Sexual behaviour, STI and HIV testing and testing need among gay, bisexual and other men who have sex with men recruited for online surveys pre/post-COVID-19 restrictions in the UK.

OBJECTIVES: We examined sexual behaviour, sexually transmitted infection (STI) and HIV testing and testing need, and identified associated factors, among gay, bisexual and other men who have sex with men (GBMSM) in the UK after COVID-19 restrictions ended, and compared these with 'pre-pandemic' estimates. METHODS: We analysed survey data from GBMSM (N=1039) recruited via social media and Grindr in November-December 2021. We then compared Grindr-recruited 2021 participants (N=437) with those from an equivalent survey fielded in March-May 2017 (N=1902). Questions on sexual behaviour and service use had lookback periods of 3-4 months in both surveys. Unmet testing need was defined as reporting any new male and/or multiple condomless anal sex (CAS) partners without recent STI/HIV testing. Participants were UK residents, GBMSM, aged ≥16 years who reported sex with men in the last year. Multivariable logistic regression identified associated sociodemographic and health-related factors with unmet STI/HIV testing need in 2021, and then for 2017/2021 comparative analyses, adjusting for demographic differences. RESULTS: In 2021, unmet STI and HIV testing need were greater among older GBMSM (aged ≥45 years vs 16-29 years; adjusted OR (aOR): 1.45 and aOR: 1.77, respectively), and lower for pre-exposure prophylaxis (PrEP) users (vs non-PrEP users; aOR: 0.32 and aOR: 0.23, respectively). Less unmet STI testing need was observed among HIV-positive participants (vs HIV-negative/unknown; aOR: 0.63), and trans and non-binary participants (vs cisgender male; aOR: 0.34). Between 2017 (reference) and 2021, reported sexual risk behaviours increased: ≥1 recent new male sex partner (72.1%-81.1%, aOR: 1.71) and ≥2 recent CAS partners (30.2%-48.5%, aOR: 2.22). Reporting recent STI testing was greater in 2021 (37.5%-42.6%, aOR: 1.34) but not recent HIV testing, and there was no significant change over time in unmet STI (39.2% vs 43.7%) and HIV (32.9% vs 39.0%) testing need. DISCUSSION: Comparable community surveys suggest that UK resident GBMSM may have engaged in more sexual risk behaviours in late 2021 than pre-pandemic. While there was no evidence of reduced STI/HIV service access during this time, there remained considerable unmet STI/HIV testing need

Difficulty accessing condoms because of the COVID-19 pandemic reported by gay, bisexual and other men who have sex with men in the UK: findings from a large, cross-sectional, online survey.

BACKGROUND: COVID-19 restrictions severely reduced face-to-face sexual health services, an important access point for condoms. We examine whether gay, bisexual and other men who have sex with men (GBMSM) in the UK had difficulty accessing condoms during the first year of the pandemic, and if so, which groups were most affected. METHODS: Questions about difficulty accessing condoms were asked as part of a short, online cross-sectional survey of GBMSM undertaken November/December 2021, recruited via social media and Grindr. Eligible participants were UK-resident GBMSM (cis/trans/gender-diverse person assigned male at birth [AMAB]), aged ≥16 years who were sexually active (reported sex with men in the last year). Multivariable logistic regression was used to examine if and how reporting this outcome varied by key sociodemographic, health and behavioural factors independent of the potential confounding effect of numbers of new male sex partners. RESULTS: Of all participants (N = 1039), 7.4% (n = 77) reported difficulty accessing condoms due to the pandemic. This was higher among younger GBMSM (aged 16-29 years vs. ≥45; 12.8% vs. 4.9%; aOR: 2.78); trans/gender-diverse AMAB participants (vs. cis gender males; 24.4% vs. 6.6%; aOR = 4.86); bisexually-identifying participants (vs. gay-identifying; 11.1% vs. 6.5%; aOR = 1.78); and those without degree level education (vs. having a degree; 9.8% vs. 5.6%; aOR = 2.01). CONCLUSIONS: A minority of sexually active GBMSM reported difficulty accessing condoms because of the pandemic, however, this was more common amongst those who already experience a disproportionate burden of poor sexual health. Interventions are needed to address these inequalities in accessing this important primary STI/HIV prevention measure

COVID-19 infection and vaccination uptake in men and gender-diverse people who have sex with men in the UK: analyses of a large, online community cross-sectional survey (RiiSH-COVID) undertaken November-December 2021.

