No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
High-risk drug practices tighten grip on London gay scene
... Some drugs like rush popper could relax the anal sphincter, reduce anal pain and help MSM quickly expand blood vessels to reach orgasm in a short period, improving the sexual experience [15]. However, a growing body of research indicated that recreational drug use was associated with increased risk of unprotected anal intercourse (UAI) [16][17][18], intimate partner violence (IPV) [19], group sex [17] and HIV/sexually transmitted infection (STI) [11,[19][20][21][22]. Moreover, MSM could ensue dependent and abuse in recreational drugs after long-term continuous use [23]. ...
... Some drugs like rush popper could relax the anal sphincter, reduce anal pain and help MSM quickly expand blood vessels to reach orgasm in a short period, improving the sexual experience [15]. However, a growing body of research indicated that recreational drug use was associated with increased risk of unprotected anal intercourse (UAI) [16][17][18], intimate partner violence (IPV) [19], group sex [17] and HIV/sexually transmitted infection (STI) [11,[19][20][21][22]. Moreover, MSM could ensue dependent and abuse in recreational drugs after long-term continuous use [23]. ...
... In the context of HIV treatment, recreational drug using among HIV-positive individuals had been proved to be associated with non-adherence of antiretroviral treatments (ARTs) [24][25][26]. That meant if the HIV-positive individuals were treated with ARTs and still used recreational drugs at the same time, they would become more infectious to other individuals when engaging in sexual behaviors [17]. [27]. ...
Background- Recreational drug use among young men who have sex with men (YMSM) was a public health issue of worldwide concern. Evidence had shown the relevance between recreational drug use and human immunodeficiency virus (HIV) infection. This study aimed to investigate the current prevalence state of recreational drug use among YMSM in Tianjin, discern the characteristics of YMSM who used recreational drugs or not and examine the interaction effect of recreational drug use and unprotected anal intercourse (UAI) on HIV infection.
Methods- In 2018, a cross-sectional study was conducted in Tianjin, China. The snowball sampling method was used to recruit YMSM. Participants were recruited from gay bars, gay bathhouses, social network sites (WeChat, QQ, gay chat website), gay apps and peer referrals. Structured questionnaires were used to collect data.
Results- A total of 1075 YMSM met the eligibility criteria and were included in the study eventually. The overall HIV prevalence was 4.3% (46/1075). Of all the recreational drugs involved in this study (rush poppers, methamphetamine, capsule No.0), rush poppers (406/517,78.5%) were the most popular among YMSM in Tianjin. Compared with non-drug users, drug users were more likely to have first sex earlier, be bisexual, be male sex worker (MSW), have a higher education level, seek sex partners through physical venues, engage in UAI, have sexually transmitted infection (STI), and receive HIV testing. Moreover, recreational drug use and UAI were associated with the increased risk of HIV infection [adjusted OR:3.6 (95%CI: 1.7-7.6) and 4.9 (95%CI: 2.2-10.4), respectively]. There was additive interaction of recreational drug use and UAI on HIV infection [relative excess risk due to interaction (RERI): 6.949 (95%CI: 0.011‐13.887); attributable proportion due to interaction (AP): 0.809 (95%CI: 0.578‐1.039)].
Conclusions- Recreational drug use was common and correlated with HIV infection among YMSM in Tianjin. There was an urgent need to build novel targeted HIV prevention strategies to discern and reduce recreational drug use among YMSM in China.
... For several years now, there has been an increasing amount of research, clinical, and practitioner evidence, suggesting an increase in the use of new psychoactive substances (NPS), both within heterosexual [1] and men who have sex with men (MSM) populations [1,2], with a particular focus on mephedrone, 3-MMC, and 4-MEC. ...
... Other studies focused on more specific subpopulations: MSM attending addiction management services [44,61], MSM drug users [10,31,32,44,61], MSM admitted to HIV care units [33,34,38,41,[45][46][47][48], MSM consulting in sexual health clinics [2,35,37,41,42,46,47], MSM infected with HCV [33,37], MSM infected with Shigella [17,19]; MSM being reported to national surveillance systems [36,39,40], MSM attending gay venues (bar, sauna, and backroom) [49], and MSM using gay social networks [29,30,46,47]. ...
... Regarding MSM, recruited by gay social networks or attending gay venues, who filled out survey on their practices, the prevalence also varied greatly between studies, ranging from 2 to 50% [29,30,47,49]. Among MSM users attending sexual health clinics, the prevalence was gener-ally around 25% [2,35,37,41,42]. The prevalence of slammers among MSM infected with Shigella was close to 20% [17,19]. ...
Background:
Slamming has been developing since 2011 as a new international phenomenon, mostly among men who have sex with men (MSM). It consists of intravenous drug injection before or during planned sexual activity to sustain, enhance, disinhibit, or facilitate the experience. We aimed to synthesize the available published evidence through a systematic literature review in order to precisely describe this phenomenon and to better characterize the population engaging in this practice and its specific motives.
Methods:
A systematic review of the available literature was conducted to identify all relevant publications using PubMed, Psyc-INFO, the Cochrane Library, and ScienceDirect. To complete the review, we followed the recommendations of the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" method. We limited the search to studies published between January 2008 and May 2020.
Results:
Our search identified 530 publications, of which 27 were included in the final data synthesis. One study focused on heterosexual and homosexual subpopulations, and all other studies focused on MSM-specific samples. Among MSM, slam prevalence was extremely variable, ranging from 2 to 91%; regarding other sexually active subjects, prevalence ranged from 7 to 14%. The prevalence of HIV-positive subjects varied widely across studies, ranging from 0.6 to 100%. We found less data about hepatitis C virus serostatus, ranging from 3 to 100%. Methamphetamine and mephedrone were the 2 most used drugs.
Discussion/conclusion:
The data we found in international literature were very heterogeneous and from poorly reproducible studies. The definition of slamming in the international literature is not always clear, which limits the completeness of the collected data. This topic has been open to studies only recently; however, health professionals must be trained in the management of this practice, considering its risks in the short and medium terms and its addictive potential. We provided and discussed recommendations and potential future directions.
... In the UK, the most commonly used chemsex drugs are crystal methamphetamine, GHB/GBL and mephedrone, although other drugs may be used. 2,6,7 The increasing prevalence and awareness of chemsex poses a public health challenge for health professionals and social scientists attempting to understand the motivations and risks involved. Chemsex is not necessarily commonplace among the general MSM population, but the use of harmful drugs, such as crystal methamphetamine, is high among MSM who do engage in chemsex. ...
... Many studies have used sexual behaviours associated with high transmission of STIs as their main outcome (in particular condom-unprotected anal intercourse (cUAI)), and assumptions are made that this translates into increased transmission of STIs. 4,6,13,14 Crystal methamphetamine has been shown to be associated with engagement in cUAI, cUAI between HIV serodiscordant partners, higher numbers of sexual partners and multipartner encounters, all of which are risk factors for HIV transmission. 4,9,10,15,16 Crystal methamphetamine has been the primary focus for research; published research demonstrating associations of GHB/GBL and mephedrone with high-risk behaviours, such as UAI and multipartner encounters, is less consistent. ...
... 4,9,10,15,16 Crystal methamphetamine has been the primary focus for research; published research demonstrating associations of GHB/GBL and mephedrone with high-risk behaviours, such as UAI and multipartner encounters, is less consistent. 2,6,16,17 Multipartner encounters and cUAI have been associated with GHB use in the previous 6 months. 5 Although several studies have found evidence of an association between crystal methamphetamine and HIV among MSM, differing study designs, samples sizes and methods of data collection and analysis have led to inconsistent results. ...
Background Illicit drug use among men who have sex with men (MSM) has been associated with sexual risk and HIV. Less is documented about associations with other sexually transmissible infections (STIs). The aim of the present study was to determine whether the use of drugs commonly associated with chemsex is associated with increased risk of gonorrhoea among MSM.
Methods:
Using data from 16065 UK-based respondents to the European MSM Internet Survey (2010), we examined associations between a recent diagnosis of gonorrhoea and three chemsex drugs (crystal methamphetamine, γ-hydroxybutyric acid (GHB)/γ-butyrolactone (GBL) and mephedrone). Univariate logistic regression identified determinants of gonorrhoea diagnosis and multivariate logistic regression models calculated adjusted odds ratios (aORs) for independent associations between chemsex drugs and gonorrhoea.
Results:
MSM who reported using crystal methamphetamine and GHB/GBL in the previous year had 1.92- and 2.23-fold higher odds of gonorrhoea respectively over the same period (P=0.0001 and P<0.0001; n=15137) after adjusting for age, recruitment website, HIV status, residence and use of other chemsex drugs. MSM reporting the use of all three chemsex drugs had the highest increased odds (aOR 3.58; P<0.0001; n=15174). Mephedrone alone was not associated with gonorrhoea in multivariate models.
Conclusions:
Use of chemsex drugs is associated with a higher risk of gonorrhoea. The results of this study complement existing research about crystal methamphetamine and indicate a role for GHB/GBL in adverse sexual health outcomes. The use of mephedrone alongside other chemsex drugs may account for its lack of association with gonorrhoea in multivariate models. Future research should use encounter-level data, examine other STIs and attribute pathways through which chemsex leads to infection.
... Polydrug use is the norm for many MSM engaging in chemsex, although percentages vary between 7% and 78.3%, depending on the study locations and definition used (starting from 2 or 3 substances) [2,13,[62][63][64]. Other important risk behaviors include the use of crystal methamphetamine [29,65] and new psychoactive substances [66], injecting drug use during sex (known as "slamming") [18,29,67,68], sharing user equipment (snorting devices and injecting equipment) [18], using high doses [2], extensively redosing [2,69], and going multiple days without sleep [67]. ...
