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Everywhere Final Dissemination Seminar, September 10, 2010, MadridEMIS EMIS 201020101
EMIS results on MSM in Spain – new drugs and sexual risks of HIV
EMCDDA annual expert meeting on Drug‐related deaths (DRD) & Drug‐related infectious diseases (DRID)
16‐18 October 2013 – EMCDDA (Lisbon)
Cinta FolchCEEISCAT
Spanish EMIS team work: Percy Fernández‐Dávila, Laia Ferrer, Mercedes Díez, Raúl Soriano and Jordi Casabona
BackgroundDrugs use among MSM
• MSM use a wide selection of drugs, often for recreational purposes (parties and sex)
• The use of recreational drugs has been associated with high‐risk sexual practices
• Rising use of crystal methamphetamine, mephedrone & GBL/GHB
• Injection of crystal and mephedrone on the rise (“Slamming”)
• The Lancet recently reported a dramatic rise in injecting among gay men on London’s party scene and group sex circuit.
BackgroundHarms associated with drug use
• Harms to physical and mental health
• Harms to sexual health and well‐being
• Treatment non‐adherence issues for men with diagnosed HIV
• Needle sharing: HIV/HCV transmission
Objective
• To describe the patterns of injecting and non‐injecting drug use among Spanish MSM participating in the European MSM Internet Survey (EMIS).
EMIS Methodology
• Implemented in 2010 in 38 European countries.
• Online questionnaire (in 25 European languages)
• Data on socio‐demographics, sexual behaviour, drug consumption and other sexual health variables
• National and pan‐European web sites.
• 3 months (June through August 2010)
EMIS Partners Spain
Associated
Collaborating
Final sample in Spain: 13,111 ( 7.5%)
EMIS (Europe): 174.111
12.0%HIV prevalence (among those tested)
73.8%Ever tested
17.6%Students
66.1%Employed
33.1 (10,1)Mean age (SD)
58.6%High educational degree
51.4%Living in cities > 500,000 inhabitants
79.9%Self‐described as gay/homosexual
77.2%Born in Spain
Description of study participants
Prevalence of recreational drugs (last 12 months)
0,7
0,9
28,4
18,7
5,4
5,7
1,4
5,9
7,7
10,1
1,3
30,1
0 5 10 15 20 25 30
Crack Cocaine
Heroin
Poppers
Cocaine
Ketamine
GHB/GLB
Mephedrone
Crystal meth
Amphetamine
Ecstasy/MDMA
LSD
Cannabis
%
0 5 10 15 20 25 30 35 40
Crack
Heroin
Poppers*
Cocaine*
Ketamine*
GHB*
Mephedrone*
Crystal
Amphetamine
Ecstasy*
LSD*
Cannabis*
%
25 or more
Less than 25
Drug consumption by age
0 10 20 30 40 50 60
Crack*
Heroin
Poppers*
Cocaine*
Ketamine*
GHB*
Mephedrone*
Crystal*
Amphetamine*
Ecstasy*
LSD*
Cannabis*
%
HIV positive
HIV negative/untested
Drug consumption by self‐reported HIV status
24,2
10,05,3 3,7 2,6
5,7
48,6
,0
10,0
20,0
30,0
40,0
50,0
60,0
0 1 2 3 4 5 morethan 5
%
Number of drugs (last 12 months)
12% reported more than 3 different drugs
UAI with non‐steady male partners by drug use**
0
10
20
30
40
50
60
70
Yes No Yes No Yes No
Party drugs (last 12months)*
Heroine/Crack (last 12months)*
Poppers (last 12months)*
%
*p<0,0001; **among those who had anal AI with non‐steady male partner (last 12 months)
Drugs use and control over sex and sexual risk
‘The sex I have is always as safe as I want it to be' (mean)
Association test
‘I find it easy to say NO to sex Idon’t want' (mean)
Association test
"Party drugs" (1) <0,0001 <0,0001Never or more than 12 months 4,33 4,25Last 12 months 4,2 4,18Poppers <0,0001 <0,0001Never or more than 12 months 4,32 4,25Last 12 months 4,17 4,15Heroine and crack 0,049 0,023Never or more than 12 months 4,29 4,23Last 12 months 4,15 4,06
(1) Ecstasy, amphetamine, crystal, mephedrone, GHB, Ketamine, cocaine, LSD
Drug injection. EMIS 2010, Spain
*anabolic steroids excluded
1,4%
2,5%
0,0%
0,5%
