56 Dean Street is leading the way in helping combat the rapidly increasing prevalence and mortality among men who have sex with men (MSM) with the launch of an informative discussion guide for healthcare professionals. As the activities in which this group engages are ever-changing, nuanced and often taboo, many HCPs and service providers currently find it difficult to communicate appropriately with their patients, thereby limiting effective discussions around the risks of and importance of testing and treatment. With 7% of gay men in the UK co-infected with HIV and HCV, and 84% of all newly diagnosed HCV infections in London, it is vital that healthcare professionals have information at their fingertips to help address this challenge.1
The ChemSex and hepatitis C: a discussion guide for HCPs has been developed by 56 Dean Street's David Stuart, who has a wealth of experience in providing drug addiction services to HIV/HCV co-infected MSM. The guide, endorsed by The Hepatitis C Trust, is based on over 500 conversations with MSM, aims to inform healthcare professionals and services providers across the UK around ChemSex (the use of recreational drugs for sex) and HIV/HCV co-infection to empower them to use the terminology that will most resonate with these at-risk groups, and to ensure they are being diagnosed and treated effectively.
David Stuart, Substance Use Lead at 56 Dean Street said: "The recent increase of ChemSex and HIV/HCV co-infection in the UK, and particularly London, has become a major public health concern. Most challenging is that unless healthcare professionals are familiar with the cultural and behavioural contexts of MSM's practices, they may struggle to identify a risk when someone presents at the clinic. As MSM are historically proactively engaged with and informed about their HIV, HCV is often stigmatised and MSM tend not to be as informed and proactive. By sharing best practice and giving other services the necessary tools, we can increase awareness, diagnosis and treatment rates for manageable and often treatable conditions.'
The increase in ChemSex and HIV/HCV co-infection is a result of several factors; the availability of recreational drugs and sexual activities, which are organised online and through apps, often taking place in private homes rather than public sex venues. This trend makes the group not only hard-to-reach, but also difficult to understand exactly what activities are occurring and how to message public health initiatives. As such, sexual health clinics are the new front line in addressing these complex risks and harms, and staff in these clinics need tools to raise awareness and skills beyond their traditional remit.
Charles Gore, CEO of The Hepatitis C Trust commented: "We are seeing a worrying increase in hepatitis C infection among men who are aware of the dangers of HIV/HCV co-infection and who are being treated for hepatitis C multiple times but who seem either unaware of the precise risks for contracting hepatitis C or are unable to mitigate those risks successfully. Tools like this guide therefore have a vital role in helping this well-informed and active community, with support from their HCP, identify and halt what can be a deadly combination of diseases."
The primary goal is prevention of HIV/HCV co-infection, but it is also important for co-infected individuals to be tested and treated. Successful treatment of HCV in HIV/HCV-co-infected patients is associated with decreased liver-related mortality,2 as well as non-liver-related mortality, and AIDS progression.3 Early treatment for HCV in HIV positive individuals is important not only for stopping further transmission, but also as responses to HCV treatment are higher if identified in the first year of infection than in the later phase of chronic infection.1
The ChemSex and hepatitis C: a discussion guide for HCPs can be downloaded by visiting 56 Dean Street's website. http://www.code-clinic.co.uk/chemsex-co-infection-booklet