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stiffer, so just quickly, kind of first he might. My name's Ellie on about of this rash steering committee. So for those of you that came to our last event, welcome back. And those of you that new to us Don't worry. We're pretty new anyway. And you haven't missed out on much yet. Say, Stash formed earlier this year. Um, and essentially, we kind of want to just foster a collective of pre specialty doctors and medical students and just get them engaged with sexual health and HIV medicine, help them to kind of discover it and to enjoy it as well. Uh, before we get started, just two things to mention still pushing them from last time that, uh, firstly, we are keen. Start a podcast on, but we want to get your ideas on how best to do that. So my colleague Jason and Hannah running a Google format moment, I'll pop the link in a chest in in just a second. And the other thing, um, if you're, uh if there's not a local ambassador at your local you know your in your local Diener E and your same medical student or a pre specialty doctor then we'd be really keep to hear from you if you're interested in getting involved. Um, we've been really fortunate have our our investors kind of spreading the word. And it's probably why a lot of you here this evening anyway. Again, I'll put the link in the chat about that as well, and then you can discover a little bit more. So we're here this evening to hear from Steven and Christopher. See, Stephen is a lecturer in mental health with a special interest in minority populations. Health in a quality, particularly mental health and sexual health. Um, he's completing his PhD focused on men, have sex with men, substance use and it's prepped up. Take a well as medication adherence on Do then we have crystal wards. So Christopher is, ah, project lead for a service aimed at improving health and wellbeing of all men who have sex with men and living in Scotland on his backgrounds, in health promotion, community development, on engagement with quick communities. So we'll hear from them both in there talking. You're welcome to put questions in the trap as we go along on by the I'll try and feel them to them uh, when it comes to it, if if the moment seems right or otherwise, we'll save them for the end. Super safe. I stopped sharing my screen, and then I can handle a visit. EBay share socks. So this is all? Yeah. Yep. Now, that's perfect things. Hi. Everyone has the list here to, um, election. And it broke and actually just completely refused to you. Goodness, Uh, except for, um, so Slate for just, you know, kind of introductory came six on services lecture. Um, looking at mental health, more interest from them. Play a pond and many of six with me. I'm like crescent reduce until Yeah, evening, everyone. So I'm Chris boards and I'm the SX lead for the service for we'll take care for a game by sexual minute All men who have sex with men living across Scotland. So the basic former for the Xeloda smoke with fluid would be attentional slaves just in some basic information when boys came six. Um, what type of us? Because it involves or type of these cholesterol actually interventions we we can consider run. And we're working with that high in a script that gauge became sex. The name on, but cases end it gets it back on and the Crestor leader in the name and resources, you cannot say the preferred reading and watching is realism. That he was on some anginal creations of the end on so many or sex with me and has a generalized epileptic Ultram. A quiz gave a sexual and other media sex with men. You mean identifying this Could give or bisexual um, and terms of a beer same as a Jane girl. As a general group, the artist proportion effected by weight or health The quality is not your sexual. I'm generally how pure hell, though, comes and computer to Jane life population on behind countries under other hand. In conclusion, um, there are high risk smoking among Amisyn computed life population hired it's chronic diseases and that was being physical, chronic diseases on material that comes on the considerably improved on generalized population. Taking the mail to moderate for me to hold this protective actually is anxiety on melting order to clear she it has the group still most effectively HIV on the other thing. We advances in the last since it is a protective layer in the last 20 years old and each of your coverage generally a small cluster and hip. Technologically, the arsenal be effected. I have a high street to reach instance. Come in the UK and he starts one from 2020. 105,000 people current living with the HIV off which approximately any saying mark equation between 45 47 Would percent ish or what number? Excuse me. What you mean by MSN? Maybe your sex with me? What may hear six with me. Men have sex with men. Yeah, well, okay, it's a generalized. It became a logical time. So came six. Is everybody haired of claims? It's There's not a lot of the new terror to most people. I never heard of 10 sex before. Okay, some people may have came a course of others. You know, it's a relatively new term, and it's chemo drug misuse among mail your stage of men on. But that's been about maybe a few just in recent last few years, and so came. Six. Does have a formalized definition from public health England, which mean around a few years now. So came six Essentially, is the plan to use of cycle off drugs, potentially psychoactive drug. Similar Qassams was key drugs before or during sex, which is two purposely and intentionally, either to enhance it. Assaulted? Um, prolong it in some way. Um, that's essentially taken. None has been amended from the public. Your thing when Definition, Um, although there s a revealing definitions of work that may look at this other terminology that shoes, which makes the final, came six quite complicated. Um, in terms of payments for came six, someone make your sex with men or weight being prevalence estimates, Um, depending on the sexual canton rear, the, um, really study sound has been taken from generally and the more generalized larger men. Your sex with males studies samples strains between 15 13% more short between 50 and 10%. So it's important to say as a minority off maybe her sex of may be actually on gauge what we define. This came six um, waiter dropping alcohol misuse. Um oh, maybe your sex from a does have higher rates and compared to general population anyway, on D, but they're the 10 came six on the behaviors. Associate it with our has a protect your tech alert kind of a corpuscle context. It's claim port is whale applies within the mortar a little bit. Why men who have sex with me and engaging came six. Crestfallen. Going to talk about is we'll market some of those behaviors was really weird D too, but that may be on again. There are definitely are limitations, and Esther Meeting prevalence is use the differences in terminology. Studies on relation is naturally, and we'll take the drug stuff. Maybe, for example, in his forties nation. It who has a general, corny, say the public