Category: Health

For some years now, one substance has been attracting more attention from users, experts and medical institutions: Monkey Dust. Emergency services are reporting more and more interventions in connection with this drug - in Germany, particularly in Berlin and Göttingen - although monkey dust represents a comparatively small proportion of the total number of drugs consumed. Public interest has also been growing since 2023, which is reflected in an increase in internet searches.

But what exactly is Monkey Dust, how and where is it consumed, and why are even experts, who have long favoured personal responsibility on the part of users, explicitly warning against a drug for the first time? The answers to these questions are complex - but one Study by Charité Berlin and the prevention project Sidekicks, in which Monkey Dust users were asked about their consumer behaviour, now provides important information.

What is Monkey Dust?

It is not always clear among both experts and users what exactly is meant by “monkey dust”. It is a collective term for a whole range of substances from the class of synthetic cathinones, i.e. artificially produced stimulating substances, chemically related to the khat plant. These include in particular MDPV or MDPHP. Sometimes they are also called “pyros” (pyrovalerones). Other variants are α-PHP or α-PiHP, which circulate as “Alpha” or “Flex”.

Monkey Dust has a strong stimulant effect and can trigger intense euphoria, increased energy, disinhibition and increased libido. It can also be understood as a smokable, stronger and riskier variant of mephedrone and 3-MMC - similar to how crystal meth is a smokable, stronger and riskier variant of speed. It is a crystalline powder or fine powder that varies in colour from whitish to brown. Some forms are reported to smell like semen.

It is important to emphasise here that the rate of misdeclaration and contamination of monkey dust is high. Without toxicological analysis, it is often unclear whether what is sold as Monkey Dust is actually synthetic cathinones or other psychoactive substances. Due to different dosages and duration of effect, confusion is particularly dangerous.

In what contexts is Monkey Dust consumed?

Monkey Dust is most commonly consumed - at least in Berlin - at so-called “chills”, i.e. group sex parties. It thus joins the ranks of the well-known chemsex drugs GHB/GBL, ketamine, mephedrone and crystal meth. Frequent users also mention clubs and festivals as places of consumption.

However, a remarkable proportion of the users surveyed by Charité (women, heterosexuals) do not fit the chemsex pattern. This is consistent with reports on the consumption of synthetic cathinones in milieus with homelessness and social precarity, such as the „Flex” scene in Göttingen.

How is Monkey Dust consumed?

Monkey Dust is usually smoked, but can also be sniffed, swallowed, inserted rectally or injected intravenously. However, the “freebase” version of MDPHP is not water-soluble and sticks to the mucous membranes, making it unsuitable for nasal or rectal consumption. When sniffing, it should be noted that Monkey Dust, despite its chemical relationship to mephedrone, must be dosed much lower, as it is significantly stronger.

The users surveyed in the study reported consumption levels of up to 2000 mg per session, with a mean value of 488 mg. These figures far exceed the usual dosages given by Sidekicks (5-10 mg when smoking, 10-20 mg when sniffing, 20-40 mg when swallowing). A reliable dosage is often not possible, as Monkey Dust can be present in very different concentrations and degrees of purity.

Depending on the form taken, the duration of effect is 2 to 8 hours. When smoking, however, after the initial high of 30 to 40 minutes there is a strong urge to top up. If you then top up immediately, the stimulating effect adds up, often resulting in very long sessions. In the study, users reported the duration of a typical session to be up to 72 hours, with an average of around 20 hours. Such a long session can increase the risk of unpleasant side effects. After-effects such as insomnia and increased heart rate can last for 6 to 12 hours.

How does Monkey Dust feel?

Typical effects of Monkey Dust are stimulation, desire for sex and disinhibition, but also motivation, alertness, sociability and self-confidence. Rather negative effects include a suppressed feeling of hunger and thirst, hallucinations and a strong urge to crave more.

In the study, users cited both the reinforcement of positive feelings and the suppression of negative feelings as motives. Monkey Dust triggers a euphoric state, increases sexual performance and intensifies the feelings during sex. Users report that they become “super horny” through consumption and that sex becomes more “animalistic”. Users with frequent use also stated that consumption makes them forget problems, anxiety and depression, and some also use Monkey Dust as self-medication for ADHD.