BACKGROUND: Men and gender-diverse people who have sex with men are disproportionately affected by health conditions associated with increased risk of severe illness due to COVID-19 infection. METHODS: An online cross-sectional survey of men and gender-diverse people who have sex with men in the UK recruited via social networking and dating applications from 22 November-12 December 2021. Eligible participants included self-identifying men, transgender women, or gender-diverse individuals assigned male at birth (AMAB), aged ≥ 16, who were UK residents, and self-reported having had sex with an individual AMAB in the last year. We calculated self-reported COVID-19 test-positivity, proportion reporting long COVID, and COVID-19 vaccination uptake anytime from pandemic start to survey completion (November/December 2021). Logistic regression was used to assess sociodemographic, clinical, and behavioural characteristics associated with SARS-CoV-2 (COVID-19) test positivity and complete vaccination (≥ 2 vaccine doses). RESULTS: Among 1,039 participants (88.1% white, median age 41 years [interquartile range: 31-51]), 18.6% (95% CI: 16.3%-21.1%) reported COVID-19 test positivity, 8.3% (95% CI: 6.7%-10.1%) long COVID, and 94.5% (95% CI: 93.3%-96.1%) complete COVID-19 vaccination through late 2021. In multivariable models, COVID-19 test positivity was associated with UK country of residence (aOR: 2.22 [95% CI: 1.26-3.92], England vs outside England) and employment (aOR: 1.55 [95% CI: 1.01-2.38], current employment vs not employed). Complete COVID-19 vaccination was associated with age (aOR: 1.04 [95% CI: 1.01-1.06], per increasing year), gender (aOR: 0.26 [95% CI: 0.09-0.72], gender minority vs cisgender), education (aOR: 2.11 [95% CI: 1.12-3.98], degree-level or higher vs below degree-level), employment (aOR: 2.07 [95% CI: 1.08-3.94], current employment vs not employed), relationship status (aOR: 0.50 [95% CI: 0.25-1.00], single vs in a relationship), COVID-19 infection history (aOR: 0.47 [95% CI: 0.25-0.88], test positivity or self-perceived infection vs no history), known HPV vaccination (aOR: 3.32 [95% CI: 1.43-7.75]), and low self-worth (aOR: 0.29 [95% CI: 0.15-0.54]). CONCLUSIONS: In this community sample, COVID-19 vaccine uptake was high overall, though lower among younger age-groups, gender minorities, and those with poorer well-being. Efforts are needed to limit COVID-19 related exacerbation of health inequalities in groups who already experience a greater burden of poor health relative to other men who have sex with men

The success of HIV combination prevention: The Dean Street model

The 56 Dean Street combination prevention model, a strong engagement with the LGBTQI community and flexible services adapted to users’ changing needs led to an 80% drop in HIV diagnoses in gay, bisexual and other men who have sex with men (GBMSM) from 2015 to 2017. We describe the service changes at 56 Dean Street since 2012 which resulted in an increase in the frequency of HIV testing, the introduction of pre-exposure prophylaxis, earlier HIV diagnosis and a shorter time to viral suppression in those living with HIV. This model could be adapted to deliver similar results in those settings of high HIV prevalence among GBMSM and where access to technological innovation in healthcare and engagement with the community can be achieved

A Census of Star-Forming Galaxies in the z~9-10 Universe based on HST+Spitzer Observations Over 19 CLASH clusters: Three Candidate z~9-10 Galaxies and Improved Constraints on the Star Formation Rate Density at z~9

