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Public Health England's (PHE) recent report described transmission of sexually transmitted infections (STIs) among men who have sex with men (MSM) despite evidence of access and engagement with services.1 In 2014, a London Health Protection Team (HPT) was notified of 40 men linked to a single residence, all newly infected with HIV and other STIs. Investigation revealed high levels of drug use such as crystal methamphetamine—a known ‘chemsex drug’. Chemsex is sex that occurs while using recreational drugs, frequently unprotected and high risk in nature.1
As part of a service improvement, we reflect on the management of this outbreak and propose PHE should standardise their response to chemsex outbreaks. This was the first chemsex outbreak managed by a London HPT and the pre-existing ‘Guidance for managing STI outbreaks and incidents, 2010′ was used. The Incident Control Team implemented primary and secondary interventions, including sexual health messages using smartphone geospatial networking applications.
Guidance suggests the basic principles of an STI outbreak are the same for any outbreak of infection;2 however, tackling chemsex outbreaks is complex and a holistic life-course approach is needed,1 such as addressing drug use in association with STIs and risk-taking behaviour. Needles were made available in sexual health clinics to patients reporting injecting drug use and access to drugs and alcohol services was improved by providing dedicated after-hour clinics to service users. The outbreak also illustrated difficulties in using traditional epidemiological approaches, where contact tracing and questionnaire completion are essential, as the client group declined to engage in order to protect confidentiality.
London Sexual Health Leads agree that the management of complex STI outbreaks should be discussed further to be prepared for future outbreaks. These discussions should take place with sexual health advisors and national experts to produce specific guidance, including available management tools and how best to increase trust with clientele. The outbreak identified training and educational needs among public health staff to improve confidence and skills in communicating risk to clients who engage in chemsex. PHE continues to raise professional awareness of chemsex across London forums aiming to create comprehensive communications plans tailored to the MSM population.
Many thanks to Sofia Saeed, Marko Kerac, Christ Lovitt and Andy Williams for their valued support with the management of this incident. We would also like to take this time to thank the late Heather Anderson who was extensively involved in the management of this outbreak.
Contributors All authors have been involved in the undertaking and completion of the work, and in the final writing and agreement of the letter. OO: nurse specialist involved with outbreak response, writing, editing and revising manuscript. SC: lead consultant involved with outbreak response and writing and revising final manuscript.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.