Chemsex – A new epidemic? Tamás Bereczky – European AIDS Treatment Group

Evidence

Ü  Reduction in the number of new infections Ü  More than 33% reduction globally since 2001

Ü  But not in EE and CA – MSM and IDU drive the epidemic Ü  High rate of late presenters (49%)

Ü  Robert Koch Institute data

Ü  EMIS data

Ü  ITM data on TasP

Ü  Discussion ongoing (UNAIDS, ILGA, WHO, EATG etc.)

Dr. Ulrich Marcus, Rober Koch-Institute, Berlin, UNAIDS Consultation, presented on 22/01/2014

Dr. Ulrich Marcus, Rober Koch-Institute, Berlin, UNAIDS Consultation, presented on 22/01/2014

The HIV epidemic among Men having Sex with Men in Belgium

Source WIV- HIV Surveillance report 2011

Marie Laga, Institute of Tropical Medicine, Antwerp, UNAIDS Consultation, presented on 22/01/2014

Marie Laga, Institute of Tropical Medicine, Antwerp, UNAIDS Consultation, presented on 22/01/2014

Different explanations Ü  Scientific/biological – Fragile rectal mucosa

Ü  Scientific/policy – Cascade of care

Ü  Behavioural – Increased risk taking and seeking

Ü  Socio-cultural – Manliness vs. condoms

Ü  Cultural – Changing face of the epidemic

Ü  Cultural/behavioural – Prevention fatigue

Ü  Cultural/behavioural – Easy access to sex through the internet

Ü  Policy/political – No access to Tx, no information on prevention

Ü  Socio-cultural – Stigma and discrimination on many levels

Drugs in the context of HIV

•  Adherence ↓ •  Viral Load ↑ •  Potential for development of resistance ↑ •  (In some cases) aggressive behavior ↑ •  Use of safer sex ↓ •  Transmission risk ↑ (several causes) •  Organ damage (heart, liver, kidney, lung, CNS) ↑ •  Risk of developing dependence ↑ •  Drug-related crime / sex work ↑ •  Criminalization / stigmatization ↑ •  Additional risks with injecting •  Interactions with ART / concomitant medication

Siegfried Schwarze, as presented on 6 April 2014

Synergistic epidemics

Ü  Depression: significantly higher rate with gays (Cochran 2009)

Ü  Chronic anxiety: significantly higher rate with gays (Botswick et al. 2010)

Ü  Suicide and suicidal ideation: significantly higher risk with MSM, especially the young (Paul et al. 2002)

Ü  Substance use, chemsex, novel forms of drug use: ethical issues, however, some new substances more prevalent

Ü  HIV

Ü  HCV

Ü  TB

Why do people take drugs?

-  To experience pleasure (“recreational”) -  expectation -  social interaction -  religious / spiritual setting -  relaxation -  alertness -  disinhibition -  increased sexuality -  boredom / escape from reality -  peer pressure

-  To avoid suffering (“medicinal”)

-  bodily pain -  psychic suffering -  avoidance of withdrawal symptoms

→ Risk / benefit assessment similar to medical drugs!

Siegfried Schwarze, as presented on 6 April 2014

The ugly face of HIV and discrimination in general in the

gay community

Ü  Health fascism and the fetishisation of (a certain type of) health and beauty

Ü  The queer rebellion against this form of heteronormative control - diversion, transgression and deviance

Ü  Lived experience of social rebelling against society and the “gay norm”

Contradictory expectations create tension

Depression, anxiety, drug use

Ü  Mental health and substance use

Ü  Mental health and physical health

Ü  Setting the right priorities within the community Ü  Shift from an only rights-based approach to more

health-based one

Marriage – The Trojan horse of heternormativity

Ü  In Central Europe (and also farther east) the discourse around gay rights is about equality, the right to marry, the right to adopt children. The voices of "alternative" sexualities and identities are weak, yet there are some who say that "gay marriage" is another vehicle of heteronorming, i.e. it is aimed at transforming gays into "surface straight" citizens who do everything exactly like "normal" people except for sleeping with each other.

Refocus our efforts

HEALTH OR RIGHTS? OR BOTH? AND HOW?

What next?

Ü  We must work on developing and promoting new, more neutral and morally unbiased discourses on drugs, risks and behaviour

Ü  Convince the audience and avoid their fatigue concerning "safer sex", condom use and testing.

Ü  Approach should be based on data, and aimed at different patterns of behaviour rather than essentialist/moralistic arguments

Ü  Are LGBT organisations fighting the right fight?

Acknowledgements Ü  Tom Hayes / UKPositivelad

Ü  Siegfried Schwarze / Deutsche AIDS-Hilfe

Ü  Dr. Christian Hilton

Ü  Henning Mikkelsen / UNAIDS

Ü  David Stuart / Antidote

Ü  Marie Laga / Institute of Tropical Medicine, Antwerp

Ü  Gus Cairns / NAM

Ü  European AIDS Treatment Group

Ü  European Commission’s Civil Society Forum on HIV/AIDS