Sex, drugs and smart phone applications: findings from semistructured interviews with men who have sex with men diagnosed with Shigella flexneri 3a in England and Wales.
OBJECTIVE
To inform control strategies undertaken as part of an outbreak of Shigella flexneri 3a among men who have sex with men (MSM).


METHODS
All men aged ≥18 years diagnosed with S flexneri 3a between October 2012 and May 2013 were invited to participate. Semistructured in-depth quantitative interviews were conducted to explore lifestyle and sexual behaviour factors.


RESULTS
Of 53 men diagnosed, 42 were interviewed of whom 34 were sexually active MSM. High numbers of sexual partners were reported (median=22) within the previous year; most were casual encounters met through social media networking sites (21/34). 63% (20/32) were HIV-positive and actively sought positive partners for condomless sex. 62% (21/34) of men had used chemsex drugs (mephedrone, crystal methamphetamine and γ-butyrolactone/γ-hydroxybutrate), which facilitate sexually disinhibiting behaviour during sexual encounters. 38% (8/21) reported injecting chemsex drugs. Where reported almost half (12/23) had attended or hosted sex parties. All reported oral-anal contact and fisting was common (16/34). Many had had gonorrhoea (23/34) and chlamydia (17/34). HIV-positive serostatus was associated with both insertive anal intercourse with a casual partner and receptive fisting (adjusted OR=15.0, p=0.01; adjusted OR=18.3, p=0.03) as was the use of web applications that promote and facilitate unprotected sex (adjusted OR=19.8, p=0.02).


CONCLUSIONS
HIV-positive MSM infected with S flexneri 3a used social media to meet sexual partners for unprotected sex mainly at sex parties. The potential for the transmission of S flexneri, HIV and other infections is clear. MSM need to be aware of the effect that chemsex drugs have on their health.
HIV and STI Department, PHE Health Protection Services, London, UK.
V L
VL
Gilbart
HIV and STI Department, PHE Health Protection Services, London, UK.
I
I
Simms
Gastrointestinal Bacteria Reference Unit, PHE Reference Microbiology Services, London, UK.
C
C
Jenkins
HIV and STI Department, PHE Health Protection Services, London, UK.
M
M
Furegato
PHE Health Protection Field Epidemiology Services, Bristol, UK.
M
M
Gobin
PHE Health Protection Field Epidemiology Services, Bristol, UK.
I
I
Oliver
Division of Population Health, University College London, London, UK.
G
G
Hart
HIV and STI Department, PHE Health Protection Services, London, UK.
O N
ON
Gill
HIV and STI Department, PHE Health Protection Services, London, UK.
G
G
Hughes
D000328:Adult; D004405:Dysentery, Bacillary / Q000453:epidemiology* / Q000523:psychology; D004739:England / Q000453:epidemiology; D006679:HIV Seropositivity / Q000453:epidemiology* / Q000523:psychology; D018451:Homosexuality, Male / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D012309:Risk-Taking; D012725:Sexual Behavior / Q000523:psychology / Q000706:statistics & numerical data*; D012747:Sexual Partners / Q000523:psychology*; D012763:Shigella flexneri / Q000472:pathogenicity*; D000068997:Smartphone; D061108:Social Media; D047568:Unsafe Sex; D014852:Wales / Q000453:epidemiology
GAY MEN; HIV; SEXUAL BEHAVIOUR