... Polydrug use is the norm for many MSM engaging in chemsex, although percentages vary between 7% and 78.3%, depending on the study locations and definition used (starting from 2 or 3 substances) [2,13,[62][63][64]. Other important risk behaviors include the use of crystal methamphetamine [29,65] and new psychoactive substances [66], injecting drug use during sex (known as "slamming") [18,29,67,68], sharing user equipment (snorting devices and injecting equipment) [18], using high doses [2], extensively redosing [2,69], and going multiple days without sleep [67]. ...
Background
Chemsex refers to the intentional use of drugs before or during sex among men who have sex with men (MSM). Engaging in chemsex has been linked to significant negative impacts on physical, psychological, and social well-being. However, no evidence-based support tools have addressed either these harms or the care needs of MSM who engage in chemsex.
Objective
The purpose of this paper was to describe the development of a mobile health intervention (named Budd) using the intervention mapping protocol (IMP). Budd aims to support and inform MSM who participate in chemsex, reduce the negative impacts associated with chemsex, and encourage more reasoned participation.
Methods
The IMP consists of 6 steps to develop, implement, and evaluate evidence-based health interventions. A needs assessment was carried out between September 2, 2019, and March 31, 2020, by conducting a literature study and in-depth interviews. Change objectives were selected based on these findings, after which theory-based intervention methods were selected. The first version of the intervention was developed in December 2020 and pilot-tested between February 1, 2021, and April 30, 2021. Adjustments were made based on the findings from this study. A separate article will be dedicated to the effectiveness study, conducted between October 15, 2021, and February 24, 2022, and implementation of the intervention. The Budd app went live in April 2022.
Results
Budd aims to address individual factors and support chemsex participants in applying harm reduction measures when taking drugs (drug information, drug combination tool, and notebook), preparing for participation in a chemsex session (articles on chemsex, preparation tool, and event-specific checklist), planning sufficient time after a chemsex session to recover (planning tool), seeking support for their chemsex participation (overview of existing local health care and peer support services, reflection, personal statistics, and user testimonials), taking HIV medication or pre-exposure prophylaxis in a timely manner during a chemsex session (preparation tool), and contacting emergency services in case of an emergency and giving first aid to others (emergency information and personal buddy).
Conclusions
The IMP proved to be a valuable tool in the planning and development of the Budd app. This study provides researchers and practitioners with valuable information that may help them to set up their own health interventions.
International Registered Report Identifier (IRRID)
RR1-10.2196/39678
... Although the association between MSM and shigellosis has been reported, the rate of concomitant HIV infection and shigellosis in our study was higher than rates previously reported, including in a study of New York, New York, residents, in which 27% with shigellosis infection were living with HIV (12). In addition, although methamphetamine use by MSM can increase the risk for HIV and for hepatitis C virus infection (22,23), to our knowledge only a small number of reports have described an association between methamphetamine use and shigellosis, specifically among MSM (24,25). Unlike the studies that documented methamphetamine use in MSM living with HIV, we also found high rates among those who were unhoused. ...
... Isolation of S. flexneri from 55% of stool specimens in our study is much higher than the national prevalence of 12.6% in 2016 reported by the Centers for Disease Control and Prevention (CDC) (26). Other studies have found high rates of S. flexneri causing shigellosis in certain populations, including in 34% of sporadic cases in a New York, New York, study (12) and 65% of cases from a cohort of MSM in the United States (22). Similarly, we found high rates of S. flexneri in GBM/transgender persons, persons living with HIV, and those receiving PrEP. ...
Annually, Shigella spp. cause ≈188 million cases of diarrheal disease globally, including 500,000 cases in the United States; rates of antimicrobial resistance are increasing. To determine antimicrobial resistance and risk factors in San Diego, California, USA, we retrospectively reviewed cases of diarrheal disease caused by Shigella flexneri and S. sonnei diagnosed during 2017-2020. Of 128 evaluable cases, S. flexneri was slightly more common than S. sonnei; most cases were in persons who were gay or bisexual cisgender men, were living with HIV, were unhoused, or used methamphetamines. Overall, rates of resistance to azithromycin, fluoroquinolones, ampicillin, and trimethoprim/sulfamethoxazole (TMP/SMX) were comparable to the most recent national data reported from the Centers for Disease Control and Prevention; 55% of isolates were resistant to azithromycin, 23% to fluoroquinolones, 70% to ampicillin, and 83% to TMP/SMX. The rates that we found for TMP/SMX were slightly higher than those in national data.
... 2 In the UK, the most common chemsex substances are crystal methamphetamine (crystal meth), gamma-hydroxybutyric acid/gamma-butyrolactone (GHB/GBL) and mephedrone (MCAT); however, other substances (often stimulants) are used. [3][4][5] In the UK, chemsex occurs more frequently among HIV-positive than HIV-negative MSM. 6 7 Due to the decrease in inhibitions, the prolonged nature of mucosal contact during chemsex sessions and the substantial opportunity for multipartner encounters involving condomless sex, there is increased risk of STI transmission. [8][9][10][11][12] Injecting of substances, known as 'slamming', carries significantly greater risk of bloodborne viruses such as HIV, hepatitis B and hepatitis C, especially when injecting equipment is shared. ...
... Multivariable logistic regression models (table 2 and online supplemental tables S1-S4) show that participation in recent multipartner chemsex versus no recent chemsex has associated aOR of 2.6 (95% CI 1.7 to 4.1, p<0.001) for syphilis, 3 Sensitivity analyses (table 3 and online supplemental tables S5-S8) indicate that the associations between recent syphilis and gonorrhoea diagnoses with recent multipartner chemsex remain significant, although these associations are weakened, particularly in the group with the lowest STI rates. However, the association between a recent chlamydia diagnosis and recent multipartner chemsex among PrEP non-users becomes nonsignificant when also adjusting for the number of recent nonsteady partners or consistency of condom use. ...
Introduction
In the last decade diagnoses of most STIs have risen among men who have sex with men (MSM). Although a significant proportion of this is likely due to increased STI screening, understanding the role of behavioural drivers remains critical. We measure the associations between stimulant use to enhance and prolong sexual experiences (chemsex) and bacterial STI diagnoses in UK MSM, individually considering HIV-diagnosed MSM, pre-exposure prophylaxis (PrEP) users and other MSM.
Methods
We used the UK 2017–2018 European MSM Internet Survey data (n=9375). We constructed causal inference models using multivariable logistic regression, calculating adjusted OR (aOR) and 95% CI of the associations between participation in recent (≤12 months) exclusively dyadic or multipartner chemsex versus no chemsex and recent self-reported diagnoses of syphilis, gonorrhoea and chlamydia.
Results
Among MSM with an HIV diagnosis, 25% of users indicated recent multipartner chemsex, vs 28% of PrEP users and 5% of other MSM. Adjusting for age, ethnicity, UK birth, cis-trans status, sexual identity, education, settlement size and relationship status, participation in recent multipartner chemsex versus no chemsex was associated with greater odds of recent syphilis, gonorrhoea and chlamydia diagnosis. aORs for recent syphilis, gonorrhoea and chlamydia diagnoses were 2.6 (95% CI 1.7 to 4.1), 3.9 (95% CI 2.6 to 5.8) and 2.9 (95% CI 1.9 to 4.3), respectively, in HIV-diagnosed MSM; 1.9 (95% CI 1.1 to 3.3), 2.9 (95% CI 2.0 to 4.2) and 1.9 (95% CI 1.3 to 2.8), respectively, in PrEP users; and 4.0 (95% CI 2.3 to 6.9), 2.7 (95% CI 1.9 to 3.8) and 2.3 (95% CI 1.6 to 3.4), respectively, in other MSM. Conversely, exclusively dyadic chemsex had no significant associations with bacterial STI diagnoses among HIV-diagnosed MSM, only gonorrhoea (aOR 2.4, 95% CI 1.2 to 4.7) among PrEP users and syphilis (aOR 2.8, 95% CI 1.4 to 5.6) among other MSM.
Discussion
Multipartner chemsex may drive the association between chemsex and bacterial STI diagnoses and thus should be the focus of future tailored chemsex interventions. Additionally, PrEP acceptability among MSM and particularly chemsex participants has generated an emergent group suitable for such interventions.
... Chemsex and its correlates -Internet use, crystal meth use and sex with multiple partners -have long been produced in the epidemiological and public health literature as a pathogenic site, mainly because of the statistical correlations researchers have found with HIV transmission (Halkitis, Parsons & Stirratt 2001;Parsons et al. 2007Parsons et al. , 2012Kirby & Thornber-Dunwell 2013a, 2013bStuart 2013;Daskalopoulou et al. 2014). As I have discussed elsewhere, the translation of chemsex from a vernacular practice into an object of public health concern has relied predominantly on these associations (Race 2009, pp. ...
... Indeed, scientists can sometimes be less thoughtful about how to handle the ethical and practical challenge of making their findings intelligible and available to relevant public agencies, since they are constrained mainly by the disciplinary standards attributed to colleagues (who are often presumed to share conservative values) and the peers who anonymously review and endorse their analyses, all the while protected by the presuppositions of positivist science, with all the privilege and authority of 'neutral objectivity' that goes with these. Indeed, one only need take a quick flip through recent discussions of chemsex in medical journals such as The Lancet to recognise many of the same tropes and amplifications of affect that I will go on to discuss in relation to popular media discourses of chemsex (Kirby & Thornber-Dunwell 2013a, 2013b. ...
... We also found that the slammers tended to have a job, which has been previously reported (8). The frequency of HIV infection has been very variable in the literature, ranging from 0.6% (33) to 100% (34), but our sample of slammers was in the upper range (4,8,15,31,(33)(34)(35)(36)(37). In contrast, HCV infection was less common in our sample than in the literature (8,15,31,(35)(36)(37)(38). ...
... The frequency of HIV infection has been very variable in the literature, ranging from 0.6% (33) to 100% (34), but our sample of slammers was in the upper range (4,8,15,31,(33)(34)(35)(36)(37). In contrast, HCV infection was less common in our sample than in the literature (8,15,31,(35)(36)(37)(38). There were similar findings regarding STIs (38). ...
