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Prevalence of drug use among MSM across the USA

Prevalence of drug use among MSM across the USA

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Numerous studies have demonstrated that men who have sex with men (MSM) experience disproportionate levels of ill-health compared to the general population, and are one of the highest risk groups for HIV in every part of the world.MSM frequently face significant stigma and discrimination from their families, communities and, in some countries, are...

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... approach is appropriate in terms of influencing local harm reduction interventions but makes country-level comparison difficult. Table 4 ...

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... 35 ISSUE 2, AGUSTUS 2022 26 CASE REPORT berkontribusi terhadap meningkatnya risiko penularan IMS. 14 Selain itu, faktor pengaruh alkohol dan obat-obatan juga dapat menurunkan kesadaran dan kepatuhan dalam melakukan aktivitas seksual yang aman. 15 Pemeriksaan nonserologis yang berguna dalam membantu penegakan diagnosis sifilis adalah pemeriksaan histopatologi dan imunohistokimia. Kasus sifilis atipikal umumnya terjadi pada fase sekunder, di mana gejala dan tanda yang muncul sangat tidak khas atau dapat menyerupai penyakit lainnya. ...
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... The drugs used in chemsex -cathinones (including mephedrone), GHB/GBL (gamma-hydroxybutyrate/gamma-butyrolactone) and methamphetamine -are characterized by a particular action mechanism absent from drugs which have been "on the market" longer and are therefore better known. In the population using chemsex, cathinones are the most frequently used and most readily available drugs [7,8]. Mephedrone, like other synthetic cathinones, has psychoactive and sympathomimetic action similar to amphetamine, and a stronger entactogenic effect, causing increased sensory sensitivity, sexual arousal and disinhibition [9]. ...
Article
Wraz ze zwiększającym się społecznym przyzwoleniem na szukanie pomocy w zakresie zdrowia psychoseksualnego, w gabinetach specjalistycznych można zaobserwować bieżące przemiany społeczno-kulturowe oraz zrodzone z nich zjawiska. Jednym z takich relatywnie nowych fenomenów jest chemsex. To szczególna i stosowana niemal wyłącznie przez mężczyzn forma łączenia ściśle określonych substancji psychoaktywnych z aktywnością seksualną. Ze względu na podwyższone ryzyko zdrowotne, zarówno związane z używanymi środkami jak i częstym brakiem zabezpieczeń w kontaktach seksualnych, chemsex uznawany jest przez międzynarodowe instytucje zdrowia publicznego za problem zdrowotny mężczyzn mających kontakty seksualne z mężczyznami (MSM). Choć wprowadzenie w latach 90-tych kategorii MSM – głównie w kontekście HIV – miało istotne przesłanki epidemiologiczne (ważne w kontekście ryzyka jest zachowanie, a nie identyfikacja), to właśnie pomijanie tożsamości seksualnej może być jednym z brakujących ogniw w intersekcjonalnym rozumieniu i adekwatnym adresowaniu problematycznego chemsexu. Artykuł adresowany jest szczególnie do lekarzy psychiatrów, psychologów, psychoterapeutów, terapeutów uzależnień oraz seksuologów pracujących z tą grupą pacjentów.
... Our analysis revealed that recreational drug use was closely linked to clubbing, where sex was an often expected and appreciated by-product, though not always the intention. In this way the mens' experiences did not always fit the definition of chemsex as used in previous literature where drugs are used intentionally for heightening the sexual experience [1,14,45,49]. This is an important finding that should be considered when targeting men for harm reduction efforts, as it may be that MSM who are clubbing would not consider themselves as part of the chemsex scene but are exposed to similar risks if having sex as a by-product of their clubbing. ...
