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Daskalopoulou M, Rodger A, Phillips AN, et al. Recreational drug use, polydrug use, and sexual behaviour in HIV-diagnosed men who have sex with men in the UK: results from the cross-sectional ASTRA study. Lancet HIV. 2014;1(1):e22-31doi: 10.1016/S2352-3018(14)70001-3.
Daskalopoulou, M., Rodger, A., Phillips, A. N., Sherr, L., Speakman, A., Collins, S., Elford, J., Johnson, M. A., Gilson, R., Fisher, M., Wilkins, E., Anderson, J., McDonnell, J., Edwards, S., Perry, N., O'Connell, R., Lascar, M., Jones, M., Johnson, A. M., Hart, G., Miners, A., Geretti, A. M., Burman, W. J., & Lampe, F. C. (2014). Recreational drug use, polydrug use, and sexual behaviour in HIV-diagnosed men who have sex with men in the UK: results from the cross-sectional ASTRA study. The lancet. HIV, 1(1), e22-31. https://doi.org/10.1016/S2352-3018(14)70001-3
Daskalopoulou, Marina, et al. "Recreational drug use, polydrug use, and sexual behaviour in HIV-diagnosed men who have sex with men in the UK: results from the cross-sectional ASTRA study." The lancet. HIV vol. 1,1 (2014): e22-31. doi: https://doi.org/10.1016/S2352-3018(14)70001-3
Daskalopoulou M, Rodger A, Phillips AN, Sherr L, Speakman A, Collins S, Elford J, Johnson MA, Gilson R, Fisher M, Wilkins E, Anderson J, McDonnell J, Edwards S, Perry N, O'Connell R, Lascar M, Jones M, Johnson AM, Hart G, Miners A, Geretti AM, Burman WJ, Lampe FC. Recreational drug use, polydrug use, and sexual behaviour in HIV-diagnosed men who have sex with men in the UK: results from the cross-sectional ASTRA study. Lancet HIV. 2014 Oct;1(1):e22-31. doi: 10.1016/S2352-3018(14)70001-3. Epub 2014 Sep 07. PMID: 26423813.
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Lancet HIV. 2014 Oct;1(1):e22-31. doi: 10.1016/S2352-3018(14)70001-3. Epub 2014 Sep 07.

Recreational drug use, polydrug use, and sexual behaviour in HIV-diagnosed men who have sex with men in the UK: results from the cross-sectional ASTRA study.

The lancet. HIV

Marina Daskalopoulou, Alison Rodger, Andrew N Phillips, Lorraine Sherr, Andrew Speakman, Simon Collins, Jonathan Elford, Margaret A Johnson, Richard Gilson, Martin Fisher, Ed Wilkins, Jane Anderson, Jeffrey McDonnell, Simon Edwards, Nicky Perry, Rebecca O'Connell, Monica Lascar, Martin Jones, Anne M Johnson, Graham Hart, Alec Miners, Anna-Maria Geretti, William J Burman, Fiona C Lampe

Affiliations

  1. Research Department of Infection and Population Health, University College London, London, UK. Electronic address: [email protected].
  2. Research Department of Infection and Population Health, University College London, London, UK.
  3. HIV i-Base, London, UK.
  4. City University London, London, UK.
  5. Royal Free London NHS Foundation Trust, London, UK.
  6. Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
  7. Pennine Acute Hospitals NHS Trust, Manchester, UK.
  8. Homerton University Hospital NHS Trust, London, UK.
  9. Central and North West London Community Foundation Trust, London, UK.
  10. Barts Health NHS Trust, London, UK.
  11. East Sussex Healthcare NHS Trust, Eastbourne, UK.
  12. London School of Hygiene & Tropical Medicine, London, UK.
  13. Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.
  14. Denver Public Health, Denver, CO, USA.

PMID: 26423813 DOI: 10.1016/S2352-3018(14)70001-3

Abstract

BACKGROUND: Recreational drug use in men who have sex with men (MSM) is of concern because it might be linked to the transmission of HIV and other sexually transmitted infections. Evidence about drug use in HIV-diagnosed MSM in the UK is limited by representativeness of the study populations. We describe patterns of drug use and associations with sexual behaviours in HIV-diagnosed MSM in the UK.

METHODS: We used data from the cross-sectional ASTRA study, which recruited participants aged 18 years or older with HIV from eight HIV outpatient clinics in the UK between Feb 1, 2011, and Dec 31, 2012. We examined data for MSM, assessing the prevalence of recreational drug use and polydrug use in the previous 3 months and associations with sociodemographic and HIV-related factors. We examined the association of polydrug use with measures of condomless sex in the previous 3 months and with other sexual behaviours.

FINDINGS: Our analysis included data for 2248 MSM: 2136 (95%) were gay, 1973 (89%) were white, 1904 (85%) were on antiretroviral treatment (ART), and 1682 (76%) had a viral load of 50 copies per mL or lower. 1138 (51%) used recreational drugs in the previous 3 months; 608 (27%) used nitrites, 477 (21%) used cannabis, 460 (21%) used erectile dysfunction drugs, 453 (20%) used cocaine, 280 (13%) used ketamine, 258 (12%) used 3,4-methylenedioxy-N-methylamphetamine (MDMA), 221 (10%) used gamma-hydroxybutyrate or gamma-butyrolactone, 175 (8%) used methamphetamine, and 162 (7%) used mephedrone. In the 1138 individuals who used drugs, 529 (47%) used three or more drugs and 241 (21%) used five or more. Prevalence of injection drug use was 3% (n = 68). Drug use was independently associated with younger age (p < 0·0001), not being religious (p = 0·001), having an HIV-positive stable partner (p = 0·0008), HIV-serostatus disclosure (p = 0·009), smoking (p < 0·0001), evidence of harmful alcohol drinking (p = 0·0001), and ART non-adherence (p < 0·0001). Increasing polydrug use was associated with increasing prevalence of condomless sex (prevalence range from no drug use to use of five or more drugs was 24% to 78%), condomless sex with HIV-seroconcordant partners (17% to 69%), condomless sex with HIV-serodiscordant partners (10% to 25%), and higher-HIV-risk condomless sex after taking viral load into account (4% to 16%; p ≤ 0·005 for all). Associations were similar after adjustment for sociodemographic and HIV-related factors. Methamphetamine was more strongly associated with higher-HIV-risk condomless sex than were other commonly used drugs.

INTERPRETATION: Polydrug use is prevalent in HIV-diagnosed MSM and is strongly associated with condomless sex. Specialist support services for MSM with HIV who use recreational drugs might be beneficial in the reduction of harm and prevention of ongoing transmission of HIV and other sexually transmitted infections.

FUNDING: National Institute for Health Research.

Copyright © 2014 Daskalopoulou et al. Open Access article distributed under the terms of CC BY. Published by Elsevier Ltd.. All rights reserved.

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