Analysis of HIV pre-exposure prophylaxis (PrEP) needs and PrEP use among men who have sex with men in Germany

Aims:We aim to estimate the number of PrEP users among men having sex with men (MSM) in Germany from 2017 through 2020, and analyse if PrEP needs expressed in 2017 might have been met by the expansion of PrEP until 2020.Subject and Methods:We estimated the number of PrEP users by using drug prescription data and information on on-demand/intermittent PrEP use from online surveys to determine the proportion of on-demand/intermittent and daily PrEP use as well as the average number of PrEP pills used.The number of MSM in need of PrEP in 2017 was estimated based on four groups defined among respondents to a large online survey, combining respondents with PrEP use intention and respondents indicating substantial sexual risks. The size of each group was estimated based on self-selection biases. MSM with PrEP need in 2017 were compared with the estimated number of persons taking PrEP by June 2020.Results:We estimated a total of 15,600 to 21,600 PrEP users in Germany by the end of June 2020, corresponding to 40-55% of men with PrEP use intention in 2017. A correlation between the regional distribution of PrEP use intention in 11/2017 and actual PrEP use by 06/2020 suggested an unequal regional distribution of unsatisfied needs. The number of men with unmet PrEP needs ranged between 27,500 and 93,000 in 06/2020.Conclusion:PrEP use in Germany has increased considerably between 10/2017 and 06/2020, but large regional inequalities persist. PrEP is not yet readily accessible and there is a need to expand services and encourage uptake.

The Association of Recurrent and Multiple Types of Abuse with Adverse Mental Health, Substance Use, and Sexual Health Outcomes among Out-of-School Adolescent Girls and Young Women in Cape Town, South Africa

Although physical and sexual abuse exposure is a well-established risk for poor health, the dimensions of abuse associated with health among socially vulnerable adolescent girls and young women (AGYW) remain underexamined. This article describes associations between combinations of abuse type and timing with mental health, substance use, and sexual risk outcomes among a sample of 499 AGYW (aged 16 to 19) who had left school early and were recruited for a cluster randomized trial in Cape Town, South Africa. Approximately one-third (33.5%; 95% CI: 28.7, 38.6) of participants reported lifetime abuse. Exposure to more than one type of abuse was associated with increased risk of depression (β = 3.92; 95% CI: 2.25, 5.59) and anxiety (β = 3.70; 95% CI: 2.11, 5.28), and greater odds of polydrug use (OR = 2.10; 95% CI: 1.02, 4.34) and substance-impaired sex (OR = 2.17; 95% CI: 1.31, 3.86). Exposure to multiple types of abuse during childhood/early adolescence and again in late adolescence was associated with increased risk of depression (β = 4.65; 95% CI: 3.15, 6.14), anxiety (β = 4.35; 95% CI: 2.70, 6.02), and polydrug use (OR = 2.37; 95% CI: 1.03, 5.73). Findings underscore the need for trauma-informed interventions that reduce mental health, substance use, and sexual risks among AGYW who have experienced multiple forms of abuse and recurrent abuse.

1283Licit and Illicit substances use among Brazilian youth population: a cross-sectional, nationwide study

Background Psychoactive substances are increasing within the young population enhancing exposure to sexual risks, violence and mortality by preventable causes. Moreover, the use of these substances at this stage of life can be a predictor of abuse in adult live. Thus, this study aims to examine the patterns of drugs use in Brazilian young adults. Methods A cross sectional study was performed in all Brazilian capitals between September-2016 to December-2017. 8581 participants aged 16 to 25 years answered a structured interview with socio and behavioral questions. The sample was weighted in each capital by age range and sex. Results Alcohol (71.6%), cannabis (27.4%), and cocaine (9.9%) were the most common addictive substances experienced once in life in the sample. The regular use in the past 12 months was reported in 40.5%, 12.5% and 2.5%, respectively. Significant differences were observed between men and women in regular use of alcohol (48.7% and 32.5%, p<.001), cannabis (18.8% and 6.3%, p<.001) and cocaine (3.8% and 1.4%, p<.001). Also observed high drug consumption regarding to low education level, upper class population and who had partner presence. Additionally, participants who had previous homosexual relationship had high rates of regular alcohol (65.9%) and cannabis use (22.6%). Conclusions Brazilian youth showed high rates of psychoactive substances use mainly alcohol and cannabis. Thus, knowledge about the patterns of alcohol and drugs use in this population is important to direct actions and prevent associated risks. Key message High rates of alcohol and cannabis use are reported in Brazilian youth population.

Brief Report

Religiosity has been shown to be a protective factor against risky sexual behavior (RSB). The current study sought to identify which aspects of perceived significant other and personal religiosity (i.e., private, coping, conviction, social, and conservatism) predict RSB in emerging adults and how this might differ by gender. The sample (N = 275; 72% female, 28% male) consisted of adults aged 18–25 years (mean = 19.31, SD = 1.42) attending a large Southern university and used the Stearns–McKinney Assessment of Religious Traits scale and Student Sexual Risks Scale. For males, significant other private religiosity and personal conservatism predicted RSB. For females, significant other private religiosity and religious coping as well as personal conviction and conservative religiosity predicted RSB. Thus, religious traits and gender differed regarding the prediction of RSB of emerging adults.

