Background Men who have sex with men (MSM) constitute a risk group for sexual transmitted infections(STI). Syndemic theory holds that psychosocial problems often co-occur, interact and mutually reinforce each other, thereby increasing risk behavior. We studied the prevalence of psychosocial problems and whether raising awareness of these psychosocial problems increases help seeking behavior.

Methods An open-label randomized controlled trial was conducted among MSM with high risk behavior recruited from the STI clinic of Amsterdam (NCT02859935). Inclusion criteria were: either two STI or PEP treatment for HIV negative MSM or one STI for HIV positive MSM in the last 24 months. The following syndemic domains were explored: alcohol, drugs and sex addiction (AUDIT, DUDIT, SCS), anxiety disorder(HADS), depression(HADS), childhood sexual abuse and partner violence. Participants received trimonthly standard STI care for one year. Additionally, the intervention group received face-to-face feedback on syndemic questionnaires.

Results Between September 2016 and August 2017 155 MSM were included. Median age was 43(IQR [34–51]), and 103/155(66%) were HIV positive. At baseline, 37/155(24%) tested positive for chlamydia, gonorrhea or syphilis, 1/52(2%) for HIV, 138/148(93%) reported using drugs during sex in the preceding 3 months, and 51/155(33%) self-reported help seeking behavior. In total, 114/155(75%) scored positive for at least 1 questionnaire: 47/154(31%) for alcohol use disorder, 76/154(49%) for drug use disorder, 28/154(18%) for sexual compulsivity, 47/154(30%) for anxiety disorder, 26/154(17%) for depression, 17/154(11%) for sexual abuse and 12/154(8%) for partner violence. Between the intervention and control group, we found no significant difference in self-reported help seeking behavior (35% vs 24% p=0.168), or in number of partners(13 IQR[5.5–30] vs 8.5 IQR[5–15] respectively, p=0.128).

Conclusion Psychosocial and addiction related problems are alarmingly high in high risk MSM, and a syndemic approach seems necessary. Preliminary results indicate that our intervention did not increase self-reported help seeking behavior. Data collection on confirmed help seeking is ongoing.

Disclosure No significant relationships.