Prevalence of hepatitis C in a Swiss sample of men who have sex with men: whom to screen for HCV infection?

BACKGROUND While the numbers of hepatitis-C-virus (HCV) infections among men who have sex with men (MSM) who are co-infected with the human immunodeficiency virus (HIV) are on the rise, with vast evidence for sexual transmission of HCV in this population, concerns have also been raised regarding sexual HCV-transmission among MSM without HIV infection. Therefore, the aim of this study was to estimate the prevalence of hepatitis C among MSM without HIV diagnosis in Zurich (Switzerland). METHODS Participants were recruited from a gay health centre and various locations such as dark rooms, saunas and cruising areas in Zurich. Participants self-completed a questionnaire assessing known and suspected risk factors for HCV-infection, and provided a blood sample for detection of past (antibodies) and present (core antigen, RNA) infections with HCV. RESULTS In total, 840 MSM aged 17-79 (median: 33 years) underwent HCV-testing and completed the questionnaire, among whom 19 reported living with HIV. Overall, seven tested positive for HCV-antibodies, and two were also positive for HCV core antigen and HCV-RNA-these two were immigrants, one from a country where HCV is endemic. None of the seven were aware of their infection. The seroprevalence of hepatitis C among the 821 non-HIV-diagnosed MSM was 0.37% (95%-CI: 0.12-1.69%), and one man harboured replicating virus (0.12%; 0.02-0.69%), resulting in a number needed to test of 821 to detect one active infection. Significant univariable associations of lifetime HCV-infection were found with known HIV-diagnosis (OR=72.7), being tattooed (OR=10.4), non-injection use of cocaine/amphetamines (OR=8.8), and non-Swiss origin (OR=8.5). For MSM without HIV-diagnosis, the only variable marginally associated with positive HCV-serostatus was being tattooed (OR=8.3). No significant associations were observed with reported injection drug use, unprotected anal intercourse, sexual practices that may lead to mucosal trauma, or proxy measures for group sex and lesion-prone STIs. CONCLUSIONS Our findings suggest that in Switzerland, hepatitis C among MSM without diagnosed HIV is not more prevalent than in the general population. We found no evidence of elevated rates of sexual transmission of HCV among MSM without HIV-infection. Therefore, we currently see no reason for promoting HCV-testing among all MSM in Switzerland

Queer quit: a pilot study of a smoking cessation programme tailored to gay men

BACKGROUND: The prevalence of cigarette smoking among adult gay males is higher than that of heterosexuals. There is a need for interventions adapted to gay culture. We conducted a pilot study using a modified version of a British smoking intervention programme tailored to gay men in Switzerland. As the main outcome, we assessed point prevalence smoking abstinence six months following programme attendance. METHODS: Seventy gay smokers attended seven weekly sessions in groups (median size = 5) taught by gay facilitators. A quit day was set in session 3. Integral components of the intervention were: discussing nicotine replacement therapy, performing carbon monoxide tests and forming 'quit teams'. Seven-day point prevalence smoking abstinence, mental and physical health and the frequency of alcohol and drug use were assessed at baseline, in session 7 and at a six-month follow-up. RESULTS: Point prevalence abstinence significantly increased throughout the study (p = .00). At six months, 20 participants (28.6%) reported smoking abstinence over the previous 7 days. We observed increases in participants' mental health between baseline and the six-month follow-up (p = .00). Participants who dropped out during the programme or were lost to follow-up smoked more cigarettes and were more nicotine dependent than the participants who were retained throughout the study duration (p ≤ .05). CONCLUSIONS: This smoking cessation programme for gay men produced rates of point prevalence abstinence that were similar to interventions for non-gay groups. The programme presented an opportunity for gay men to quit smoking and interact with other gay non-smokers. Our results confirm the need to test this programme more systematically with a view toward implementing it on a larger scale in Switzerland