title: Recreational drug use and chemsex among HIV-infected in-patients: a unique screening opportunity.
abstract: While a high rate of recreational drug use (RDU) has been documented among HIV-infected out-patients, particularly in men who have sex with men (MSM), there is a distinct lack of data for HIV-infected in-patients. Hospital admission offers a unique opportunity to engage drug users. We aimed to establish and characterize RDU among new admissions to a large dedicated London HIV in-patient unit and compare it to RDU among general medical admissions to inform clinical pathways.
  
  
  
  A prospective opt-out survey was administered to all new HIV-positive admissions over a 10-week period (cases) and all medical Acute Assessment Unit admissions over two 24-h periods (controls). All provided consent for urine toxicology upon admission.
  
  
  
  Data were collected in 59 of 65 (91%) newly admitted HIV-positive individuals and in 48 of 54 (89%) non-HIV-positive medical admissions. HIV-infected in-patients were more likely than non-HIV-positive medical admissions to be male (P < 0.0001) (71% MSM), to be younger (P < 0.0001), to report current RDU (41 vs. 10%, respectively; P = 0.0001), to have a positive urine toxicology screen (19 vs. 2%, respectively; P = 0.0091) and to be a drug-related admission (15% vs. none; P = 0.004). Thirteen of 26 HIV-infected current recreational drug users admitted to sexualized drug taking and nine to injecting drugs. Twenty-seven per cent (seven of 26) were known to drug services. Crystal methamphetamine, mephedrone, gamma butyrolactone/gamma hydroxybutyrate and ketamine were exclusively taken by MSM. In total, 13 of 59 HIV-infected in-patients had current or past infection with hepatitis C virus, of whom 92% reported lifetime drug use.
  
  
  
  These data strongly support the use of formal screening and drug service referral pathways at the time of admission to hospital to engage HIV-positive drug users.
authors.affiliation: HIV/GUM Directorate, Chelsea and Westminster Hospital, London, UK.
authors.forename: E R
authors.initials: ER
authors.lastname: Elliot
authors.affiliation: Sexual Health Service Greenway Centre, Newham General Hospital, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Singh
authors.affiliation: HIV/GUM Directorate, Chelsea and Westminster Hospital, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Tyebally
authors.affiliation: HIV/GUM Directorate, Chelsea and Westminster Hospital, London, UK.
authors.forename: K
authors.initials: K
authors.lastname: Gedela
authors.affiliation: HIV/GUM Directorate, Chelsea and Westminster Hospital, London, UK.
authors.forename: M
authors.initials: M
authors.lastname: Nelson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015658:HIV Infections / Q000150:complications*; D016174:Hepacivirus; D006801:Humans; D013287:Illicit Drugs; D008131:London; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012725:Sexual Behavior; D019966:Substance-Related Disorders / Q000453:epidemiology*
chemical_list: D013287:Illicit Drugs
keywords: 
  HIV
  ; chemsex; homosexual; in-patient; recreational drug use