Mainline——對抗荷蘭的藥愛 (chemsex)
資料來源：http://www.thelancet.com/hiv 第 9 卷/2022 年 10 月 / 財團法人台灣紅絲帶基金會編譯
Mainline 成立於 1990 年，最初是一家小型慈善機構，致力於幫助荷蘭的注射藥癮者 (IDU)，當時該國死於 HIV 的人數急劇增加。三位志願者決定聚在一起幫忙。「人們害怕與這個非常高風險的群體交談」，Mainline 主管 Machteld (Mac) Busz 解釋道。「Mainline 想要改變這一點。我們需要向注射藥癮者提供信息，以幫助他們避免感染 HIV」，她告訴 《刺胳針愛滋病毒期刊》。
Mainline 的團隊透過監測不斷變化的藥物使用趨勢以發揮作用，依靠其志願者網絡向他們更新新出現的藥物或不斷變化的使用模式。該團隊目前正面臨所謂的藥愛流行病，即使用藥物來增強性體驗，這種流行病已經席捲了世界各國。 Mainline 不以診所為基礎，但為各種專業人士提供了藥愛 培訓，以確保有藥愛問題的人得到適當的照護，包括將他們轉介給性健康診所內的專家或心理治療師。
隨著 Mainline 的聲譽越來越高，它的國際地位也越來越高，該團隊現在正在為世界各地面臨自身藥愛流行病的國家提供支持。「我們目前專注於更好地記錄我們的證據基礎並翻譯更多我們的工作，並且還將工作擴展到與男性發生性關係（MSM）的非男性人群，因為藥愛行為現在在雙性戀和異性戀男性和女性中變得越來越普遍」，Busz 解釋道。
在 Mainline 的使命中至關重要的是那些擁有真實藥愛經驗的人。 Sjef Pelsser 陷入了藥愛場景，作為與他的長期伴侶出現問題的安慰機制。他直接開始使用了甲基安非他命（也稱為冰毒或蒂娜），發現儘管他的年齡相對較大，但其他冰毒使用者還是接受了他。「我從吸食蒂納迅速發展為注射它」，他解釋道。「整個場面都因與其他性高潮男子發生無保護措施的性行為而火上澆油。我的生活變得瘋狂。我丟了工作，我失去了控制」。
Pelsser 參加了戒毒匿名會議，以恢復他生活中的一些結構，並在 2 年後在他的伴侶和廣泛的朋友和家人網絡的支持下成功戒毒。他因吸毒而認識的 Mainline 找到了他，透過他們為注射藥癮者製作的雜誌講述他的故事，他同意「即使這只會幫助一個人避免我所經歷過的事情」。講述完自己的故事後，Pelsser 想幫助別人。他於 2019 年與 Mainline 簽約，現在自己是一名培訓師，在國際部門工作，幫助越南等多個國家應對該國的藥愛流行病。他解釋說，無論選擇何種藥物、使用者的年齡或國籍如何，根本問題基本上是相同的。「有大量隱藏的人群在從事藥愛行為。我們所能做的就是向他們提供信息，讓他們更安全地使用，並幫助人們在願意的情況下放棄。但毫無疑問藥愛流行病正在各地蔓延」。
Leon Knoops 在 Mainline 工作了十多年。 Mainline 邀請他擔任外展工作人員，近年來他轉換了角色，幫助培訓遇到藥愛苦苦掙扎的人們的各種工作人員，並為那些想要結束藥愛依賴的人舉辦小組治療課程。
Knoops 在 Mainline 領導了多項研究，這些研究為本次培訓提供了信息，包括採訪 MSM 有關吸毒和注射（或靜脈注射or slamming）冰毒的藥物使用情況。「因為這些人在家裡使用這些藥物，所以在俱樂部、桑拿浴室或其他聚會場所沒有檢測到他們的使用」，他解釋說。 2018 年，他幫助創建了 Mainline 的 Sexntina 網頁，提供有關更安全使用和放棄冰毒（甲基安非他命）的支持和建議。
Knoops 關注各種趨勢，包括slamming者在一個晚上重複注射的頻率。「以前注射兩次或三次現在可能多達 20-25 次，尤其是在slamming注射 3-MMC [一種類似於甲氧麻黃酮的卡西酮家族藥物] 時，它比冰毒更短。使用者可能會嚴重損傷他們的靜脈，以至於不得不住院」，他告訴《刺胳針愛愛滋病毒期刊》。「slamming注射現在不僅在家裡，而且在俱樂部、桑拿浴室和戶外巡航區。 COVID-19 大流行還導致人們在家中slamming或參與藥愛的人數大幅增加，並且還導致受到控制的人復發」。他的研究還顯示，雖然在 2015 年，幾乎沒有任何 MSM 知道slamming是什麼，但到 2020 年，他接觸的幾乎所有 MSM 都知道這個詞，甚至包括 20 歲以下的人。
阿姆斯特丹 DC 診所的護士 Loek Elsenburg 對此表示贊同：「我是一名專門看診 HIV 感染者的護士，我們的許多患者都熟悉吸毒情況」。她強調了 Mainline 培訓的價值並解釋說：「為了充分了解吸毒趨勢，我參加了 Mainline 會議……Mainline 還定期與使用者聯繫，並專門為他們組織會議，他們可以在沒有批判性的情況下討論他們的經歷並關鍵性地審視他們的行為」。”
Knoops 目前正在升級 Mainline 的藥愛網頁以包含新資源，並希望荷蘭政府認真對待藥愛。 「雖然四分之三的男同性戀者在性行為中從不吸毒或酗酒，但有四分之一的人吸毒或酗酒，而且失控的群體還在增加。這種趨勢非常令人擔憂」。
托尼.柯比敖報導
Mainline—confronting chemsex in the Netherlands
http://www.thelancet.com/hiv Vol 9 / October 2022
Mainline started out in 1990 as a small charity dedicated to helping injecting drug users (IDU) in the Netherlands, after deaths from HIV sharply increased in the country. Three volunteers decided to get together to help. “People were too scared to talk to this very high-risk group”, explained Mainline director Machteld (Mac) Busz. “Mainline wanted to change that. We needed to get information out to people injecting drugs to help them avoid HIV infection”, she told The Lancet HIV.
