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Background An increasing number of studies are exploring the profiles of men who have sex with men (MSM) in the context of the sexualized use of drugs (chemsex). However, less attention has been paid to MSM who use drugs but do not engage in chemsex. We do not know to what extent the latter are different from the former, or whether they require similar harm reduction services. This study aimed to compare both populations in terms of their sexual risk practices, health, and pre-exposure prophylaxis (PrEP) use. Methods We used longitudinal data from the ongoing French cohort study ANRS-PREVENIR, which comprises 3076 MSM receiving PrEP. Analyses were conducted on MSM who engaged in chemsex, MSM who used drugs but did not engage in chemsex, and MSM who did not use drugs. Only persons with available data from at least one follow-up visit between M0 and M36 were included, representing 19,375 visits. We built a three-category outcome: (i) MSM who did not use drugs (non-DU), (ii) MSM who used drugs but did not engage in chemsex (DU), and (iii) MSM who engaged in chemsex (CX). A multinomial logistic functional form was used to estimate odds-ratios and 95% confidence intervals, using the DU category as a reference. Results Among the 2493 cohort participants, at baseline, 62.8%, 22.5%, and 14.6% of the participants were classified in the non-DU, DU, and CX categories, respectively. Compared to DU, non-DU were less likely to (i) declare fisting/BDSM practices, (ii) have a moderately risky sex life, ii) report lifetime PrEP use. Compared to DU, CX also had lower alcohol consumption, and were less likely to have (i) a tertiary education qualification, and (ii) a main partner; in contrast, CX were more likely to be depressed. CX were more likely to report fisting/BDSM practices, but less likely not to use PrEP and to report suboptimal PrEP adherence compared to DU participants. Conclusions Differences between the DU and CX populations were observed; the latter were more likely to (i) have at-risk sexual practices, (ii) suffer from depression, and (iii) have optimal PrEP adherence. It is essential to provide suitable mental health services to people who engage in chemsex, and to implement tailored sexual health and harm reduction services to MSM who use drugs but who do not engage in chemsex.

Chemsex—the use of drugs in a sexual context—has been associated with more at-risk sexual practices and substance-related complications in men who have sex with men (MSM). To date, no study has focused on the impact of France’s first coronavirus disease 2019 (COVID-19)-related lockdown on the mental health and drug/alcohol use of MSM who practice chemsex. We implemented a web-based survey of 9,488 MSM living in France in June 2020 (after the country’s first COVID-19 lockdown). Specifically, we first compared the subpopulation of MSM who self-reported practicing chemsex during their most recent sexual intercourse (defined as “chemsexers”) with other MSM, using five outcomes: increased 1/tobacco use, 2/alcohol use, and 3/other psychoactive drug use. 4/using psychotropic medication during the lockdown, and finally 5/psychological distress. We then analyzed the outcomes’ associations with the main explanatory variable “chemsexer,” after adjusting for all relevant variables. Among 7,195 MSM who had sexual intercourse with a man during the previous 6 months, 359 participants (5%) were identified as “chemsexers.” Multivariable analyses showed that during the first lockdown period, chemsexers were significantly more likely than non-chemsexers to have increased their use of tobacco, alcohol, and other psychoactive substances. Chemsexers were also more likely to have used psychotropic medication and to have experienced psychological distress during the previous month. Given the ongoing COVID-19 pandemic in France and worldwide, this finding highlights the need to develop psychosocial interventions and harm reduction services for MSM chemsexers, potentially via mobile health.