of the England definition as a fuel real except standard definition. Some, um, I could eat limitations with in it. Thanks, Stephen. So, yeah, I'm going to talk a bit about the motor that is, You're engaging in chemistry. X. So when we're talking about the inhibitions in relation to come sex, we generally talking about different experiences of game bisexual men and men who have sex with men, he's gonna extend from internalized feelings of shame, Societal pressures and potentially group pressure's a swell about performing in an idea idealized way. This is sometimes actually perpetuated through pornography and other representation of sex between men. It's also been shown as well. That, particularly with income sex communities, was a higher rate of people living with HIV or older men as well, who have known to be carrying more of the burdens in relation to mental health issues but also substance abuse issues as well. Now the drugs are used in camp. Sick scenarios enable men to escape from these internal and external pressures. And then Stephen is gonna go on to talk about that more of some of the specific drugs a bit later. But ultimately, many of these drugs can increase The sense of confidence, can make men feel more relaxed or more aroused and lead to more impulsive behaviors. And in some cases, the drugs can actually lose to a loss of feeling, which can leave people vulnerable to injurious well on day. Some of the people that we've worked with directly have described as the best sex they've ever had. Onda, as the drugs enable them to feel more in touch with their partners and last longer free from distractions. So there's many different reasons why individuals might engage from potential previous trauma is to just bit wider expectations on them as well and these are kind of listed inside of kind of internal sexual pleasure into personal dynamics and escapism. A swell if you want to go to the next slide, Steven. So these are kind of listing some of the different drugs and desired enhancements that men may have. So the desire to have asthma from the drugs they're interested in taming are not mentioned a few, but not limited to just the following. But these examples of social emotional alterations resonate with many of the experiences of our service users, with many of them noting that without drugs they feel unable to converse with guys, let alone feel any intimacy of connection with, um. In addition, many individuals note that they have taken part insects that they wouldn't have without the aid of these drugs as well. For example, fisting There's something that people engaged with your income's expertise that prior to that they wouldn't have engaged with. And this this is because of the suggestion that feel less pain. But also they feel more trust in their partner. So it's more about realizing these things in isolation, in terms of how much they make people feel in the moment this idea of sense, of increased confidence on just the increased sense of intimacy they have with the others, particularly for individuals who had really negative experiences growing up, a lot of shame around their sexuality and their desires came Sex provides this perfect storm of making them feel safe, making them feel loved and making them feel part of the community that they've always wanted to be part. And in addition, these kind of ideas about having the best sex, how to perform better, how to just actually relax and get really into the moment are big drivers and big reasons why people struggle to come away from camp sex and go back to when I quit would just be sober sex. And ultimately, this is the kind of thing that you'll see and kind of have to pick up on because the next slide Steven so much you don't have a look. It became six cortex and Tim's watch little car. Something remains cool. Came six station and chills The wind Guys will complain drugs with six commonly association and within not when you press with that, accordance calmly last few over 37 hours, maybe three hours over to 70 hours, and that's more common, although in some circumstances you get some sessions the last war get up to to your feet. He's on that as more than reality. A lot of it has a potential for it to happen. Stations usually occur mostly in people's probably holes, and seven years been moved towards more recently, Some evidence? Sure not. Um, you know, with yourself things like and social networking applications, mid meeting people lane offices, US facilitated and easier meet with in people's private homes. Um seven. Historically, um, I'm certainly recently on still claim succession still Duke or cover from six on plain. It's been used so that that will, that will be places like soreness. Commercial based type payments is a lowered that trying probably a one C is between 50 and 60 65% of the car with him playing wounds. Lawyers potential. The duke still occur, but not evidence, certainly assuring that and usually start us is linked. On Day two came sex and of all that became six. Get your reports of Amy. Same on more lately, 10 mg came Sex and non DHA be part of a medicine and there's clearly evidence to indicate that defend that scenario is well, but as injecting of drugs within a claim succession like on occur, um, that's often a fair to Asar Cool Quint Kogelo Terror, which is called slumming. Um, a law again. The thing that came safe population. It's more time in order to that will, um, inject came sex and she, um, and again, clearance estimates do really weight lift about like a waiter and studies that look a prevalence estimates of large a miss generalized large a me see examples, um, for him, maybe six of me. You combine drugs for six on for sexual purposes. Essentially, I'm sorry, 29% perspiration Those estimates on the drug Most associate it Teo injecting with Kim sex contexts What we call Krystal myth and 15 intercristal made for short because it's word was usually called that are are the drugs that are injectable Israel wife owners a custom if jail is the more common drug within, that's not really a major sex minimal. And Jake, for sexual reasons within the cortex of came succession, often involves a few partners on which can over be casual. Any changes that might get on a Ms or they may be in the one anonymous. So I phoned is the guy's engaging came sit and I came. Succession will often and do the regular northern ornaments partners so conscious during sex partners on something, tightens a guy about engaging, came, say, through his long term eat partners. Well, generally, um, came six just from my phone and my niece came six. Generally, um, has with a few partners older, the Lasix vying for sex sometimes come in a 1 to 1. Be assess several in some circumstances. And within bigger came six events that my last for longer periods, that has been evidence. Were came successions kind of both numbers like 15 to 2025 partners. I gave more calmly sold a bit. I'm not five partner number and see my friends more colon, Um, certainly created association to calm everything, really complaining off unless it's