DiverGENTE: case characterization of an LGBTQ-focused addictology outpatient service in Lisbon, 2020-2023
DiverGENTE is a multidisciplinary outpatient unit within ICAD (the State-run addictology services in Portugal), focused on the LGBTQ population in Lisbon. Firsty, it aimed to strengthen existing interventions for chemsex partakers and sex workers, during lockdown. Strongly connected to community organizations for sexual health and harm reduction from the get-go, this work directed the team to identify their training and knowledge gaps in terms of LGBTQ populations, and to open the project for other needs besides the contexts of chemsex and sex work.
Methods: Retrospective revision and descriptive analysis of data from 150 patients who contacted DiverGENTE from April 2020 to December 2023.
Results: From 150 contacts, mainly referred by community organizations (59%), 112 cases were admitted, with 83 active in 2023. With a mean age of 35, cases were generally from the age groups 24-35 (50%) or 36-45 years old (37%). 88% were MSM, 8% trans or non-binary people, and 25% sex workers; 53% were migrants, mainly from Brazil (81%).
As for their drug use, 86% reported the sexualized type and 50% the injected type. 78% used ‘chems’, meaning cathinones, GHB, methamphetamine, or a combination of those. Percentages for recurrent use of cocaine, MDMA/amphetamines, methamphetamine, methcathinones (such as mephedrone and clophedrone) and pyrovalerone analogues (such as ‘monkey dust’ and ‘alpha’) were, in that order, 59%, 47%, 45%, 79% and 18%. As for recurrent use of cannabis, GHB, ketamine and heroine, they were, respectively, 52%, 62%, 17% and 5%. 43% and 13% reported abuse of alcohol and benzodiazepines.
Regarding other health issues, 59% were living with HIV and 19% had taken PrEP. As for psychiatric comorbidity, Hepatitis C, syphilis, suffering interpersonal violence, homelessness, suicidal crisis, toxic psychosis, sexual dysfunction and sexual compulsivity, frequency was, in that order, 64%, 20%, 26%, 29%, 12%, 28%, 16%, 5% and 7%.
In our intervention, cases were usually assigned a psychiatrist (97%) and a psychologist (91%). For 7%, harm reduction was the main intervention. 17% benefited from sex therapy, 15% for couple/family interventions, and 8% group therapy. 4% had been under in-patient detoxification, 15% were proposed or entered a residential program. 81% received pharmacotherapy, mainly with anticonvulsants (60%) and serotoninergic antidepressants (55%).
Conclusions: DiverGENTE's collaboration with community organizations favors patient access. Support regarding ‘chems’ use by MSM is a major issue, that shouldn’t overshadow other LGBTQ needs. Intervention with ‘chemsex’ partakers requires attention to novel substances and injected drug use, and it also benefits from delivering multiple approaches, such as sex therapy. Addictology services for LGBTQ must articulate with the fields of mental health, sexology, sexual health, social inclusion, and trauma, in a responsive way towards gender, sexuality, migrations and other aspects of human diversity.