ObjectivesDespite the wide implementation of HIV oral pre-exposure prophylaxis (oPrEP), uptake, adherence and persistence issues remain. Long-acting injectable cabotegravir (CAB-LA) is a promising new PrEP HIV prevention option. However, little is known about oPrEP users’ interest in it. We investigated men who have sex with men (MSM) oPrEP users’ willingness to participate (WtP) in a CAB-LA PrEP study in France.MethodsWe designed a cross-sectional questionnaire (‘NewPrEP’) to evaluate attitudes to CAB-LA of daily and event-driven oPrEP users participating in the ANRS-PREVENIR cohort study (2017–2025). The outcome, WtP, was dichotomised into ‘Willing’ (absolutely/probably) or ‘Unwilling’ (probably not/absolutely not/I would like to discuss this with my doctor before making a decision). We used multivariate logistic Bayesian model averaging to estimate factors associated with WtP.ResultsOf the 1555 MSM followed in ANRS-PREVENIR in February 2023 with baseline data, 879 (57%) answered the NewPrEP questionnaire. Median age and follow-up time were 38 and 4.7 years, respectively; 37% and 22% were on daily- and event-driven oPrEP, respectively; 41% used a combination of both regimens. 64% had heard of CAB-LA PrEP, and 43% were WtP in a related study. Multivariate results showed that willing participants were younger and more likely to have heard of CAB-LA, to use daily oPrEP exclusively or in combination, to find it difficult to adhere to their regimen, to engage in chemsex, to trust their doctor and to be more interested in PrEP effectiveness than in the administration mode. They were less likely to perceive the obligatory 2-monthly hospital visits for CAB-LA PrEP as constraining, to be scared of injections and to fear long-acting medications.ConclusionsWtP in a CAB-LA study among MSM oPREP users was moderate but concentrated among those with the greatest need. This highlights the need to enable free distribution. Future studies should evaluate adherence and retention in long-acting iPrEP.

ObjectivesThis study investigated the acceptability by gay men, bisexual men and other men who have sex with men (GBMSM) of French public health information and prevention measures implemented during the 2022 Mpox outbreak.MethodsANRS-MPX-SHS \"Mpox: perception of risks, health measures and vaccination\" is a cross-sectional survey conducted in GBMSM between July and September 2022. Online questionnaires collected information about Mpox-related awareness, perceptions and prevention behaviours. Multiple correspondence analysis identified participant profiles according to their level of acceptability of the information and prevention measures implemented during the 2022 outbreak. The study outcome was a variable grouping participants into three profiles: ‘strong endorsers’, ‘uninformed hesitant endorsers’ and ‘indifferent objectors’. Multinomial logistic regression was used to estimate factors associated with each profile.ResultsOf the 5688 participants, 5320 (93.5%) had available data for the outcome. The latter were mostly cisgender men (98%), aged between 35 and 54 years (54.5%), with tertiary education (82%); 44% were living in the Greater Paris region. Strong endorsers, uninformed hesitant endorsers and indifferent objectors accounted for 77.8%, 14.4% and 7.8% of the sample, respectively. Participants with tertiary education, those who had sex exclusively with men, those taking pre-exposure prophylaxis (ie, HIV-negative participants), HIV-positive participants and individuals living in the Greater Paris region, were all less likely to be uninformed hesitant endorsers or indifferent objectors. Participants with no lifetime HIV/sexually transmitted infection (STI) screening and those with infrequent screening were, respectively, more likely to belong to these two profiles.ConclusionsParticipants’ acceptability of the information and prevention measures implemented during the 2022 Mpox outbreak in France depended on the perceived capability of public health authorities to effectively diversify information targets, representations and communication channels. In order to prevent the transmission of Mpox (and other STIs) in the general population in future outbreaks, information and measures adopted must take into account the needs, perceptions and experiences of persons never or not regularly screened for HIV/STIs.