What are the side effects and long-term effects of Monkey Dust?

Common side effects of Monkey Dust include palpitations, high blood pressure, dry mouth, jaw cramps, muscle twitching, nausea, headaches, sweating, anxiety, increased aggression and erectile dysfunction. Overdoses can lead to life-threatening overheating and psychotic states. Sidekicks recommends seeking medical help immediately in the event of acute psychotic disorders.

Typical side effects when coming down are paranoia and delusions, feelings of guilt and anxiety as well as concentration and memory problems. Physical symptoms include insomnia, headaches, aching limbs and muscle cramps.

As the duration or frequency of use increases, long-term consequences such as psychosis, exhaustion, cardiovascular problems, a weakened immune system, severe weight loss, depression and social withdrawal become increasingly likely.

The study participants cited paranoia, panic or anxiety attacks, an unpleasant social environment, weeks of persistent sensory disturbances, severe weight loss, loss of reality, sexual encounters with people they did not like and sexualised violence as negative consequences.

What other substances is Monkey Dust consumed with?

Around half of the study participants stated that they usually combined smokable synthetic cathinones with other substances. GHB/GBL was most frequently used simultaneously, followed by 4-/3-MMC, crystal meth and (crack) cocaine. The main reasons given for mixed use were: Increase in sexual desire, intensification of intoxication as well as weakening of the effect, e.g. „GHB to counteract the nervous side effects”.

Sidekicks warns that mixed consumption places greater strain on the body and mind. The effects of the individual substances can be intensified, weakened or delayed. If Upper Monkey Dust is taken together with a downer (GHB/GBL or alcohol), the effects mask each other - this leads to excessive consumption. If Monkey Dust is mixed with another upper (4-/3-MMC, crystal meth, speed or cocaine), the cardiovascular system is heavily strained, which can lead to overheating and circulatory collapse.

How do I practise safer use and safer sex?

Only around a third of respondents stated that they used safer-use strategies when consuming monkey dust, such as „hygiene“, „using personal utensils“, „measuring the dosage“ or „buying from very trustworthy people“. Although this indicates a certain level of risk awareness, it also shows that the majority do not take such measures.

Sidekicks recommends the following safer-use strategies before consumption Drugchecking or the KnowDrugs-app as well as raising awareness of one's own pre-existing conditions (cardiovascular, metabolic, psychotic or schizophrenic) and strategies for dealing with cravings. When it comes to consumption itself, it is recommended to only test a small amount at first and to measure the dose precisely. If anxiety or paranoia occur, use should be stopped immediately. Overheating should be avoided by taking regular breaks during sex, getting fresh air and drinking enough. Longer breaks of at least 4 to 6 weeks are recommended after use. The use of substances to get high is not recommended, as they harbour a high potential for addiction.

The effects of Monkey Dust lead to longer and more intense sex. Safer sex practices are often forgotten and the risk of infection with HIV and other sexually transmitted infections increases. It is therefore recommended to clarify in advance which sex practices are wanted and which are not, and to have sufficient safer sex utensils ready. You should only consume so much that you can still clearly say what you want and what you don't want - and also recognise when others are setting boundaries. As always, regular testing for sexually transmitted infections is also recommended.

What are the interactions with HIV therapy?

There are still no clear findings on interactions between Monkey Dust and HIV medications. There are indications that certain drugs such as ritonavir could increase MDPV concentrations.

It is therefore recommended that drugs and HIV medication are always taken at different times, which can minimise possible interactions. In addition, drugs should always be taken in lower doses when taking medication at the same time. Especially during longer sessions, it is easy to forget to take medication altogether - so it is best to always have a reserve of medication with you and to always take it at the right time.

How problematic is the consumption of Monkey Dust?

In the study, 60 % of respondents with frequent use and just under 38 % with occasional use showed indications of probable problematic use. 75 % of respondents with frequent use and just under 14 % with occasional use reached a diagnostic threshold indicating probable substance dependence.

