Associations between Drug Use and Sexual Risk Behaviours among Men Who Have Sex with Men in Japan: Results from the Cross-Sectional LASH Study.

This study assessed drug use patterns among men who have sex with men (MSM) in Japan, and evaluated their potential associations with sexual risk behaviours. Between September and October 2016, study subjects were recruited through a cross-sectional survey (LASH: Love Life and Sexual Health) using a geosocial networking application for MSM. Of the participants, 25.4% (1756/6921) reported ever having used drugs, and 11.3% (780/6921) reported having done so in the past six months. Those who used drugs were more likely to have greater knowledge of HIV/sexually transmitted infections (STIs). Drug use in the past six months was independently associated with each of the following sexual risk behaviours in the same period: (i) six or more sexual partners (adjusted odds ratio [aOR] = 2.70, 95% confidence interval [CI]: 2.30-3.17); (ii) condomless anal intercourse (aOR = 2.88, 95% CI: 2.43-3.42); (iii) group sex (aOR = 2.60, 95% CI: 2.22-3.05); and (iv) sex work (aOR = 2.30, 95% CI: 1.67-3.16). These results suggest that MSM in Japan who use drugs are more likely to report sexual risk behaviours, while also having greater knowledge of HIV/STIs. Supporting MSM to minimise the harm from drug use may be helpful in reducing HIV transmission among this priority population.

Characterizing changes in drug use behaviour following supply shortages of 5-MeO-DIPT, alkyl nitrites and new psychoactive substances among men living with HIV in Japan.

BACKGROUND: Since 2005, Japan has incrementally banned a range of new psychoactive substances (NPS), including 5-MeO-DIPT (5MO; foxy) and alkyl nitrites (AN; rush, poppers) that have commonly been used among men who have sex with men (MSM). After the largest ban in 2014, these drugs were reported to have disappeared from the domestic market. Given that 5MO/AN/NPS use has been prevalent among men living with HIV in Japan, a population largely comprised of MSM, we sought to characterize changes in their drug use behavior following the supply shortages. METHODS: Using data from two waves of a nationwide survey of people living with HIV in Japan in 2013 and 2019-20 (n = 1042), we employed multivariable modified Poisson regression to identify correlates of self-reported reactions to the 5MO/AN/NPS shortages and changes in drug use behavior in 2019-20 vs. 2013. RESULTS: Among 391 men (96.7% MSM) surveyed in 2019-20, following the supply shortages, 234 (59.8%) stopped using 5MO/AN/NPS, 52 (13.3%) retained access to the supply, and 117 (29.9%) used substitute drugs: most commonly, methamphetamine (60.7%). Individuals who used substitutes were more likely to report unprotected sex (adjusted relative risk [ARR]=1.67; 95% confidence interval [CI]: 1.13-2.47) as well as low (ARR=2.35; 95% CI: 1.46-3.79) and lower middle (vs. upper middle to high) socioeconomic status (ARR=1.55; 95% CI: 1.00-2.41). The prevalence of past-year methamphetamine use (ARR=1.93; 95% CI: 1.11-3.35) and self-reported uncontrollable drug use (ARR=1.62; 95% CI: 1.07-2.53) were significantly higher in 2019-20 compared to 2013. CONCLUSION: Following the supply shortages, approximately one-fifth of our participants used methamphetamine as a substitute for 5MO/AN/NPS. Methamphetamine use and perceived uncontrollable drug use also appeared to have increased at the population level after the supply shortages. These findings suggest a potentially harmful substance displacement effect of the aggressive ban. Harm reduction interventions are needed in this population.

"Staying at home" to tackle COVID-19 pandemic: rhetoric or reality? Cross-cutting analysis of nine population groups vulnerable to homelessness in Japan.