Despite huge advances in the fight against HIV concerning diagnosis, clinical efficacy of antiretroviral treatments (ART), patient survival and quality of life, there is still no cure. Recent developments in HIV cure research have opened the way for clinical trials which could lead to a temporary or definitive end to ART. However, ethical questions exist about related trial-participation risks. The main goal of the ANRS-APSEC survey was, using Q-methodology, to investigate the viewpoints of people living with HIV (PLWH) and HIV healthcare providers (HHP) regarding motivations for and barriers to participation in HIV Cure-related clinical trials (HCRCT). Thirty-three statements were defined encompassing seven dimensions: treatment and follow-up; risks; benefits; patient-physician relationship; beliefs and attitudes; information; target population. Forty-one PLWH and 41 HHP from five French HIV services were asked to rank-order the statements. Five main viewpoints were elicited from \"the most motivated\" to \"the most reluctant\" vis-à-vis HCRCT participation. All placed importance on the wish to participate in HIV research. This result is in line with the HIV-specific culture of joint mobilization. For some viewpoints, the motivation to participate in/propose HCRCT was primarily conditioned by side-effects and/or by constraints, which overall were more accepted by PLWH than HHP. Some viewpoints placed particular importance on HCRCT recruitment strategies. Finally, some expressed a high acceptance of risks and constraints but emphasized the need for information. HIV cure research clinical trials (HCRCT) constitute a risky yet unavoidable step towards the goal of finding a cure. To improve future HCRCT and informed consent designs, based on PLWH and HHP preferences and expectations, we need greater knowledge about how these populations perceive the risks and the benefits of HCRCT. Our results confirmed the importance of careful, studied HCRCT design, management and communication, to ensure PLWH and HHP acceptability and convergence of their expectations.

Chemsex is mostly approached through the prism of risk-taking, neglecting the pleasure and social linking dimensions. However, feedback from the field and few studies highlights a diversity of chemsex practices and relationships to chemsex (RtC). Using Q-methodology, we identified the main RtC and their divergences and convergences, to help develop tailored prevention and care programs. Q-methodology enables the exploration of complex subjective structures and provides a multifaceted picture of a phenomenon. In 2019–2020, we asked 126 men who have sex with men living in France and practicing chemsex to rank order 37 statements. RtC were defined through by-person factor analysis and interpreted using a holistic process. Five RtC emerged, highlighting various motivations for practicing chemsex, relationships to substance use and to sexuality, and regulation strategies implemented: (1) From compensation to fulfillment; (2) The pleasure-seeking manager; (3) Between addiction and management; (4) From curiosity to the destruction of sexuality; and (5) From the hope of compensation to disillusion. Respondents all agreed on two statements: the need to first accept oneself as a drug user in order to be able to manage drug use, and the possibility of harm reduction during chemsex sessions. Our results are the first to elicit the main RtC and the intricacies between the dimensions at stake. The five analysis-based narratives derived from RtC might facilitate discussion during interviews or support groups on chemsex, and could serve as a standardized survey tool. Our findings advocate longitudinal studies to identify factors associated with shifting from one RtC to another.

HIV cure-related clinical trials (HCRCT) with analytical antiretroviral treatment interruptions (ATIs) have become unavoidable. However, the limited benefits for participants and the risk of HIV transmission during ATI might negatively impact physicians’ motivations to propose HCRCT to patients. Between October 2016 and March 2017, 164 French HIV physicians were asked about their level of agreement with four viewpoints regarding HCRCT. A reluctance score was derived from their answers and factors associated with reluctance identified. Results showed the highest reluctance to propose HCRCT was among physicians with a less research-orientated professional activity, those not informing themselves about cure trials through scientific literature, and those who participated in trials because their department head asked them. Physicians’ perceptions of the impact of HIV on their patients’ lives were also associated with their motivation to propose HCRCT: those who considered that living with HIV means living with a secret were more motivated, while those worrying about the negative impact on person living with HIV’s professional lives were more reluctant. Our study highlighted the need to design a HCRCT that minimizes constraints for participants and for continuous training programs to help physicians keep up-to-date with recent advances in HIV cure research.

