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Prevalence of drug use during sex amongst MSM in Europe: Results from a multi-site bio-behavioural survey
Abstract
Background: Substance use has been consistently reported to be more prevalent amongst Men who have
Sex with Men (MSM) compared to the general population. Substance use, in particular polydrug use, has
been found to be influenced by social and contextual factors and to increase the risk of unprotected
intercourse among MSM. The objective of this analysis was to investigate the prevalence and predictors of
drug use during a sexual encounter and to identify specific prevention needs.
Methods/design: A multi-site bio-behavioural cross-sectional survey was implemented in 13 European
cities, targeting MSM and using Time-Location Sampling and Respondent-Driven Sampling methods
Multivariable multi-level logistic random-intercept model (random effect of study site) was estimated to
identify factors associated with the use of alcohol, cannabis, party drugs, sexual performance
enhancement drugs and chemsex drugs.
Results: Overall, 1261 (30.0%) participants reported drug use, and 436 of 3706 (11.8%) reported the use of
two or more drugs during their last sexual encounter. By drug class, 966 (23.0%) reported using sexual
performance enhancement drugs, 353 (8.4%) – party drugs, and 142 (3.4%) the use of chemsex drugs.
Respondents who reported drug use were more frequently diagnosed with HIV (10.5% vs. 3.9%) before and
with other STIs during the 12 months prior to the study (16.7% vs. 9.2%). The use of all the analysed
substances was significantly associated with sexual encounter with more than one partner.
Discussion: Substance and polydrug use during sexual encounters occurred amongst sampled MSM
across Europe although varying greatly between study sites. Different local social norms within MSM
communities may be important contextual drivers of drug use, highlighting the need for innovative and
multi-faceted prevention measures to reduce HIV/STI risk in the context of drug use.
... We then used multivariable logistic regression to assess the independent effects of each risk factor on frequent use for all five substances. Risk factors were chosen a priori and were selected from previous literature (Jamal et al., 2018;Kalichman et al., 2004;Li et al., 2021;Reitsma et al., 2021;Rosińska et al., 2018;Vaccher et al., 2020). The risk factors of interest included age, relationship status, education, bothersome pain during RAI, dissatisfaction with pleasure during RAI, lifetime RAI exposure, number of sexual partners, and history of childhood sexual trauma. ...
... Participants in an open relationship were more likely to frequently use marijuana and nicotine. As reported previously in other literature, education level was strongly correlated with meth and nicotine use (Reitsma et al., 2021;Rosińska et al., 2018). ...
... When controlling for all other demographic factors, we found that younger respondents were more likely to frequently use nicotine, consistent with trends seen in previous tobacco prevalence studies (Jamal et al., 2018;Reitsma et al., 2021). Likewise, we reiterate that lower educational attainment may be a very strong predictor of frequent meth and nicotine use (Rosińska et al., 2018). Among our cohort, there was a 15-fold increase in the likelihood of frequent meth use among those with a high school education equivalent or less. ...
Sexualized drug use (SDU) describes use of any psychoactive substance before or during planned sexual activity to facilitate, intensify, or prolong intercourse. The impact of pain, pleasure, and other mediators on SDU is not well characterized. This study aimed to distinguish the motivations behind different classes and frequencies of substance use during receptive anal intercourse (RAI). Data were from an internet-based survey conducted between July 2022-January 2023. We measured the frequency of SDU for five substances: poppers, alcohol, marijuana, methamphetamine, and nicotine. Satisfaction with pleasurable sensations during RAI and any type of pain bother during RAI were assessed on a 5-point scale. Multivariable logistic regression was performed for 1,119 respondents. Our results showed a strong association between bothersome pain during RAI and frequent alcohol (aOR 2.1), marijuana (aOR 2.4), nicotine (aOR 3.1), and meth (aOR 5.9) use. None of the five substance classes studied was correlated with dissatisfaction with pleasure during RAI. Frequent popper use was associated with increasing lifetime RAI experience and number of sexual partners. The mechanism behind SDU during RAI is substance-specific and multifactorial. Bothersome pain during RAI is highly associated with frequent SDU. Inquiring about pain during RAI may offer avenues for intervention.
... Most studies estimating the percentage of SMM engaging in chemsex have significant limitations, such as including only SMM living with HIV [12][13][14], recruiting participants from sexually transmitted infection clinics (where high-risk practices are overrepresented) [15][16][17][18][19][20], having small sample sizes [12,13,15,16,20], or identifying any use of certain substances as chemsex [13,14,18,19,21]. Furthermore, despite sessions being a fundamental aspect of the cultural concept of chemsex, the vast majority of studies define any sexualized substance use as chemsex, disregarding specific contexts, participation in chemsex sessions, or participants' referring to what they do as chemsex [15][16][17]20,[22][23][24]. ...