Background“Slam” has emerged since 2008 as a new international phenomenon among men who have sex with men (MSM); it consists of the intravenous injection of drugs before or during planned sexual activity. The practice of slam is associated with the use of psychostimulants, including synthetic cathinones.Methods
All spontaneous notifications (Nots) of slam practice reported between January 2012 and October 2019 at the Nantes addictovigilance center in France were collected and analyzed. The purpose of this work was to analyze cases of slam to characterize cathinone use disorder according to the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and to further our knowledge of slam practice based on data on drug use, risk taking and harmful consequences.ResultsWe collected 39 slam Nots. The severity of cathinone use disorder was mild, moderate and severe for 18%, 12%, and 58% of the patients, respectively. “Much time spent using cathinone” was the diagnostic criterion most often cited (82%).Conclusions
To the best of our knowledge, our study is the first to evaluate the presence of a cathinone use disorder. Cathinone use disorder seems particularly important in this population of users, and negative consequences of slam practice appear quickly.
... Chemsex often includes both injecting drug use and risky sexual behaviour, such as not using condoms, which can substantially increase the risk of transmitting infectious diseases. As such, the use and injection of these drugs has been reported to be a factor in the increased transmission of a number of sexually transmitted infections (Bourne, Reid, Hickson, Torres Rueda, & Weatherburn, 2014;Kirby & Thornber-Dunwell, 2013). ...
... Although the scale of this behaviour remains unclear, specialist lesbian, gay, bisexual and transgender drug services have seen an increase in the number of MSM who report injecting methamphetamine and mephedrone in recent years, and the behaviour is now evident among MSM accessing general drug services (Glass, Hope, Tanner, & Desai, 2017). The use and injection of these drugs has also been reported to be a factor in the increased transmission of a number of sexually transmitted infections (Bourne et al., 2014;Kirby & Thornber-Dunwell, 2013). ...
... Una práctica relacionada con el ChemSex es el uso inyectado de drogas, conocida como slam o slamming. En algunas ciudades europeas, como Londres y Paris, se ha alertado de la existencia de las slam parties, un tipo de fiestas de sexo en grupo, en las que se suelen inyectar drogas como la metanfetamina y/o mefedrona (Foureur et al., 2013), y en las que es frecuente practicar sexo sin condón (Kirby y Thornber, 2013;Leobon et al., 2013). Esta vía de administración es la que ha disparado las alarmas en el Reino Unido donde se ha enfatizado que abordar el ChemSex debe ser una prioridad de salud pública (McCall et al., 2015), dada sus graves consecuencias: rápida adicción, gran dificultad para tener relaciones sexuales de manera sobria, alto riesgo de infección por el VIH y el VHC, adquisición de ITS y algunas enfermedades como la Shigella, etc. (Hegazi et al., 2017;Petersson et al., 2016;Gilbart et al., 2015;Rogstad, 2016). ...
Este estudio buscó describir y comprender los usos, patrones, motivos, riesgos, cuidados y significados del consumo de drogas para tener sexo entre hombres gais, bisexuales y otros HSH de la ciudad de Barcelona. El propósito del estudio fue proponer una serie de recomendaciones para el desarrollo de acciones orientadas a entender, abordar y tratar el consumo de drogas asociado al sexo según las necesidades de los propios consumidores.
Esta investigación utilizó una metodología cualitativa. Fueron 26 hombres que participaron en entrevistas individuales. Los participantes se seleccionaron a través de diferentes fuentes de captación: locales de ocio gay donde se practica sexo (una sauna gay), páginas de contacto gay en Internet y apps geo-sociales de teléfonos móviles, redes sociales y sexuales de los propios entrevistados (técnica de “la bola de nieve”), terceras personas y Unidad del VIH de un hospital público de la ciudad de Barcelona. Las entrevistas se realizaron entre noviembre del 2015 y marzo del 2016. El enfoque de la Teoría Fundamentada fue utilizado para analizar los datos.
... A chemsex jelenség prediktív komponenseinek azonban a homonegativitás konstruktuma sem volt megfelelő, kapcsolatot nem találtunk. Eredményünk azon szerzőket igazolja, akik nem hozzák kapcsolatba ezen tényezőket (Barrett és mtsai., 2019;Bourne és mtsai., 2014;Halkitis és Singer, 2018;Hurley és Prestage, 2009;Kirby és Thornber-Dunwell, 2013;Sewell és mtsai., 2019). ...
Background: Sex under intoxication poses an increasing public health risk. From a health psychology perspective, our research focuses on the link between suicide risk, psychological wellbeing, compulsive sexual behaviour, homonegativity, coming out, and sex under intoxication in sexual minorities in a Hungarian sample.
Method: For measuring the constructs, we used self-assessment scales and inventories standardised for use in Hungarian. Regarding coming out and sexual drug use, we used surveying. The online data collection took place in December 2021.
Results: We found a weak but positive correlation between chemsex and homosexuality. Sex under intoxication can be linked to compulsive sexual behaviour (Coping). However, no other constuct has proven to be statistically predictive of chemsex behaviour. Homonegativity measured within the sexual minority groups suggests the presence of internalised homophobia. Our results indicate increased measures of hopelessness (as suicide risk factor) in bi- and pansexual groups versus other minority groups. We found no evidence of psychological wellbeing disparity between the sexual minorities and the sexual majority. Living completely out is uncommon, and being in the closet for a long time may prolong the undesired effects of minority stress.
... Entre estas drogas, encontramos el gamma-hidroxibutirato/gamma-butirolactona (GHB/GBL, "bote", o erróneamente denominado "éxtasis líquido"), la 4-metilmetcatinona (mefedrona, "mefe", o "miau"), y la N-metil-1-fenilpropan-2-amina (metanfetamina, "tina", o "crystal meth") (7,21 (39,46,51). En cuanto a la vías de administración, la mayoría de GBHSH que practican chemsex consumen drogas por vía oral y/o nasal (inhaladas y esnifadas) (3), mientras que otros eligen la administración intravenosa, práctica conocida como "slamsex o slamming", o la vía anal, también denominada "booty bumping" (14,17,(52)(53)(54). ...
El chemsex o sesión en España, se ha convertido en un problema de salud pública debido a sus riesgos asociados. Esta práctica se ha relacionado en los últimos años con el uso intencional de sustancias psicoactivas para facilitar, mantener y/o mejorar la experiencia sexual (1–3). Aunque el uso de drogas y su asociación con contextos sexuales es conocido desde hace décadas (4), los cambios en el patrón de consumo han relacionado el chemsex principalmente con hombres gays, bisexuales y otros hombres que tienen sexo con hombres (GBHSH) (5). El documento de consenso del 2º European ChemSex Forum, define el chemsex como “un tipo particular de práctica de consumo sexualizado de sustancias, entre hombres gays, bisexuales, otros HSH, y personas trans y no binarias que participan en la 'cultura de sexo casual o sin compromiso’ gay” (p. 4) (6). Esta práctica, a menudo, tiene como objetivos aumentar la excitación y las experiencias sexuales intensas, así como manejar la inhibición y la falta de confianza para realizar determinadas prácticas sexuales (7,8). El uso de sustancias para mejorar la experiencia sexual puede conducir a conductas sexuales de riesgo (9) y, con ello, a un mayor riesgo de contraer infecciones de transmisión sexual (ITS) (10,11), incluido el Virus de la Inmunodeficiencia Humana (VIH) (12). Además, el chemsex también podría estar asociado con riesgos para la salud mental como la depresión y la ansiedad (13,14). Este fenómeno también es conocido como “Party and Play” (abreviado como “PnP”) (15), “intensive sex party” (16), "4/20" (8), "chill outs" (17), y en España “sesión”, “chuches”, “vicio” (18), “guarrichill”, o “chill”. Aunque muchos GBHSH perciben el uso de drogas en el ámbito sexual como un comportamiento común y normalizado (7,17), el grado y frecuencia del consumo de sustancias psicoactivas antes y/o durante las sesiones de sexo varía ampliamente entre los GBHSH. La prevalencia del chemsex presenta grandes diferencias entre los distintos estudios, oscilando entre el 4% y el 94% (19). Probablemente las estimaciones de prevalencia varíen tanto debido al método de reclutamiento, el perfil de los usuarios entrevistados y la elección de las sustancias utilizadas para el chemsex (20–22).
... Entre estas drogas, encontramos el gamma-hidroxibutirato/gamma-butirolactona (GHB/GBL, "bote", o erróneamente denominado "éxtasis líquido"), la 4-metilmetcatinona (mefedrona, "mefe", o "miau"), y la N-metil-1-fenilpropan-2-amina (metanfetamina, "tina", o "crystal meth") (7,21 (39,46,51). En cuanto a la vías de administración, la mayoría de GBHSH que practican chemsex consumen drogas por vía oral y/o nasal (inhaladas y esnifadas) (3), mientras que otros eligen la administración intravenosa, práctica conocida como "slamsex o slamming", o la vía anal, también denominada "booty bumping" (14,17,(52)(53)(54). ...
... Concurrent crystal methamphetamine and opioid use has also been described as prolonging synergistic euphoric effects (Ellis et al., 2018;Palmer et al., 2020). Among men who have sex with men (MSM), crystal methamphetamine use has been implicated in the context of 'chemsex', where substances are used for sexual enhancement (Kirby and Thornber-Dunwell, 2013;McCall et al., 2015). Among sex workers, crystal methamphetamine has been used to promote alertness, wakefulness, and productivity (Maher et al., 2011). ...
Objectives
Methamphetamine use is rising globally and we have limited treatments for this. Subgroups within the diverse methamphetamine-using population may have distinct treatment needs. Among a community-recruited sample of people who use crystal methamphetamine, we aimed to identify subgroups and characterize their overdose risk and access to addiction care.
Methods
Data from prospective cohorts of people who use drugs in Vancouver, Canada from 2014-2018 were used to conduct a repeated measures latent class analysis among participants who used crystal methamphetamine. Multivariable generalized estimating equations models were fit to determine the associated factors.