drugs for six. And unless it's drugs do effect their function because of the pathways, reason judgment on it affects influencing undeserving medically, so often than not, Point takes. Obviously, that will affect sexual judgment. Making decision making I'm just taking is well under move those and the passions within that circumstance as clear association. The evidence that I I risks appointment with your sex with him. A came six station sitting off. That's important terms of HIV risk because we're planning a trip somewhere, maybe, except mentally, HIV as corn and muscle intercourse on. Then that corn takes Israel smear is to give that is it. It wouldn't call it is like eight Exceptional ox itself been associated with came sex context, for example, and vested, and also that involves somehow your risks a zoo. Well, from that context, that's, um, generalized less behavior in the balls for cell from a came six court takes a sexual response rate of, um as Christmas Day earlier. I don't the drugs the drug see next? Yes, there's the drug shoes with, you know that complains on with Sex two in Heinz facility for long experience. These are some of the mean dogs that are used in the UK or low. It's important to you. Besides that, um, across nations within unit the your expanded, uh on steel Yeah, for example, in high income countries, drugs of choice do really defend regions on beside nations is well, even within the UK andare relations and what may be used, um, seventies or some of the war ever did Strokes are being went to came sex. Um, actually more more calmly off and Ms will see to to not take this naturally custom if off for two on tier GHB slash tbl or from the fertility makes the joint or and we're basically no one asked me on now cocaine Charlie on Katie mean fair to scan the stuff that just generalized just involved with, You know, most are all types of the less drugs going back to similar. Think I mentioned earlier about, um, you know what effect important to function on a decision making ability? Uh, con and effect judgment on that's an association with most types of the less drugs were were. Inevitably, when somebody becomes doesn't have it at the Baltimore just generally on the Cialis treatable more substances, for example, calculable mostly on extreme stating that came six point takes for the high risk behaviors are intensifying. The label risk on the same time obviously increases the risk of, you know, things are usually about possession. For example, there's different effects that people me years percent of drugs for on different risks involved with those and definitely is off menacingly strokes. Um, crystal meth. Um, again, as I mentioned earlier, it's probably the most injected drugs within that came six context a lot con and be started swolled a swell Vallo beating me If it's this is just a somebody will providing What information on these protect drugs. Israel that you can be cut teach be GPO, his office world in a liquid form, clear liquid form on by can be injected. Israel. A PSA potential. One breast part, particularly, is the highly addictive nature, or GHB. Risk of dependence when capital letters up to succeeding. GHB is the risk of overdose on because as a replacement, and it comes generally in a clear liquid form on, there's a high risk of all the doors. Protect it when it's combined with other drugs, like our whole or other places. Methedrine maybe more radiation or next quite commonly used a difficult sex context and made it tapes and populations. Um, getting cold, always swollen, kind of started. Um, just see it obviously, about anxiety. Increased heart palpitations on. Go along with that cane again more calmly waiting on, um, and were generalized context of breath on the meaning of me. Six population again. Particular risk with our again just hardly eat. Um, can be some potential issues and, in part, annoying on chest on ketamine. Um, it's probably less well normally used truck, and one probable may sell used Chantix looks but still can be used. Um, in that context, essentially effects of it are the numbness, feeling loss of feeling generally and being vulnerable to assault and engine on coming again. Released mixed nations that come use like snorted, swollen on potentials can be injected. Certainly, from my experience is looking with the search crystal meth. There's heart pilots factors. Israel on potential weakening, zero and and addictive nature on obviously not association goes with injecting increases. That those risk factors I'm stressed or made has been protected, like to certain risk behaviors as well. Um, I meant to health, and part of our Israel can be obviously difficult. Is they'll officials in part noise? Listen A. She's in a short period. After using these types of drugs on potential longer turns, real provide more links in each Pacific. Three of these drugs you can have a look at one of the reps say it's not me pleasure, but what we do to get from our you're resting Altra Suture was tapes, trucks to consider. But generally, ah, name drugs in the context may excuse. Probably Klestil may have GHP method drawn, often often seen Ecstasy is, well, um, outside of London. On again come differences between seven Wonderland, and they say they're placed. You came directions for potential, in part on biological the psychologic from social health and claim sex on the card is it's one just factors when you combine your structure of six and rescue he was involved in. That was obviously a clear risk. Increased risk of each any heart possession. The key sexual stopped to. That's condom. It's, you know, six a lot. Obviously, people are injecting and sharing, injecting quit mint off any tape. Obviously, there's a less call each of you being passed through sharing of any type of injecting equipment, hepatitis to see that being a few pavement. Studies have done a bone hepatitis either on me in her six mean to engage in sexual eyes, drug use, and they're waiting, veering play once a estimates. Um because the nature of the studies, it's difficult to draw on you from conclusions from North, say only obviously attempt I hope it take to see even a breath came sex context and one of the plain idiots options mission for hepatitis C is injecting drugs. Years that's more raised in generally defend on injecting drugs using population in the UK, so Kim six court takes up. Same scenario applies sharing of injecting. From that came sex a shin carries. Just keep a potato. See all you can't escape a sexual rescue. Attentional e off and potato see past for in sexual Israel it has they swelled on injecting, but it still has a potential desk sexually. Way you could see when he remembers factory gyms again over your blood borne viruses. Hepatitis B because I'd be as more contagious essentially survives. That's like the boy longer a Z Z e t. O. And passed on by reading different methods again. Sexual risk factors car you without injection drug use carrots without arms, also sharing off snorting equipment as protecting a spot from not as well continuous Children like