The Beliefs and Practices on Sexual Health and Sexual Transmitted Infection Prevention of Myanmar Migrant Workers in Thailand

Background: Thailand is recognized as one of the countries in Southeast Asia that has attracted a large number of migrant workers from her neighboring counterparts. The issue of sexual transmitted infections among transnational migrant workers has caused grave concerns for Thai government, particularly the authority responsible for healthcare policy and planning. Objective: This study aimed to explain the sexual beliefs and practices on sexual health and sexual transmitted infections prevention of Myanmar migrant workers in Thailand. Methods: The qualitative research method was applied in this research. The data collection covered observation, field note takings, in-depth interviews, and secondary data derived from literature reviews of various sources. The participants consisted of 22 Myanmar migrant workers who could communicate in Thai and live in Thailand for at least one year. The data was analyzed by using the method of content analysis. Results: The findings of this study included two major themes and four subthemes as follows: 1. The meanings of sexual transmitted infections 2. The sexual health and sexual transmitted infections prevention: 2.1) Males and Females: equality to STI’s prevention2.2) Sexual Risk Behaviors: No prostitute services, No sexual risks 2.3) Condom usage: unaffordable and the symbol of promiscuous and untrustworthy and 2.4) Abortion: unavoidable solutions to unwanted pregnancy. Conclusion: The findings provided an understanding of sexual beliefs and practices on sexual health and sexually transmitted infections prevention among Myanmar migrant workers that can be applied to the policy making as a foundation data including to inform and propose to the concerned society, healthcare organizations, healthcare providers and nurses, in particular.

Guy Talk: A Gender-Specific Sexual Education Program to Reduce Sexual Risk Behaviors With High School Males

Purpose The purpose of this study was to investigate the feasibility and effectiveness of a gender-specific intervention targeted to adolescent males to reduce sexual risks. Method This study used a randomized clinical trial comparing a broad-based male empowerment curriculum with a no-treatment control group. The sample ( N = 580) was recruited from schools and was implemented in community-based settings mostly in an after-school context. Assessments were conducted at baseline, postintervention, and 3 months follow-up time periods. Results There were significant differences between the two groups favoring the intervention group on several of the outcome indicators, including condom technical skills, attitudes toward women, social skills, peer assertiveness, and attitudes toward consent. Quality of implementation was rated high, and qualitative data suggest themes that reflect key lessons emphasized in the curriculum. Conclusions Gender-specific programs for adolescent males can help reduce indicators that are related to sexual risk reduction. More long-term follow-up is needed to assess impact on sexual behaviors. Efforts directed at male populations should continue to be researched for potential in reducing sexual risks.

Intersectionality of cultural norms and sexual behaviours: a qualitative study of young Black male students at a university in KwaZulu-Natal, South Africa

Background Sexual risk behaviours that occur among young men are based on dominant notions and practices that prevail in cultural contexts. As such, understanding the intersection of cultural norms and sexual risk behaviours among young men is very important. Methods The study used a qualitative design and conducted four focus group discussions with 36 male students who were purposively selected from different levels of study at the University of KwaZulu-Natal. Data were analysed through line-by-line coding, and grouped into emerging themes and sub-themes facilitated by the use of Atlas.ti. Result The findings emphasize that socialisation agents such as the family, peers and community play an important role in prescribing acceptable and unacceptable sexual behaviour of young men. Some of the young men seemed to adhere to prescribed gender norms of what it means to be a man while some rejected them for alternative versions of being a man. In the context of the university environment, these findings reveal that male students cannot make informed decisions regarding condom use when they are intoxicated, and thus expose themselves to sexually transmitted infections and other risks. Conclusion University sexual risk reduction programs should be developed considering the specific cultural context, using strategies that empower young men to challenge the widely accepted cultural norms that may predispose them to sexual risks. Plain English summary Sexual behaviours and cultural norms are interconnected, it is through culture that people learn how to behave and understand the world around them. In many cultural contexts, young men are taught from a very young age how to behave based on dominant notions of what it means to be a man in that particular context. As such, in some cultural context sexual risk-taking such as having multiple sexual partners and unprotected sex are perceived as normal behaviour for men. Some young men embrace such normalised sexual behaviours which often has negative implications on their future. This study explored the influence of cultural norms on the sexual behaviour of young men. This qualitative study was conducted at the University of KwaZulu-Natal. Four focus group discussions were conducted among first-year students to postgraduate students who were between the ages of 18 to 30 years. Our findings revealed that there other influences on the sexual behaviours of the young men, which included family, community and peers. It also emerged that gender norms regarding what it means to be a man still prevailed which some of the young men in the study adhered to, notably such notions seemed to be rejected by some of them. The university setting appeared to be space where a lot of sexual risk-taking took place, which potentially exposed the young men in the study to many sexual risks. In conclusion, targeted programs for the university setting should aim to challenge gender norms that expose young men to sexual risks.