In Kazakhstan, the HIV epidemic has a significant impact on marginalized groups such as gay, bisexual and other men who have sex with men (GBMSM), exacerbated by homophobic attitudes (in society) and (resulting) minority stress. This stress often leads to coping behaviors such as chemsex - the use of synthetic stimulants to enhance sexual experiences. Our study explores the motivations and perceived risks associated with chemsex among GBMSM in Almaty. We conducted semi-structured in-depth interviews with 21 chemsex participants self-identified as GBMSM in Almaty, Kazakhstan. Participants were recruited through community-based organizations to ensure a diverse sample in terms of age and ethnicity. Thematic analysis was used to identify key themes related to motivations and risks. Participants practiced chemsex to seek liberation from societal norms and personal inhibitions, increase sexual pleasure, and escape daily stressors. Chemsex sessions provided intensified sexual experiences, emotional comfort, and social connections, challenging constraints on sexual behavior. Participants recognized significant risks, including mental and physical health issues, social stigma, and violence victimisation. Despite these risks, the desire for the perceived benefits of chemsex, particularly feelings of freedom and happiness, underscored its appeal. The study reveals a complex dynamic in which chemsex serves as a coping mechanism for minority stress, a source of sexual liberation, and a social connector for GBMSM in Kazakhstan, while also posing significant health risks. These findings emphasize the need for targeted harm reduction strategies, mental health support, and community-building efforts that are responsive to the experiences and needs of GBMSM who engage in chemsex.

The use of illicit drugs during sex (Chemsex) in gay, bisexual and men who have sex with men (GBMSM) has been a challenge for sexual health services globally. In Russia, HIV remains a significant public health concern and access to prevention and treatment services is limited. Little is known about the nature of Chemsex and the challenges GBMSM practicing Chemsex in Russia face when accessing medical care. This study explored GBMSM's experience with Chemsex and access to medical care. We conducted three focus groups with GBMSM (n = 19) based in Moscow and Yekaterinburg in December 2020. The focus groups explored their experience with Chemsex and accessing medical care. We used an Interpretative Phenomenological Analysis to analyze the data. GBMSM engaged in Chemsex through social networks and cited pleasure as one of their main reasons for engaging. The men described their addiction and perceiving many dangers at Chemsex group sessions. They reported using several self-care mechanisms to recover after a group session. Many reported feeling stigmatization from other members of the GBMSM community. Perceived barriers to medical care included legal barriers and stigmatization from medical professionals. To better support GBMSM, they felt there was a need for better access to sexual health and HIV prevention services, and psychological support. Our study highlights the unmet need in services for GBMSM engaging in Chemsex in Russia. It highlights how societal perceptions of homosexuality and drug use act as barriers to effective interventions for both sexual health and drug use.

Background: In the Kyrgyz Republic, it is estimated that 18% of people living with HIV are undiagnosed and more than half are diagnosed late (CD4 lymphocyte count of <350 cells/μL). For viral hepatitis, before 2023, free testing was only available to people living with HIV, which led to a low testing uptake. A new national program on the elimination of HIV and viral hepatitis infection for the years 2023-2027 recognizes the need to scale up testing to reduce the gap in undiagnosed people in the country. Objective: This study aimed to identify and describe the most important barriers and facilitators to HIV and viral hepatitis B, C, and D testing from the perspective of health care workers working in primary health care settings in the Kyrgyz Republic. Methods: A cross-sectional, mixed methods study was conducted in 2 phases. A purposive sampling approach was applied to recruit health care workers in primary health care settings. In phase I, in-depth, semistructured interviews were conducted with 22 participants to gather detailed information about the key barriers and facilitators for testing. We applied a thematic approach for qualitative analysis. The themes identified informed the development of a questionnaire with the main barriers and facilitators for phase II. The questionnaire was distributed electronically, and the target sample size was 400 participants. We performed descriptive analyses of the questionnaire data, reporting the most frequently mentioned barriers and facilitators for HIV and viral hepatitis testing. Results: The study received financial support in the framework of the Global Health Protection Programme by the Federal Government of Germany. Data collection took place in June 2024 for phase I and in November 2024 for phase II. Data analyses and writing up of results will be done in early 2025 and results are expected to be published in spring 2025. Conclusions: The results of the study will improve the understanding of existing barriers and facilitators to HIV and viral hepatitis testing in order to increase testing offers and uptake in primary health care settings in the Kyrgyz Republic. Importantly, the findings will inform steps to improve the implementation of the new testing strategy and, ultimately, increase the number of people diagnosed and treated in the Kyrgyz Republic. International Registered Report Identifier (IRRID): PRR1-10.2196/62929