This paper analyses how French general practitioners’ (GPs) labour supply would respond to changes in their fee per consultation, seeking to determine whether there is a backward-bending curve. Because French GPs’ fees only evolve very slowly and are generally fixed by the National Health Insurance Fund, fee variability is not sufficient to observe changes in labour supply. Therefore, we designed a contingent valuation survey randomly presenting GPs with three hypothetical fee increases. Empirical evidence from 1,400 GPs supports the hypothesis of a negative slope in their labour supply curve. This suggests that increasing fees is not an effective policy to increase the supply of medical services. JEL Codes: C21, I12, J22, J4.

Introduction Despite the advent of HIV cure‐related clinical trials (HCRCT) for people living with HIV (PLWH), the risks and uncertainty involved raise ethical issues. Although research has provided insights into the levers and barriers to PLWH and physicians' participation in these trials, no information exists about stakeholders' preferences for HCRCT attributes, about the different ways PLWH and physicians value future HCRCT, or about how personal characteristics affect these preferences. The results from the present study will inform researchers' decisions about the most suitable HCRCT strategies to implement, and help them ensure ethical recruitment and well‐designed informed consent. Methods Between October 2016 and March 2017, a discrete choice experiment was conducted among 195 virally controlled PLWH and 160 physicians from 24 French HIV centres. Profiles within each group, based on individual characteristics, were obtained using hierarchical clustering. Trade‐offs between five HCRCT attributes (trial duration, consultation frequency, moderate (digestive disorders, flu‐type syndrome, fatigue) and severe (allergy, infections, risk of cancer) side effects (SE), outcomes) and utilities associated with four HCRCT candidates (latency reactivation, immunotherapy, gene therapy and a combination of latency reactivation and immunotherapy), were estimated using a mixed logit model. Results Apart from severe SE – the most decisive attribute in both groups – PLWH and physicians made different trade‐offs between HCRCT attributes, the latter being more concerned about outcomes, the former about the burden of participation (consultation frequency and moderate SE). These different trades‐offs resulted in differences in preferences regarding the four candidate HCRCT. PLWH significantly preferred immunotherapy, whereas physicians preferred immunotherapy and combined therapy. Despite the heterogeneity of characteristics within the PLWH and physician profiles, results show some homogeneity in trade‐offs and utilities regarding HCRCT. Conclusions Severe SE, not outcomes, was the most decisive attribute determining future HCRCT participation. Particular attention should be paid to providing clear information, in particular on severe SE, to potential participants. Immunotherapy would appear to be the best HCRCT candidate for both PLWH and physicians. However, if the risk of cancer could be avoided, gene therapy would become the preferred strategy for the latter and the second choice for the former.

The applicability and efficacy of a scalp cooling system were studied in 105 breast cancer patients receiving four cycles of adjuvant chemotherapy with mitoxantrone + cyclophosphamide (NC chemotherapy). Women accepting the scalp-cooling system were compared for alopecia both against those who refused and against a \"reference\" group of 109 patients similarly treated but without being offered a scalp-cooling system. Hair loss in the 105 study patients was evaluated by nurses using World Health Organization (WHO) criteria at each cycle of chemotherapy. Concomitantly, tolerance and side-effects of the helmet were also recorded in 48 accepting patients. Similarly to reference group patients, a subsample of 27 accepting patients self-assessed hair loss using a specific questionnaire measuring its frequency and severity and the distress associated with this symptom. Nurses' ratings ( n = 105) indicated that hair loss frequency was constantly lower, at each cycle of chemotherapy, in study patients with scalp-cooling system ( n = 77) than in those without ( n = 28). Differences between the two groups were statistically significant at cycles 1 and 3 ( P < 0.05). When compared with those reported by reference group patients ( n = 109), study patients' self-measures of alopecia frequency ( n = 27) provided even more marked results than those achieved by nurses (cycles 1-3: P < 0.01; cycle 4: P < 0.05). Tolerance was generally good and no scalp metastasis was observed among the 77 accepting patients followed up. This study demonstrates that scalp cooling was an effective method of protection against hair loss caused by NC chemotherapy. Its routine use as part of adjuvant chemotherapy, especially in cancers with low prevalences of scalp metastasis, should be seriously considered.