Around a third of those surveyed reported a very strong urge to come back for more (“sometimes after just ten minutes”), frequent loss of control and always or often consuming more than intended during a typical session. In contrast, around half reported only a slight or no urge to use and a third only a slight or no loss of control. This suggests that the compulsive, high-risk patterns of use reported anecdotally may not be universal.

Nevertheless, it is important to recognise risks at an early stage. The mental and physical health indicators observed in the study indicate a possible increased vulnerability in people who consume Monkey Dust. A third reported currently suffering from a mental disorder and more than a quarter tested positive for clinically relevant symptoms of depression or anxiety. These rates are higher than those of the general population.

What are the motives and strategies for reducing or quitting?

Over a third of the study participants have tried to reduce their consumption or stop altogether because they are worried about their own physical and mental health. Many feel deterred by experiences of paranoia as well as risky and transgressive behaviour: „I have seen friends become shadows of themselves within a few months.“

The following strategies were mentioned: Avoiding consumption contexts (such as deleting dating apps from mobile phones, moving away from Berlin), complete abstinence, seeking therapy or counselling services and participating in self-help groups.

Anyone who wants to talk about their consumption or is looking for support, who feels they are consuming too much or is worried about friends and acquaintances, can find help at various counselling centres: Gay counselling, Man-O-Meter, Vista , Emergency drug service, organised by Sonar Party drug consultation hours or the consultation hour for party drug-associated diseases of the Charité.

Anyone interested in the path to complete abstinence can contact non-binding self-help groups such as Narcotics Anonymous or Crystal Meth Anonymous visit. This is where those affected share their experiences and help each other to lead a fulfilling life without drugs. More and more Monkey Dust users who have used in chemsex contexts are finding other sufferers at CMA in particular.

FAQ: Monkey Dust - effects, risks and consumption

What exactly is Monkey Dust, how does the drug work and why are experts increasingly warning against it? The most important questions and answers at a glance.

What is Monkey Dust?

Monkey Dust is a collective term for synthetic cathinones such as MDPV or MDPHP. These artificially produced substances have a strong stimulating effect and are chemically related to the khat plant.

How does Monkey Dust work?

The drug has a strong stimulant effect and can trigger euphoria, increased energy, disinhibition and increased libido. At the same time, side effects such as anxiety or hallucinations are also possible.

Why is Monkey Dust considered particularly dangerous?

Monkey Dust is difficult to dose and is often contaminated. The strong urge to vape and the risk of psychosis, overheating and cardiovascular problems make its consumption particularly risky.

How is Monkey Dust consumed?

The substance is usually smoked, but can also be snorted, swallowed, consumed rectally or intravenously. The effects and risks vary greatly depending on the form of consumption.

What side effects can occur?

The most common side effects include palpitations, high blood pressure, insomnia, paranoia, anxiety and aggression. In severe cases, psychosis or life-threatening conditions can occur.

Is Monkey Dust widespread in Germany?

The drug has been rather rare to date, but is gaining increasing attention. In cities such as Berlin in particular, emergency services are reporting an increasing number of call-outs in connection with monkey dust.

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Sources:

https://sidekicks.berlin/monkeydust

https://link.springer.com/article/10.1186/s12954-026-01428-8

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Advice for queer people on alcohol, drugs and chemsex.

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Chemsex Check – Checkpoint Berlin

Self-test to assess your own chemsex consumption.

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Drugs & substance use – AIDS support

General information about drugs, risks and support.

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Support services for people with chemsex experiences.

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Chex – Man-O-Meter Berlin

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Salus Clinic Hürth

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Lenné House Berlin

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Vista Berlin

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A monkey emoji in a dating profile seems harmless. But in the gay dating scene, it now often stands for Monkey Dust - a barely researched, highly potent substance that appears primarily in the context of chemsex.

In a very personal text Jeff Mannes in the magazine VICTORY COLUMN, how he is confronted with it for the first time on a date. The encounter begins in a familiar way: chat, attraction, sex.

