[外文專譯] 英國確診感染志賀氏痢疾桿菌的男同性戀者經常被報導發生“化學的性行為”
本文由財團法人台灣紅絲帶基金會編譯,若有引用,請註明出處,商用行為請於本會聯絡。
(資料來源:英格蘭和威爾斯的男男性行為者間有關高風險藥物的使用與桿菌性痢疾flexneri 3A感染的關聯。第三次英國愛滋病協會(BHIVA)與英國性健康與愛滋病協會(BASHH)聯合研討會,利物浦,2014年。)
根據英國愛滋病協會(BHIVA) 和英國性健康與愛滋病協會(BASHH)最近聯席會議提交之研究指出,在英國確診感染志賀氏痢疾桿菌的男同性戀者經常被報導發生“化學的性行為”(發生性行為時使用軟性毒品)以及參與了性派對。
調查採訪了42名新近診斷為志賀氏痢疾桿菌男性感染病患。總體來看,四分之三的人表示使用了娛樂性藥物和三分之一的人報告曾“slamming”- 注射藥物。大多數男性使用特定尋求性行為的網站和智慧型手機apps應用軟体,以尋找性伴侶,從而導致“密集”的疾病傳染網絡。研究人員相信他們的發現,對男同志性健康的預防工作有重要意義。
在英國同志間及其他男男間性行為者( MSM)不斷爆發志賀氏痢疾桿菌感染。它是由糞口的途徑感染,因口腔接觸到污染的糞便而傳播,可引起嚴重的腹瀉,但透過適當的抗生素治療可以治愈。通常志賀氏桿菌感染案件,在英國此症典型都與到流行地區國家旅遊的感染有關。但從2005年到2013年間,在英國沒有這種旅遊史的男性確診個案增加了750 %,其中大部分的診斷涉及同志和其他男男間性行為者。
英國公共衛生調查人員希望對同志族群間感染志賀氏痢疾桿菌,其社會上和性行為上的危險因素進一步清楚的認識。因此,他們在2012年年底和2013年年初,對42位確診感染志賀氏菌的男同志進行了深入訪談。受訪者年齡中位數為39歲,91 %是白人,79 %是出生在英國。幾乎三分之二( 61 %)居住在倫敦,其中59 %為愛滋感染者。
受採訪者絕大多數(88 %)之前沒有聽說過志賀氏痢疾的感染與診斷。當症狀發生時,56 %的人到他們的家醫科醫師那裡看診,而對其感染常管理不善。症狀是如此嚴重,導致 29 %的人因急症進入急診室,以及四分之一的患者住院治療。
受訪者具高度性經驗-其中男性愛滋感染者報告在過去一年中性夥伴的中位數為45個,而男性HIV陰性者報告性伴侶的中位數為13個。所有的受訪者均報告有口交或口-肛接觸(rimming)。
愛滋感染者顯著比陰性者更容易在志賀氏痢疾桿菌診斷前兩週有無保護性之肛交( P <0.05 ),受訪的愛滋感染者當中約60 %報告曾有插入型的無保護肛交,和70 %的愛滋感染者曾有接受型無保護肛交。
愛滋感染者相較於未感染者,也顯著地更可能報告有插入/接受型之拳交,且顯著地參加過性派對的可能性較大( P <0.05)。許多受訪報告尋找性伴侶或安排性聚會,會透過尋求性行為的網站和使用智慧型手機應用軟體apps。研究者認為,這會造成志賀氏痢疾桿菌的傳播網。
總體而言,76 %的受訪者報告有使用軟性毒品。但根據愛滋感染狀況分析其藥物使用的情形顯示,相較於HIV陰性的人有40%用藥,而愛滋感染者則所有的人均有使用的藥物。
受訪者的31%報告有採注射方式用藥“slamming”,但回到施打比率仍以愛滋感染者較高(約40 %比5%左右)之間。注射方式通常發生在性派對上,且多數這些施打者報告是由其他另外的人幫其施打。研究者認為叫注射毒品為“slamming” 是企圖對這種行為去污名。
常用的軟性毒品包括甲基安非他命、γ-羥丁酸/ 液態搖頭丸、喵喵和K他命(methamphetamine, GHB/GBL, mephedrone and ketamine),愛滋毒感染者相較於未感染者有較高的比率使用甲基安非他命及γ-羥丁酸/液態搖頭丸。
研究人員相信他們的發現對促進健康的相關活動有影響;對於男同性戀者這些訊息包括,如何提高對於藥物使用在性和整體健康上影響的認知。該調查還指出,健康促進機構應該深入暸解性網站以及在性健康信息中應加入針具交換相關資訊。
他們還認為泌尿生殖醫學之臨床醫師應該與他們所照顧的人討論有關非法藥物使用相關問題,家醫科醫師則需要被教育有關志賀氏痢疾桿菌在同志族群風險增加之訊息。
‘Chem sex’ commonly reported by UK gay men diagnosed with shigella
Michael Carter Published: 17 April 2014
‘Chem sex’ (taking recreational drugs during sex) and attendance at sex parties are commonly reported by UK gay men with shigella infection, according to research presented to the recent Joint Conference of BHIVA (British HIV Association) with BASHH (British Association for Sexual Health and HIV).