We utilise a two-color Lyman-Break selection criterion to search for z~9-10 galaxies over the first 19 clusters in the CLASH program. A systematic search yields three z~9-10 candidates. While we have already reported the most robust of these candidates, MACS1149-JD, two additional z~9 candidates are also found and have H_{160}-band magnitudes of ~26.2-26.9. A careful assessment of various sources of contamination suggests <~1 contaminants for our z~9-10 selection. To determine the implications of these search results for the LF and SFR density at z~9, we introduce a new differential approach to deriving these quantities in lensing fields. Our procedure is to derive the evolution by comparing the number of z~9-10 galaxy candidates found in CLASH with the number of galaxies in a slightly lower redshift sample (after correcting for the differences in selection volumes), here taken to be z~8. This procedure takes advantage of the fact that the relative volumes available for the z~8 and z~9-10 selections behind lensing clusters are not greatly dependent on the details of the lensing models. We find that the normalization of the UV LF at z~9 is just 0.28_{-0.20}^{+0.39}\times that at z~8, ~1.4_{-0.8}^{+3.0}x lower than extrapolating z~4-8 LF results. While consistent with the evolution in the UV LF seen at z~4-8, these results marginally favor a more rapid evolution at z>8. Compared to similar evolutionary findings from the HUDF, our result is less insensitive to large-scale structure uncertainties, given our many independent sightlines on the high-redshift universe.Comment: 22 pages, 11 figures, 5 tables, accepted for publication in the Astrophysical Journal, updated to include the much deeper Spitzer/IRAC observations over our three z~9-10 candidate

RELICS: The Reionization Lensing Cluster Survey and the Brightest High-z Galaxies

Massive foreground galaxy clusters magnify and distort the light of objects behind them, permitting a view into both the extremely distant and intrinsically faint galaxy populations. We present here the z ~ 6-8 candidate high-redshift galaxies from the Reionization Lensing Cluster Survey (RELICS), a Hubble and Spitzer Space Telescope survey of 41 massive galaxy clusters spanning an area of ≈200 arcmin². These clusters were selected to be excellent lenses, and we find similar high-redshift sample sizes and magnitude distributions as the Cluster Lensing And Supernova survey with Hubble (CLASH). We discover 257, 57, and eight candidate galaxies at z ~ 6, 7, and 8 respectively, (322 in total). The observed (lensed) magnitudes of the z ~ 6 candidates are as bright as AB mag ~23, making them among the brightest known at these redshifts, comparable with discoveries from much wider, blank-field surveys. RELICS demonstrates the efficiency of using strong gravitational lenses to produce high-redshift samples in the epoch of reionization. These brightly observed galaxies are excellent targets for follow-up study with current and future observatories, including the James Webb Space Telescope

Demand for and availability of specialist chemsex services in the UK: A cross-sectional survey of sexual health clinics.

BACKGROUND/INTRODUCTION: Chemsex amongst men who have sex with men (MSM) is well documented in major cities within the United Kingdom (UK), but few data from less urban areas exist. We undertook a survey of sexual health clinic (SHC) healthcare workers (HCWs) to explore demand for and availability of chemsex services to understand training needs and inform service planning. METHODS: An online survey was distributed to HCWs in all SHCs across the UK. For English clinics, we explored associations between responses and geo-demographic region using national surveillance data and population statistics. RESULTS: Responses were received from 56% (150/270) of SHC's in the UK (89% (133/150) from English clinics). 80% (103/129) of UK clinics reported chemsex consultations and in 50% (65/129) these occurred at least monthly, with no significant difference found when analysed by the geo-demographic characteristics of England (p=0.38). Respondents from most clinics (99% (117/118)) wanted chemsex training, 81 %(103/129) felt there was a local clinical need for a chemsex service and 33% (14/43) had chemsex care-pathways for referrals in place. DISCUSSION/CONCLUSION: Patients reporting chemsex regularly present to SHCs throughout the UK including rural areas. Given the potential negative health outcomes associated with chemsex, there is a need for local, high quality, appropriate services and training to minimise harm