But then something changes. A strange smell, an uneasy feeling - and the realisation that his counterpart has been secretly consuming Monkey Dust. The break is not the consumption itself, but the silence about it.

What follows is not a sermon on morality, but a reflection on boundaries, responsibility and a lack of knowledge. Months later, the author learns that the man has died. Too young. Too suddenly. Monkey Dust is said to have played a role in the death - but it has not been conclusively clarified.

What is Monkey Dust? Effects, risks and lack of research

Monkey Dust is not a clearly defined substance. It is usually a very strong synthetic cathinone that works quickly and can get out of control just as quickly. People report intense pleasure, euphoria and disinhibition - but also anxiety, paranoia, loss of control and waking phases lasting for days. There are hardly any scientifically proven findings. This is precisely what makes the substance so treacherous.

The text shows: Monkey Dust is talked about a lot in the queer community - but often behind closed doors. Out of fear of stigma. Out of insecurity. Out of a lack of education. But exactly the opposite is needed: honest conversations, knowledge, transparency and solidarity. Not to condemn - but to make risks visible and minimise damage.

You can read the full original article by Jeff Mannes in SIEGESSÄULE:

Monkeydust: Of monkey emojis in dating profiles

If there is no clarification, Monkey Dust becomes unpredictable

What makes Monkey Dust particularly dangerous is not only its powerful effect, but above all the lack of knowledge about it. Counselling centres such as Sidekicks.Berlin report that the substance can quickly lead to a loss of control - over quantity, duration and personal limits. People tell of intense periods of wakefulness, anxiety, paranoia and massive mental crises. At the same time, there is little certainty about what happens in the body in the long term. Reliable studies are still almost completely lacking.

In addition, there is a further risk Drug checking in Berlin Monkey Dust has been detected in samples sold as other substances. This means that people can consume a drug without realising it. This makes unwanted effects, overdoses and dangerous interactions more likely.

Despite this, Monkey Dust is often only spoken about quietly in the queer community. For fear of stigmatisation, out of insecurity or because experiences are difficult to categorise. Projects such as Sidekicks.Berlin or Checkpoint BLN therefore rely on education rather than condemnation. An accepting, non-moralising attitude is crucial - without ignoring the real risks.

Honest dialogue, transparent information and supportive solidarity can protect lives. Because as long as knowledge is lacking and consumption remains invisible, monkey dust remains a substance that is difficult to assess - and that is precisely what makes it so dangerous.

Monkey Dust: Frequently asked questions and answers

Monkey Dust is increasingly appearing in the context of chemsex, but has hardly been researched and is difficult to assess. Here you will find answers to frequently asked questions about effects, risks and why education is so important.

Chris, thank you for taking the time. What was the starting point for the realisation of this research project?

The starting point for the project was that although there is a great deal of community knowledge, there was no reliable data available for German-speaking countries. Against the background of the international data situation, e.g. in North America, it was obvious that people from the trans and non-binary communities also belong to the vulnerable groups with regard to HIV and STI. This gave rise to the idea of collecting this missing scientific data together with the RKI.

What were the aims of the research project?

The goals were diverse. On the German AIDS service organisation side, we had 4 subject areas that interested us. These were

1. How is sexuality and language perceived and experienced?
2. What aspects play a role in a positive self-image?
3. What barriers are there to utilising existing services in the context of sexual health?
4. What factors influence sexual health?

The RKI's aim was to obtain data on the spread and prevalence of HIV and STIs in the relevant communities and to identify factors that play a role in sexuality and therefore in sexual risks. In other words, to determine needs and experiences in the context of sexuality, HIV, prevention, counselling and care.

In other words, the RKI was more concerned with the quantitative part and the DAH with the qualitative part. Can you outline this in more detail? In other words, how was the project structured and how important was participatory research?

The participatory research approach was the element that connected both parts. From the outset, it was important for both sides to involve community representatives. For example, there was a project advisory board made up of representatives from the communities that accompanied the project from start to finish. The advisory board played a critical role in the monitoring process, for example in the context of feedback loops. However, it was also important that the project was consistently carried out and implemented by people who were and are themselves representatives of the relevant communities, despite a number of staff changes during the course of the project.