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Background Recreational and sexual drug use among men who have sex with men may result in increased risk of poor health. The aim of this study was to better understand drug use and harm reduction techniques among Swedish men who have sex with men traveling to Berlin in order to improve the health of this population and inform public health strategies. Methods A qualitative study based on semi-structured interviews with 15 Swedish men aged 23–44 with experience of drug use were recruited through network sampling. Interviews were conducted in Stockholm and Berlin and analysed using content analysis. The interview guide included questions on drug use, context, health and safety. Results The participants engaged in drug use in both settings and in various contexts. Participants saw themselves as capable of finding a balance between pleasure, safety and risk with the aim to maximize positive effects while minimizing negative ones. The different risks of drug use were known, and participants relied on knowledge, harm reduction strategies and self-defined rules of intake to stay safe and healthy in a broad sense, both short term (i.e. during each session) and long term. Choice of drug and, frequency of intake, multi-use, risk of overdose, risk of HIV, purpose and context of use, how often, etc. were all part of the overall strategy. Knowledge of these methods was spread within the community and on-line rather than from counsellors or other health care providers. However, it did not always translate perfectly into practice and some had experienced overdoses and problematic use. Conclusions The findings of this study point to the need for increased adoption of harm reduction techniques in this population focusing on mitigating harm and prevention of risk of problematic use or starting injection drugs. Existing traditional services require adaptations to become more accessible and acceptable to sub-groups of drug users, including low-threshold services providing non-judgemental, evidence-based information. This will require funding of alternative providers such as STI/HIV clinics, among others, and health care providers to increase adoption of prevention strategies, specifically pre-exposure prophylaxis for HIV.
... Sexualised drug use (SDU) is a term used to refer to sexual activities whilst under the influence of a wide range of drugs and substances, such as cannabis, amyl nitrates (poppers), and crystal methamphetamine and has been a topic of research among men who have sex with men (MSM) for some time ( Bourne, 2012 ;Leigh & Stall, 1993 ). Chemsex (sometimes referred to as 'party and play') is a particular form of SDU whereby men engage in sex with other men for long periods of time with multiple sexual partners, typically taking one or more of crystal methamphetamine, -hydroxybutyrate/ -butyrolactone (GHB/GBL), methedrone, cocaine and/or ketamine immediately before or during sex to facilitate and enhance the sexual experience ( Bourne, Reid, Hickson, Torres Rueda, & Weatherburn, 2014 ). ...
... Research investigating SDU among MSM has mostly been conducted in Western countries, and the term chemsex is typically used in a Western context , but SDU, including the sexualised use of drugs associated with chemsex, has also been observed internationally ( Bourne, 2012 ;Maxwell et al., 2019 ;Tomkins et al., 2019 ). Due to the nature of researching SDU, studies tend to be crosssectional, making causation hard to infer. ...
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Introduction: Chemsex is a specific form of sexualised drug use (SDU) that is an emerging public health issue among men who have sex with men (MSM). Although the recent focus on chemsex is a reflection of the associated harms it is important to understand SDU more broadly and its associations with risk behaviours. Additionally, some of the reasons suggested for MSM engagement in SDU are also likely to apply to women who have sex with women (WSW) and trans people. The aim of this review was to investigate SDU, including chemsex, among lesbian, gay, bisexual and trans (LGBT) people internationally in relation to sexual health outcomes (HIV status, STI diagnosis, condom use). Methods: Papers that were published between January 2010 and June 2020 reporting SDU in MSM, WSW, or trans people were identified through Medline, PsycINFO, CINAHL Plus and Web of Science. Results were synthesised using a narrative approach. Results: The search identified 2,710 publications, of which 75 were included in the final synthesis. The majority of studies measured SDU among MSM (n = 71), and four studies measured SDU among trans people. Research into SDU had been conducted in 55 countries and 32 countries had recorded the use of a chemsex drug among MSM, although the drugs used to define chemsex varied. Among studies that researched MSM, SDU was most commonly investigated in relation to condomless anal intercourse (n = 42), followed by HIV prevalence (n = 35), and then STI diagnoses (n = 27). Drug use was generally associated with sexual health outcomes, but particularly in chemsex studies. Conclusions: SDU research is lacking among WSW and trans people, despite trans women having a high HIV prevalence. Among MSM, most drugs were associated with sexual health outcomes, and therefore it is important to include both chemsex drugs and other drugs in SDU research.
