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Few theory-informed interventions to support people who use drugs during sex have been conceptualized and developed. We conceptualize sexualized drug use, also referred to as chemsex or pharmacosex, as a self-control challenge, and draw on extant theory and research to propose intervention approaches that can be tailored to meet the differing needs of people who engage in sexualized drug use. We draw on a continuum perspective of sexualized drug use, in particular chemsex, and discuss the role of reasoned and automatic processes in behavioral decisions, as well as critical components of effective self-control of behavior. A self-control approach can empower people to tackle their sexualized drug use, and classify their experienced sex-related drug use as problematic. Self-control encompasses clarifying one's goals and identifying strategies to mitigate behaviors to achieve these goals, despite competing pharmacosex desires. Our approach to self-control sexualized drug use contains three critical components: goal setting, goal enactment, and goal progress appraisal and goal adjustment. Goals should be formulated specific, ambitious yet realistic, and tailored to the individual's needs and wishes. Goals may target aspects of drug use, protecting sexual health and mitigating negative impacts. Implementing goal enactment implies translating goals into concrete (short-term) actions to move toward the higher-order goal via goal intentions and action/coping plans. During the goal progress appraisal and adjustment stage, people compare their actual with their planned behavior. This reflection may result in goal adjustment through feedback loops to adjust their goals and action/coping plans. We propose that our self-control approach can guide the development of interventions to effectively support people to prevent or limit pharmacosex, and helps to effectively mitigate or reduce negative impacts via self-help, peer support or professional support, offered via personal counseling or digital tools.

Resumen Se describe la implementación del trabajo de campo de una prueba piloto cuyo objetivo fue fomentar el diagnóstico precoz de la infección por el virus de la inmunodeficiencia humana (VIH) ofreciendo una prueba de cribado en los locales y zonas de cruising (zonas de contacto sexual al aire libre) frecuentados por hombres que tienen sexo con hombres (HSH) en la ciudad de Barcelona y en Sitges, y consultando el resultado a través de la página web del proyecto. La prueba piloto resultó viable y contó con la aceptabilidad del colectivo al que va dirigida. Abstract Description of the implementation of the field work of a pilot intervention whose objective was to promote the early diagnosis of HIV infection by offering a screening test for HIV in gay venues and cruising areas (outdoor sexual contact areas) frequented by men who have sex with men (MSM) in the city of Barcelona and Sitges, and consulting the result through the project website. The pilot intervention was viable and counted with the acceptability of the target group.

SUMMARYBackground: Throughout Europe, differences in satisfaction with HIV-care of people living with HIV (PLHIV) persist, despite a tendency towards harmonisation of policy and management.Methods: A European sample of 1,549 PLHIV responded to an anonymous questionnaire assessing demographic background, general health, mental health, sexual health, and HIV-service provision. We compared the results across 3 regions: Western, Southern and Central/Eastem Europe.Results: PLHIV differed in several socio-demographic variables (gender, migrant status, sexual orientation, and financial situation) as well as specific psychosocial aspects (HIV-related discrimination, satisfaction with sexual and reproductive health (SRH) services in HIV-care settings, and complaints about service provision). Using multivariate analysis, a predictive model for satisfaction with SRH services in HIV clinics was developed, resulting into region of residence, and participants' satisfaction with their own health status as significant predictors.Conclusions: Better integration of SRH services in HIV-care should be encouraged. Service providers should be trained and encouraged to discuss SRH issues with their patients to create a supportive environment, free of discrimination. More time should be allocated to discuss SRH issues with individual patients.Key words: sexual and reproductive health, HIV-care, EuropeINTRODUCTIONHIV continues to be a public health problem in Europe. In the European Economic Area (EEA) - European Union Member States, Norway, Iceland, and Liechtenstein - and Switzerland, 28,038 new HIV cases were reported in 2011, a rate of 5.7 per 100,000 population (1). The four countries with the highest rates were Estonia, Latvia, Belgium, and the United Kingdom, with rates above 10 per 100,000 population. The predominant mode of transmission of HIV in the EU/EEA-region and Switzerland is sex between men, accounting for 39% (10,855 cases) of the HIV-diagnoses reported in 2011, followed by heterosexual transmission excluding individuals originating from countries with generalised epidemics (23%). For 19% of the newly diagnosed cases in 2011, the transmission mode was unknown (1). While trends towards stronger harmonisation of HIV policy and management across Europe have been observed, there are indications that evidence-based policies, programmes and services are still implemented differently in European countries (2). This may have an impact on patients' satisfaction with health care services. A recent review gathered evidence on perceived service quality of HIV-services. Several factors were found to improve patient's satisfaction. They were either related to individual health care provider (i.e. knowledge, caring and respectful attitude, communication skills, and information provision) or to organisations (responsive and flexible services) (3).In this article we present a subset analysis using data from a European public health project on sexual and reproductive health needs of people living with HIV (PLHIV) in 14 European countries. Details on the study design and overall results are described elsewhere (4). Here we compare socio-demographic variables, measures of satisfaction with sexual and reproductive health services delivered in HIV clinics, and perceived levels of HIV-related discrimination across three European regions. The identified critical differences in HIV-service provision could inform HIV policy makers and service providers to improve care.MATERIALSAND METHODSProceduresThe research was carried out in a network of 17 HIV treatment and research centres in 14 European countries between March and October 2007. A self-administered, anonymous questionnaire was developed including questions on demographic background characteristics, general health related aspects, mental health, sexual health, and HIV-service provision. It was translated into 12 languages, and was distributed to consecutive patients at the collaborating sites. …