snorting ships, extremities using a cooking, for example, Um, these are all things just read off in terms of blood born by. This is obviously qd start getting that, um, it was looking at new one and hope for viruses are more other bacteria related to ST I. Some things like chlamydia, gonorrhea, syphilis, syphilis or research. It's in recent years and last 10 years. Technology manual sex with me, the clear evidence there's that shown an association came sex engagement on Bacterial ST I diagnosis and treatment. Get another stopped actually within the context for when we are engage in sexual, have a consultation with me six men and you might engage in came Sex is well and no biological to stop physical without. Are you crazy important? And that kind of have a waiter and parked in the life Israel Until what? We could set up a six. A psychological, um, social impact. Um, there's some evidence which is limited has been more the evidence done on the biological components like other ST I see on the HIV risks of the house in the psychosocial components. But there's evidence to suggest that win for mean your section men who engage in caves X can have I can have a negative impact on that side. Kalashnikov. A social well being, Um, defend some of that context, then parked from the wager Life Know, biologic for the stupid, from individual to individual on our individual of experiences of those guys and have a lot more in your face. Um, you know, we know from the evidence Is that is that compared to claim the mental functioning more generally so? And things like melt more. Give me two l mess things like anxiety, agitation, social functioning as well, depending on the nature. Um, over social networks of arthritis, that can be potentially isolation from non came sex networks. Like an isolation from family on my, I don't know, came six friends, occupational declaim, um Israel and then called activity artwork and potential sickness from mark on potential losses of employment. Um, there's a sore smoking declining in terms off a graduate to decline, and Tim's off. The impact on the severity of them popped my half. Um on came six in cages. Life say only evidence indicates that the higher the frequency intense to became six the higher degree off problematic and part of me harmful in their psychosocial and park a lot up, maybe living by wise reasons again by some to make you to claims. 67. Set some of them for my PhD. You could intimate that guys who region came six, maybe for escapist purposes from wait are places and the life Worth me have hard, few more bit mental illness that's been exacerbated to me. Engage in came six for escapism on, then start to engage in it morphine equipment and commendable control. Compulsion on that and irritably, wasn't test cycle declining, calling to function on the declaiming cycle, off cycle, psychological in social function and weight and popped in the lives on Certainly like, um, between norm came sakes. Problem like a drug use is really low and frequency and severity of drug use a condom Intentions are on 70 of the unique factor about baby escapist mechanism. Why something engaging came six. Not reading, too. On increase desire to engage in just behaviors are there in the places from wager life or, um, exacerbation of made film. This is the combination of that Getting into a compulsion 100 wanted to escape into the speakers, for example, and potential, and parked in increasing intensity on the severity of imparting me half on. But it's made to help social well be, um, occupation function, for example, and tells a generalized risk reduction. There are being kind. Of course, production lately is, um, is really car and discuss which applied to drug use in sexual behavior. More. Jane Oy. Um, so and so some of those key aspects we advised using came to someone that you trust. Obviously, as I mentioned earlier, Pair of judgment has impacted upon so often advised by using claims and UTI and came six. It's whether people be know, establish some sort off, even if it's just a cardinal relationship and former be sick Lane of judgment. Um, we're not engaging in a came succession together. Some people that established on me, you know, just know where General it can slightly just start Risk goes without saying limited with different types of drugs on the quantity of drugs. So often I came succession can involve, um, had a Polish sausages on the can be multiple substances used within one came sex session on the country or, them know, came So extract substances within that context like alcohol, for example. So, um, cancel it advised the limit tapes of drugs to use every just limit. You know, it talks that the feel maybe harvest a detriment impact on their cottons. Cognizance on, then making and she's feeling quantity are measuring of quantity off There's strokes Israel, which is important, um, of are using cames for too long a pd it again later. It is longer the use men, not short period of time. The more little experience things like hallucinations and paranoia, which is always important under called to function on this fucking your weight loss factors, um, you get exposed to, you know, and the PT it and it came succession. Repeat it after the claims extension. Avoid healing all snorting or injecting equipment. Smart relates to area kind of a drug use the cream at all. And so snorken jobs, or if they are injecting, not doesn't just will be two needles that also relates to things like syringes and, like water mixing cops and a part of funnily a involved in injecting red vials. Hawks they're not. She had nearly kind of mention that whole. Did you start desk avoid late in it. In when else inject, um back in car gets on risk. For example, have you seen that person use sterile injecting equipment? Half How is in the other person? Draw up the drug that you're going to be injected, that hardness in on the Paris and measure like that drug and actually know what they're going to be injected with. Androgel Key factors with a knife. Let somebody else inject them. That's quite important factors and not oxidase inhibitor checked equipment provision that are judged Ginger's prorated between all nature tightens on cities across the U. K. Which people can access is well, I can get those from actual print services on medical or and can get the fuel injected. Quit prevention. Um, so I think what guys are and maybe or changing access your services don't necessarily smelly See himself has drug users. And there's always that stigmatization about accessing these tapes. Serious is that are some barriers just trying trying to juice in terms of my guys perspective? Well, maybe you eyes, you know, and being a service that me know before heading, for example. But it's important to access stable injecting equipment on dust, all the use once a day. And within that context, uh, kind of standard and vaccination protocol for manual sex minutes for hepatitis B and hepatitis C much con Or as Jamie Given through our PGD piece directive. There are different combinations of that. I'm complaining. Vaccinations