Mainline’s team functions by monitoring changing trends in drug use, relying on its network of volunteers to update them on emerging drugs or changing use patterns. The team is currently confronting the so-called chemsex epidemic, where drugs are used to enhance sexual experiences, that has gripped countries all over the world. Mainline is not clinic-based but has provided chemsex training to a wide variety of professionals to ensure people with chemsex problems receive appropriate care, including referring them to experts based within sexual health clinics or psychotherapists.
As Mainline’s reputation has grown, so has its stature internationally, and the team is now providing support to countries all over the world confronting their own chemsex epidemics. “We are currently focusing on better documenting our evidence base and translating more of our work, and also expanding to work in non-men who have sex with men (MSM) populations because chemsex behaviours are now becoming more common in bisexual and heterosexual men and women”, Busz explained.
Vitally important in Mainline’s mission are those who have real-life experience of chemsex. Sjef Pelsser fell into the chemsex scene as a comfort mechanism for problems with his long-term partner. He went straight into methamphetamine (also known as crystal meth or tina) use, finding that despite his relatively older age other crystal meth users accepted him. “I rapidly progressed from smoking tina to injecting it”, he explained. “The whole scene was fuelled by unprotected sex with other men who were high. My life went crazy. I lost my job and I lost control.”
Pelsser attended narcotics anonymous sessions to regain some structure in his life and successfully came off drugs after 2 years, supported by his partner and an extensive network of friends and family. Mainline, who he knew of through his drug use, approached him to tell his story via a magazine they produce for injection drug users, to which he agreed “even if it would help just one person avoid what I went through”. After telling his story, Pelsser wanted to help others. He took a contract with Mainline in 2019, and is now a trainer himself, working in the international department helping multiple countries, such as Viet Nam, face their own chemsex epidemics. The underlying issues are essentially the same, whatever the drug of choice, age or nationality of the user, he explained. “There is a huge hidden population practising chemsex. All we can do is get information to them to make use safer and help people give up if they want to. But there is no doubt the chemsex epidemic is growing everywhere.”
Leon Knoops has worked with Mainline for more than a decade. Mainline approached him to be an outreach worker, and in recent years he has switched roles to help train the various workers who come across people struggling with chemsex and run group therapy sessions for those wanting to end their chemsex dependency.
Knoops has led on various research at Mainline that has informed this training, including interviewing MSM about drug use that included smoking and injecting (or slamming) crystal meth. “Because these men were using these drugs at home, their use was not being detected in clubs or saunas or other meeting places”, he explained. In 2018, he helped create Mainline’s Sexntina webpages that provide support and advice on safer usage and giving up crystal meth.
Knoops is concerned about various trends, including how frequently those who slam are repeating injections on a single night. “Two or three injections previously can be as many as 20–25 now, especially when slamming 3-MMC [a cathinone family drug similar to mephedrone] which involves a shorter rush than crystal meth. Users can damage their veins so badly they are hospitalised”, he told The Lancet HIV. “Slamming is now not only in homes, but clubs, saunas, and outdoor cruising areas. The COVID-19 pandemic also led to a big increase of people slamming or engaging in chemsex at home, and also led to people who were under control relapsing.” His research has also shown that while in 2015, hardly any MSM knew what slamming was, by 2020 almost all MSM he contacted knew the term, even those aged under 20 years.
Loek Elsenburg, a nurse at the DC Clinic, Amsterdam agreed: “I am a specialised nurse seeing people with HIV, and many of our patients are familiar with drug use.” She highlighted the value of Mainline’s training and explained: “To stay well informed about the trends in drug-use I participate in meetings Mainline…Mainline is also in regular contact with users and organises meetings especially for them, where without judgement they can discuss their experience and look critically at their behaviour.”
Knoops is currently upgrading the Mainline’s Chemsex webpages to include new resources and wants the Dutch Government to take chemsex seriously. “While threequarters of gay men never use drugs or alcohol during sex, one-quarter do and the group who lost control is growing. This trend is very worrying.” Tony Kirby