Objectives Fertility-related decisions are challenging for women and couples living with HIV, in spite of vertical HIV transmission rates lower than 1% under effective antiretroviral treatment. This multicentre study identified factors influencing child desire of women and men living with HIV in Europe. Methods We gathered quantitative data by means of anonymous, self-administered questionnaires distributed through a network of 13 European HIV treatment centres. Data analysis employed descriptive statistics and multivariate logistic regression. Results The majority of 427 heterosexual HIV-positive study participants were sexually active. Forty-three percent reported a child desire, 28% had unmet family planning needs. Factors independently associated with child desire were: being younger than 36 years for both genders, and having no children for women. Perceived HIV-related discrimination by health care providers was associated negatively with child desire for women, but positively for men. Conclusions Many women and men living with HIV in Europe desire children and have fertility intentions, for which they need unbiased support to conceive and deliver safely. Comprehensive and gender-specific sexual and reproductive health counselling, including pre-conception and contraceptive counselling, should be integrated into HIV care delivery. © 2013 The European Society of Contraception and Reproductive Health.

Infections with the human immune deficiency virus (HIV) remain an important health issue. In Europe and Belgium, high numbers of new HIV diagnoses persist. Without the prospect of a cure for HIV within the coming years, prevention, early diagnosis, linkage and access to specialized care and treatment are cornerstones of the management of HIV. Effective HIV prevention has been prioritized since the beginning of the HIV epidemic. An approach with a high and sustainable impact is combination prevention. Combination prevention for HIV covers a set of prevention interventions involving three dimensions: biomedical, behavioral and structural.The general objective of this thesis was to improve HIV prevention across all three dimensions of the HIV combination prevention concept. In the different chapters, we presented projects that aimed to provide evidence on the effectiveness of innovative prevention activities on HIV prevention. On the biomedical dimension, testing has been highlighted as a prevention intervention. After having provided an overview of innovation and evolution of HIV testing activities in Europe in chapter two, we presented results of two consecutive HIV testing projects in Belgium in chapters three and four. Both projects used outreach approaches for sample collection. In the second project, we added a self-sampling approach allowing people to order a sampling kit via a website. We combined collection of blood and oral fluid samples with a test executed in the laboratory and delayed communication of HIV test results using cell phone messages (chapter three) and a secured website (chapter four). Although we aimed for innovation in both projects, safeguarding quality in all aspects of the HIV testing approach was fundamental. Both testing interventions were found to be effective as 2.9% and 2.2% of participants were newly diagnosed with HIV respectively. These proportions are higher than the consensus of 0.1% newly diagnosed participants as cut-off for cost-effectiveness in HIV testing projects.Regarding the behavioral dimension of HIV combination prevention, results from a survey research project were presented in chapter five. We observed a decline in sexual inactivity among a group of European men who have sex with men living with HIV since the introduction of antiretroviral treatment for HIV. This finding suggests a tendency towards normalization of the sex life of people living with HIV. This implies investment to support people living with HIV in their sexual health. In chapter six, we presented results from a project studying the effectiveness of a computer-assisted counselling intervention for safer sex for people living with HIV. This intervention was tested among a group of European men who have sex with men, and consisted of three individual counselling sessions with a trained counsellor using computer-assisted tools (including video clips and interactive slide shows) to increase condom use in sexual encounters. A significant increase in condom use was observed three months after completion of the intervention, providing evidence for short term effectiveness. This effect could not be sustained up to six months after completion. Booster sessions may yield a longer term effect.Structural prevention interventions aim to tackle circumstances that hinder people to practise safer sex, or make them vulnerable for HIV acquisition. In this light, identifying groups at risk for HIV acquisition may be considered as a structural prevention intervention. Using an online survey, we assessed the sexual health of a group of swingers, their risk for acquisition of HIV and sexually transmitted infections (STI), and testing experiences, as presented in chapter seven. Compared to the general population, swingers were sexually very active, and several risk factors for acquisition of HIV and STI were identified. Swingers were more likely to have been diagnosed with an STI. Although swingers found their way to existing structures for testing, strengthening these structures and providing alternative testing options should be considered.The different projects presented in chapters two to seven provided evidence on the effectiveness of a combination approach in HIV prevention. Turning this knowledge into practice is a key element to success of prevention. Therefore, a collaboration between policy makers, program officers, health care providers, researchers and communities is required to ensure access to qualitative support and functioning programs. Improving quality and functionality may also include innovation to find appealing ways of the delivery of services and programs. Computerized technologies may attract new users, and should receive attention in research and practice. Adapting prevention to new trends, their consequences and responses, is important in effective prevention. In chapter eight, effects and responses to pre-exposure prophylaxis, chemsex and couple testing were discussed.Combination prevention for HIV covers a range of interventions on a structural, behavioral and biomedical level. All three levels are necessary to achieve highly effective prevention. Securing rights of key populations to reduce stigma and discrimination, and safeguarding or improving access to services are crucial structural ambitions. Investment in the development and evaluation of effective behavioral interventions using appealing ways of program delivery is a challenge on the behavioral dimension. An important biomedical goal is to diagnose as many people living with HIV unaware of their status as possible by expanding HIV and STI testing approaches. Although testing for HIV is critical, linkage to care, and retention in care should be integrated in the evaluation of each testing approach. Optimizing linkage and retention requires qualitative HIV care. Quality is reflected in accessibility, and a team of professional health care providers with medical and psychological expertise who treat patients with an open and respectful attitude.