... Previous articles have found that chemsex is associated with different sociodemographic factors [23,[25][26][27][28][29]. Some of those factors are age [25][26][27][28][29], living with HIV [23,25,28,29], living in larger cities [25], ethnic heritage [27], migratory status [29,30], educational level [25], financial status [30], or openly living their sexuality [25]. ...
... Previous articles have found that chemsex is associated with different sociodemographic factors [23,[25][26][27][28][29]. Some of those factors are age [25][26][27][28][29], living with HIV [23,25,28,29], living in larger cities [25], ethnic heritage [27], migratory status [29,30], educational level [25], financial status [30], or openly living their sexuality [25]. However, these studies had the same limitation as those that investigated the proportion of SMM engaging in chemsex, as they classified any use of certain substances as chemsex. ...
Background
Chemsex prevalence is still not well known, and both the lack of homogeneity and cultural component of chemsex practices are usually overlooked.
Objective
This study aims to estimate the proportion of sexual minority men (SMM) engaging in chemsex sessions, while understanding the cultural dimension of chemsex, and to analyze distinct session typologies with potential risk differences and the sociodemographic factors associated with engaging in them.
Methods
A total of 5711 SMM residing throughout Spain participated in an anonymous web-based survey that assessed chemsex session engagement and characteristics, drug use, and sociodemographic variables. We measured the association of sociodemographic factors with engaging in chemsex sessions by calculating adjusted prevalence ratios, using multivariate Poisson regression analysis. Chemsex typologies were analyzed using latent class analysis, and sociodemographic factors were associated with the different risk classes.
Results
Our results determined that 21.1% (1205/5711; 95% CI 20.0%‐22.1%) of SMM engaged in chemsex sessions during their lifetime. Participating in sessions was significantly associated with being a migrant, not having a comfortable financial situation, openly living their sexuality, residing in bigger municipalities, older age, using steroids, and living with HIV (adjusted prevalence ratio: range 1.17-2.01; all P values <.05). Three typologies of sessions with different risks were identified with latent class analysis, with 23.2% of SMM engaging in sessions taking part in higher-risk ones, which was associated with younger age, using steroids, living in bigger municipalities, openly living their sexuality, and living with HIV, compared to SMM engaging in lower-risk sessions (odds ratio: range 2.75-4.99).
Conclusions
Chemsex is relatively common among SMM in Spain, but it is important to differentiate typologies of sessions with varying risks, and the proportion of SMM engaging in high-risk sessions is low. Chemsex is highly associated with sociodemographic factors. Chemsex should be prioritized in public health programs, which should consider the different forms of sessions with their varying risks and prevalence, while also considering the cultural dimension inherent to chemsex.
... The moment of consumption can take place prior to or during the sexual encounter, with the aim of facilitating, improving, and/or maintaining the experience (Maxwell et al., 2019). The most common profile of the participant generally corresponds to the gay male sexual orientation with an average age of 30 years, no partner, a high level of academic training, a medium-high socioeconomic level, a job, and a residence in a large city (Fernández-Dávila, 2016;Íncera et al., 2022;Rosińska et al., 2018). Chemsex is also characterized by the consumption of a specific type of substance, certain routes of administration and forms of acquisition of the drug, the performance of certain sexual practices, and certain risks to the health of the person, framed within what is known as the culture of "casual sex or without commitment" gay relationships (European ChemSex Forum, 2018). ...
... Several scientific studies have explored the risks associated with chemsex and its impacts on the physical and mental health of the individuals involved. Specifically, chemsex has been associated with higher rates of STIs (sexually transmitted infections) (Glynn et al., 2018;González-Baeza et al., 2018;Hegazi et al., 2017;Rosińska et al., 2018;Sewell et al., 2017;Tomkins et al., 2019), intravenous drug use (Hegazi et al., 2017;Rosińska et al., 2018), higher rates of condomless anal intercourse (Glynn et al., 2018;Sewell et al., 2017;Weathernburn et al., 2017), mental health issues (e.g., anxiety, depression and addiction), hypersexualization of leisure activities (Soriano & del Amo, 2020;Tomkins et al., 2019) and is more prevalent among HIV-positive individuals (Edmundson et al., 2018;Rosińska et al., 2018). Globally, it is estimated that one in six HIV-positive individuals has contracted an episode of STI at any time of HIV infection (Marcus et al., 2020). ...
