Sex, drugs and smart phone applications: findings from semistructured interviews with men who have sex with men diagnosed with Shigella flexneri 3a in England and Wales.

OBJECTIVES: To inform control strategies undertaken as part of an outbreak of Shigella flexneri 3a among men who have sex with men (MSM). METHODS: All men aged ≥18 years diagnosed with S flexneri 3a between October 2012 and May 2013 were invited to participate. Semistructured in-depth quantitative interviews were conducted to explore lifestyle and sexual behaviour factors. RESULTS: Of 53 men diagnosed, 42 were interviewed of whom 34 were sexually active MSM. High numbers of sexual partners were reported (median=22) within the previous year; most were casual encounters met through social media networking sites (21/34). 63% (20/32) were HIV-positive and actively sought positive partners for condomless sex. 62% (21/34) of men had used chemsex drugs (mephedrone, crystal methamphetamine and γ-butyrolactone/γ-hydroxybutrate), which facilitate sexually disinhibiting behaviour during sexual encounters. 38% (8/21) reported injecting chemsex drugs. Where reported almost half (12/23) had attended or hosted sex parties. All reported oral-anal contact and fisting was common (16/34). Many had had gonorrhoea (23/34) and chlamydia (17/34). HIV-positive serostatus was associated with both insertive anal intercourse with a casual partner and receptive fisting (adjusted OR=15.0, p=0.01; adjusted OR=18.3, p=0.03) as was the use of web applications that promote and facilitate unprotected sex (adjusted OR=19.8, p=0.02). CONCLUSIONS: HIV-positive MSM infected with S flexneri 3a used social media to meet sexual partners for unprotected sex mainly at sex parties. The potential for the transmission of S flexneri, HIV and other infections is clear. MSM need to be aware of the effect that chemsex drugs have on their health.

Willingness to be vaccinated against shigella and other forms of dysentery: a comparison of three regions in Asia.

We conducted a cross sectional survey of 3163 women and men in six Asian countries to examine willingness for children and adults to be vaccinated against shigellosis and other forms of dysentery. The six sites were clustered into three regions for ease of comparison. The regions are: Northeast Asia (China), Southeast Asia (Thailand, Vietnam, and Indonesia) and South Asia (Bangladesh and Pakistan). We used multiple logistic regression to identify region-specific models for vaccination willingness for both adults and children. A vaccine to protect against dysentery, if available would be very much in demand throughout the three Asian regions for children. For adults, the responses indicate that vaccine uptake by adults will vary. A large proportion of respondents in all regions, specifically in China, do not perceive themselves at risk yet still consider a shigellosis vaccine desirable.

The health belief model and factors relating to potential use of a vaccine for shigellosis in Kaeng Koi district, Saraburi province, Thailand.

Shigellosis is an important cause of morbidity and mortality throughout the world. Approximately, 1.1 million deaths occur a year due to this disease, making it the fourth leading cause of mortality worldwide. This paper explores local interest in and potential use of a vaccine for shigellosis in Thailand where Shigella poses an important public-health concern. Data for this study were collected during June-November 2002 from 522 subjects surveyed using a sociobehavioural questionnaire in Kaeng Koi district in central Thailand. The community demand and likely use of a vaccine were examined in relation to the Health Belief Model, which provides analytical constructs for investigating the multiple issues of local readiness to accept and access a new vaccine. As the key outcome variable, most respondents showed interest in receiving a vaccine against dysentery which they thought would provide useful protection against the disease. However, there was only a moderate number who perceived dysentery as serious and themselves as susceptible to it, although it was perceived to cause some burden to and additional expense for families. Most people identified a number of groups who were thought to be especially vulnerable to dysentery, such as the elderly, pre-school, and school-age children, and poor labourers. Other outcomes of the study included the identification of acceptable and convenient sites for its delivery, such as government health clinics and private clinics, and respected sources for information about the vaccine, such as health clinic personnel and community health volunteers. This information suggests that components of the Health Belief Model may be useful in identifying community acceptance of a vaccine and the means of introducing it. This health information is important for planning and implementing vaccine programmes.

Social and behavioral factors in transmission and response to shigellosis.

Biomedical approaches to shigellosis tend to emphasize unique etiologic and clinical features of the disease, e.g., those related to the development of vaccines or case management. The biologic characteristics of the organism and sociocultural responses to it imply that it is unlikely that a purely technologic solution (vaccine) to shigellosis will be found soon. Infrastructural development (protected water supply and sanitary disposal of feces) may be too expensive to be feasible due to the economic, environmental, and demographic conditions in developing countries. Behavioral change to reduce the risk of transmission may be a more effective preventive strategy. Case management in developing countries will require prompt, appropriate action when symptoms of shigellosis occur. A general model of health-seeking behavior suggests patients' parents or guardians (anyone responsible for care of the child and for overseeing the child's health, e.g., older siblings or grandparents) will take no action if the symptoms are not recognized or are perceived as normal or if the condition is not evaluated as serious or treatable. It is not necessary for patients' parents or guardians to learn about etiologic models from medical practitioners to behave in ways that will reduce the risk of infection or to seek effective treatment. For example, hand washing may be promoted on the basis of symbolism. Agreement between potential patients or their guardians and health care providers on signs of potentially severe disease may be enough to bring them into effective contact.