About a third of Vemurafenib order the participants reported unprotected insertive or receptive anal

intercourse. This percentage is within the range found in the study by Drumright et al. [34], but much higher than that in the study by Morin et al. [36], who reported a rate of 12%. It is important to note that the subjects of this study were HIV-infected MSM in specialized care, in contrast to MSM in general. This means that a lot of the participants in the study sample showed sexual risk behaviour despite knowledge of their HIV infection and despite often long-term treatment in specialized care. Therefore, the findings accentuate the need for diagnostic and therapeutic strategies regarding sexual risk behaviour and substance use in HIV-positive MSM. A case history of substance use should be obligatory for the attending physician in specialized HIV-medical centres. The focus should be on heavy alcohol use, cannabis and MSM community-specific and sex-associated substances. Because of the specific relevance of substance use immediately before or during sexual contacts, the context of consumption should be requested. Such a diagnostic procedure could be supplemented EX 527 nmr by respective screening procedures for substance-related disorders. If there is a manifest substance-related disorder, adequate psychiatric counselling or treatment should be offered. A combination of evidence-based psychotherapy and

medication should be the first-choice treatment. For recreational drug use, it is possible to offer information on and suggest strategies for ‘safer use’ to avoid or reduce health complications.

In addition to improved mental health and quality of life, this could reduce the rate of 4��8C sexual risk behaviour (given that there is a causal relationship between substance use and sexual risk behaviour). To date, there have been no programmes for the reduction of sexual risk behaviour among HIV-positive individuals in Europe evaluated in randomized-controlled trials. For the development of interventions, it is recommended to orientate to interventions, which were found to be effective in a meta-analysis of US studies [44]. Effective programmes were based on behavioural theory and aimed specifically at HIV-transmission risk behaviour (e.g. sexual risk behaviour and needle sharing). Training in behavioural skills (e.g. problem-solving strategies, communication competence for negotiating condom use, and strategies for coping with HIV diagnosis) was shown to be effective, in addition to consideration of mental health problems and disorders. Interventions should be offered by health-care professionals or trained counsellors; peer-group interventions were less effective. Programmes should be implemented in settings where patients receive their HIV-specific medical care. The present study provides evidence that substance use was a determinant of sexual risk behaviour in a sample of HIV-positive MSM in specialized medical care. However, there are some limitations.