... Several scientific studies have explored the risks associated with chemsex and its impacts on the physical and mental health of the individuals involved. Specifically, chemsex has been associated with higher rates of STIs (sexually transmitted infections) (Glynn et al., 2018;González-Baeza et al., 2018;Hegazi et al., 2017;Rosińska et al., 2018;Sewell et al., 2017;Tomkins et al., 2019), intravenous drug use (Hegazi et al., 2017;Rosińska et al., 2018), higher rates of condomless anal intercourse (Glynn et al., 2018;Sewell et al., 2017;Weathernburn et al., 2017), mental health issues (e.g., anxiety, depression and addiction), hypersexualization of leisure activities (Soriano & del Amo, 2020;Tomkins et al., 2019) and is more prevalent among HIV-positive individuals (Edmundson et al., 2018;Rosińska et al., 2018). Globally, it is estimated that one in six HIV-positive individuals has contracted an episode of STI at any time of HIV infection (Marcus et al., 2020). ...
Chemsex is described as the use of psychoactive substances during sexual activity to sustain, enhance, disinhibit, or facilitate the sexual experience. It preferentially concerns men who have sex with men. The main objective of this study was to examine the relationship between participation in chemsex and the psychological variables impulsivity, sexual assertiveness, and hypersexuality. The sample was composed of 137 Spanish men. A total of 104 participants reported that they had engaged in chemsex, with ages ranging from 19 to 42 years (M = 31.41, SD = 4.83). A total of 33 participants reported that they had never participated in chemsex sessions. The participants were contacted and recruited at social centers, LGBT associations, and key informants. Results showed that men who participated in chemsex reported higher impulsivity, higher hypersexuality, and lower sexual assertiveness than those who have never participated in it. The frequency of participation in chemsex, as well as the number of substances consumed, was positively and significantly correlated with dimensions of impulsivity and hypersexuality. This frequency and this consumption were negatively and significantly correlated with sexual assertiveness. Findings showed significant differences in the psychological variables based on the number of consumed substances (polydrug use/consumption of one substance) and the time of consumption (before, during or before and during sex). In conclusion, the study demonstrates the existence of a clear relationship between the experience of chemsex and psychological factors such as being an impulsive person, presenting hypersexual behavior, and/or having low sexual assertiveness.
... Chemsex also carries serious health risks. In this sense this practice is associated with unprotected anal intercourse (Drückler et al., 2018;Frankis et al., 2018;Glynn et al., 2018;Kenyon et al., 2018) and leading to increased rates of sexually transmitted infections (STIs) (Pufall et al., 2018;Rosińska et al., 2018). Furthermore, individuals engaging in chemsex are more likely to be HIV positive compared to those who do not participate in this practice (Frankis et al., 2018;Pakianathan et al., 2018;Rosińska et al., 2018). ...
... In this sense this practice is associated with unprotected anal intercourse (Drückler et al., 2018;Frankis et al., 2018;Glynn et al., 2018;Kenyon et al., 2018) and leading to increased rates of sexually transmitted infections (STIs) (Pufall et al., 2018;Rosińska et al., 2018). Furthermore, individuals engaging in chemsex are more likely to be HIV positive compared to those who do not participate in this practice (Frankis et al., 2018;Pakianathan et al., 2018;Rosińska et al., 2018). Beyond physical health concerns, chemsex has been associated with other issues, such as legal problems, family conflicts, the risk of overdose, interactions with other treatments, and non-adherence to medical treatments (Tomkins et al., 2019). ...
... Similarly, Khaw et al. (2021) observed that older men, specifically those aged 46-55 and older, reported more frequent involvement in chemsex, although the statistical significance of these differences was not conclusive. Conversely, other research, such as that conducted by Rosińska et al. (2018), identified a higher prevalence of chemsex among younger age groups. The apparent discrepancies between these findings could be attributed to methodological differences across studies, particularly in terms of recruitment strategies and sample characteristics. ...
Background: Although significant progress has been made in the rights of the LGBTQ+ community, even today
this population still faces stigma and discrimination that impacts their mental health. In the case of men who
have sex with men, it has been demonstrated that the use of drugs in a sexual context (chemsex) is one of the
coping mechanisms and means of escape to deal with these situations.