... Evidence indicates that young sexual and gender minority men (SGM men; including those who identify as gay, bisexual, queer and/or transgender) experience higher rates of cannabis use than their heterosexual and cisgender counterparts (i.e., about three times higher past-year prevalence rates) (Bourne, 2012;Branstrom & Pachankis, 2018;McCabe, Hughes, Bostwick, West & Boyd, 2009;Trocki, Drabble & Midanik, 2009). Young SGM men also experience disproportionately high rates of mental illness including depression, anxiety, substance use and trauma/stressor-related disorders (Branstrom & Pachankis, 2018;Guzman-Parra et al., 2014;Hughes, L. & McNair, 2010;Lachowsky et al., 2017;Mustanski, Garofalo & Emerson, 2010), as well as high rates of suicidal behaviours (including suicide thoughts, plans and attempts) (Lachowsky et al., 2017). ...
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Despite a growing body of evidence demonstrating that cannabis use is associated with mental illness among sexual and gender minority (SGM) men, little is known about the motivations, patterns and contexts that influence this relationship. Our study aimed to characterize how cannabis use features within the mental health-related experiences of young SGM men in Vancouver, Canada. From January to December 2018, semi-structured interviews were conducted with 50 SGM men ages 15 to 30 years to explore their experiences using cannabis. We draw on thematic analysis to reveal three themes regarding participants’ experiences with cannabis use and mental health. First, participants experiences emphasized the interconnectedness of cannabis use, sexual, and mental health, including using cannabis to: (i) cope with mental health symptoms during sexual encounters (e.g., anxiety, sexual trauma-related stress); and (ii) substitute or replace other substances (e.g., crystal methamphetamine, MDMA) to reduce drug-related harms in Chemsex practices (e.g., decreased ability to consent, drug-induced psychosis). Second, participants discussed the instrumental use of cannabis to alleviate and address symptoms of mental health (e.g., depression, post-traumatic experiences). Third, participants described adverse effects of cannabis use on their mental health, including feelings of paranoia that they associated with cannabis use, as well as concerns around developing cannabis dependence. Our findings reveal important implications for public health policy on how cannabis can be used to manage experiences of mental health among young SGM men, while also highlighting the need to develop harm reduction services for those who may experience mental health-related harms.
... Alkyl nitrites are a group of chemical compounds which include amyl nitrite and other volatile liquids referred to as 'poppers' (Haverkos, Kopstein, Wilson & Drotman, 1994). The use of poppers has been commonly reported among gay, bisexual and other men who have sex with men (GBM) (Bourne, 2012). In Australia, approximately twothirds of GBM report lifetime use of poppers ( Jin et al., 2018 T least one-third of GBM reporting use in the previous six months ( Jin et al., 2018;Lea et al., 2013). ...