Investigators interviewed 42 men recently diagnosed with shigella. Overall, three-quarters reported recreational drug use and a third reported “slamming” – injecting drugs. Most of the men used specific sex-seeking websites and smartphone apps to meet partners, leading to “dense” transmission networks.
The investigators believe their findings have important implications for sexual health prevention work with gay men.
There is an ongoing outbreak of shigella among gay and other men who have sex with men (MSM) in the UK. It is spread by oral contact with contaminated faeces.The infection can cause severe diarrhoea but can be cured with appropriate antibiotic therapy. Shigella cases in the UK are typically associated with travel to countries where the infection is endemic. Diagnoses among men in the UK without such a travel history increased by 750% between 2005 and 2013. Most of these diagnoses involve gay and other MSM.
Investigators from Public Health England wanted to get a clearer understanding of social and sexual risk factors for shigella infection among gay men.
They therefore conducted in-depth interviews with 42 gay men with confirmed shigella infection. The interviews were conducted in late 2012 and early 2013.
The interviewees had a median age of 39 years, 91% were white and 79% were born in the UK. Almost two-thirds (61%) were living in London and 59% were living with HIV.
The vast majority (88%) of the men interviewed had not heard of shigella before their diagnosis with the infection. When symptoms occurred, 56% attended their GPs where the infection was frequently mismanaged. Symptoms were so severe that 29% presented to A&E, and a quarter of these patients were admitted for inpatient care.
The men were highly sexually experienced – the men living with HIV reported a median of 45 sexual partners in the past year, and the HIV-negative men reported a median of 13 sexual partners. All the men reported oral sex and oral-anal contact (rimming).
Men living with HIV were significantly more likely than HIV-negative men to report unprotected insertive and receptive anal sex in the two weeks before their shigella diagnosis (p < 0.05). Approximately 60% of the interviewees who had HIV reported unprotected insertive anal sex and 70% reported unprotected receptive anal sex.
Men living with HIV were also significantly more likely to report insertive/receptive fisting than their HIV-negative counterparts, and were significantly more likely to have attended sex parties (p < 0.05).
Many of the men reported meeting partners or arranging sex parties via sex-seeking websites and the use of smartphone apps. The investigators believe this is creating transmission networks of shigella.
Overall, 76% of men reported use of recreational drugs. But analysis of drug use according to HIV status showed that all the men living with HIV used drugs compared to approximately 40% of the HIV-negative men.
Injecting drugs – slamming – was reported by 31% of interviewees, but rates were again higher among men living with HIV (approximately 40% vs approximately 5%).
Injecting frequently occurred at sex parties and most of those injecting reporting being injected by another individual. The investigators suggest men called injecting drug use “slamming” in an attempt to de-stigmatise this behaviour.
Commonly used recreational drugs included methamphetamine, GHB/GBL, mephedrone and ketamine, with men living with HIV reporting higher rates of use of methamphetamine and GHB/GBL compared to HIV-negative men.
The investigators believe their findings have implications for health promotion campaigns.
For gay men these include raising awareness of the impact of drug use on sexual and general health. The investigators also suggest that health promotion agencies should engage with sex-seeking websites and that sexual health information should be put in needle-exchange packs.
They also suggest that GUM (genitourinary medicine) clinicians should discuss drug use with the people in their care and that GPs need to be educated about the gay man’s increased risk of shigella.
Reference
Gilbart V High-risk drug practices associated with Shigella flexneri 3a infections amongst MSM in England and Wales. 3rd Joint BHIVA with BASHH Conference, Liverpool, 2014.