Infections with the human immune deficiency virus (HIV) remain an important health issue. In Europe and Belgium, high numbers of new HIV diagnoses persist. Without the prospect of a cure for HIV within the coming years, prevention, early diagnosis, linkage and access to specialized care and treatment are cornerstones of the management of HIV. Effective HIV prevention has been prioritized since the beginning of the HIV epidemic. An approach with a high and sustainable impact is combination prevention. Combination prevention for HIV covers a set of prevention interventions involving three dimensions: biomedical, behavioral and structural.The general objective of this thesis was to improve HIV prevention across all three dimensions of the HIV combination prevention concept. In the different chapters, we presented projects that aimed to provide evidence on the effectiveness of innovative prevention activities on HIV prevention. On the biomedical dimension, testing has been highlighted as a prevention intervention. After having provided an overview of innovation and evolution of HIV testing activities in Europe in chapter two, we presented results of two consecutive HIV testing projects in Belgium in chapters three and four. Both projects used outreach approaches for sample collection. In the second project, we added a self-sampling approach allowing people to order a sampling kit via a website. We combined collection of blood and oral fluid samples with a test executed in the laboratory and delayed communication of HIV test results using cell phone messages (chapter three) and a secured website (chapter four). Although we aimed for innovation in both projects, safeguarding quality in all aspects of the HIV testing approach was fundamental. Both testing interventions were found to be effective as 2.9% and 2.2% of participants were newly diagnosed with HIV respectively. These proportions are higher than the consensus of 0.1% newly diagnosed participants as cut-off for cost-effectiveness in HIV testing projects.Regarding the behavioral dimension of HIV combination prevention, results from a survey research project were presented in chapter five. We observed a decline in sexual inactivity among a group of European men who have sex with men living with HIV since the introduction of antiretroviral treatment for HIV. This finding suggests a tendency towards normalization of the sex life of people living with HIV. This implies investment to support people living with HIV in their sexual health. In chapter six, we presented results from a project studying the effectiveness of a computer-assisted counselling intervention for safer sex for people living with HIV. This intervention was tested among a group of European men who have sex with men, and consisted of three individual counselling sessions with a trained counsellor using computer-assisted tools (including video clips and interactive slide shows) to increase condom use in sexual encounters. A significant increase in condom use was observed three months after completion of the intervention, providing evidence for short term effectiveness. This effect could not be sustained up to six months after completion. Booster sessions may yield a longer term effect.Structural prevention interventions aim to tackle circumstances that hinder people to practise safer sex, or make them vulnerable for HIV acquisition. In this light, identifying groups at risk for HIV acquisition may be considered as a structural prevention intervention. Using an online survey, we assessed the sexual health of a group of swingers, their risk for acquisition of HIV and sexually transmitted infections (STI), and testing experiences, as presented in chapter seven. Compared to the general population, swingers were sexually very active, and several risk factors for acquisition of HIV and STI were identified. Swingers were more likely to have been diagnosed with an STI. Although swingers found their way to existing structures for testing, strengthening these structures and providing alternative testing options should be considered.The different projects presented in chapters two to seven provided evidence on the effectiveness of a combination approach in HIV prevention. Turning this knowledge into practice is a key element to success of prevention. Therefore, a collaboration between policy makers, program officers, health care providers, researchers and communities is required to ensure access to qualitative support and functioning programs. Improving quality and functionality may also include innovation to find appealing ways of the delivery of services and programs. Computerized technologies may attract new users, and should receive attention in research and practice. Adapting prevention to new trends, their consequences and responses, is important in effective prevention. In chapter eight, effects and responses to pre-exposure prophylaxis, chemsex and couple testing were discussed.Combination prevention for HIV covers a range of interventions on a structural, behavioral and biomedical level. All three levels are necessary to achieve highly effective prevention. Securing rights of key populations to reduce stigma and discrimination, and safeguarding or improving access to services are crucial structural ambitions. Investment in the development and evaluation of effective behavioral interventions using appealing ways of program delivery is a challenge on the behavioral dimension. An important biomedical goal is to diagnose as many people living with HIV unaware of their status as possible by expanding HIV and STI testing approaches. Although testing for HIV is critical, linkage to care, and retention in care should be integrated in the evaluation of each testing approach. Optimizing linkage and retention requires qualitative HIV care. Quality is reflected in accessibility, and a team of professional health care providers with medical and psychological expertise who treat patients with an open and respectful attitude.