Background: Mpox denotes a viral zoonosis caused by the Orthopoxvirus monkeypox (MPXV), which is endemic in West and Central Africa. In spring 2022, notable outbreaks of MPXV clade IIb were recorded in several high-income countries, predominantly affecting men who have sex with men (MSM). At the peak of the outbreak, over 200 new mpox cases per week were reported in Berlin, which constitutes one of the largest MSM population in Europe. Within the same year, the outbreak significantly declined, and it is unclear which factors contributed to this rapid decrease. Methods: To investigate the concomitant effects of sexual contact networks, transient contact reductions and the effect of infection- vs. vaccine-derived immunity on the 2022 mpox outbreak, we calibrated an agent-based model with epidemic, vaccination, contact- and behavioral data. Results: Our results indicate that vaccination has a marginal effect on the epidemic decline. Rather, a combination of infection-induced immunity of high-contact individuals, as well as transient behavior changes reduce the number of susceptible individuals below the epidemic threshold. However, the 2022 mpox vaccination campaign, together with infection-derived immunity may contribute to herd-immunity in the Berlin MSM population against ongoing clade I mpox outbreaks. Demographic changes and immune waning may deteriorate this herd immunity over time. Conclusions: These findings highlight that, in addition to vaccination, timely and clear communication of transmission routes may trigger spontaneous protective behavior within key populations; underscoring the importance of targeted sexual health education as a core component of outbreak response.

Introduction: Men-who-have-sex-with-men (MSM), as well as transgender and non-binary individuals, continue to face a disproportionate burden of stigma, mental health challenges, HIV, and other sexually transmitted infections. To address their needs, public health planners require reliable and comparable data. Monitoring behaviours in these populations also supports the evaluation of health policies. Methods: The European-MSM-Internet-Survey (EMIS-2024) builds on our international surveys conducted in 2010 and 2017, expanding its scope to include explicitly transgender women and non-binary people. It provides much-needed data for planning interventions, promoting health, and harmonising behavioural surveillance. A key strength of EMIS-2024 is the use of a shared sampling frame and a core questionnaire across all participating countries. This approach allows meaningful cross-national comparisons, unlike many national surveys with varying methods. The three core consortium partners (Deutsche Aidshilfe, Robert Koch Institute and Maastricht University) led the revision of the EMIS-2017 questionnaire. Results: Over 60 partners from 40 countries played a key role in the survey’s success, providing high-quality translations in 35 languages and actively promoting the survey. National partners ensured the survey’s visibility, credibility, and relevance once dating app advertisements or invitations appeared. The survey ran online during the first half of 2024. Overall, 165,380 responses were received, of which 50,330 qualified for the analytic sample. Conclusions and Policy Implications: EMIS-2024 demonstrates that large-scale, multi-country sexual health surveys are feasible with public funding. A harmonised questionnaire, shared sampling strategy, and meaningful community involvement were key to generating robust, comparable data across Europe.

Mpox denotes a viral zoonosis caused by monkeypox virus (MPXV), which is endemic in West and Central Africa. In spring 2022, notable outbreaks of mpox clade IIb were recorded in several high-income countries, predominantly affecting men who have sex with men (MSM). At the peak of the outbreak, over 200 new mpox cases per week were reported in Berlin, which constitutes one of the largest MSM communities in Europe. Within the same year, the outbreak virtually disappeared, and it is unclear which factors contributed to its rapid decline. To investigate the concomitant effects of sexual contact networks, transient contact reductions and the effect of infection- vs. vaccine-derived immunity on the 2022 mpox outbreak, we calibrated an agent-based model with epidemic, vaccination, contact- and behavioral data. Our results indicate that vaccination had a marginal effect on the epidemic decline. Rather, a combination of infection-induced immunity of high-contact individuals, as well as transient behavior changes reduced the number of susceptible individuals below the epidemic threshold. However, the 2022 mpox vaccination campaign, together with infection-derived immunity may have contributed to herd-immunity in the Berlin MSM community against ongoing clade I mpox outbreaks, which are responsible for the death of 1,140 individuals in Kongo alone. However, demographic changes and immune waning will deteriorate this herd immunity over time.