Method: We assessed 284 native Spanish speakers’ participants, 45,4 % were not engaged in sexualised drug use
(n = 129) while 54,6 % were chemsex users (n = 155) using 18,7 % of them the injected via. The participants
completed six questionnaires about life and sexual satisfaction, depression, anxiety, internalised homophobia
and personality. Bivariate and multivariable logistic regression were performed to assess the associations between sexual behaviour-related and psychological variables. Kruskal-Wallis H test was used to analysed the
impact on mental health of the administration via.
Results: Aged, unprotected sexual relationships, positive serostatus, homonegativity and conscientiousness predicted the chemsex engagement. Furthermore, we found differences regarding the administration via.
Conclusions: We conclude that mental health significantly correlates with the practice of chemsex, highlighting
the importance of integrating mental health considerations into the prevention of risky sexual behaviors.
... Finally, eight articles passed the final quality filter and constitute the main result (Scheme 1). All the included articles were cross-sectional studies performed across Europe, in 16 different countries; three of them were multinational studies [28][29][30][31][32][33][34][35]. The median sample size of the different studies was 2883 MSM, ranging from 250 to 9407, and four of eight articles (50%) were obtained by attendants in sexual clinics [29][30][31]34]. ...
... The drugs included in all manuscripts were gamma hydroxybutyrate or gamma butyrolactone (GHB/GBL)-also named liquid ecstasy-mephedrone, and crystal meth. Ketamine is another drug generally included in chemsex, included in five of the eight manuscripts [28][29][30][31]34]. The complete list of the drugs included in the chemsex definition is included in Table 1. ...
... The main difficulty we have encountered is that there is no universal and accepted definition of chemsex. Although all articles include mephedrone, crystal methamphetamine, and GHB/GBL [28][29][30][31][32][33][34][35], others also include ketamine [28], drugs such as so-called "club drugs" or drugs to enhance sexual effects such as poppers and Viagra, and other illicit drugs such as cocaine, ecstasy, or cannabis [29][30][31]34]. This has already been reported in previous reviews [5,36], which is why a consensus has been developed in the public health system of England [4], which is a reference in Europe because it is the region where the phenomenon of chemsex has been studied the most. ...
Background: In recent years, in Europe, there has been a growing concern about the use of sexualized drugs among men who have sex with men (MSM), due to its possible link to an increase in sexually transmitted infections. The aim of this review is to study the prevalence of chemsex, and the sexualized drug used in Europe, describing both different consumption patterns and other sexual behaviors considered risky and their possible relationship with positivity in diagnoses of sexually transmitted infections, including human immunodeficiency virus. Methods: We conducted a literature review in the main scientific databases (PubMed, Embase, Scopus, Cochrane Library, Web of Science), filtering for articles published between January 2018 and April 2023 that collect information on sexualized drug use and sexual practices conducted in European countries among men who have sex with men, including whether these behaviors can lead to diagnoses of sexually transmitted infections. Results: The definition of drugs included in chemsex is not clearly defined and shows heterogeneity between study publications; the three drugs presented in all manuscripts are mephedrone, GHB/GBL, and crystal methamphetamine. The prevalence of chemsex in Europe is 16% [11–21%] among MSM. The most frequent risky sexual behavior associated with chemsex practice was unprotected sex with a high number of partners. The log risk ratio of STIs was 0.86 (95% CI: 0.49 to 1.23). Conclusions: Adherence to definitions, stringent research methodologies, and focused interventions are needed to tackle the intricate relationship between substance use, sexual behavior, and the risk of HIV/STI transmission in MSM.
... Studies of a wide range of drugs show that the prevalence of SDU of the most commonly used drugs for any purpose (such as cannabis or cocaine) tend to be much higher than the prevalence of chemsex drugs (10,34). Besides making the sexual experience more intense, pleasurable or long-lasting, there are many other reasons for drug use (recreational, performance enhancement, etc.), Analysis of the available information suggests that, with the exception of poppers and the 4-chems, psychoactive drugs are probably used more frequently by most MSM for purposes other than sex. ...
... However, there are no studies that confirm or refute these hypothesis. Likewise, there is no additional drug-specific information on the circumstances surrounding the first sexualized use, as almost all studies focus on the last SDU or the last sexual encounter (34,35). ...
... This association with risk behaviors was to be expected, especially for chemsex drugs. Since it is already known that such an association exists for those who have practiced SDU (10,18,34,38), it is logical that it would be found among people who start using those drugs for sex. That the strongest correlates are common to both drugs seems logical, since, as we have pointed out, a large percentage began consumption as SDU for both types of drugs. ...