The online questionnaire was also developed in a participatory manner at the RKI and was completed by over 3,000 people in the end.

At DAH, we also conducted interviews in various forms. What was unique and new was that we combined the data collection with elements of empowerment for the participants. At the weekend events, for example, we initially wanted to create a space that allowed people to talk about these very intimate topics of sexuality and sexual health and to show their vulnerability in the process. It was important to us that everyone could benefit and take something away with them. We didn't just want to "explore" the people, we also wanted everyone to be able to take something away with them at the end. Be it new contacts, new perspectives or new knowledge. In addition to these three weekend events, there were also one-day events, two completely anonymous online events and four individual interviews. In the individual interviews, it was important to us to reflect the perspectives that were neglected in the other surveys. We had a total of 59 participants in the qualitative part.

After a tweet from the RKI, there was a huge shitstorm and TERFs, as well as other opponents, were called upon to sabotage the survey. Of the 10,000 completed questionnaires, only 3,000 could be analysed in the end.

That really sounds like a very exciting and worthwhile approach. What challenges did you face in the project?

One of the biggest challenges with the questionnaire was that it had to be subjected to very intensive data cleansing. The reason for this was that there was a huge shitstorm after a tweet from the RKI and TERFs and other opponents were called upon to sabotage the survey. Of the 10,000 completed questionnaires, only the 3,000 mentioned above could be included in the final analysis. This also shows once again how much rejection there is and how active the opposing side is online. Nevertheless, and this is the most important thing: so many people honestly filled in this questionnaire of more than 100 questions because the topic was important to them.

Another challenge was that we unfortunately did not manage to reach all people from the different trans and non-binary communities in the qualitative part. For example, there were only a few trans women or HIV-positive participants overall.

Perhaps we should have organised another weekend explicitly for trans women only. But these are very important findings that we would like to try to take more into account in follow-up projects. Because if the study has shown one thing, and this is not really a surprise, it is how diverse the trans and non-binary communities are overall.

This brings us to the results. What are the key results and findings of the study?

I would once again differentiate between RKI and DAH. An overarching key finding was the diversity of the communities in terms of gender identities, but also in terms of sexual orientations and bodies and lived sexuality. A broader understanding of safer sex among the participants, which goes far beyond the understanding of safer sex as protection against HIV/STI and also includes, for example, psychosocial aspects such as consent and communication, is one of the key findings. The aspect of consensus and communication in particular ran through all the events. That it is important to be asked how body parts are named, but also to ask questions yourself. It became clear that it takes more than pure HIV/STI prevention to feel safe to live one's own sexuality with others.

On the other hand, there was also a not-so-surprising finding that highlighted the inadequate care situation for trans and non-binary people in the area of sexual health and the counselling and testing landscape. Nationwide, three projects were repeatedly mentioned in the interviews that were rated as good. In the qualitative section, projects with a peer-to-peer approach were rated particularly highly. Projects without such an approach tended to be rated lower. However, this is also a point in which the results of the RKI and the DAH differ, as the RKI also explicitly asked about this again. According to the RKI survey, 62.4% of people were also satisfied with the counselling, even if it did not have a peer-to-peer approach.

The final key finding was how important prevention knowledge is for personal empowerment and the importance of knowledge sharing in communities and between peers. These are factors that lead to taking care of oneself, one's own body and one's own sexual health and thus also generate a higher self-esteem.
The key finding of the RKI is that HIV/STI vulnerabilities occur in patterns similar to those described in the research literature. At the same time, the RKI was able to highlight the barriers that exist when it comes to making use of counselling and testing services in the health sector. For example, shame and previous or feared experiences of discrimination in the counselling setting are factors that lead to people virtually anticipating discrimination and thinking twice about whether to take up this offer because they expect to have similar experiences again.

People come to counselling as people seeking advice and end up having to explain the reality of their own lives to the person giving the advice.