Although the "stay-at-home" order is advocated against the coronavirus disease 2019 (COVID-19), the lives of individuals lacking adequate housing are threatened. We developed a framework to assess various populations with unstable housing in terms of socio-economic consequences of COVID-19, risk of COVID-19 infection and progression, existing/urgent measures, and remaining challenges. Within the framework, nine groups vulnerable to homelessness in Japan were classified into (i) "people without accommodation," (ii) "people living in temporary or crisis accommodation," and (iii) populations that include "people living in severely inadequate and insecure accommodation." The assessment revealed that "staying at home" was physically and practically unattainable across groups. The study identified specific institutional, social, and cultural challenges apart from the common economic crisis, whereas the utilization of social welfare was low. Findings suggest that the rapid increase of groups classified as "(i)" and "(ii)" should be addressed by engaging stakeholders to enhance the availability and accessibility of social welfare and rescue measures, and to ensure safe and private accommodations for all groups. It is critical to enhance multi-sectoral collaboration in responding to the common and specific vulnerabilities of these population groups from health, socio-economic, and humanitarian perspectives. Under the pandemic, homelessness should be regarded less as a peculiar problem for specific populations but an extension of daily life. The framework can be a reference when planning the comprehensive yet concise assessment of populations with unstable housing in other countries to inform responses to the pandemic.

High prevalence of quasi-legal psychoactive substance use among male patients in HIV care in Japan: a cross-sectional study.

BACKGROUND: Syndemics of illicit drug use and HIV remain as significant public health issues around the world. There has been increasing concern regarding the rapidly growing market of new psychoactive substances, particularly in Asia. In response, the Japanese government has increasingly banned such substances in recent years. We sought to identify the prevalence and correlates of use of quasi-legal psychoactive substances among people living with HIV/AIDS (PLHIV) in Japan. METHODS: Data were derived from a nationwide survey of PLHIV conducted at nine leading HIV/AIDS care hospitals between July and December 2013. The prevalence and correlates of the use of quasi-legal psychoactive substances (e.g., synthetic cannabinoids, cathinone derivatives, etc. that had not been prohibited from using at the time of survey) among male participants were examined using multivariate survey logistic regression. RESULTS: Among 963 study participants, the majority (95.3%) were male. The most commonly used drug among men was quasi-legal psychoactive substances (55.3% ever and 12.8% in the previous year). In multivariate analysis, the lifetime use of tryptamine-type derivatives (i.e., 5-MeO-DIPT or N,N-diisopropyl-5-methoxytryptamine) (adjusted odds ratio [AOR]: 2.42; 95% confidence interval [CI]: 1.36-4.28) and methamphetamine/amphetamine (AOR: 3.59; 95% CI: 2.13-6.04) were independently associated with recent quasi-legal psychoactive substance use. CONCLUSIONS: In our sample of male PLHIV in Japan, quasi-legal psychoactive substances were the most commonly used drugs. Individuals who had ever used tryptamine-type derivatives or methamphetamine/amphetamine were more likely to report recent quasi-legal psychoactive substance use, suggesting a potential shift in drug use patterns from regulated to unregulated substances among this population. These findings indicate a need for further research to examine implications for HIV care.

Responding to ever-changing epidemiological dynamics of Ebola virus disease.

With the incidence and mortality rates of Ebola virus disease (EVD) in Guinea, Liberia and Sierra Leone now at zero and reports of the largest and most complex EVD outbreak in history no longer on the front pages of newspapers worldwide, the urgency of that crisis seems to have subsided. During this lull after the storm and before the next one, the international community needs to engage in a 'lessons-learned' exercise with respect to our collective scientific, clinical and public health preparedness. This engagement must identify pragmatic, innovative mechanisms at multinational, national and community levels that allow research and development of next generation diagnostics and therapeutics, the safe and effective practice of medicine, and the maintenance of public health to keep pace with the rapid epidemiological dynamics of EVD and other deadly infectious diseases.

A Service Or a Right: Informed Consent for HIV-Positive Latin American Men in Japan.

Since April 1996, Japanese health care providers who practise informed consent have been financially rewarded. Although there is no precedent for this financial gain, there are no detailed studies. Focused on a group of Latin American men living with HIV/AIDS, this paper clarifies the actual practices of informed consent at Japanese medical facilities. Twenty HIV-positive men were interviewed in order to investigate how they obtained medical treatment and how they were informed about their physical condition. From April to September 2002 and during August 2003 and 2004, a set of six interviews were conducted with each male, who were 28-37 years old. Participants were acquired through a hospital and a non-governmental organization, and by snowball sampling. The interviews showed that most of the informants received information concerning medical treatment, but they were advised neither about alternative treatments nor about the feasibility of seeking a third party's advice. Informed consent and communication between the informants and physicians were obstructed by language and structural, as well as cultural barriers. In conclusion, this paper adds a new dimension to the understanding of informed consent as the authors regard the practice as an educational process for health care providers and patients.