Altres ajuts: This work was supported by the Consumers, Health, Agriculture and Food Executive Agency (CHAFEA, European Commission); grant number 2013-11-01-613233. Community-based voluntary counselling and testing (CBVCT) services for men who have sex with men (MSM) can reach those most-at-risk and provide an environment for gay men that is likely to be non-stigmatising. Longitudinal data on the behaviour of HIV-negative MSM are scarce in Europe. The aim of this protocol, developed during the Euro HIV Early Diagnosis And Treatment (EDAT) project, is to implement a multicentre community-based cohort of HIV-negative MSM attending 15 CBVCT services in 5 European countries. (1) To describe the patterns of CBVCT use, (2) to estimate HIV incidence, and to identify determinants of (3) HIV seroconversion and (4) HIV and/or sexually transmitted infection (STI) test-seeking behaviour. All MSM aged 18 years or over and who had a negative HIV test result are invited to participate in the COmmunity-BAsed Cohort (COBA-Cohort). Study enrolment started in February 2015, and is due to continue for at least 12 months at each study site. Follow-up frequency depends on the testing recommendations in each country (at least 1 test per year). Sociodemographic data are collected at baseline; baseline and follow-up questionnaires both gather data on attitudes and perceptions, discrimination, HIV/STI testing history, sexual behaviour, condom use, and pre- and post-exposure prophylaxis. Descriptive, exploratory and multivariate analyses will be performed to address the main research objectives of this study, using appropriate statistical tests and models. These analyses will be performed on the whole cohort data and stratified by study site or country. The study was approved by the Public Health authorities of each country where the study is being implemented. Findings from the COBA-Cohort study will be summarised in a report to the European Commission, and in leaflets to be distributed to study participants. Articles and conference abstracts will be submitted to peer-reviewed journals and conferences.

Current research indicates that emotional support is strongly associated with physical and psychological adjustment in persons living with HIV/AIDS. While gender-differences in health and health behaviors of HIV positive patients are well studied, less is known about how men and women living with HIV/AIDS may differentially perceive and integrate support into their lives, and how it subsequently affects their psychological well-being. This cross-sectional study examines how emotional support received from partners and family/friends and gender explains psychological well-being (i.e., stress, depression, anxiety) in a sample of 409 partnered European HIV positive individuals. We hypothesized that gender would modify the associations between support and psychological well-being such that men would benefit more from partner support whereas women would benefit more from family/friend support. Results revealed that regardless of the source of support, men's well-being was more positively influenced by support than was women's well-being. Women's difficulties in receiving emotional support may have deleterious effects on their psychological well-being. © 2009 Springer Science+Business Media, LLC.