You have already mentioned some of the obstacles that trans and non-binary people face with regard to their sexual health and protection against HIV/STIs. Would you like to add any more and what can be done about them?

In particular, the lack of adequate services explicitly aimed at trans and non-binary people is one of the biggest hurdles. But also the lack of knowledge in the various areas. On the one hand, the very different levels of knowledge in the trans and non-binary communities, but also the lack of access to or lack of appropriate resources. On the other hand, the lack of knowledge on the part of the counsellors. Many participants reported that there is often a role reversal. In other words, people come to counselling as people seeking advice and end up having to explain the reality of their own lives to the counsellor. This imbalance should not exist and must therefore be urgently addressed and reduced by means of nationwide training (based on a training curriculum) by counselling centres by building up knowledge. The experiences mentioned above, such as invasive questions, deadnaming when calling or the use of incorrect pronouns, also play a special role here. According to the survey, this lack or scarcity of knowledge in the counselling centres was one of the main hurdles.

What other aspects play a special role in sexual health and protection against HIV/STIs for trans and non-binary people?

A particularly important aspect is that people feel addressed by the counselling and taken seriously in order to get what they need and help them further.
This can be new knowledge or physical self-awareness through body appropriation. Sharing experiences with other people from the community can help reduce anxiety and make you feel more confident. Getting tested together with friends can also help to reduce anxiety and take care of each other's sexual health. This can definitely be a small happening, so perhaps go to a café together beforehand and then get tested afterwards. Community can play an important role here.

Don't be alarmed, now comes a small block of questions, but they all belong together: What are the prevalences in relation to HIV/STIs and how do they differ compared to other groups? What specific factors lead to people from trans and non-binary communities having an increased vulnerability to HIV and other STIs? And what role does this have for future HIV/STI prevention?

HIV prevalence in the trans and non-binary communities is 0.7%, which is significantly higher than in society as a whole, where it is 0.1%. Compared to the prevalence of HIV in MSM, it is significantly lower. According to the last EMIS study from 2017, this is 11%. A new EMIS study is currently underway that will update this figure again. Based on these two comparison groups, however, it is already very clear that a prevalence seven times as high is not insignificant. Nevertheless, it is also important to differentiate between the trans and non-binary communities, as these have different prevalence rates.

This internalised trans negativity is particularly evident in a quote from our study, which I would like to quote here: "I already trust my counterpart with my trans body. I don't feel like I have to insist that we use a condom."

An important factor for the increased vulnerability is the social stigmatisation of trans and non-binary people and their internalisation. This internalised trans negativity is particularly evident in a quote from our study, which I would like to quote here: "I already trust my counterpart with my trans body. I don't feel like I have to insist that we use a condom." That's blatant and incredibly difficult to hear. But it also shows the consequences that self-image and self-worth have on lived sexuality.

At the same time, shame was also an important factor, and we also identified the lack of knowledge in relation to safer sex, barrier methods, STIs etc. as stress factors. At this intersection, body dysphoria and transition processes, such as gender reassignment surgery, are further factors that can also have an impact on one's own protective behaviour. Finally, counselling and testing services also play an important role. People reported negative experiences that they themselves had had with services that labelled themselves as trans-inclusive, but where basic things such as the difference between trans men and trans women were not known.

These experiences are continuing and that would also be the point where future prevention work should start. In other words, the creation of needs-orientated services and peer-to-peer offers. We need more knowledge, more sensitisation and greater consideration of trans and non-binary people in their living environments and realities. This should definitely be taken on board for future prevention work.

What protection strategies are available for trans and non-binary people with regard to HIV and STIs? Are these already known or is there a lack of knowledge in certain areas, so that some are perhaps not considered?

It is fundamental to say that the communities themselves are very diverse and so are the protection strategies within them, again with regard to very different levels of knowledge. Some people are well informed, others rather poorly. For example, the Condom as a protection strategy, but for many it was also the only protection strategy they knew. Knowledge of other protection strategies depends on the subcommunities in which individuals move. For example, trans and non-binary people who are more likely to be in gay communities even those who have at least heard of the PrEP and the PEP have heard of them. This does not mean that they have taken them themselves, but that they were familiar with them.
Other things that were mentioned were lick cloths, but also practices such as peeing after sex or hand hygiene. That's how different the levels of knowledge and understanding of protection strategies were.