Article
Background and aims: Gay, bisexual and other men who have sex with men (GBM) use alkyl nitrites ('poppers') at higher rates than other populations to functionally enhance sexual experiences. Their use has been associated with HIV sexual risk behaviours including receptive anal sex. We investigate the prevalence, frequency, and motivations for poppers use and their relationship with HIV risk. We also discuss the implications of the recent scheduling changes to poppers by the Australian Therapeutic Goods Administration. Methods: Data were drawn from the Following Lives Undergoing Change (Flux) study, a prospective observational study of licit and illicit drug use among GBM. Between 2014 and 2018, 3273 GBM enrolled in the study. In 2018, 1745 GBM provided data relating to frequency of and motivations for poppers use and were included in this analysis. Results: Median age was 33 years (IQR 25-46) and 801 GBM (45.9%) had used poppers in the previous six months ('recent use'). Among these men, 195 (24.3%) had used them weekly or more frequently. Most recent users (77.4%) reported using poppers for a 'buzz' during sex or to facilitate receptive anal intercourse (60.8%). The majority (57.7%) of HIV-negative men reporting recent poppers use were concurrently taking HIV pre-exposure prophylaxis. Recent poppers use was independently associated with receptive anal intercourse with casual partners (aOR 1.71; 95%CI 1.35-2.16) and chemsex (aOR 4.32; 95%CI 3.15-5.94). Poppers use was not associated with anxiety, depression, or drug-related harms. Only 15.4% of current users indicated they would stop using poppers if they were criminalised; 65.0% said they would 'find other ways' to obtain them. Conclusions: Poppers are commonly used by Australian GBM to functionally enhance sexual experiences, particularly to facilitate receptive anal intercourse. Few men experienced drug-related harms from poppers use. Regulatory changes must ensure potential harms from popper use are minimised without increasing barriers to access or perpetuating stigma.
... Chemsex is associated with risky sexual behaviour and increased risk of STIs including HIV, hence the importance within a sexual health consultation. 15,16 Onward referral to appropriate services that can support chemsex users towards abstinence or risk reduction strategies should be considered. (2D) -Previous and current HIV PEP (postexposure prophylaxis) and PrEP (preexposure prophylaxis) use if these are available in your practising country. ...
... Recreational drug use is more prevalent in gay and bisexual male populations, relative to heterosexual male populations, and is often rooted in sexualised contexts (Bourne, 2012;Hunter, Dargan, Benzie, White, & Wood, 2014;Mackesy-Amiti, Fendrich, & Johnson, 2008;McCabe, Hughes, Bostwick, West, & Boyd, 2009). Terms such as 'chemsex' and 'party and play' -denoting the use of drugs such as gamma-hydroxybutyrate/gamma-butyrolactone (GHB/GBL), crystal methamphetamine (crystal meth), and mephedrone before or during sexual activity among GBMSM (Bourne, Reid, Hickson, Torres-Rueda, & Weatherburn, 2015) -have become incorporated into the lexicon of gay male culture and society (Bianchi, 2016;Glyde, 2015). ...
Article
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Background: Sexualised substance use, or 'chemsex' has been shown to be a major factor driving the syndemic of HIV/AIDS in communities of gay, bisexual, and other men who have sex with men (GBMSM) around the world. However, there is a paucity of research on chemsex among GBMSM in Singapore due to punitive drug laws and the criminalisation of sexual behaviour between men. This qualitative descriptive study is the first to explore perceptions towards, motivators to engaging in, and the barriers to addressing the harms associated with chemsex among GBMSM in Singapore. Methods: We conducted 30 semi-structured in-depth interviews with self-identifying GBMSM between the ages of 18 to 39 in Singapore following a purposive sampling strategy. Interview topics included participants' perceptions of drug use among GBMSM in Singapore, perceptions towards chemsex, reasons for drug use and chemsex, and recommendations to address the harms associated with chemsex in Singapore. Interviews were audio-recorded, transcribed, coded, and analysed using thematic analysis. Results: Participants reported that it was common to encounter chemsex among GBMSM in Singapore as it could be easily accessed or initiated using social networking phone apps. Enhancement and prolongation of sexual experiences, fear of rejection from sexual partners and peers, and its use as a means of coping with societal rejection were three main reasons cited for engaging in chemsex. The impact of punitive drug laws on disclosure and stigmatisation of GBMSM who use drugs were reported to be key barriers towards addressing chemsex. Participants suggested using gay-specific commercial venues as avenues for awareness and educational campaigns, and social media to reach out to younger GBMSM. Conclusions: This study highlights the complexities behind chemsex use among GBMSM in Singapore, and the range of individual to institutional factors to be addressed. We recommend that community-based organisations and policy-makers find ways to destigmatise discussion of chemsex and provide safe spaces to seek help for drug use.