like trend looks. There are more nerve oxidation in Israel with schedules that will pretend to the local, and it changes trust for board skates. And what those particles are Lots of standard vaccinations for me and your sex me in you kid. And in terms of the structures associated thing came sex. Really? Really advise on standardize ST I HIV and hep C screening 1 63 months. Um, I'm being a bagel or thing. I just encourage people to 10 months ago few months for a few months, screen on, obviously no real help the exposure prophylaxis or itchy pick. Um, introduce. Engaging in came 67, and it was just factor to associate that quarter machine or sex less associated with having to use that diagnosis for next year on intention 10 gauge in the corner machine or six. Um, you know, and we qualifying criteria for you know, it, um, I'm Keith. Thing about it is obviously the juices the vasculature in the acquisition by up to 99% which is clear within the evidence, which is always the highly effective, which is an important total of these other dress conduction years. I've been reducing the risk of each other question. She Thanks, Stephen. If you could click through those and yeah, I just wanted to highlight as well like, particularly when it comes to these different risk reduction strategies. It's always good to kind of be aware of simple questions around a Stephen highlight, lack of access of services or difficulty accessing services, but also additional concerns such a scorer, gyn or intimate partner violence in a relationship that prevent someone from accessing. And when we're talking around setting boundaries in relation to restriction, the key thing is to focus on a list expose as it to a system for reducing the risk, particularly when discussing topics around pleasure and consent on there really vital to understand someone's motivation or so enable them to decide what is healthy and realistic for them so he could click for the first one. Stephen just go through them. So the key thing is knowing what they're mixing, so particularly when it comes to camp sex drugs. Some of them can really counteract each other on lead to really drastic consequences. Additionally, for someone who's living with hatred IV some of the drugs can affect how I hate you're being medication works in their body is well, so it's key to keep that in mind and also be consider about who's organizing the party on where these drugs are coming from. A swell because it may come premixed. Be clear about the limits. So this is a big part of what we do through our come six page on the website is understand what they're willing to do before they meet their partners as well and so clear expectations. Usually when it comes to come successions that prearranged they're pre agreed on. Do you need to be clear about what you're arriving two. And understand what your limits are when you're going to be at this session. Find out about the type of section session as Steven alluded to some sessions congee very different to one another. Some could have new individuals arriving people could have very set in kind of clear boundaries about, but also around whether condoms are available, whether people are using prepping the party, but also in comes off the type of sex that they're having in terms of is fasting involved? What precautions are being managed there, and what do they need to think about if they're going to attend the session? And here 31 is thinking about what they actually do, what they find pleasurable, and are they confident, uncomfortable? What's going on there? Onda. This is a recap eating that we work on, talking about understanding, pleasure, understanding, consent and making sure that the sex that they're having is pleasurable and consensual with the least harm. And he think about concern it. If they want to change their mind, even though they may have attended the party, they do have the right to leave and that they always have the right to say no, it's their body. So ultimately, these drugs can inhibit well, disinhibited your ability to kind of give consent. So the key thing is to keep in mind. If you could stay level on, managed to maintain your ability to consent any situations. So I'm gonna talk a bit about one of the case studies of an individual that we worked with Now the service user was referred by a sexual health clinic Do to re occurring S t i z over a few months on by think for a case to the one. This is a key case to detail highlight because it notices a new of the motivations regarding internalized feelings of shame in relation to religion but also precious to performance that and kind of sexualized stereotype within gait culture. So the key thing for him was actually shame around his sexuality. The fact that Ken Sex was the only time he fail, able to enjoy sexuality and act upon it. But due to quite a lot of these drugs that he was using was leaving him Teo being unable to consent but also understanding pain levels. There was some physical trauma that had happened in sex parties as well. I think just to highlight one of the key areas when we're thinking about motivators, towards came sex, he said. I want intimacy. I want to feel close to someone and cans or what made him feel naked and free from prejudice. So it's really understanding what these motivations and drivers are for this person. On just the the interest of time. I think what we'll do is go through these and then come up with questions around the case to do at the end. If you could click through Steven, so in terms of the incident intervention that we did, we kind of did basic sexual health interventions and the importance of guarding against infections, particularly HIV, with backup taking immunizations. But there were really concerned conversations around his identity. Is a gay man his interaction with that on his face than his community as well. On thinking about these restrictions in terms of safer practices in relation to come sex? Whether the party was attending, Listen, think he was comfortable attending whether he knew people involved, whether other people were mixing his drugs about people, absolutely doing the injecting and how he felt shape with that and the needle exchanges as well, and a clear one was actually around consent and pleasure. The one thing we always talk about in our work is actually talking about how you have conversations around gaining consent and when you feel uncomfortable when it's not feeling comfortable on how you can be aware, of course. So this individual, the confidence was a big outcome foreign. He felt more confident going to situations he had actually reduced his attendants to come. Sex part is a swell and felt like he was able to understand what triggers on build healthy strategies to counter them when they arrived. They also managed to lower the amount of hatred the risk on ST I risk and also get tested more regularly and pick them up and just see some questions. So this is a very different scenario in terms off the case study we've seen before. So this individual had very clear