What about the use of HIV/STI counselling services? What experiences do trans and non-binary people have in these settings? What is already working well, what needs to be improved? Are there best practice examples of successful counselling services or approaches?

The participants reported that they also repeatedly experience discriminatory situations in HIV/STI counselling services, whether at local AIDS service organisations or other services.

Peer-to-peer programmes were generally rated positively. What all best practice examples have in common is that they are mainly found in large cities. Many people sometimes have to travel very long distances to take advantage of these services, which highlights the problem of comprehensive care and services. So-called testing days specifically for trans and non-binary people, and in some cases also inter people, are also well received.

Above all, the expansion of peer-to-peer services was recommended and also that services that do not have a peer-to-peer approach should undergo further training in order to sensitise themselves and demonstrate an appreciative and non-aggressive manner. This means that counselling should be respectful, especially with regard to gender identity, names and pronouns, and this should be collected using questionnaires, for example, so that the doctor knows how the person would like to be called. Unfortunately, it still happens far too often that people are called by their dead name, i.e. the old name they have filed away, or that they are addressed with the wrong gender. These are all problems that often happen before the actual counselling and then of course have a lot to do with how I approach the counselling. This means that the entire practice team needs to be sensitised to these aspects.

What are the most important recommendations for counselling on sexual health and HIV/STI that have emerged from the study?

On the one hand, there is information tailored to trans and non-binary people, which should also be known to counsellors or can be used for appropriate further training. This is also associated with an appreciative attitude, respectful and appreciative language and the counselling centres should recognise the diversity of the trans and non-binary communities and be geared towards them. Intersectional approaches are needed, particularly with a view to diversity, in order to reach as many people as possible.

In the future, we need to consider what it means to work in an intersectional way and review existing programmes accordingly. For example, if I only reach white trans and non-binary people, then it is not an intersectional approach. Then I have to check what I can do so that I can also reach other people.

What do the results mean for existing community projects in the field of sexual health and HIV/STI prevention?

We should bear in mind that not all communities are the same, but that they are very diverse and that we should rather speak of communities here. Not all projects that claim to be queer have explicitly dealt with trans and non-binary lifeworlds or are not automatically competent in trans issues. In future, it will be necessary to consider what it means in concrete terms to work intersectionally and to review the existing programmes in this regard. It is important to sharpen the focus and realise who I want to reach and who I have (not) reached so far. If, for example, I only white trans and non-binary people, then it's not an intersectional approach. Then I have to check what I can do so that I can also reach other people. Future or existing community projects should also be able to scrutinise themselves, reflect and clarify for themselves who they specifically want to reach and compare this with the status quo in order to then make adjustments and see what needs to change in order to reach more people or reach the people they want to reach.

Have things already changed or developed after the study was carried out? If so, which ones and what is the next step with the results?

At DAH, we have designed a follow-up project (SeBiCo), which is funded by Techniker Krankenkasse. With a view to the recommendation, we have set ourselves the goal of transferring knowledge to the communities on the one hand and promoting peer-to-peer work on the other. The first step is to train twelve multipliers who themselves come from the trans and non-binary communities. We want to train them as trainers who will then lead peer-to-peer workshops. In other words, we are ultimately developing two different curricula, one curriculum for the trainer training and then a curriculum for the peer-to-peer workshops. The idea is that the people we train can subsequently implement these workshops themselves in the cities in which they live, linked to the local AIDS service organisations or other providers. This promotes dialogue with the community, but also among the multipliers. It was not easy to select the twelve multipliers, as there was a great deal of interest in the training series. We are very pleased to get to know these people personally.

We are ultimately developing two different curricula, one curriculum for the trainer training and then a curriculum for the peer-to-peer workshops. The idea is that the people we train can subsequently implement these workshops themselves in the cities in which they live, linked to the local AIDS service organisations or other providers.