This original study compares the prevalences of drug use for any purpose and for sexualized drug use (SDU) among MSM. It also describes relevant characteristics of first SDU, analyzes to what extent SDU has been the first experience (the gateway) with different drugs by age and explores the correlates of SDU. Study participants included 2,919 HIV-negative MSM attending four HIV/STI diagnosis services in Madrid and Barcelona. They answered an online, self-administered questionnaire. Poisson regression models with robust variance were used. About 81.4% had ever used any drug, and 71.9% had done so in the last-12-months, while 56% had ever engaged in SDU, and 50% had done so in the last-12-months. Participants under 25 years old had the lowest prevalences of SDU, and the 25–39 age group the highest, except for Viagra, which was higher among those over age 40. The most frequently used drugs for first SDU were poppers (53.6%), cannabis (19.6%) and Viagra (12.2%). These drugs were also the most ever consumed for SDU. Among sexualized users, methamphetamine (78.3%) and Mephedrone (75.4%) were used always/most of the times for sex in the last-12-months. Around 72.2% of Mephedrone sexualized users and 69.6% of Methamphetamine vs 23.1% of ecstasy users' first consumption of these drugs involved use for sex. These drugs were provided to them free where they have sex for 66.8, 79.1, and 31.9%, respectively. On that occasion, 8.1% of Mephedrone, 6.8% of Methamphetamine and 18.4% of ecstasy users had sex only with steady partner; with 50.2, 56.2, and 26.2% respectively using a condom with any partner. SDU in the first use was associated with similar variables for recreational and chemsex drugs. The highest prevalence ratios were for having ever been penetrated by >20 men and having ever injected drugs. It can be concluded that the prevalence of SDU was more than half of the prevalence for any purpose. Thus SDU was the gateway to use for many drugs in an important proportion of users, who frequently consumed drugs that were free and had condomless anal sex with occasional and multiple partners. These circumstances were much more common for chemsex than for recreational drugs.
... A survey from the UK among 3933 MSM showed that in the last year, 10% of MSM engaged in SUIPS (Blomquist et al., 2020), and another study among 2328 MSM from Scotland, Wales, Northern Ireland, and Ireland reported a last year prevalence of 8% (Frankis et al., 2018). In Hongkong (n = 407) (Wang et al., 2020), Germany (n = 1583) (Schecke et al., 2019), and across multiple European cities (n = 1261) (Rosińska et al., 2018), last year prevalence of SUIPS among MSM was 6.6%, 27%, and 11.8%, respectively. Higher rates are found (> 20%) in specific subgroups of MSM, like HIV-positive MSM at sexual health clinics (Bohn et al., 2020;Donnadieu-Rigole et al., 2020;Sewell et al., 2017). ...
... Research generally reports MSM practicing SUIPS as between 25 and 45 years (Blomquist et al., 2020;Graf et al., 2018;Guerras et al., 2020;Schecke et al., 2019;Schmidt et al., 2016). One out of four MSM used more than one psychoactive substance just before or during sex, and, thus, polydrug use seems to be quite common (Rosińska et al., 2018). Whereas most research focusses on MSM, SUIPS was also reported in lesbian and bisexual women, and often at a considerably higher prevalence than in heterosexual people (Lawn et al., 2019;Rosner et al., 2021). ...
Sex under the influence of psychoactive substances (SUIPS) has gained much attention in the press and scientific literature over the last years, especially among men who have sex with men (MSM). Concerns have thus far been expressed in relation to short-term physical health risks, like contracting bloodborne diseases, like viruses. However, much less is known about long-term mental health consequences of SUIPS, like depression, anxiety, and substance use disorders (SUD). Therefore, we systematically reviewed literature for evidence on mental health complications of SUIPS in MSM. SUIPS was associated with a lower general mental health status, and higher rates of depression, anxiety disorders and suicide ideation in 15 studies, and higher rates of SUD were found among MSM practicing SUIPS in four studies. Motives of SUIPS were increasing sexual performance, fear of rejection, anxiety, and low self-esteem among others. Furthermore, long-term mental health risks, as associated with some of the most frequently reported psychoactive substances in the context of SUIPS, include psychosis and substance dependence. Therefore, the present findings indicate that SUIPS is associated with mental disorders and that they are probably closely intertwined with motives for SUIPS and the long-term effects of using psychoactive substances. This underlines the need to address the presence of mental disorders in people practicing SUIPS, alongside the physical risks.
