecuentar más locales de sexo, alto consumo de drogas y tener una mayor proporción de diagnóstico de otras ITS. En el modelo multivariado, visitar un local de sexo público, practicar fisting receptivo, tomar medicamentos para la disfunción eréctil y tener un diagnóstico de sífilis estuvieron independientemente asociados con un primer diagnóstico del VHC en los últimos 12 meses. CONCLUSIONES: La infección del VHC no parece ser restrictiva a los HSH VIH-positivos. Algunas conductas sexuales (fisting, visitar locales donde se practica sexo), el consumo de drogas y las ITS ulcerativas parecen estar asociadas a un diagnóstico del VHC

Hepatitis C virus infection and its relationship to certain sexual practices in men-who-have-sex-with-men in Spain: results from the European MSM internet survey (EMIS).

OBJECTIVES: To compare sexual practices and risk behaviours between MSM who were first diagnosed with hepatitis C (HCV) in the previous 12 months and those who were never diagnosed; and, to identify factors associated with a diagnosis of HCV. METHODS: The European-MSM-Internet-Survey (EMIS) was implemented for 3 months during 2010, mainly on websites for MSM. Data on socio-demographic characteristics, sexual behaviour, drug use, STI history, and other sexual health variables were collected. The Chi-square test and logistic regression analysis were used to analyse the data. RESULTS: Data from 13,111 respondents were analysed. The proportion of MSM who had ever been diagnosed with HCV infection was 1.9% (n=250), and of those currently infected with the virus was 0.6% (n=78). The percentage of those first diagnosed in the last 12 months was 0.4% (n=46), of whom 70% were HIV-negative and 22% had HIV coinfection. Having a first diagnosis of HCV in the last 12 months was more common among HIV-positive than among HIV-negative MSM (0.9% vs 0.4%) and among MSM born abroad than among Spanish-born (0.7% vs 0.3%). MSM diagnosed with HCV in the last 12 months were more likely to have had: more than 10 sexual partners, sex abroad, receptive anal intercourse, insertive/receptive fisting, and unprotected anal intercourse with non-steady partners of unknown or discordant HIV-status. Likewise, they reported more frequent visits to sex-focused venues, higher drug use, as well as a higher proportion of STI diagnosis. In the multivariate model, visiting a public sex-focused venue, practicing receptive fisting, using erection enhancing medication and having a diagnosis of syphilis were independently associated with a first diagnosis of HCV in the last 12 months. CONCLUSIONS: HCV infection does not seem to be restricted to HIV-infected MSM. Certain sexual behaviour (fisting, visiting sex-focused venues), drug use, and ulcerative STI seem to be associated with a diagnosis of HCV.

[High prevalence of drug consumption and sexual risk behaviors in men who have sex with men]. / Alto consumo de drogas recreativas y conductas sexuales de riesgo en hombres que tienen relaciones sexuales con hombres.

BASIS AND OBJECTIVE: To describe the pattern of drug use among men who have sex with men (MSM) living in Spain and its association with sexual risk practices. MATERIAL AND METHOD: The European MSM Internet Survey was implemented in 2010 in 38 European countries on websites for MSM and collected data on sociodemographics, sexual behavior, and other sexual health variables. The association between unprotected anal intercourse (UAI) with casual partners and drug consumption was evaluated using multivariate logistic regression models. RESULTS: Among the 13,111 participants, most consumed drugs were cannabis (30.1%), popper (28.4%) and cocaine (18.7%). The risk of UAI with casual partners was 1.5 among those who had used drugs in relation to the other participants. The proportion of MSM who had injected drugs at least once in life was 2.5%, and 1.4% in the last 12 months. The prevalence of UAI with casual partners (53.4%), human immunodeficiency virus (HIV) (23%), hepatitis C (8.2%) and sexually transmitted infections (STI) (15.8%) was higher in MSM injectors related to those who had not used injected drugs (P<.05). CONCLUSIONS: The results of this study confirm a high prevalence of drug use in MSM and their relationship to sexual risk behavior. Although the use of injected drugs in MSM is a minority, this group reported a higher level of sexual risk behaviors, self-reported HIV, hepatitis C and other STI.

