BACKGROUND:Chemsex increases HIV risk, but the Dutch substance landscape is evolving beyond traditional drugs (e.g. GHB/GBL, methamphetamine) to include novel synthetic cathinones. This study mapped the spatial distribution of sexualised substance use and identified distinct chemsex-user profiles among men who have sex with men (MSM) in the Netherlands. METHODS:Data from 1413 Dutch MSM in the EMIS-2024 survey (December 2023-July 2024) were analysed. Bayesian spatial ecological regression estimated the regional posterior prevalence and relative risk (RR) of chemsex engagement and its association with regional self-reported HIV prevalence. Latent-class analysis (LCA) identified substance-use patterns. Logistic regression assessed associations between HIV, chemsex engagement, and user patterns. RESULTS:Overall, 19.8% of MSM reported chemsex. Regional prevalence was highly heterogeneous, ranging from 25.2% (RR = 1.27) in GGD-Amsterdam to 16.4% (RR = 0.83) in GGD IJsselland. Amsterdam and unexpected border regions (e.g. GGD-Drenthe) showed significantly higher RRs for chemsex engagement and the broader sexualised substance use. Substance use varied widely, with a notable presence of novel synthetic stimulants (13.9%) and ecstasy (21.4%). LCA revealed two distinct profiles: a 'Traditional Substance-Moderate use' class and a 'Broader-Polysubstance' class using a broader range of sexualised substances. Both individual and ecological analyses confirmed a strong association between chemsex engagement and higher self-reported HIV prevalence. CONCLUSION:Chemsex among Dutch MSM is geographically heterogeneous and increasingly features broad polysubstance use. Its consistent link to higher self-reported HIV prevalence at individual and regional levels highlights the need for geographically tailored harm-reduction strategies.
BACKGROUND:People with HIV have an increased risk of heart failure (HF) compared to people without HIV. Guideline-directed medical therapy (GDMT) is the cornerstone of HF management, but little is known about GDMT prescription in this high-risk population. OBJECTIVE:To evaluate GDMT intensity and identify patient factors associated with optimal HF therapy among people with HIV and systolic HF. METHODS:We conducted retrospective analyses of the PATHWAYS study, a multi-institutional study of underrepresented racial and ethnic minorities with HIV. Adult patients with systolic HF (by ICD code) were included. A composite GDMT score was constructed using dosage-weighted prescription of GDMT drugs, ranging from 0% to 100% (with 100% indicating optimal therapy). RESULTS:Among 451 PWH with systolic HF, the median age was 54 years (IQR = 47-62), 34.6% were female, and 96.6% were Black. In the year after HF diagnosis, 85.8% of patients were prescribed any GDMT, and 45.5% of patients attended a cardiology clinic visit. The mean GDMT score was 30% (SD = 22%). In multivariable analyses, lower GDMT scores occurred among patients with older age (adjusted mean ratio [AMR] = 0.96, 95% CI: 0.93-0.99) and severe renal disease (AMR = 0.84, 95% CI: 0.71-0.99). Higher GDMT scores occurred among patients with diabetes mellitus (AMR = 1.33, 95% CI: 1.16-1.53), prior myocardial infarction (AMR = 1.17, 95% CI: 1.02-1.35), and those who attended a cardiology clinic visit (AMR = 1.29, 95% CI: 1.13-1.47). CONCLUSIONS:People with HIV and HF had low GDMT scores, suggesting suboptimal intensity of HF care. Cardiology clinic attendance was associated with higher GDMT scores.