boundaries regarding partners. Usage, injection, sexual health and hatred be prevention. As he was already accessing three months the testing, it was using event based preps and organizing the parties himself. He was linked into the local needle exchanges. He had very measured control in terms of it had impacted, and financially it wasn't affecting his work. But he wants having difficulty about having sober sex. So again, it came to this link around intimacy and concerns that he couldn't engage with men with outcomes of the stage on. This was very clear that this was an area he wanted to work on that he didn't see his camps. Excuse is something that he wanted to change. So, of course, the basics was around. Re dressing the six monthly testing vaccinations, reviewing his prep it here it's and making sure that it was effective for the kind of parties he was having. It was also around concerns about mixing Kemp's making sure he knew that safe practices information about consent and healthy relationships, particularly as well as he was an organizer of these parties that he was looking out for the other individuals attending these camps successions and again, conversations about pleasure. There was actually a reduction and progress towards having sex with tens, but ultimately it was a situation where he didn't want to stop having came sex. And it was the focus on the key strategy about having the most pleasurable in consensual sex with the least harms. Regardless of drugs being used in this situation on management around ST I was going further and ongoing reduction in terms of hatred. The the key thing was he was learning to engage with partners emotionally with outcomes, but he was still worried about super sex. So this was non going conversation about understanding, pleasure, engagement, confidence and actually gaining intimacy with individuals. So we've kind of at the end just listed some useful information. So as I'm always going to talk SX Scotland, I think because I manager is a very useful resource community developed from our own information. SDF, which is the Scotch drugs for him on also lived experience with men around the different drugs, mixing cams, how living with HIV incomes and also's and basic tips they've got jmf a Terrance Higgins Trust, Dean Street and also the video content that we have listed is really useful. And there's also a film called Um Sex, which Steven told me to plug a few differences from reading there. If you are still planes on, do do some like a day with bleeding, but not could take about motivation to do so. Um, there's quite better show in case Aches has been publishing out in evidence based on so hopefully going up a little friendly. Don't you interested to do on a publisher? Came six review in 2019, um, which was quite common place of registry office number three on be quite interesting. We does. The first reference is their study by item border and he's not Living in Australia was one of the first came takes that it's done in the U. K. Which climb Interesting article. Israel Ondas All friendly things real cheap about become, became, say, someone mentioned. It does as kind of, um, as kind of educational. Canada's sure came six. As so, it's not for the heart attack in artist Who's going to watch? Er, you know, it does have that advisory way we will finish a sphere likes. Plus it makes sense on dollars of the references crispy chicken with the news, Um, and the further bleeding particularly and 60. And me if you were saying it's particularly useful against. We also has good information, but it has. Links to our virtual are like a note when a care plan called through to Israel's like an old think. Your plan that guys can do is really quite a lot of resources out there to be able to be day and seven Kenard and mixed up, protected from was protected like dog start camping with information is veil. When the key came six strokes from the front sight and increases have anything, thank you so much base of you. I think you had a soul, all hooks, and those case studies at the end, we really helpful to kind of bring it all together. There's a couple of questions in the chat and just while anymore, coming through, it wants to us as well with them when you were just talking through the kind of interventions that you can do that. And, um, I just wanted to kind of who or how many different kind of professional. Sorry, hold in that. I might leave now. Well, thanks for Sunday. Thanks. Um, yes. So intend. The interventions kind of. There was some kind of different psychological and medical ones who who's kind of involved in that team. Yeah, that's a recreationally. You mean, obviously for stuff, except for sale to deliver table or things have been Certainly my comic clinician, buddy background, um, as a nurse, having watched in sexual hills and 12, um, I think it's a combination of partner working on the federal on that will depend on how the services of the liver profend the local afford a TIA, which will obviously very some, for example, in a gym. But, uh um mean sexual health services there, dear Look, the biomedical pregnancy, which is always the big key for Kasich and Stith IV tasting on delivery or playing assessment on implicate Give you's on access. Things like 46 was a portal access, Um, but within those services really do have a specialist any J service that set off in the mean by medical provision that and pervades specialist psych. A social support from one to ones like talking about confidence about Except shall it either, sexual health. Having was basically, it's reduction to Benji's, there was a lot, of course, like between, um, our child for sexual health services. It ain't broke. We would've fair people to class of service who deal off the psychosocial delivery of the stuff he was talking about. I'm talking about sexuality confidence in DC eating, you know, behavior change type stuff is well by the same hand here. Six. Historically, you know, or the changes recorded would have done. And rid of some clinics is way on with their six, for example, that the charity under the chest with the clinics together, you know, and with really return tastings Well, um, you know, with the use of pocket. It's so that's set up on the number of people involved. We'll definitely be really. Certainly the traditional roles off the medic on the nurseries tasting problem still is the main focus models. Good friend was nursing doctor to give the hunt those kind of conversations that, and obviously rest reduction on being able to. They discuss materials for engaging in Kim's. Except there's patient going them on the way tomato health stuff, competent stuff and be able to feel the morning. Two more specialists and really being services well, which is always important about having a real mess of the services available. You look clear and that you can advise people to access, including your lane resources available. Obviously, it became 60 applying, for example. Great, thank you. And, um, Rebecca had a question is well, and they asked, uh, in terms of how you