Results
Among 824 eligible participants, a five-class model was identified as the best fit: (1) primary stimulant use (15.7%); (2) women engaged in sex work and opioid use (21.4%); (3) street income generation and opioid use (31.6%); (4) opioid agonist therapy (OAT) patients (22.3%); and (5) men who have sex with men (9.0%). In multivariable analyses, compared to the primary stimulant use group, non-fatal overdose was positively associated with street income generation (adjusted odds ratio [AOR] = 1.49, 95% confidence interval [95% CI]=1.30-1.71), sex work (AOR = 1.38, 95% CI=1.20-1.59) and OAT (AOR = 1.22, 95% CI=1.06-1.41) subgroups; engagement in non-OAT addiction care was negatively associated with street income generation (AOR = 0.81, 95% CI=0.68-0.97) and sex work (AOR = 0.78, 95% CI=0.63-0.98) subgroups.
Discussion
Socioeconomically marginalized subgroups with opioid and crystal methamphetamine co-use were at highest risk of non-fatal overdose and had poorer access to addiction care, highlighting the need for tailored interventions.
... [5] Some chemsex practices, particularly IV drug use has been described as a "perfect storm" for transmission of HIV and hepatitis C virus. [6] Moreover, the coexisting STI facilitates the transmission and acquisition of other STIs including HIV. Nonulcerative STIs caused by Chlamydia trachomatis and genital mycoplasmas potentially increase the susceptibility of HIV acquisition and transmission and can act as candidate "cofactors" in the pathogenesis of AIDS or can act in synergy with HIV to exacerbate the retroviral disease. ...
... Similarly, expert commentary and research also refer chemsex cultures as scenes. For example, in commentary published in The Lancet, Kirby and Thornber-Dunwell (2013) characterize chemsex as 'high-risk drug practices' that 'tighten [their] grip' on the 'London gay scene'; in effect describing chemsex as the confluence of a number of intersecting factors that, together, generate the 'perfect storm' for blood borne virus transmission and other health-related concerns. Yet, what the authors refer to as a 'slamming [injecting] community' is reportedly 'largely hidden' from the 'rest of the gay scene', suggesting that cultures of chemsex can be considered both derivative of and a departure from the more commonly recognized gay commercial venues. ...
The term ‘chemsex’ references an identifiable set of circumstances and behaviours ascribed to gay male culture at the same time as operating as a politically salient category capable of spurring policy and programmatic responses. Increasingly, the word ‘scene’ is used in association with ‘chemsex’ in media reporting, expert commentary and research on the phenomenon. Rather than dismissing the coupling of chemsex and scene as mere vernacular, ‘scene’ offers a fruitful entry point for exploring how the combination of sex and drugs achieves cultural salience over time. In this article, I read chemsex cultures through the material and representational elements characteristic of ‘scene’. By emphasizing scenes’ temporal logics, I speculate on the value of this alternative approach in generating new understandings of chemsex cultures.
... Participants in the study managed the combination of crystal and sex in a balancing act between pleasure-seeking and risk reduction. In contrast to the view of crystal use in sexual contexts as "the perfect storm for transmission of both HIV and HCV " ( Kirby & Thornber-Dunwell, 2013 ), participants' accounts confirmed that they mostly understood and managed risk when using crystal and having sex, and that they worried more about the risk of dependence. ...
Crystal methamphetamine (hereafter crystal) is associated with deleterious health outcomes, such as drug dependence and physical and mental health disorders. While some harms from crystal use can affect all users, there may be additional risks for people who combine the use of drug with sex. Compared with the broader population, gay and bisexual men in Australia report a higher prevalence of methamphetamine use, and crystal is the most commonly injected illicit drug among this population. The Crystal, Pleasures and Sex between Men research project was conducted between 2017 and 2019 and examined gay and bisexual men's crystal use in four capital cities in Australia, with the aim of identifying how to best support men who use crystal for sex. In this article, we examine how risk is understood and prioritised by gay and bisexual men who combine crystal use and sex and identify the range of risk reduction practices that they used. We classified these risks as those associated with the transmission of HIV, HCV and STIs, and those associated with dependence on either crystal or the sex it facilitated. Gay and bisexual men overwhelmingly prioritised the risk of dependence over any other risks associated with crystal-enhanced sex, and this prioritization was reflected in the risk reduction practices they employed. While some of the strategies that gay and bisexual men have adopted may contradict anticipated public health principles, they derive from a carefully considered and shared approaches to the generation of pleasure, the maintenance of a controlled form of feeling “out of control”, and the negotiated reduction of risk. The consolidation of these strategies effectively constitutes a “counterpublic health” underpinned by forms of “sex-based sociality”, which gives primacy to the priorities and practices of gay and bisexual men in Australia who combine crystal and sex.
... For example, many epidemiologists and behavioural scientists have approached these practices as pathologies (e.g. Kirby and Thornbur-Dunwell, 2013). According to Hurley and Prestage (2009), the main rationale behind 'intensive sex partying' (ISP) is the desire to maximize sexual pleasure, and they claim that a disproportionate number of the men practicing ISP are HIV-positive (although we would suggest that increasing numbers of men who use PrEP are participating in these subcultural practices too). ...
Recent biomedical innovations in the field of HIV prevention and treatment – namely PrEP, TasP, and ‘undetectability’ – have completely reshaped the experience of living with HIV, as well as the meanings of ‘risk’ and ‘safety’ in relation to sexual practices, leading to new forms of pleasure and sociality for gay and bisexual men in the Minority World. While human geographers have been slow to engage with the changing social dimensions brought by these innovations, scholars across the whole spectrum of the social sciences have been far more creative and responsive contributing to a critical understanding of what these processes entail in terms of subject formation as well as social and communal relations. This article proposes a distinctly geographical contribution to analysing and interpreting these biomedical technologies, exploring the ways that new spatialities and spatial relations emerge from their use and circulation. Our approach is based on provisional assemblage thinking as it offers the possibility to think the complex connections between biomedical innovations in the field of HIV, sexual practices, subjectivity, pleasure, spaces, and technologies, going beyond the subdisciplinary preoccupations and methodological reflexes of geographers focused primarily on either health or sexuality.
... A previous qualitative study (in-depth interviews with 30 GBMSM) examining social norms relating to chemsex also suggested the existence of within-group stigmatization. More specifically, negative attitudes are often held regarding certain drug or sex practices, such as the use of crystal methamphetamine and injection drug use ("slamming") [40]. This stigmatization of certain behaviors can also act as a barrier for these subgroups of GBMSM to seeking harm reduction information or accessing services [35]. ...
Chemsex is a growing public health concern, with little evidence-based care and support available. The aim of this study is to understand current risk reduction practices, and the information and care needs of gay, bisexual, and other men who have sex with men (GBMSM) who engage in chemsex. Between January and March 2020, semi structured in-depth interviews with drug-using GBMSM (n = 20) were conducted. Data were analyzed thematically. The reported preparatory measures were: deliberately scheduling chemsex sessions, and discussing preferences regarding setting and attendees. During the event, a logbook is kept to monitor drugs taken by each participant. People try to take care of each other, but this is often counteracted. Respondents highlighted needs: reliable and easily-accessible information, anonymous medical and psychological healthcare, chemsex-specific care, and a value-neutral safe space to talk about chemsex experiences. Results imply two types of users: planned and impulsive users. Adherence to intended harm reduction practices are complicated by drug effects, peer pressure, and feelings of distrust among users.
... Its use, along with other recreational drugs such as mephedrone and Gamma-Hydroxybutyrate (GHB), has been described to facilitate sex (known as chemsex) and has been described in Europe, the US and Southeast Asia including Malaysia, Singapore and Thailand, associated with high-risk sexual behaviour and an increased risk of HIV in MSM. [42][43][44][45][46][47] Recent data from the United Nations Office on Drugs and Crime highlighted the expansion of methamphetamine markets in Southeast Asia. 48 The associated risk of HIV ties into both MSM and PWID populations. ...
Indonesia has one of the fastest growing HIV epidemics in the world. AIDS related deaths in Indonesia have not fallen and have increased significantly since 2010. HIV infection rates remain high and rising in key affected populations. We provide an on the ground, evidence-based perspective of the challenges Indonesia faces. We discuss what is required to adopt tailored public health approaches that address context specific challenges, confront structural barriers and the heterogeneity of the current evolving HIV epidemic.
... The use of recreational drugs, specifically crystal meth, mephedrone and gamma-hydroxybutyrate (GHB) to facilitate sex (known as chemsex) in MSM has been well described in Europe and the US, associated with high risk sexual behaviour and an increased risk of HIV. 15,16 Crystal meth is becoming an increasing problem in Indonesia and is understood to be the second most widely used illicit drug after cannabis. 17 Data from Bangkok report the use of 'club drugs' (includes crystal meth, ecstasy, amphetamine, ketamine, cocaine, GHB) often used with erectile dysfunction drugs in MSM, to be significantly associated with HIV incidence. ...
full text available
https://journals.sagepub.com/doi/10.1177/0956462420949795
... Chemsex, 'the use of drugs before or during planned sexual activity to sustain, enhance, disinhibit or facilitate the experience' (HM Government, 2017) has been described as a public health issue in recent years (Kirby & Thornber-Dunwell, 2013;Stuart, 2013). The term chemsex is often associated with the use of methamphetamines, gamma-hydroxybutyrate (GHB) / gamma-butyrolactone (GBL) and mephedrone (Bourne et al., 2015), even though differences between regions (Schmidt et al., 2016) and user samples (Edmundson et al., 2018) have been observed. ...