1,0%
1,5%
2,0%
2,5%
3,0%
Ever injected (n=320) injected in the last 12 months(n=181)
2,5%
1,4%
Socio‐demographic characteristics by injecting drug use
No Yes p
Settlement size: >500,000 51,1% 57,4% 0,041
Born in country of residence 78,1% 67,8% <0,0001
Age: Less than 25 22,7% 19,1% ns
High level of education 58,8% 51,1% 0,006
Sexual identity: Gay 79,9% 82,1% ns
Outness: out to most 64,8% 81,6% <0,0001
Visited a gay social venue* 62,4% 77,2% <0,0001
Visited a gay commercial venue* 60,6% 74,1% <0,0001
Visited a sex venue* 37,4% 49,4% <0,0001
*last 4 weeks
Ever IDU
Sexual behaviour by injecting drug use
No Yes p
UAI (casual partners)* 45,9% 53,4% 0,028
Paid for sex** 7,8% 8,0% ns
Have been paid for sex** 5,0% 10,6% <0,0001
Sex abroad** 25,9% 27,7% <0,0001
*among those who have had anal intercourse with non‐steady partner in past 12m
** last 12m
Ever IDU
HIV, HCV and STI self‐reported status by injecting drug use
8,6%
1,7%
11,3%
23,0%
8,2%
15,8%
,0%
5,0%
10,0%
15,0%
20,0%
25,0%
Self‐reported HIVpositive*
Self‐reported HCVpositive*
Self‐reported STIs (last12 months)*
No IDU Yes, ever IDU
*p<0,01
Concerns about recreational drugs
• 5.1% were worried about their use of recreational drugs
• Among polydrug users: 17.4%
• Among IDU: 18.9%
MSM who injected drugs in the last 12 months. Comparison with male IDU recruited in Harm Reduction Centers
EMIS 2010, Spain (%) REDAN 2010‐11 (%)
Born in country of residence 70,8 57,9Age: Up to 24 27,1 5,7High education 51,1 8,8OcupationEmployed 72,1 18,5
Unemployed 6,1 49,9
Other 21,8 31,6
Have been paid for sex (last 12 months) 14,2 2,4
Previous HIV test 80,6 94,6
Self‐reported HIV positive 20,6 26,5
Self‐reported HCV positive 2,8 63,3
Major limitations
• Self‐selection bias; the sample may not be representative of MSM Spanish population.
• Recall bias
• The respondents were not asked directly if they used drugs before or during sex.
• Methamphetamine: misclassification?
Conclusions
• Recreational drug use is common among Spanish MSM and is well established in gay social and sexual environments.
• Higher prevalence of sexual risk behaviours among Spanish MSM who used drugs.
• Among certain subpopulations (HIV positive MSM), the prevalence of drug use is higher.
Conclusions
• Although the use of injecting drugs is low, this group shows a higher prevalence of blood‐borneand sexually transmitted infections and associated risk behaviours.
• MSM who inject drugs do not fit the typical profile of a person with a serious drug addiction.
Next steps
• To monitor drug consumption and its determinants among MSM to develop early interventions
• Improve staff knowledge about club drugs and associated harms
• Efforts to develop and to implement prevention strategies highlighting the party drugs issue and its use for sex are needed
• Closer working between drug service, HIV and sexual health clinics
Everywhere Final Dissemination Seminar, September 10, 2010, MadridEMIS EMIS 20102010
Acknowledgment
All men who responded to the Survey
All the NGOs and AIDS AutonomousPlans for collaborating in the diffusion of the survey.
Funding: The EMIS project was funded by the ExecutiveAgency for Health and Consumers (EAHC), EU Health
Programme 2008–2013, co‐funded by the five AssociatedPartners [CEEISCAT; Department of Health
for England; Regione del Veneto; Robert Koch Institute,and Maastricht University].
In Spain, the EMIS wassupported by the Ministry of Health, Social Services and
Equality.
Everywhere Final Dissemination Seminar, September 10, 2010, MadridEMIS EMIS 2010201027
www.emis‐project.euwww.ceeiscat.cat
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