approach the subject of specific types of activity, you discussed about kind of higher risk activities like fisting. How would you approach conversation asking about those behaviors? That's yeah. I mean, some people are because it is a step ties behavior that injury people do kind of shy away from my son's would indeed creations and certainly, you know, working in sexual energy. You know, it's about asking those questions and you're on. The confidence is just from the terrorists. More than anything else, you know, in the reason I would ask about our, you know, and depending of some discomfort, you know, I'm sure cause make you dizzy. Um, it's it's opening up with generalized Christian gentle hair. Things been since your last detained for your last. You know, Stith, I've you test, you know, they're going to creations about, um, Central last, and I haven't used any drugs and more alcohol on DC area. That conversation Gore's you know, separately asking, you know, every see yes, and that's going to take you about the use off and came on been asking protected and sexual beginners. Historically, you know, I read Ask. Somebody came in three months ago. Little pullback in front, just under the taste. I would ask about what number early was a partners it hard and not tighten types of partners. On main. I would ask the label of us, believe or effort, daily corner machine or sex on. Then I asked him about in your the types off and type of sexual behaviors are higher. So dust, um, central last time, you know, I mean a part of your confidence in those X rays, you know, just presented with those factors. Hum. I think it's basically with that. I think about adult North of Essentially asked, um, has that involved and resting particular? But it may be more of a generalized question, but it's really called in Was your sex has been in your other you know, you know, six in the other in your six tapes at all and not more J lines open chord in Texas You like I says, Um, thinking Tim's off the behavior like vesting is more to the read of our take a lot of circumstances. So, you know, because engaged in came six. And maybe you should just ask around not using esoteric sexual acts that somebody gave me a cane over there and academic 10. So we use that. I would just ask the Corn 100 have you engage points in sex and ask about Has there been any other you know, they're, you know, tapes, sex at all in a more general lives. Real sure class may probably agree with our, um, just keeping it quite walking about, you know, play, for example. And I got here in juice more January and avoiding. I'm keeping quite open. And they seem like they responses from that. Yeah, you're much more polite than I. I think I would say what sort of sex if you had recently, you know, is there anything new types of sex that have you tried a new play? Does that include Fistic doesn't include sex stories because there's more questions to be asked there. Yeah, I l terminal depends on how the arm so but creation about? Yeah, so it's really as well as condoms, condoms, pain treat a vegan sixes in a boat house opinion. You know that, you know, play a toll and seeing what tapes, the things that merely dangle or going to and if you know they're engaged in came say exactly, they come into pre about a no specific less factors. Medicine helps the testing about asking those percent questions, for example, and seeing without risk and conversation goes, there's a couple more coming through. I'm trying to say think how best to get through these. I don't want to keep your eyes too long. I will have to apologize that we'll have to do go for it. So I mean, that's safe to be fine. I'm That's just a question for you about your outreach work anyway. Then I think, um, in terms of the average, do you do? Do you do things outside of clinics in the community? Um, I'm happy to talk about that one, because that's my main. The main renal of their sex is to kind of get people to engage in services, get involved in the clinical settings on. We do outreach through a variety of ways, from in person outreach in public sex environments, which is cruising grounds. We also do online outreach through certain sexual social APS, which will act as a meeting point for some guys. And we act as a Pulmicort is, um, so people can act as direct questions regarding prep, sexual health and also came sex during the pandemic. We previously would have gone into bars and clubs to do in face outreach, but due to the shut down of most night venues, we actually developed on online life chapter and kept open during the evenings, and we found that a lot of canned sex users would talk to us on a Monday when they'd accidentally missed work and kind of how to come down experience and talking through that on. That proved really, really useful in terms of getting people the right information and that was used across Scotland. And we also had enquiries around the whole UK because there wasn't a likewise service in the area. But outreaches really key because I think the clinics are really important for getting people into their treatment, getting them on the treatment, getting tested and maintained. But there's also an element where people, particularly around this subject, don't want to talk to the end. It just a statue services about it for fear of kind of repercussions that may come about or perceived repercussions Girl, Thank you. If I can ask you just one more question, it's just about I try and summarize what uh, cemetery be said, That's, um, about how we can kind of re conceptualize things like fisting and talk about them. That so it's not just a risk behavior, and whether there's better kind of wordings that we can use s so that we're not Fill the jars. They kind of evidence of comes excellent types of a day playing things in terms of reality. Converted issues are Let's walk. I don't know if you'd be happy. So I meet yourself to us. Sorry. Um, I suppose he's not going to make money. Sorry. I suppose where my question is coming from is that I find discussions. It comes, like, quite interested in because, I mean, I think from a sexual health perspective, we take on this order on emphasis on the wrist, which I don't think necessarily aligns with people who engage in those practices. Stay, for example, taking, taking analogy like, I don't smoke, but lots of my friends do you and then was a little bit horrified that my friends smoke weed and clearly because we're operating with different conception of the lists involved. But I think that's okay, because I'm not a doctor. But when it comes to sort of, you know, sexual axe exposed like minorities, actually, I think discussions about what we'll do convenient to be quite sticking time in the pathology, anything if the solar plexus is about I don't know. Actually, I think I think what? I actually was just said. Um yeah, sorry, I didn't actually Oh, I can't wait. You mean I mean yeah, but you have this conversation is being erections. Academics in them, um, you speak to other people? Israel are maybe normal from the claims expired, like