10 year history serving the Substance Use needs of London’s LGBT

1. 10 year history serving the Substance Use needs of London’s LGBT (Lesbian, Gay, Bisexual & Transgender) community 8,000 contacts, 700+ people in various types of treatment each year. A National Training Programme ------------------------ In partnership with; CNWL’s CLUB DRUG CLINIC 56 Dean St (CODE Clinic) Mortimer Market PEP Clinic Turning Point (SWDAS)

2. UKDPC: Drugs and diversity 2010

3. Crystal Methamphetamine “Club Drugs” are Problematic Drugs

5. (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. 2 Week Snapshot Survey; Party-Drugs at 56 Dean st 285 MSM attending for a GUM screen • 55% of drug using MSM agreed with the statement; • ‘When I use drugs I do things sexually that I wouldn’t 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. • GUM Clinics were the most popular choice (40%), • Specialist LGBT drug service (33%), • 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.” 6

7. ANTIDOTE DATA; Sexual Health Consequences • 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

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 LGBT reasons for drug use Sexual SHAME HIV FEAR/STIGMA Shame/judgment Inappropriate/outdated messages re HIV prevention Bullying/Rejection • Gay sex = • Sin • Disease • rejection

9. Managing Social Networking

13. The popularity of “BareBacking”, PrEP

14. “HIV prevention” includessexually active HIV+ people. • Are you confident disclosing your status? • Do you feel confident & sexy, or diseased and unclean? • Are you comfortable discussing HIV with friends/lovers? • 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 care about your health and others… even when high? • 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?

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 15

16. Antidote carries most (all?) the weight of this work at present; core funding is neither drug funds or HIV prevention funds. • Are we prepared for the costs of PEP & ARV’s (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?; • “Are you an injecting drug user?” • “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?

17. David Stuart david.stuart@me.com