Chemsex among gay, bisexual and other men who have sex with men (GBMSM) has received increasing attention as a public health concern in recent years. Chemsex can affect a variety of aspects of the lives of GBMSM and contribute to physical, social and emotional health burden. Starting from a continuum perspective of chemsex, rather than a binary view of problematic vs. non-problematic use, we argue that men engaging in chemsex at different points in their chemsex journey may benefit from tailored and personalized support to cope with the various and evolving challenges and concerns that may be related to their chemsex behavior. To date, interactive digital communication technologies are not much used to provide support and care for GBMSM engaging in chemsex, neither for community-based support and care nor by health services. This suggests potential for missed opportunities, as GBMSM are generally avid users of these technologies for social connections and hookups, including in relation to chemsex. Recent research has provided emerging evidence of the potential effects of so-called just in time adaptive interventions (JITAI) to provide effective support and care for a variety of health issues. JITAI hold much promise for the provision of appropriate, tailored support and care for GBMSM at different points in the chemsex journey. Co-designing JITAI with potential users and other stakeholders (co-design) is key to success. At the Institute for Tropical Medicine, in Antwerp (Belgium), we initiated the Chemified project to develop an innovative digital chemsex support and care tool for GBMSM. This project illustrates how current understanding of chemsex as a journey can be integrated with a JITAI approach and make use of co-design principles to advance the available support and care for GBMSM engaging in chemsex.
... Sixty-four patients had changed HAART regimens. The reasons to change HARRT regimens included HAART-related side effects (28), simplification (24), HIV resistance to prior regimen (11) and avoiding potential DDI (1). There were 106 STDs during the one-year follow-up, included 91 syphilis, 8 gonorrhea, 11 chlamydia and 8 Herpes simplex virus infections (Table 3). ...
Background
It is unclear about the impact of recreational drug use on the adherence, drug-drug interaction and the occurrence of sexual transmitted diseases (STDs) among people living with HIV.
Material and methods
A retrospective study was conducted between Dec 2016, and July 2018 to assess the clinical impact of recreational drug consumption in people living with HIV with antiretroviral therapy. We collected data of the demographics, recreational drug use, laboratory results and STDs diagnoses. Potential drug-drug interactions were checked with reference databases. The association between recreational drug use and STDs, HIV viral load suppression and drug interactions were evaluated.
Results
A total of 462 participants were enrolled, included 384 recreational drug users and 78 non-recreational drug users. Younger age (adjusted odds ratio [aOR], 0.94; 95%CI: 0.91-0.98; p=0.001), longer HIV infection period (aOR,1.11; 95%CI: 1.03-1.20; p=0.009) and poor antiretroviral drug adherence (1-2 pills missing per month: aOR, 6.82; 95%CI: 3.50-13.27; p<0.001; >2 pills missing per month: aOR, 3.50; 95%CI: 1.28-9.61; p=0.015) were factors associated with recreational drug use. Methamphetamine and nitrites were two most common recreational drugs. Recreational drug use was significantly associated with STDs in one-year follow-up period (aOR, 2.43; 95%CI: 1.11-5.32; p=0.027) but was not significantly associated with unsuppressed viral load, though a trend was observed (OR, 2.23; 95%CI: 0.92-5.37; p=0.074). Potential interactions with recreational drugs included 33.1% antiretroviral drugs and 31.3% medications for comorbidities.
Conclusion
Recreational drug was associated with STDs. A great proportion of the patients consuming recreational drugs had potential interactions with antiretroviral drugs and medications for comorbidities. The association of recreational drug use and unsuppressed viral load warrants further investigation.
... Constructing a universal definition of chemsex is difficult, as the drugs used might vary per place and time area. In the United Kingdom (UK), chemsex is defined by the use of crystal methamphetamine, mephedrone, γ-Butyrolactone (GBL)/γ-hydroxybutyric acid (GHB) during sex (Georgetti et al., 2017;Hegazi et., 2017;Kirby et al., 2013;Measham et al., 2011). In the Netherlands, ecstasy (XTC), GHB and ketamine are the most popular drugs to use during sex among MSM (Achterbergh et al., 2019;Evers et al., 2019). ...
Drug use during sex (‘chemsex’) has been associated with sexually transmitted infections (STIs) and mental health harms. Little quantitative evidence exists on the health care needs of MSM practicing chemsex from a patient perspective. This study assessed self-perceived benefits and harms and the needs for professional counselling among MSM practicing chemsex. In 2018, 785 MSM were recruited at eight Dutch STI clinics and 511 (65%) completed the online questionnaire. Chemsex was defined as using cocaine, crystal meth, designer drugs, GHB/GBL, ketamine, speed and/or XTC/MDMA during sex <6 months. Chemsex was reported by 41% (209/511), of whom 23% (48/209) reported a need for professional counselling. The most reported topic to discuss was increasing self-control (52%, 25/48). Most MSM preferred to be counselled by sexual health experts (56%, 27/48). The need for professional counselling was higher among MSM who engaged in chemsex ≥2 times per month (30% vs. 17%, p=0.03), did not have sex without drugs (sober sex) in the past three months (41% vs. 20%, p=0.04), experienced disadvantages of chemsex (28% vs. 15%, p=0.03), had a negative change in their lives due to chemsex (53% vs. 21%, p=0.002), and/or had an intention to change chemsex behaviours (45% vs. 18%, p<0.001). Our study shows that almost one in four MSM practicing chemsex expressed a need for professional counselling on chemsex-related issues. STI healthcare providers should assess the need for professional counselling in MSM practicing chemsex, especially in MSM with above mentioned characteristics, such as frequent users.
... From these data, it would appear that individuals are not only intravenously injecting the cathinones, but that they are in at least some places combining opiates with these compounds, as they have previously done with opiates and other stimulants. Several reports have recently warned about the spread of intravenous synthetic cathinone use (EMCDDA, 2014;Hope et al., 2016;Kelly et al., 2013;Kirby and Thornber-Dunwell, 2013;Péterfi et al., 2014;Peyrière et al., 2013). Interestingly, "slamming" (the intravenous injection of drugs of abuse), has recently been applied to the synthetic cathinones. ...
... Bars that hold fetish nights and city centre saunas frequented by MSM were identified as two key locations for outreach work. As touched on earlier, This combination of factors associated with chemsex has been described as 'a perfect storm for transmission of both HIV and HCV, as well as a catalogue of ensuing mental health problems' (Kirby & Thornber-Dunwell, 2013). ...
... In addition to being injected intravenously, crystal-meth has been smoked by MSM at sex parties during the last decade, mainly in the London gay scene [22]. The potent disinhibiting effect of this drug has been related to high-risk sexual behaviors and an increase in the frequency of STIs, particularly HIV infection [23]. ...
Objectives
Sexualized intravenous drug use, also known as slamsex, seems to be increasing among HIV-positive men who have sex with men (MSM). Physical and psychopathological symptoms have previously been reported in this population, although research on the subject of slamsex is scarce. The objectives of our study were to describe the psychopathological background of a sample of HIV-positive MSM who engaged in slamsex during the previous year and to compare physical, psychopathological, and drug-related symptoms between these participants and those who engaged in non-injecting sexualized drug use.
Design and methods
Participants (HIV-positive MSM) were recruited from the U-Sex study in 22 HIV clinics in Madrid during 2016–17. All participants completed an anonymous cross-sectional online survey on sexual behavior and recreational drug use. When participants met the inclusion criteria, physicians offered them the opportunity to participate and gave them a card with a unique code and a link to access the online survey. The present analysis is based on HIV-positive MSM who had engaged in slamsex and non-injecting sexualized drug use.
Results
The survey sample comprised 742 participants. Of all the participants who completed the survey, 216 (29.1%) had engaged in chemsex, and of these, 34 (15.7%) had engaged in slamsex. Participants who engaged in slamsex were more likely to have current psychopathology (depression, anxiety, and drug-related disorders) than participants who engaged in non-injecting sexualized drug use. In addition, participants who engaged in slamsex more frequently reported high-risk sexual behaviors and polydrug use and were more often diagnosed with sexually transmitted infections (STIs) and hepatitis C than those who did not inject drugs. Compared with participants who did not inject drugs, participants who engaged in slamsex experienced more severe drug-related symptoms (withdrawal and dependence), symptoms of severe intoxication (loss of consciousness), and severe psychopathological symptoms during or after slamsex (eg, paranoid thoughts and suicidal behaviors).
Conclusion
Slamsex is closely associated with current psychiatric disorders and severe drug-related and psychiatric symptoms.
... This is particularly the case for crystal methamphetamine [16]. Although chemsex is a relatively new phenomenon, it has gradually become normalized within the social and sexual contexts among fragments of the gay community [17], especially in HIV-infected MSM [18]. Several theories have been endorsed to explain the increased use of RD/EA among HIV-infected MSM. ...
Background:
HIV-infected men who have sex with men (MSM) who use recreational drugs (RD) or excessive alcohol (EA) may be involved in risky sexual behaviours, including unprotected anal intercourse (UAI). This study describes the prevalence RD/EA-use among HIV-infected MSM, and compares those who used RD/EA with those who did not.
Methods:
This cross-sectional study included HIV-infected MSM who were recruited in a convenient sample from two AIDS-treatment centres and events for HIV-infected MSM in Israel in 2016. Participants completed anonymous questionnaires including RD/EA-use and their sexual behaviours. RD/EA-use was defined as consumption of any psychoactive stimulants or dissociative anaesthetics, or an uptake of alcohol until drunkenness before or during sex.
Results:
Of all 276 HIV-infected MSM, 202 (73.2%) used RD/EA. Those who used RD/EA were younger, reported earlier sexual debut, had more sexual partners, were more likely to perform UAI with casual partners, more commonly involved in paid sex, used psychiatric medications and more likely to be unsatisfied with their health-status compared to those who did not use RD/EA. HIV-infected MSM who used RD/EA reported a lower CD4-count and higher viral-load than those who did not. In a multivariate analysis, being younger, reported earlier sexual debut and been prescribed psychiatric drugs were associated with RD/EA-use among HIV-infected MSM.
