10 year history serving the Substance Use needs of Londons LGBT ( L esbian, G ay, B isexual & T ransgender) community 8,000 contacts, 700+ people in various types of treatment each year. A National Training Programme In partnership with; CNWLs CLUB DRUG CLINIC 56 Dean St (CODE Clinic) Mortimer Market PEP Clinic Turning Point (SWDAS)

2 UKDPC: Drugs and diversity 2010

Crystal Methamphetamine Club Drugs are Problematic Drugs

Crystal Meth 0%40% GHB GBL 3.2%27% Mephedrone 0%18% LGB&T people poly-using these 3 drugs now account for 85% of our presentations (alcohol, marijuana, cocaine the remainder) Referrals from GUM clinics, A&E or statutory drug services 8%63%

(Unsubstantiated) DRAMA! MSM Chem-Sex is responsible for rising HIV/HCV numbers in London Gay men are dying in saunas and bedrooms (in the pursuit of chem-sex) 2 gay men are sectioned each month (in the pursuit of chem-sex) Gay men are flocking to GU clinics for PEP each week (as a result of chem-sex) HIV infections amongst MSM are climbing for the first time in years, likely as a result of Chem-sex HCV infections (including re-infection) amongst MSM are rising fast, likely as a result of increased injecting chem-sex by MSM. NONE OF THIS IS BEING MONITORED THIS IS WHERE WE START

6 55% of drug using MSM agreed with the statement; When I use drugs I do things sexually that I wouldnt do sober. Of concern, 34% agreed that they were more likely to have unprotected anal sex when under the influence of drugs. 27 people reported using PEP in the last 6 months. Of these 11 (41%) reported this followed sex on drugs. Only 21% of these MSM expressed a preference to use current generic drug services for advice regarding their drug use. 1.GUM Clinics were the most popular choice (40%), 2.Specialist LGBT drug service (33%), 3.GP (9%). Discussion arising; MSM in London report high levels of recreational drug use with associated increased HIV sexual risk behaviour. These users express a preference for accessing help away from existing generic drug services. GUM services are well placed to provide a holistic approach combining risk reduction for both sexual behaviour and drug use. 2 Week Snapshot Survey; Party-Drugs at 56 Dean st 285 MSM attending for a GUM screen

7 Of the Crystal Meth, and Mephedrone users at Antidote; 95% are using to facilitate sex 80% are injecting 70% report having shared needles to inject Prefer to use Bareback sites to find sexual partners Report an average of 5 sexual partners per episode 75% are HIV positive; of these, 60% report not taking HIV medicines when on drugs 90% attribute their HIV or Hep C diagnosis to the use of drugs or alcohol Of the HIV Negative clients, more than half have had two or more courses of PEP in the last year ANTIDOTE DATA; Sexual Health Consequences

LGBT reasons for drug use Sexual SHAME Shame/judgment Gay sex = Sin Disease rejection HIV FEAR/STIGMA Bullying/Rejection Inappropriate/outdated messages re HIV prevention

Managing Social Networking 9

13 The popularity of BareBacking, PrEP

HIV prevention includes sexually active HIV+ people. Are you confident disclosing your status? Are you confident disclosing your status? Do you feel confident & sexy, or diseased and unclean? Do you feel confident & sexy, or diseased and unclean? Are you comfortable discussing HIV with friends/lovers? Are you comfortable discussing HIV with friends/lovers? Do you use Bareback sites to avoid the HIV topic? Do you use Bareback sites to avoid the HIV topic? Do you want support in writing your online profiles/setting boundaries on line? Do you want support in writing your online profiles/setting boundaries on line? Do you care about your health and others… even when high? Do you care about your health and others… even when high? Unsafe sex may be fine… but sharing needles? Unsafe sex may be fine… but sharing needles? Is compulsive sexual behaviour a result of HIV+ men being out of work, benefit dependent, low self-esteemed, lonely, needing affirmation, not at ease with their status? 14

15 Always use a condom Know your status Disclose your status Get tested/treated more regularly Condoms distributed in bars/clubs Interventions that offer; How to put on a condom (and all the above) NONE OF THESE INTERVENTIONS/MESSAGES SPEAK TO THE BEHAVIOURS DEFINING THE MOST-AT-RISK GROUPS The best way to address rising HIV/HCV numbers… is to reduce MSM drug use; By addressing stigma, sexual dysfunction

16 Are we prepared for the costs of PEP & ARVs ( HIV and HCV ) if these trends continue at this rate? (Can we project these costs?) Can we afford to sit patiently in drug services waiting for clients to access support? Are these standard GUM assessment questions sufficient?; 1.Are you an injecting drug user? 2.Have you slept with an injecting drug user? If there are 33 PEP presentations following one Bank holiday weekend at Dean st (100% of which result from chem-sex), how many are not presenting in time? Is this a SEXUAL HEALTH issue, or a SUBSTANCE USE issue? (funding/treatment) How does pan-London commissioning/current restructuring, affect these issues? Who is training drug services in MSM sexual behavioral trends? (Who is not )? Who is training GUM/HIV services in MSM drugs awareness? (Who is not )? If this drug use data (Antidote, GU/HIV services) is not captured on NDTMS et al… how are we to understand and monitor the problem? What interventions WOULD be effective? Who is doing them? Antidote carries most (all?) the weight of this work at present; core funding is neither drug funds or HIV prevention funds.

17 David Stuart