Is there anything else that is important for you to say and should definitely not be missing from our interview?

For me, it's nice to see what's happening now after the research report and the brochure.

With the follow-up project, we now have a new training ground to reorganise ourselves and approach things differently. The new multiplier training is a kind of live development in which we have to be very flexible if we realise that something might not be quite right and then consider how we can do it differently. I'm really looking forward to being involved right from the start.

Thank you very much for your time and the insights into the study results as well as the outlook for the upcoming follow-up project, for which I wish you every success.

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You can find more information about the research project here. You can download the brochure free of charge from the Shop of the Deutsche Aidshilfe or here download. The more detailed research report is available on the website of the RKI to find. And here you can find the follow-up project "Sexual education in trans and non-binary communities" (SeBiCo).

There is only one drug authorised for PrEP in Germany. It is hardly available at the moment. Some pharmacies have remaining stocks, but more and more PrEP users are going without. Patients have also had to switch to other medications for their HIV treatment. A situation that is likely to continue until at least March 2024. This was reported by the Association of Outpatient Physicians for Infectious Diseases and HIV Medicine (dagnä) in a Press Release.

In some cities, PrEP is no longer available at all, as IWWIT has learned from local organisations. In others, such as Berlin, some surgeries are only prescribing monthly packs so that the medication lasts longer - normally one pack lasts for three months. The situation is getting worse by the day.

The reasons for the problem are complex. For example, according to our information, two factories have production problems. There also appear to be individual difficulties in the supply chain and increased demand. Price differences on the European pharmaceutical market are also likely to play a role: Manufacturers in many neighbouring countries apparently receive more money for their medicines than in Germany.

Jonathan Gregory, Head of IWWIT: "It's difficult to say when the situation will ease again. One thing is clear: we have a shortage and not all people who need the medication for PrEP or therapy can be supplied at the moment. There's nothing to gloss over."

Nevertheless, there are still some ways in which PrEP users can obtain their medication. Below are our suggestions for dealing with this difficult situation.

What PrEP users can do now

Contact HIV pharmacies

If your pharmacy no longer has PrEP, contact a pharmacy. Member of the HIV-competent pharmacies working group (DAHKA). These pharmacies exchange information with each other and support each other in supplying PrEP if there are still stocks available. You can also make enquiries via online pharmacies. To do this, ask your doctor for an e-prescription. This makes ordering much easier.

Individual imports from abroad

Pharmacies can try to order the PrEP medication abroad if they obtain prior authorisation from the health insurance company. Some pharmacies do not know this or are afraid of the effort involved. It is best to ask for an "individual import in accordance with Section 73 (3) of the German Medicines Act (AMG)". However, there is no guarantee that the pharmacy will do this and that medication will be available abroad.

Occasion-related PrEP

For some users of daily continuous PrEP, it could also be an option to switch, at least temporarily, to so-called event-related PrEP, where you only take tablets before and after (planned) sex. You can find more information on this at aidshilfe.de/hiv-prep/einnahmeschema.

Approach the practice early for therapy

If you are using the combination of emtricitabine plus tenofovir disoproxil in your HIV treatment, contact your doctor's surgery before your tablets run out so that there is enough time to try to obtain new ones.

Check other safer sex options

If nothing helps, you can consider whether other safer sex options such as condoms or protection through therapy are an option for you until PrEP is available again.

Exchange ideas

It can also be helpful to talk to other PrEP users about their experiences, for example in the Facebook group PreP.Now. Of course you can also register with our Gay Health Chat or with another Offer of the Deutsche Aidshilfe get advice.

We demand security of supply

Deutsche Aidshilfe is campaigning for security of supply for HIV drugs and has called on the Federal Ministry of Health and the Federal Institute for Drugs and Medical Devices (BfArM) to solve the supply problems.

"We won't let up until everyone who needs the medication for PrEP or therapy gets it. You can count on it!" says IWWIT campaign leader Gregory.

Message from Deutsche Aidshilfe on the PrEP bottleneck

Press release by dagnä