Conclusions:
A large proportion of HIV-infected MSM used RD/EA and also engaged in risky sexual behaviours. A subset of HIV-infected MSM can benefit from mental support during their routine treatment at the AIDS treatment centres and should also receive harm reduction intervention by their providers in order to minimize potential risks pertaining to RD/EA-use.
... ChemSex is mostly associated with non-injecting drug use, although some may also inject synthetic cathinones, amphetamines and methamphetamines (referred to as "slamming" or "blasting" within the context of ChemSex) [51], with a high level of sharing of injection equipment and consequently higher risks of HIV and HCV transmission [52][53] [54]. Mephedrone use seems to have risen among men who have sex with men in the context of ChemSex [52]. ...
The purpose of this publication is to provide guidance on implementing HIV, hepatitis C (HCV) and
hepatitis B (HBV) programmes for people who use stimulant drugs and who are at risk of contracting
these viruses. It aims to:
• Increase awareness of the needs and issues faced by the affected groups, including the intersectionality among different key populations
• Provide implementation guidance to help establish and expand access to core HIV and hepatitis
prevention, treatment, care and support services
... METH, an amphetamine derivative, is one of the popular synthetic illegal psycho-stimulants abused not only in the US 1 but also worldwide 2,3 . At present, there are about 10 million METH users in the US, and about 35 million worldwide [4][5][6] . Unfortunately, its use is gaining popularity again in the US 7,8 . ...
Methamphetamine (METH) is a powerfully addictive psychostimulant that has a pronounced effect on the central nervous system (CNS). The present study aimed to assess METH toxicity in differentiated C6 astroglia-like cells through biochemical and toxicity markers with acute (1 h) and chronic (48 h) treatments. In the absence of external stimulants, cellular differentiation of neuronal morphology was achieved through reduced serum (2.5%) in the medium. The cells displayed branched neurite-like processes with extensive intercellular connections. Results indicated that acute METH treatment neither altered the cell morphology nor killed the cells, which echoed with lack of consequence on reactive oxygen species (ROS), nitric oxide (NO) or inhibition of any cell cycle phases except induction of cytoplasmic vacuoles. On the other hand, chronic treatment at 1 mM or above destroyed the neurite-like processors and decreased the cell viability that paralleled with increased levels of ROS, lipid peroxidation and lactate, depletion in glutathione (GSH) level and inhibition at G0/G1 phase of cell cycle, leading to apoptosis. Pre-treatment of cells with N-acetyl cysteine (NAC, 2.5 mM for 1 h) followed by METH co-treatment for 48 h rescued the cells completely from toxicity by decreasing ROS through increased GSH. Our results provide evidence that increased ROS and GSH depletion underlie the cytotoxic effects of METH in the cells. Since loss in neurite connections and intracellular changes can lead to psychiatric illnesses in drug users, the evidence that we show in our study suggests that these are also contributing factors for psychiatric-illnesses in METH addicts.
... HIV affects gay, bisexual, and other men who have sex with men (GBMSM) more than any other demographic within developed countries [2,3]. Around 10% of people with HIV are not aware of their status, which indicates a great need for facilitation of opportunistic testing in environments where higher risk populations may be reached [4]. These populations include more sexually adventurous or non-gay identifying men who have sex with men (MSM) who frequent sex on premises venues (SOPV) [5,6]. ...
The aim of this study was to establish ‘proof of concept’ for a novel approach to HIV and STI testing at a sex on premises venue (SOPV) for gay and bisexual and other men who have sex with men (GBMSM) during late night group sex theme parties. A mixed-methods approach was used, and the study aimed to: (1) Build upon existing SOPV funded service delivery and establish ‘proof of concept’ for this unique setting within an SOPV; (2) evaluate the uptake and feasibility/acceptability of routine HIV/STI testing for GBMSM during theme parties in SOPV; and (3) identify beliefs/perceptions regarding this health promotion activity and venue suitability. The characteristics of patrons utilising PoCT (Point of Care Testing) were established to help further reach potentially stigmatised, highly sexually adventurous GBMSM. The findings support further PoCT endeavours within MSM communities to target harder to reach communities to reduce the rate of new transmissions of HIV. Findings can inform future health promotion, screening and interventions, as well as to identify a successful method to engage harder to reach GBMSM that need further focused targeting for HIV and STI testing to reduce transmission.
... Âûïîëíåííûé â 2016 ãîäó ðåòðîñïåêòèâíûé àíàëèç èñòîðèé áîëåçíè ïàöèåíòîâ ìóaeñêîãî ïîëà, îáðàùàâøèõñÿ â ëîíäîíñêèå êëèíèêè ñåêñóàëüíîãî çäîðîâüÿ è ñîîáùèâøèõ î òîì, ÷òî îíè ïðàêòèêîâàëè ñåêñ ñ ìóae÷èíàìè, ïîêàçàë, ÷òî «õèìè-÷åñêèé ñåêñ» ñîïðÿae¸í ñ áîëåå ðèñêîâàííûì ñåêñóàëüíûì ïîâåäåíèåì, à åãî ïîïóëÿðíîñòü çíà÷èòåëüíî âûøå ñðåäè ÂÈ×-èíôèöèðîâàííûõ ìóae÷èí [8].  ñâîåé ïóáëèêàöèè Kirby T îáðàçíî îïèñàë ïðàêòèêè «õèìè÷åñêîãî ñåêñà» (îñîáåííî, ñîïðÿae¸ííûå ñ èíúåêöèîííûì ïîòðåáëåíèåì íàðêîòèêîâ) êàê «èäåàëüíûé øòîðì» â ñâÿçè ñ ÷ðåçâû÷àéíî âûñîêèì ðèñêîì îäíîâðåìåííîãî çàðàaeåíèÿ ÂÈ×-èíôåêöèåé è âèðóñíûì ãåïàòèòîì C [19]. ...
Введение: в статье изложена информация о проблеме «химического секса», на сегодняшний день мало освещённой в русскоязычной профессиональной литературе и сопряжённой с употреблением рекреационных наркотиков и применением быстро меняющихся технологий в международной группе мужчин с высокой сексуальной активностью, которые за счёт этого поведения в значительно большей степени подвержены риску заражения ИППП и ВИЧ-инфекцией.
Цель исследования: систематизация научных данных о феномене «химического секса», описание причин его популярности и неблагоприятных последствий.
Материал и методы исследования: в качестве материала исследования использовались репрезентативные базы данных по поиску научных источников PubMed и Google Scholar. Поиск литературы проводился в период с 2010 по 2017 годы. В качестве инструментов поиска использовались следующие слова и сочетания: chemsex, mephedrone, methamphetamine, crystal meth, GHB, GBL, new psychoactive substances, synthetic cathinones, substituted cathinones, substance abuse, substance use disorder.
Результаты исследования: выполнен обзор доступных зарубежных научных источников, систематизированы и кратко представлены сведения об истории феномена «химического секса», отражены причины его популярности и неблагоприятные последствия.
Заключение: сделан вывод о важности повышения осведомлённости специалистов и пациентов о проблеме «химического секса» и необходимости привлечения внимания к этому феномену.
... The term "chemsex" was coined in 2001 by David Stuart (2001) and has gained increasing social attention as chemsex practices have become more widespread. Since chemsex was first described in medical journals (Kirby and Thornber-Dunwell, 2013;Stuart, 2013), scientific interest has increased. Chemsex describes a phenomenon of substance use in a sexual context, primarily observed in men who have sex with men, trans-and non-binary people. ...
Purpose
Chemsex is a phenomenon that has gained increasing attention in recent years. The purpose of this paper is to differentiate chemsex from other sexualized substance use, and clarify differences between recreational and problematic chemsex use. Despite plentiful publications, little has been published on underlying determinants that predispose individuals to chemsex, and their process toward problematic chemsex use.
Design/methodology/approach
During the second European Chemsex Forum, people who engage in chemsex, community organizers, researchers, clinicians, therapists, social workers and (peer) counselors discussed potential pathways to problematic chemsex. In this manuscript, we translate findings from these discussions into a framework to understand the initiation and process toward problematic chemsex.
Findings
Six stages (loneliness and emptiness, search for connection, sexual connection, chemsex connection, problematic chemsex and severe health impact) and a set of factors facilitating the transition from one stage to the next have been identified.
Originality/value
It is hoped that this “Journey towards problematic chemsex use” will stimulate reflection and debate, with the ultimate goal of improving prevention and care for people engaging in chemsex.
... While drug use in gay and bisexual men (GBM) is consistently higher than in the general population (Lea et al., 2013;Melendez-Torres et al., 2016), injection drug use by GBM remains sparsely documented and poorly understood in the UK (Public Health England, 2016). This is despite increasing media attention from 2013 onwards (Kirby and Thornber-Dunwell, 2013;Shaw, 2017). Recent evidence from Australian GBM indicates a prevalence of drug injecting of 4.7% in the last six months, with lifetime prevalence of 10.6% (Bui et al., 2018), but epidemiological description of injecting drugs among UK GBM remains scant. ...
Background:
Evidence to understand which gay and bisexual men (GBM) inject drugs remains scant, especially in the UK. We describe correlates of last-year injecting in UK GBM, and characterise subgroups of GBM who inject drugs by types of drugs used.
Methods:
Using data from the 2014 Gay Men's Sex Survey, an opportunistic internet-based survey conducted of GBM living in the UK, we examined via logistic regression correlates with any injecting of six drugs (amphetamine/speed, crystal methamphetamine, heroin, mephedrone, GHB/GBL, and ketamine) in the last year. We estimated latent class models to understand underlying subgroups of injecting drug use among GBM reporting injecting drug use in the last year.
Results:
Injecting was most common in GBM who were of middle age, who were HIV seropositive, and who lived in London, and was significantly associated with sexual risk with multiple partners in the last year, whether steady or non-steady. Most GBM who engaged in injecting either injected crystal methamphetamine, mephedrone or both (class 1, chemsex, 88.6% of injectors), whereas a smaller group had a focus on opiates (class 2, opiate, 7.9%). A small but identifiable subgroup (class 3, eclectic, 3.5%) engaged in injecting across the range of drugs examined.
