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David Stuart

Chemsex Snapshot; anecdotal update, Oct 2019

  • Typically between 40 and 60 walk in presentations per week
  • Almost consistent ART adherence among HIV positive attendees
  • Estimated 80 to 90% PrEP use amongst HIV negative attendees, thanks to PRIME. PrEP adherence seems 100% consistent
  • Not seen any remarkable rise in HCV
  • Consistent committed injectors are still the minority, but we are seeing a gentle rise over the years
  • Opportunistic occasional injecting is very common, perhaps 70 to 80% of attendees.
  • Mephedrone use seems to be declining, as meth use increases. Meth prices are dropping. G use is consistent
  • Increase in psychosis presentations. We have a lot of conversations about imaginary voices now, and how to manage them.
  • Typically, people are using every weekend, or to a lesser extent, monthly.
  • Most common goal is to take a break for a weekend with relapse prevention training. We try to extend this to 6 week plans.
  • Typical number of partners per chem-using episode is between 2 and 5

An estimated:

  • 30% visit us weekly for a 3 month period
  • 30% visit us weekly or bi-weekly for a 3 to 4 week period
  • 20% visit us repeatedly for one-offs, with long breaks between each visit
  • 20% are crisis presentations that we never see again (ish)
  • 0 to 3% attend for harm reduction information.
  • 10% attend for safer injecting equipment

  • Almost consistently, patients report zero sober sex. Rare exceptions are when in a relationship
  • Almost consistently, patients report zero condom use.
  • Patients who attend alone, or who cannot name a best friend who knows they’ve come, is approx. 95%
  • Most are wanting to make changes, but ambivalent, fearful or not confident. Rarely does a person identify complete abstinence as a goal, unless motivated by a recent trauma.

I’d estimate that close to 95% of attendees learn skills to improve their chem use, and find this helpful.

I’d estimate that 99% feel improved for having a kind person to discuss this with and a safe space to explore these issues.

80% of people who complete a 6 (+) week programme achieve their goals

Strategically; this cohort is THE highest risk group for HIV/STIs and drug-related deaths in London. Regular engagement with this cohort over the last 9 years has afforded us the unique opportunity to influence the direction of London’s HIV epidemic.Since 2011, we have been successfully engaging them in very large numbers, and in very frequent visits, during times of very high risk.This is low-threshold, assessment-free, walk-in access, with robust links to regular testing and PrEP/PEP HIV prevention awareness & mental health support, behaviour change/psychosocial interventions, harm reduction/death prevention.