OBJECTIVES:
The
aim of the study was to explore HIV testing frequency among UK men who have sex
with men (MSM) in order to direct intervention development.
METHODS:
Cross-sectional
surveys were completed by 2409 MSM in Edinburgh, Glasgow and London in 2011 and
a Scotland-wide online survey was carried out in 2012/13. The frequency of HIV
testing in the last 2 years was measured.
RESULTS:
Overall,
21.2% of respondents reported at least four HIV tests and 33.7% reported two or
three tests in the last 2 years, so we estimate that 54.9% test annually. Men
reporting at least four HIV tests were younger and less likely to be surveyed
in London. They were more likely to report higher numbers of sexual and anal
intercourse partners, but not "higher risk" unprotected anal
intercourse (UAI) with at least two partners, casual partners and/or
unknown/discordant status partners in the previous 12 months. Only 26.7% (238 of
893) of men reporting higher risk UAI reported at least four tests. Among all
testers (n = 2009), 56.7% tested as part of a regular sexual health check and
35.5% tested following a risk event. Differences were observed between surveys,
and those testing in response to a risk event were more likely to report higher
risk UAI.
CONCLUSIONS:
Guidelines
recommend that all MSM test annually and those at "higher risk" test
more frequently, but our findings suggest neither recommendation is being met.
Additional efforts are required to increase testing frequency and harness the
opportunities provided by biomedical HIV prevention. Regional, demographic and
behavioural differences and variations in the risk profiles of testers suggest
that it is unlikely that a "one size fits all" approach to increasing
the frequency of testing will be successful.
- 1MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK.
- 2Public Health England, London, UK.
- 3Glasgow Caledonian University, Glasgow, UK.
- 4University College London, London, UK.
- HIV Med. 2016 Mar 15. doi: 10.1111/hiv.12373.
Ethylphenidate is a psychostimulant and analogue of methylphenidate. Interestingly it is also produced as a metabolite from the co-ingestion of methylphenidate and alcohol (ethanol). In the UK, between April and June 2015, ethylphenidate and 6 other methylphenidate based novel psychoactive substances (NPS) were subjected to a temporary class drug order under the Misuse of Drugs Act 1971. Ethylphenidate is being abused by both novel and habitual drug users, more prominently in the East of Scotland. What is unknown in the literature is the contribution of ethylphenidate in deaths.
A search was conducted for an 18 month period (July 2013 to December 2014) to identify cases where ethylphenidate was detected during post-mortem toxicological analysis. Nineteen cases were identified and these cases were examined with regards to case circumstances, pathology findings, toxicology results and adverse effects.
The individuals ranged in age from 20 to 54 (median 37) and the majority were male (n=14) and from the East of Scotland (n=16), more specifically Edinburgh and surrounding area. Current or previous heroin abuse was a common theme in these cases (n=16) and injection was a common route of administration of "legal highs" or "burst".
The concentration of ethylphenidate in the cases ranged from 0.008mg/L to over 2mg/L in post-mortem femoral blood (median 0.25mg/L, average 0.39mg/L). Other drugs commonly detected were benzodiazepines (n=15), followed by opiates (n=11, 4 of which were positive for 6-monoacetylmorphine) and then methadone (n=8). All 19 cases received a full post-mortem examination and there were 10 cases where drug toxicity was the sole or potentially contributory factor to the cause of death.
Ethylphenidate was specifically mentioned in the cause of death for 5 cases, chronic intravenous (IV) drug use was named as part of the cause of death for 2 cases and in 6 cases there was evidence of complications and infections through IV drug use. As far as it is known to the authors, this is the first review of post-mortem cases involving the use of ethylphenidate in East and West Scotland.
This study can be used as a guide for toxicologists and pathologists when interpreting cases which are positive for ethylphenidate.
Via: http://ht.ly/Ss6hN Purchase full article at: http://ht.ly/Ss6jI
By: Parks C1, McKeown D2, Torrance HJ3.
- 1Forensic Medicine and Science, University of Glasgow, Glasgow G12 8QQ, United Kingdom.
- 2Forensic Medicine and Science, University of Glasgow, Glasgow G12 8QQ, United Kingdom
- 3Forensic Medicine and Science, University of Glasgow, Glasgow G12 8QQ, United Kingdom