... Whereas ecstasy, amphetamine, cocaine and cannabis predominated before 2007, more recently a new cohort of drugs has emerged, namely mephedrone, methamphetamine and gamma-hydroxybutyrate (GHB) and its agonist gamma-butyrolactone (GBL). 4,5 Changing use patterns are also evident, including increased intravenous use (referred to as 'slamming'), polydrug use and the intentional combining of drugs and sex to enhance sexual experiences ('chemsex'). In chemsex, methamphetamine, mephedrone and GHB/GBL are used predominantly (hereafter 'chemsex drugs'). ...
... 19,20 Recent studies indicate that a complex array of factors shape lesbian, gay and bisexual (LGB) substance use pathways, including social networks, living with HIV, the extent to which individuals live openly as LGB and the effect of MSM social spaces. 4,21 However, there is significantly less evidence regarding factors shaping chemsex pathways. The use of social media and online dating applications are thought to play a role in facilitating chemsex hook-ups. ...
Article
Methods: Using a life course perspective, the present qualitative interview study examined participants' reflections to discern pathways in and out of chemsex engagement. Six participants (aged ≥18 years) were drawn from a cohort of men who had completed the tailored therapeutic Structured Weekend Antidote Program. Transcripts were analysed using a Labovian narrative analysis framework. Results: Each man identified a multiplicity of incidents and feelings that contributed to their engagement in chemsex, and engagement in chemsex was connected to participants' identity development and desire to belong to a gay community. Underlying individual accounts, a common narrative suggested a process through which chemsex journeys were perceived as spiralling from exciting and self-exploratory incidents into an out-of-control, high-risk activity that was isolating and prompted engagement with therapy. Despite seeking therapeutic engagement, participants expressed uncertainty about maintaining a gay future without chemsex. Conclusions: Chemsex was associated with a positive gay identity gain, which explained the ambivalence participants expressed in maintaining a gay future without chemsex despite their awareness of negative consequences. This is significant for understanding both why chemsex pathways may prove attractive and why they may be so difficult to leave.
... This may support that substance use is dependent on circumstance, for example, to facilitate sexual activity. 2 Recreational substance use in the MSM population and risky sexual practices including condomless sex are well reported in the literature. 3,4 Increasingly sexual health clinics across the UK are responding to the rise of sexualised drug taking, referred to colloquially as 'chemsex', and its implications. ...
Article
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Recreational drug use (RDU) has been reported to be disproportionately higher in men who have sex with men (MSM) when compared to their heterosexual counterparts. To identify RDU, links to risky sexual practices and infections for MSM attending three sexual health clinics across Manchester, United Kingdom, a retrospective case note review was conducted using a random powered sample of service users attending three sites during 2014. Three hundred and fifty-seven case notes were reviewed across three sites. Eighteen per cent of service users reported any type of RDU. Use of at least one of the three drugs associated with chemsex (crystal methamphetamine, mephedrone, gamma hydroxybutyrate/gamma butyrolactone) was reported by 3.6%. A statistically significant difference was identified between non-drug users and any-drug users reporting: group sex (odds ratio [OR] 5.88, p = 0.013), condomless receptive anal intercourse (CRAI) (OR 2.77, p = 0.003) and condomless oral intercourse (OR 2.52, p = 0.016). A statistically significant difference was identified between chemsex-related drug user and non-drug user groups reporting: group sex (OR 13.05, p = 0.023), CRAI (OR 3.69, p = 0.029) and condomless insertive anal intercourse (OR 1.27, p = 0.039). There was also a statistically higher incidence of gonorrhoea infection in chemsex-related drug use compared with those not using drugs (p = 0.002, OR 6.88). This study identifies that substance use is common in MSM attending sexual health clinics in Manchester. High-risk sexual practices and certain sexually transmitted infections are more common in MSM reporting RDU.