Conductas sexuales de alto riesgo en hombres que tienen relaciones sexuales con hombres según tipo de pareja sexual / High-risk sexual behaviour by partner type among men who have sex with men

OBJETIVO: Identificar los factores asociados a las prácticas sexuales de alto riesgo en hombres que tienen relaciones sexuales con hombres (HSH) en España. Métodos Encuesta online realizada en 2010 sobre conductas sexuales y necesidades de prevención del VIH/ITS, entre otros. La práctica de la penetración anal no protegida (PANP) con parejas con estado serológico al VIH desconocido o discordante en el último año se consideró como de alto riesgo. Resultados De los 13.111 participantes, el 49,4% habían tenido relaciones sexuales con parejas estables (PE) y el 73,4% con parejas ocasionales (PO) en los últimos 12 meses, siendo la PANP de alto riesgo del 25,4 y el 29,4%, respectivamente. Entre los factores asociados a la PANP de alto riesgo con PE destacaron: residir en poblaciones < 500.000 habitantes (OR = 1,42 < 100.000 habitantes), declarar que casi nadie de su entorno conocía su orientación sexual (OR = 1,42) y ser VIH positivo con carga viral indetectable siempre que se presentara un nivel de conocimientos sobre el VIH/ITS elevado (OR = 3,18). Con las PO destacaron: un mayor número de parejas (OR = 4,31 > 50 parejas), haber consumido drogas para sexo (OR = 1,33) y drogas de ocio (OR = 1,19), presentar un nivel de conocimientos sobre el VIH/ITS medio (OR = 1,82) o bajo (OR = 1,33), y ser VIH positivo (OR = 1,56).Conclusiones Entre los HSH la prevalencia de conductas sexuales de alto riesgo es alta, tanto con la PE como con las PO. Los factores asociados a la PANP de alto riesgo varían según el tipo de pareja sexual (p. ej., tener el VIH con una carga viral indetectable), factores que tienen que considerarse para plantear estrategias de prevención primaria y secundaria

OBJECTIVE: To identify factors associated with high risk sexual practices among men who have sex with men (MSM) in Spain. METHODS: An online survey was conducted in 2010, which included, among others, questions on HIV/STI sexual behaviours and prevention needs. Unprotected anal intercourse (UAI) with a partner of unknown or discordant HIV status in the past year was defined as a high risk sexual behaviour. RESULTS: Of the 13,111 participants, 49.4% had had sex with steady partners (SP) and 73.4% with non-steady partners (NSP) in the last 12months; and the prevalence of high risk UAI was 25.4% and 29.4%, respectively. Factors associated with high risk UAI with SP were: living in a city of less than 500,000 inhabitants (OR=1.42 <100,000 inhabitants), being out to no-one or only a few people (OR=1.42), and being HIV-positive with undetectable viral load among those with a high level of HIV/STI knowledge (OR = 3.18). Factors associated with high risk UAI with NSP were mainly: having a higher number of sexual partners (OR = 4.31 >50 partners), having used drugs for sex (OR = 1.33), and at parties (OR = 1.19), having a medium (OR = 1.82) or low (OR = 1.33) level of HIV/STI knowledge, and being HIV-positive (OR = 1.56). CONCLUSIONS: Among MSM, the prevalence of high risk sexual practices is high with both SP and NSP. Factors associated with high risk UAI vary by type of sexual partner (e.g., having HIV with an undetectable viral load). These must be taken into account when planning strategies for primary and secondary prevention

[High-risk sexual behaviour by partner type among men who have sex with men]. / Conductas sexuales de alto riesgo en hombres que tienen relaciones sexuales con hombres según tipo de pareja sexual.

OBJECTIVE: To identify factors associated with high risk sexual practices among men who have sex with men (MSM) in Spain. METHODS: An online survey was conducted in 2010, which included, among others, questions on HIV/STI sexual behaviours and prevention needs. Unprotected anal intercourse (UAI) with a partner of unknown or discordant HIV status in the past year was defined as a high risk sexual behaviour. RESULTS: Of the 13,111 participants, 49.4% had had sex with steady partners (SP) and 73.4% with non-steady partners (NSP) in the last 12months; and the prevalence of high risk UAI was 25.4% and 29.4%, respectively. Factors associated with high risk UAI with SP were: living in a city of less than 500,000 inhabitants (OR=1.42 <100,000 inhabitants), being out to no-one or only a few people (OR=1.42), and being HIV-positive with undetectable viral load among those with a high level of HIV/STI knowledge (OR=3.18). Factors associated with high risk UAI with NSP were mainly: having a higher number of sexual partners (OR=4.31 >50 partners), having used drugs for sex (OR=1.33), and at parties (OR=1.19), having a medium (OR=1.82) or low (OR=1.33) level of HIV/STI knowledge, and being HIV-positive (OR=1.56). CONCLUSIONS: Among MSM, the prevalence of high risk sexual practices is high with both SP and NSP. Factors associated with high risk UAI vary by type of sexual partner (e.g., having HIV with an undetectable viral load). These must be taken into account when planning strategies for primary and secondary prevention.