Conclusions:
This is the first epidemiological analysis to describe subgroups of injecting, and to describe correlates of injecting drug use, in UK GBM. Implications for design of harm reduction services include a need to focus on injecting drug use beyond opiates, currently the focus of most harm reduction services.
... Different combinations may be used in different settings and for different purposes. For example, mephedrone may be consumed during partying alongside cocaine, MDMA, GBL and ketamine (Kirby and Thomber-Dunwell 2013), whereas in 'chem-sex' sessions MDMA, GBL and methamphetamine may be co-ingested with mephedrone (Bourne et al. 2015). Such combinations induce intensified sexual experiences and increased disinhibition (e.g. ...
This chapter considers the prevalence
of and motivations
for use of synthetic cathinones
. As part of the scene-setting, the availability, legal status, numbers of cathinones, number and quantities confiscated are reviewed. This leads to the first substantive section of the chapter—an epidemiological investigation of the nature and extent of what is known about the use of these molecules. The second major section is more qualitative in its approach to understanding motivations
for the use of any drug, Novel Psychoactive Substances
(NPS), and then synthetic cathinones
. An examination is conducted of how cathinones may be compared to other stimulants and why particular cathinones may be preferred to others. The converse situation is then examined, what might be the motivations
and reasons
for ceasing to take cathinones and why this may not be a rational decision. A brief examination of the consequences of ceasing versus continued use is presented. As it is very likely that further synthetic cathinones
will continue to emerge, it is important to gain a much fuller insight into what motivates or causes individuals to use or cease using these molecules, so that communities and societies can respond in appropriate ways to the varying challenges that face them and their citizens.KeywordsSynthetic cathinonesEpidemiologyPrevalenceReasonsMotivations
... Methamphetamine abuse also seems to be prevalent in specific populations such as groups of gay men, mainly in London, who participate in so-called 'slamming' or 'chem-sex' parties. Sexual intercourse under the influence of drugs is associated with an intravenous use of the drug, where the injecting equipment is often shared, and the use of a cocktail of drugs like mephedrone and gamma-hydroxybutyrate (GHB) (9,10). Although the extent of this type of drug use remains unclear, drug services in London have reported increasing demand for treatment linked to problems associated with methamphetamine use by gay men (3). ...
... 'Chemsex', the use of drugs in sexual settings amongst men who have sex with men (MSM), has received sustained attention in the United Kingdom (UK) for the last five years. Chemsex in this geographic context is typically associated with the use of mephedrone, crystal methamphetamine, ketamine and/or gamma-hydroxybutrate (GHB) or the pre-drug gamma-butyrolactone (GBL) 1,2 . Qualitative research from London highlights a range of psychological, social and relational harms associated with chemsex, as well as a propensity for overdose 3 . ...
Background:
This paper establishes the prevalence of chemsex drug use among men who have sex with men (MSM), the extent to which these drugs are used in a sexual context, as well as their associated behaviours and circumstances of use.Methods:Data from a cross-sectional, online survey of 2328 MSM recruited via gay sociosexual media in Scotland, Wales, Northern Ireland and the Republic of Ireland were analysed.Results:While almost half (48.8%) of participants had ever taken illicit drugs, lifetime chemsex drug use was less common (18.0%) and far fewer reported chemsex drug use in the last year (8.2%) or last 4 weeks (3.0%). Just over one-quarter (27.1%) of men who used chemsex drugs in the last year reported no sexualised drug use, but almost three-quarters (72.9%) did. Only 6.1% of the whole sample reported sexualised chemsex drug use in the last year. The odds of reporting chemsex in the last year were significantly higher for men aged 36-45 years (AOR=1.96), single men (AOR=1.83), men who were HIV positive (AOR=4.01), men who report high-risk sex (AOR=4.46), being fisted (AOR=7.77) or had sex in exchange for goods other than money (AOR=4.7) in the last year and men who reported an HIV test in the last 3 months (AOR=1.53).Discussion:Only a small proportion of MSM in Scotland, Wales, Northern Ireland and the Republic of Ireland reported chemsex, and, for the first time, it is demonstrated that not all chemsex drug use was sexualised. Nevertheless, MSM who engage in chemsex (MWEC) reported substantial sexual risk inequalities. These novel findings highlight several opportunities for intervention, particularly around the multiple vulnerabilities of MWEC, opportunities for early identification of those most vulnerable to chemsex-related harm and the potential to develop a specialised responsive patient pathway.
... Stimulant and heavy alcohol use are well-established correlates of HIV acquisition and poor treatment outcomes among HIV-positive individuals [12,13]. There is also increasing recognition that "chemsex, " or the use of a combination of sex enhancing drugs like stimulants, has become increasingly common among MSM residing in industrialized nations [14,15]. In a large observational study of MSM, stimulant use was independently associated with a threefold increase in risk for HIV seroconversion and an eightfold increase when combined with other chemsex drugs such as poppers [16]. ...
Introduction:
Stimulant and heavy alcohol use are prevalent and associated with elevated risk for HIV seroconversion among men who have sex with men (MSM) and transgender women. In addition, each can pose difficulties for antiretroviral adherence among people living with HIV. Scant research has examined the associations of stimulant and heavy alcohol use with adherence to daily oral pre-exposure prophylaxis (PrEP) among MSM and transgender women. To address this gap in the literature, we evaluated the hypothesis that stimulant use and binge drinking are prospectively associated with sub-optimal PrEP adherence.
Methods:
We analysed data from participants in a nested case-cohort in the iPrEx open label extension. Stimulant use (i.e. powder cocaine, crack-cocaine, cocaine paste, methamphetamine, cathinone) and binge drinking (i.e. ≥5 drinks in a single day) in the last 30 days were assessed. Baseline urine was tested for stimulants using immunoassays to reduce misclassification. Sub-optimal adherence was defined as tenofovir drug concentrations in dried blood spots less than 700 fmol per punch, indicative of less than four doses per week. We tested the prospective association of stimulant use and binge drinking with sub-optimal adherence at the 4-week follow-up visit.
Results and discussion:
Data from 330 participants were analysed. The majority of the participants were MSM (89%) with a median age at baseline of 29 years (interquartile range 24 to 39). Approximately 16% (52/330) used stimulants and 22% (72/330) reported binge drinking in the last 30 days. Stimulant users had fivefold greater odds of sub-optimal PrEP adherence compared to non-users in adjusted analysis (adjusted odds ratio [aOR] 5.04; [95% CI 1.35 to 18.78]). Self-reported binge drinking was not significantly associated with sub-optimal adherence after adjusting for stimulant use and baseline confounders (aOR 1.16 [0.49 to 2.73]). Depressive symptoms, being transgender, and number of sex partners were also not significantly associated with sub-optimal PrEP adherence (p > 0.05).
Conclusions:
Stimulant use is a risk factor for sub-optimal PrEP adherence in the month following PrEP initiation. Comprehensive prevention approaches that reduce stimulant use may optimize PrEP adherence. Creating adherence plans that specifically address PrEP dosing in the context of ongoing stimulant use should also be considered.
In recent years sexualized drug use, usually referred to as chemsex, has become the object of intense media health‐related panic and increasing academic scrutiny. Critical social scientists have challenged pathologizing perspectives, analyzing the socio‐cultural and political economy dimensions of chemsex. Against the silence of geographers in this emerging field, the paper develops a geographical relational analysis of chemsex, focusing on the experiences of gay men living with HIV in two Italian cities (Bologna; Milan) and Italian gay men living with HIV in three English cities (Leicester; London; Manchester). Demonstrating the constitutive role of place in the practice of chemsex, the paper frames place relationally, i.e. as the encounter between here and there, the material and the virtual, imagined geographies and lived spaces. To emphasize the central role of place and geographical knowledge to understand chemsex, the paper builds on ‘weak theory’, as it conceives things as open, entangled, connected and in flux, while focusing on ordinary practices and heterogeneity in more‐than‐human worlds. Showing how chemsex represents an embodied, relational geographical encounter among different human and non‐human actors, places (both physical and digital), imaginations and desires, the paper highlights the role of sexual practices in the relational construction of place‐making, therefore calling for an increased engagement with sex itself within the field of geographies of sexualities.
There are global concerns about the proliferation and misuse of club drugs and novel psychoactive substances, yet we know little about their harms and research on clinical management and treatment remains limited. This book fills the knowledge gap by providing a detailed overview of the research evidence available to date. The book provides a framework that allows readers to understand this large number of new drugs, using classifications based on primary psychoactive effect. Within this framework, the book provides detailed reviews of the more commonly used drugs. Each chapter explores pharmacology, patterns and mode of use, acute and chronic harms, and clinical interventions supported by research evidence. An invaluable resource for clinical staff, this book will support clinicians working in the emergency department, substance misuse and addiction services, mental health services, primary care, sexual health services and more. It will also be of interest to academics and those developing drug policy.
There are global concerns about the proliferation and misuse of club drugs and novel psychoactive substances, yet we know little about their harms and research on clinical management and treatment remains limited. This book fills the knowledge gap by providing a detailed overview of the research evidence available to date. The book provides a framework that allows readers to understand this large number of new drugs, using classifications based on primary psychoactive effect. Within this framework, the book provides detailed reviews of the more commonly used drugs. Each chapter explores pharmacology, patterns and mode of use, acute and chronic harms, and clinical interventions supported by research evidence. An invaluable resource for clinical staff, this book will support clinicians working in the emergency department, substance misuse and addiction services, mental health services, primary care, sexual health services and more. It will also be of interest to academics and those developing drug policy.
