Le 190 a treize ans : l'expérience du premier centre de santé sexuelle français.

Le 190 is a sexual health center in Paris founded in 2010. Its initial objective is to reduce the HIV/AIDS epidemic locally among men who have sex with men (MSM) through multidisciplinary support rooted in the reality of the sexuality and affective life of HIV-positive and HIV-negative MSM. Because of its constant concern for overall gay health and its community character, its activity has diversified and has enabled it to be a forerunner in both care and care pathways, on both the medical and regulatory aspects. Mental health and the complications of chemsex are taking an increasingly important place in the demand for care and the support has been adapted and perfected with the patients. Today, Le 190 is considered a model by many community actors and health professionals and is celebrating its 13th anniversary, an opportunity to share its experience and reaffirm its demonstrated benefit for public health and universal care. The major innovations of the center as well as the limitations and difficulties it has encountered will allow for a better understanding of community health in practice and more specifically gay health.

Distribution of HIV self-tests by men who have sex with men attending a French sexual health centre: results of the OTO study.

OBJECTIVES: HIV self-tests (HSTs) have been deployed to reduce the burden of undiagnosed HIV infections in subpopulations undertested. We assumed that patients attending sexual health centres could themselves distribute HSTs in their close network. This study aimed to assess the proportion and the characteristics of the participants who distributed HSTs, as well as the characteristics of people who received HSTs. METHODS: Three HSTs were given to patients attending "Le 190" Sexual Health Center, Paris, France, having consented for the study, between July 2018 and August 2020. Participants had to distribute HSTs within 6 months, preferably to individuals in their close circle who have not been tested for a long time. Then they had to complete a self-questionnaire, exploring HIV status, sexual practices, number of distributed HSTs, profile of persons who received HSTs, and if known, result of used HSTs. Univariable logistic regression was used to determine factors associated with HST distribution. RESULTS: Overall, 682/1062 (64%) patients accepted to be included in the study, and 283/682 (42%) completed the questionnaire. 97% were men who have sex with men (MSMs), including 86 (30%) HIV-positive individuals and 119 (42%) HIV Pre-Exposure Prophylaxis (PrEP) users. The proportion of participants having distributed 0, 1, 2 or 3 HSTs was 31%, 15%, 27% and 27%, respectively. Participants having distributed at least one HST (n=195, 69%) were more likely to have previously used HSTs themselves (OR=3.90, 95% CI=1.84 to 8.29, p<0.001). On the 901 HSTs in possession of participants who answered the questionnaire, 455 (50%) were distributed. 79% of recipients were MSMs, and 42% of whom had not been tested for more than 1 year. The result was known for 220 HSTs, including 5 positive (2.3%). CONCLUSION: MSMs attending sexual health centres could be good disseminators of HSTs, targeting a population with high level of undiagnosed HIV infections, especially if they have already experimented it.

Is There a Reduction in Chemsex Practice in Men Who Have Sex With Men During COVID-19 Lockdown? Results of the CheRRLock Study.

BACKGROUND AND AIMS: Chemsex is a growing concern among men who have sex with men (MSM). COVID-19 lockdowns have had consequences on social and sexual interactions. We aimed to assess changes in chemsex practices during COVID-19 lockdown in France among MSM and factors associated with maintaining or increasing chemsex practice. METHODS: Repeated face-to-face questionnaires were conducted at "Le 190" Sexual Health Center, Paris, France, exploring lifestyle, sexual, and chemsex practices, COVID-19 concerns and mental health before and during second lockdown in France (30/10/2020-15/12/2020). Inclusion criteria were chemsex practices at least 3 times throughout lifetime and at least once in the 3 months before second lockdown. The primary end point was the proportion of participants who declared having stopped, decreased, maintained, or increased their chemsex practice during lockdown. Univariable and multivariable logistic regressions were used to analyze factors associated with evolutions of chemsex practice. RESULTS: Ninety-three MSM were included: 66% HIV-positive and 30% taking PrEP. Drugs most used were cathinones (91%) and GHB/GBL (52%). Participants reported stopping, decreasing, maintaining, and increasing chemsex drugs use in 14%, 22%, 22%, and 42% of cases, respectively. Despite this overall increase in chemsex practice, MSM decreased their number of sexual partners. Factors significantly associated with maintaining or increasing chemsex drugs use were feeling lonely (OR = 3.24), craving (OR = 4.51), and working during lockdown (OR = 3.27), contrasting with fear of COVID-19 (OR = 0.31). CONCLUSION: Restriction measures lead to changes in sexual behavior and seem to increase chemsex practice. Maintaining care for most isolated patients should be a priority in COVID-19 context.

Obstructive sleep apnea among patients with retinal vein occlusion.

OBJECTIVE: To evaluate the possible involvement of obstructive sleep apnea (OSA) in retinal vein occlusion (RVO). METHODS: From the medical records of 63 consecutive patients with RVO, 30 patients with 2 of the 3 following risk factors for OSA were selected for further screening from February 1, 2008, through March 31, 2009: associated cardiovascular disease, snoring, or daytime sleepiness. RESULTS: Of the 30 selected patients, 23 (77%) had OSA. If all 33 of the unscreened patients did not have OSA, the OSA prevalence would have been 37%. Among the patients with OSA, the mean apnea-hypopnea index (AHI) was 21; OSA was mild (AHI <15) in 13 patients, moderate in 5 patients (AHI 15-30), and severe (AHI >30) in 5 patients. The AHI was correlated with body mass index (P = .02). CONCLUSIONS: We found a higher than expected prevalence of OSA in a series of patients with RVO. Our findings suggest that OSA could be an additional risk factor that plays an important role in the pathogenesis of RVO or at least that it is a frequently associated condition that could be a triggering factor. This association may explain why most patients discover visual loss on awakening. It is too early to assess whether OSA treatment could improve visual outcome of RVO, but it seems vital to recognize OSA in RVO for the general health of the patient.

Prefixed equimolar nitrous oxide and oxygen mixture reduces discomfort during flexible bronchoscopy in adult patients: a randomized, controlled, double-blind trial.

STUDY OBJECTIVES: Flexible bronchoscopy (FB) is an invasive procedure associated with patient discomfort and frequent nose pain. A simple sedation procedure that does not require the intervention of an anesthetist is of interest. The aim of this prospective, randomized, double-blind study was to assess efficiency of nitrous oxide inhalation on the reduction of FB-induced discomfort in adult patients. DESIGN AND SETTINGS: Two hundred six patients were randomized to receive either a prefixed equimolar nitrous oxide/oxygen mixture (N2O) or a prefixed equimolar nitrogen and oxygen mixture (control). The primary outcome was stress as assessed by pulse rate and systemic BP during the procedure. Secondary outcomes were self-assessed pain using a visual analog scale (VAS) and patient satisfaction based on a questionnaire. Adverse events were recorded. RESULTS: A significant increase in BP was observed only in the control group (p = 0.003), while pulse rate values did not differ between the two groups. As assessed by the VAS, pain was lower in the N2O group as compared to placebo (p = 0.02). Nose pain and cough were also significantly reduced by N2O. Adverse events, mostly anxiety, were reported in 10 patients. CONCLUSION: These results indicate that equimolar N2O inhalation is efficient in reducing patient discomfort and may be an alternative to general anesthesia.