Effect of Nondisclosure of HIV Status in Sexual Health Clinics on Unlinked Anonymous HIV Prevalence Estimates in England, 2005–2009

Objectives: To assess the extent of nondisclosure of known HIV status among sexual health clinic attendees and to quantify the impact of nondisclosure on estimates of undiagnosed HIV prevalence and of the proportion of patients remaining undiagnosed on leaving the clinic.

Methods: Serum samples from the unlinked anonymous survey of clinic attendees’ archive were tested for antiretrovirals. Estimates of undiagnosed HIV were adjusted using the findings.

Results: Antiretrovirals were detected in 27% of samples taken from ‘previously undiagnosed’ attendees, who did not have an HIV test but were HIV positive as detected by unlinked anonymous testing, indicating nondisclosure; 24% of such samples from MSM had antiretrovirals present compared with 32% of heterosexual men and women. Antiretrovirals were detected in 33% of samples from London clinics and in 21% from non-London clinics. Following adjustment, the estimated prevalence of undiagnosed HIV decreased nonsignificantly from 3.04% to 2.66% (2.35–3.01) among men who have sex with men (MSM), 0.31% (0.26–0.37) to 0.30% (0.25–0.36) in heterosexual men and 0.40% (0.35–0.46) to 0.37% (0.32–0.43) in women; 7% of MSM who do not have an HIV test at a clinic visit will be infected with HIV and remain unaware of their infection.

Conclusion: Nondisclosure of HIV status to healthcare professionals occurs among clinic attendees. Adjustment for nondisclosure results in a small, nonsignificant decrease in the prevalence of undiagnosed HIV estimated from the unlinked anonymous survey in sexual health clinics. Testing the population of MSM not having an HIV test remains a priority as levels of undiagnosed HIV are high.

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By:  Savage, Emma J.^a; Lowndes, Catherine M.^a; Sullivan, Ann K.^b; Back, David J.^c; Else, Laura J.^c; Murphy, Gary^d; Gill, O. Noel^a

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A Comparison of Recreational Drug Use amongst Sexual Health Clinic Users in London with Existing Prevalence Data

The objective was to give an overview of self-reported recreational drug use amongst attendees of sexual health clinics in London and compare this to existing datasets. Between December 2013 and March 2014, attendees of two sexual health clinics in London were surveyed. Data collected were: sexual history, smoking and alcohol and recreational drug use. 

Data were analysed using SPSS (version 21). A total of 1472 respondents were included; 778 (52.9%) men, 676 (45.9%) women and 3 (0.2%) transgender (15 [1.0%] did not answer). Mean age was 30.6 ± 9.0 years. A total of 339 (43.6%) men were men who have sex with men, and 18 (2.4%) women were women who have sex with women. 

Lifetime prevalence of use was: alcohol 94.1%; cannabis 48.5%; 'poppers' (volatile nitrites) 28.2%; cocaine 26.8% and 3,4-methylenedioxy-methamphetamine pills 23.2%. Our population had higher current popper, methamphetamine and mephedrone use than the Crime Survey of England and Wales but lower use of cannabis, poppers and Viagra than the European MSM Internet Survey. 

Global Drug Survey and Part of the Picture respondents' use were higher than our population for all drugs. Drug use in this population had a different pattern to general population surveys and studies involving only men who have sex with men.

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By:   Thurtle N1, Dargan PI2, Hunter LJ3, Lovett C3, White JA4, Wood DM2.

• 1Clinical Toxicology Department, Guys and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK nat_thurtle@yahoo.com.
• 2Clinical Toxicology Department, Guys and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK Clinical Toxicology Department, King's College London, London, UK.
• 3Clinical Toxicology Department, Guys and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK.
• 4Genitourinary Medicine, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK. 

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Problematic Recreational Drug Use: Is There a Role for Outpatient Sexual Health Clinics in Identifying Those Not Already Engaged with Treatment Services?

There is an association between recreational drug use, high-risk sexual activity and sexually transmissible infections. Studies have shown a higher prevalence of drug use in those accessing sexual health services; however, there are minimal data on the proportion with problematic recreational drug use. We aimed to understand whether sexual health clinics could identify problematic drug and alcohol use as a novel referral pathway into treatment services. 

Males attending two sexual health clinics in London completed questionnaires. Data were collected on demographics; gender of sexual partner; use of alcohol and recreational drugs; if they felt they had problematic use of drugs, alcohol or both; and if they had sought help for their problematic use.

In total, 867 males completed the questionnaire; 387 (44.7%) were men who have sex with men (MSM). MSM had significantly higher lifetime use of any drug compared with non-MSM (80.6% vs. 62.5%; P < 0.0001). Thirty-five (4.7%) self-identified problematic drug or alcohol use, with no difference between MSM and non-MSM (6.3% vs. 3.5%; P = 0.08). Of those with problematic drug or alcohol use, 20 were currently or had been engaged with a treatment service and 15 had never engaged with treatment services. MSM were more likely to have ever sought help for drug or alcohol problems compared with non-MSM (P = 0.003). 

Some individuals attending sexual health clinics with problematic drug use have not engaged with treatment services. It is therefore appropriate to develop screening tools for sexual health clinics to identify these individuals and novel referral pathways to engage them in treatment services.

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By: Lovett C, Yamamoto T, Hunter L, White J, Dargan PI, Wood DM.

Clinical Toxicology, Guy’s and St Thomas’ National Health Service (NHS) Foundation Trust and King’s Health Partners, Westminster Bridge Road, London, SE1 7EH, UK. 

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