There are global concerns about the proliferation and misuse of club drugs and novel psychoactive substances, yet we know little about their harms and research on clinical management and treatment remains limited. This book fills the knowledge gap by providing a detailed overview of the research evidence available to date. The book provides a framework that allows readers to understand this large number of new drugs, using classifications based on primary psychoactive effect. Within this framework, the book provides detailed reviews of the more commonly used drugs. Each chapter explores pharmacology, patterns and mode of use, acute and chronic harms, and clinical interventions supported by research evidence. An invaluable resource for clinical staff, this book will support clinicians working in the emergency department, substance misuse and addiction services, mental health services, primary care, sexual health services and more. It will also be of interest to academics and those developing drug policy.
Few theory-informed interventions to support people who use drugs during sex have been conceptualized and developed. We conceptualize sexualized drug use, also referred to as chemsex or pharmacosex, as a self-control challenge, and draw on extant theory and research to propose intervention approaches that can be tailored to meet the differing needs of people who engage in sexualized drug use. We draw on a continuum perspective of sexualized drug use, in particular chemsex, and discuss the role of reasoned and automatic processes in behavioral decisions, as well as critical components of effective self-control of behavior. A self-control approach can empower people to tackle their sexualized drug use, and classify their experienced sex-related drug use as problematic. Self-control encompasses clarifying one's goals and identifying strategies to mitigate behaviors to achieve these goals, despite competing pharmacosex desires. Our approach to self-control sexualized drug use contains three critical components: goal setting, goal enactment, and goal progress appraisal and goal adjustment. Goals should be formulated specific, ambitious yet realistic, and tailored to the individual's needs and wishes. Goals may target aspects of drug use, protecting sexual health and mitigating negative impacts. Implementing goal enactment implies translating goals into concrete (short-term) actions to move toward the higher-order goal via goal intentions and action/coping plans. During the goal progress appraisal and adjustment stage, people compare their actual with their planned behavior. This reflection may result in goal adjustment through feedback loops to adjust their goals and action/coping plans. We propose that our self-control approach can guide the development of interventions to effectively support people to prevent or limit pharmacosex, and helps to effectively mitigate or reduce negative impacts via self-help, peer support or professional support, offered via personal counseling or digital tools.
This chapter explores some of the social issues in the New Psychoactive Substances (NPS) debate including availability, prevalence and contexts of use, motivations for use, social harms, policy options and the impact of legislative control. In its consideration of the prevalence of use of key NPS in contrasting UK survey samples, this chapter presents previously unpublished data from the author’s annual surveys at English music festivals in the summers of 2010, 2011 and 2018, suggesting a picture of differentiated demand, pockets of waning popularity and a merging of drug markets. The key characteristics of the evolving NPS market moved from combining legitimate internet trading with features of the international trade in counterfeit prescription medications, to the misselling of NPS as established controlled drugs as those markets increasingly merged. A key theme of this chapter is speed: the speed of emergence of NPS echoes their predominantly stimulant effects and the rapidity of policy change around the world, contrasted with the recency of the phenomenon combined with the time lag between emergent trends in drug use and the development of a rounded scientific evidence base. I return to this point in the final section of this chapter where I cast a critical eye on the development of the NPS debate itself.
Background
Recently there has been an increase in reports of the phenomenon called chemsex, a subform of sexualized substance use. Chemsex is a neologism consisting of the two terms “chemicals” and “sex”. It describes the use of methamphetamine, γ‑hydroxybutyrate/γ-butyrolactone (GHB/GBL), mephedrone and sometimes other substances in a sexual context, especially by men who have sex with men (MSM). Chemsex has been described as a significant risk factor for mental and physical diseases.Objective
Due to the increasing importance of the phenomenon and the significantly increased number of publications on the subject, this article provides an overview of the current and relevant literature. The aim is to raise awareness on this topic among practitioners and researchers and thus to facilitate access to the help system for those affected.MethodA literature search was conducted in PubMed/Medline, Cochrane and Embase for the terms “chemsex”, “sexualized drug use” and “slamming. A total of 22 articles were identified as being relevant.ResultsIn the published literature on chemsex the current focus lies on somatic comorbidities. There is a significantly increased risk of sexually transmitted diseases. Mental illnesses such as depression, substance-induced psychosis and addiction also appear to be a significant consequence of chemsex. An individualized and specialized treatment approach is not yet established.DiscussionThe complexity of chemsex with its psychiatric and somatic aspects does not yet appear to be sufficiently reflected by the current data situation; however, due to the mutual influence of these different comorbidities, this patient clientele appears to be particularly at risk in the absence of a specialized treatment option, which is why further research on this topic is needed.
Background/purpose
Limited data are available on the role of illicit non-injecting drug use in a prolonged HIV outbreak that predominantly affected men who have sex with men (MSM) in Taiwan since 2006. We aimed to assess associations between specific types of drug use and incident HIV infections in this outbreak.
Methods
We conducted a retrospective case–control study among MSM clients at voluntary counselling and testing (VCT) service at National Taiwan University Hospital (Taipei, Taiwan). We used BED IgG-capture enzyme immunoassay to identify incident HIV infection (cases), individually matched to HIV-negative MSM clients (controls) by HIV testing date. We used a structured questionnaire to obtain the information on illicit drug use and sexual risk behaviors.
Results
From a total of 15,305 MSM client visits during 2006–2015, 387 cases were matched to 1012 controls. Use of inhaled nitrites (adjusted odds ratio [aOR] 2.1), MDMA (aOR 2.9), amphetamines (aOR 1.6), and ketamine (aOR 1.5) were independently associated with incident HIV infection. Polydrug (≥2 drugs) use was associated with the highest risk (aOR 4.3; 95% CI 2.6–7.2). While the proportion of MSM VCT clients who reported use of any recreational drug remained stable during 2006–2015 (average: 9.7%, P: 0.38), there was a shift in specific types of drug use, from MDMA/ketamine to inhaled nitrites/amphetamine, after 2011 (all Ps < 0.05).
Conclusion
Non-opioid recreational drugs use is associated with incident HIV infection in this prolonged HIV outbreak. There is an urgent need to formulate an effective public health response to mitigate the risk.
Background
Sexual transmission of hepatitis C virus (HCV) is well-documented among HIV-uninfected individuals. The use of HIV pre-exposure prophylaxis (PrEP) may be associated with engagement in activities that facilitate the transmission of sexually transmitted infections (STI) and possibly HCV among PrEP users.
Methods
Between 2012 and 2019, the incidence of HCV and bacterial STIs were calculated among HIV-negative patients receiving PrEP at the University Health Network HIV Prevention Clinic. Mucosal, anal and blood samples were taken to test for HIV, syphilis, and anti-HCV antibodies.
Results
Among 344 HIV-uninfected patients receiving PrEP, 86% were men having sex with men (MSM). Five individuals were HCV-antibody positive at the time of PrEP initiation. Serological and virological follow-up was available for 109 HCV-negative individuals over 282 patient-years (PY). Two new infections were recorded, yielding an incidence of primary HCV infection of 0.7/100 PY. In contrast with HCV, the incidence rates of chlamydia, gonorrhea, and syphilis were 49.2/100 PY, 36.3/100 PY, and 5.2/100 PY, respectively. Both individuals with new HCV diagnoses reported being MSM with a history of unprotected intercourse and one also reported recreational drug use. Both individuals were asymptomatic at the time of diagnosis and were detected by routine laboratory monitoring.
Conclusions
The low incidence of HCV infections despite significantly higher rates of other STIs suggests that sexual transmission of HCV is uncommon in HIV-negative MSM PrEP users in this community. Performing routine risk-based HCV surveillance among PrEP users should be evaluated. The high incidence of STIs in this population indicates a vital role for periodic STI monitoring in those receiving PrEP.
Male-on-male rape remains an under-researched area, and little is known about the characteristics and outcomes of this type of crime. This study examines 122 rape cases involving young adult and adult male victims reported to the London Metropolitan Police Service between 2005 and 2012. Overall, there were a number of similarities with cases involving female victims; however, male cases were more likely to involve strangers, substance use, and a victim with mental health issues, alluding to specific vulnerabilities. Moreover, younger victims, victims with poor mental health, and victims who had consumed alcohol or drugs were less likely to have their cases referred to prosecutors and more likely to be ‘no-crimed’ by police. This paper provides unique insight into the profile and trajectories of male-on-male rape cases, and preliminary recommendations for both police practice and future research are provided.
Hepatitis C virus (HCV) infection is the leading cause of cirrhosis, hepatocellular carcinoma, and liver transplantation. Current treatment rates and efficacy are inadequate to manage the disease burden caused by HCV; thus, efforts are needed to control HCV transmission. Besides the well-known transmission routes, which are health-care-associated transmission and transmission through injecting drugs, HCV could also be transmitted by sexual contact, especially among men having sex with men (MSM). MSM also have higher drug use prevalence than the general population, which may contribute to HCV infection by sexual disinhibition and other risky behavior. Since 2000, there have been emerging reports indicating HCV epidemics or outbreaks among HIV positive MSM in Europe, Australia and North America. However, previous studies often focused on HIV positive and/or injection drug using MSM, and there is still a need for study targeting on non-injection drug using MSM. The overall objective of this study is to investigate characteristics associated with HCV infection in MSM who used drugs but not injected drugs (NIDU MSM). This study used data from two projects, DASH project and YMAP project, and applied latent class analysis and dyadic data analysis to analyze the data. The main finding of this study included: (1) overall HCV prevalence in NIDU MSM was higher than the rest of general population; (2) NIDU MSM >=42 years old had a higher risk of HCV infection than NIDU MSM <42 years old; (3) NIDU MSM >=42 years old who used >6 drugs were associated with increased probability of HCV infection among all NIDU MSM; (4) among NIDU YMSM, syphilis mono-infection, HIV mono-infection, and syphilis/HIV co-infection were associated with increased risk of HCV infection. This study may provide a better understanding of HCV transmission among NIDU MSM. These results may provide a profile of subgroups with a higher HCV transmission possibility among NIDU MSM. In the long term, the results of the study may guide the development of healthcare and behavioral intervention programs related to HCV transmission, and may also guide tailored screening or treatment strategies for HCV infection.
ResearchGate has not been able to resolve any references for this publication.