damaged here, obviously from going to sleep, for example, as one of the high ukx there since national, Israel and, um, speech have a big marketing that that is an excess of breast cancer, came sex. Just reduction on a lot of the research is or rescan just risk, um, which is a kind of certain health point of view. There are the way the factors that we need to think about it, talk about, like, the social cultural aspects of came six, you know, why do guys engage in came six in the first place on base with things just talked about, You know, um, about sexual identity on a cultural identity, Um, a big feeling and stigmatized Rasheem that me talk about these things that with a k you know, with the came six sessions or with came six networks you even amongst the geek unity that that does exist so yeah, for the gait wouldn't see it, but it was way too factor initially important against against why there's a big focus and rescues because against from the profession do you have this sort of isolation? But no, you know it's a big prostate. Gets health prevention more generally, take a listen and, you know, help patients like medicine gnashing whatever may be in her revenge registered risk. Um, and against the corn takes were working. It's also important. Know Teo chastise guys for engaging Came six. Um, no, I think we're about to precision. Ideally, a rear and some guys in Eugene came sex armed the mileage and contain clips extra thin the range that doesn't cover get from a a way to determine to impact on their life because we have under control. And they continued it on, um, for the with guys know risk reduction on your advisor, bit less production. You know, a lot of my weight with fear with that is just being forcing those approaches, like using things like play on access tasting, you know. But those weight of conversations have in some stuff just look about where there's more underlying place in a while. I am kind of motivated. Condition came sex and shame. Stick mad and long run. This is intimacy, a Sephora of escapism, Um, and other psychosocial. A factor in the life in that meeting, too. Compulsive issues potentially an important to address. It was like, you know, kind of site social cultural issues are reported. It's important. Mouth was conversations, I think in place. The only unfortunate that sexual see ever see is often There's limitations in time and resources to be able to do that. Israel on the occipital big state and buying medical intervention. So I think you're really it out without, and I can understand that we're coming, forming, you know, And guys getting came six for several reasons, but it's important to find those readings That that makes sense to quit was years. And cultural social identity, which is more important, is Well, I don't know what helps it all, I think reflecting what you're saying. That helps sort of, um, tease out what I think. Religion question was crying to get out. So the foods on it, I think obviously I'm going to struggle to take it again. I I think so. When you say sort of. They managed to contain Chemist Axe. I think that's a very soon powerful metaphor that we have you lost about diet foods, drug use in general. And so far it is dot You know, even if someone is using, can stay active form of escapism or the way to navigate it showing on this actuality or have you? I find it interesting that it's sort of gets category, um, that used to come and disgracing me there. For example. I might want to, you know, um, exercise a lot of the form of escapism or right or literature or what? I don't even I said earlier, smoke cigarettes or whatever when I decided, I think there's a lot of tension there in sort of constructing this category properties and and sort of scrutinizing study. And let's see, you know, well, why do people behave that way? Why do people, you know, engage in this practice unsettled, not wanting to shame these people or so, um, make out that practice to be city. I get sort of over treat the meaning that active if that makes yeah, I totally get where you're seeing and if someday, when still gives you came safe. Ultimately, people will do for individual lesions are not in or those lines. Reasons will be different. Left experiences for mean you're engaging, came six. It's not about for my perspective. It's not about chastising until people often and getting and came sex andan fortunate. Think sometimes that maybe, is the approach not just became six, but your drug Use more weight, unfortunately, is about, you know, very till people offer, but it's wrong. Should do that on. Actually, that's not constructive. And anyway, it also That's not how I am approached him a consultation with patients. You know, sometimes that has been the approach a little up from research teams and sexual services that cumbia split between home. Well informed conditions are on there. They approach to take on baby. How the engage in guys with case. Extremely just more weight, little bit meal, same sexes. Well, more weight. Lately, on day came six Unfortunate does have its own stigma and hired to the challenge on. And I think the first thing you do is, you know, by judging guys for waving you to keep six. Um, on And you know, when I think What's important is really is radiation constructed with open questions, you know, and no telling them off indigent came six guys Toula deconstruct up to. Is there imputed interaction with patients? And anyway, I think about straw important event of some of the what's 10 years he came six. That's entirely done to feed him a choice like any other drug use. Is that just from a report of your scalp professions to help thumb on half that I tools to reduce that risk of went to engage in came six. And I think some of those other drivers about it does are paying on the reasons that I'm problematic. Drug use and laid was issues may develop into came six The calming. See, for example, compulsive, um, the other reasons behind that on that will very for people that why not? Maybe so. I mean, that's really report. Men gauging keeps excellent individual basis with patients getting remained. The waiter context of someone was case. That is, for example, inhalers too difficult drastically. Studies on it was love. Experience is very different from both falls, you know, Kiss them to win increased, ready to help me extent. Yeah. Thank you. Really? Thank you so much for staying on just a touch longer there. Steven. Um, I think we'll wrap up now, so but I don't want to keep you any longer, but yet massively great pull food for you both joining us in, please. Also know thanks to Christopher a swell. Um, and we're getting feedback three from people to say. I'm more than happy to share that with you if that That that's a value to yourselves. A swell. Um, thank you so so much. I think you're any creations. Just please feel free to let me know. Oh, yeah? Well, if we can show the the links from your slides and, uh but, yeah, I'll follow you up with an email, and we can We can make sure we get those. That's people years. Thank you. Thank you.