CLASH: Photometric redshifts with 16 HST bands in galaxy cluster fields

The Cluster Lensing And Supernovae survey with Hubble (CLASH) is an Hubble Space Telescope (HST) Multi-Cycle Treasury program observing 25 massive galaxy clusters. CLASH observations are carried out in 16 bands from UV to NIR to derive accurate and reliable estimates of photometric redshifts. We present the CLASH photometric redshifts and study the photometric redshift accuracy of the arcs in more detail for the case of MACS1206.2-0847. We use the publicly available Le Phare and BPZ photometric redshift codes on 17 CLASH galaxy clusters. Using Le Phare code for objects with StoN>=10, we reach a precision of 3%(1+z) for the strong lensing arcs, which is reduced to 2.4%(1+z) after removing outliers. For galaxies in the cluster field the corresponding values are 4%(1+z) and 3%(1+z). Using mock galaxy catalogues, we show that 3%(1+z) precision is what one would expect from the CLASH photometry when taking into account extinction from dust, emission lines and the finite range of SEDs included in the photo-z template library. We study photo-z results for different aperture photometry and find that the SExtractor isophotal photometry works best. Le Phare and BPZ give similar photo-z results for the strong lensing arcs as well as galaxies of the cluster field. Results are improved when optimizing the photometric aperture shape showing an optimal aperture size around 1" radius giving results which are equivalent to isophotal photometry. Tailored photometry of the arcs improve the photo-z results.Comment: Accepted in A&A on nov 201

The role of frequent HIV testing in diagnosing HIV in men who have sex with men

OBJECTIVES: In the UK, quarterly HIV testing is recommended for high‐risk men who have sex with men (MSM). In this manuscript we determined the risk of being newly diagnosed with HIV in MSM by their HIV testing history, considering both the frequency and periodicity of testing. METHODS: Data on HIV incidence in MSM attending a sexual health clinic (SHC) in England in 2013−2014 with testing history (previous 2 years) were obtained from GUMCAD, the national sexually transmitted infection (STI) surveillance system in England. HIV testing patterns among MSM were defined using the frequency and periodicity of testing, based on 3 month intervals, in the year preceding the first attendance during the study period. Cox proportional hazards regression was used to determine the association between HIV testing pattern and time to HIV diagnosis with and without adjustment for demographic confounders. Analyses were stratified by risk stratum, with ‘high risk’ defined as a history of a bacterial STI in the past year. Adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) are reported. RESULTS: Among the 37 702 HIV‐negative MSM attending an SHC in 2013−2014, 1105 (3%) were diagnosed with HIV infection within 1 year of their first attendance. The probability of HIV diagnosis was highest in MSM who were tested quarterly compared with those who were not tested in the past year (aHR 2.51; 95% CI 1.33–4.74); this increased 1.8‐fold among high‐risk MSM (aHR 4.48; 95% CI 0.97–21.17). CONCLUSIONS: The probability of subsequent HIV diagnosis was greatest in high‐risk MSM who were tested most frequently. Quarterly HIV testing increased the likelihood of identifying undiagnosed HIV infection and should remain a continued recommendation for high‐risk MSM

CLASH: New Multiple-Images Constraining the Inner Mass Profile of MACS J1206.2-0847

We present a strong-lensing analysis of the galaxy cluster MACS J1206.2-0847 ($z$=0.44) using UV, Optical, and IR, HST/ACS/WFC3 data taken as part of the CLASH multi-cycle treasury program, with VLT/VIMOS spectroscopy for some of the multiply-lensed arcs. The CLASH observations, combined with our mass-model, allow us to identify 47 new multiply-lensed images of 12 distant sources. These images, along with the previously known arc, span the redshift range 1\la z\la5.5, and thus enable us to derive a detailed mass distribution and to accurately constrain, for the first time, the inner mass-profile of this cluster. We find an inner profile slope of $d\log \Sigma/d\log \theta\simeq -0.55\pm 0.1$ (in the range [1\arcsec, 53\arcsec], or 5\la r \la300 kpc), as commonly found for relaxed and well-concentrated clusters. Using the many systems uncovered here we derive credible critical curves and Einstein radii for different source redshifts. For a source at $z_{s}\simeq2.5$, the critical curve encloses a large area with an effective Einstein radius of \theta_{E}=28\pm3\arcsec, and a projected mass of $1.34\pm0.15\times10^{14} M_{\odot}$. From the current understanding of structure formation in concordance cosmology, these values are relatively high for clusters at $z\sim0.5$, so that detailed studies of the inner mass distribution of clusters such as MACS J1206.2-0847 can provide stringent tests of the $\Lambda$CDM paradigm.Comment: 7 pages, 1 table, 4 figures; submitted to ApJ Letters; V3: minor correction