... An additional, negative partner effect of illicit drug use on satisfaction also emerged in discordance models, such that one's partner's illicit drug use was associated with reduced relationship satisfaction, an effect that is consistent with previous research among different sex couples (Homish et al., 2008;Mudar et al., 2001). However, it is still possible that permissive norms and contexts of illicit drug use for male couples (Cochran et al., 2012;Parsons & Starks, 2014;Rosińska et al., 2018;Starks et al., 2021) could have impacted the substantive meaning of this effect, so future research could qualitatively investigate the role of lived experience in this area. ...
... Our results suggested several novel, substance-facilitated pathways to relationship distress and resilience among male couples that are contrary to prior work exclusively conducted among different sex couples. Because unique norms (Cochran et al., 2012;Green & Feinstein, 2012;Halkitis & Palamar, 2008), contexts (Mitchell et al., 2016;Rosińska et al., 2018;Starks et al., 2021), trajectories, and interdependence processes of substance use exist among male couples, future work should explore more fully the specific conditions and pathways by which it impacts relationship quality within this at-risk population. Extreme care should also be taken when applying mechanisms of change only documented among different sex couples when intervening in SGM partnerships. ...
Research shows that, for different sex couples, individual levels of substance use are deleterious for relationship quality (e.g., satisfaction, intimate partner aggression), whereas dyadic concordance is usually protective. However, there has been no research on these effects among male couples, even though they show increased risk for substance use and certain indices of relationship distress (e.g., intimate partner aggression) compared to different sex couples. Male partners also display distinct similarity patterns and norms surrounding substance use, suggesting that there might be unique effects of substance use on relationship quality among this population. We conducted actor–partner interdependence models of substance use on relationship quality (intimate partner aggression, satisfaction) among a large sample of male dyads (N = 934 individuals, N = 467 dyads). Results suggested that there are novel actor, partner, and similarity effects that imply unique pathways to relationship well-being for male couples. These results are discussed in light of future clinical and empirical efforts. [NCT03186534 – 6/12/2017; NCT03284541 – 6/23/2017].
... During the last decade a large number of research papers has been published, which have focused on the use of different drugs immediately before or during sex (sexualised drug use, SDU), especially centred on certain drugs whose use has spread recently among MSM and that have been commonly labelled as "chem drugs": crystal methamphetamine, gamma-hydroxybutyrate/gamma-hydroxybutirolactone (GHB/GBL), mephedrone and, sometimes, ketamine. However, all these studies show that the prevalences of SDU of more traditional drugs (such as cannabis, cocaine, ecstasy or poppers) tend to be much higher than the so called "chem drugs" [8][9][10][11][12][13][14]. That said, while a very important factor, sex is only one of the reasons for using drugs, there are many others, and-with the exception of alkyl nitrites and the four chem drugs-psychoactive drugs are probably used more frequently by most MSM for purposes other than sex. ...
... The areas of Madrid and Barcelona are the two most populated in Spain and have higher prevalences of MSM [13,36,37]. Previous studies have shown that they are among the European cities with the highest SDU prevalences [8,9]. However, no study in these cities, nor in Spain, has ever compared drug-use prevalence for any purpose between MSM and GPM. ...
This study compares the prevalence of drug use and the typologies of polydrug use (PDU) in men who have sex with men (MSM) and general population men (GPM). Participants were men aged 16–64, living in the provinces of Madrid and Barcelona: 1720 were recruited in a GPM survey, and 2658 were HIV-negative MSM from HIV/STIs diagnosis services. Lifetime and last-year prevalence of drug use and prevalence ratios (PRs) of MSM to GPM for the different drugs were calculated using Poisson regression. Latent class analysis (LCA) was performed to identify typologies of PDU. Lifetime use of the drugs considered was higher in MSM, and even higher for drug use in the last-year: PRs for cannabis, hallucinogens and cocaine ranged from 2–5; for amphetamine, ecstasy and methamphetamine 12–16; and above 60 for ketamine, GHB/GBL, inhalants and mephedrone. In the LCA for lifetime PDU four classes arose from the GPM (No-PDU (79.6%); Conventional PDU (13.8%); Intensive conventional PDU (4.9%); Heavy PDU (1.8%)) and four among MSM (No-PDU (57.7%); Conventional PDU plus poppers (18.8%); PDU preferring chemsex drugs (6.4%); Heavy PDU (17.2%)). For PDU during the last-year, three classes arose in the GPM: No-PDU (94.7%); Conventional PDU (4.3%); Heavy PDU (0.9%). For MSM, we identified four classes: No-PDU (64.7%); Conventional PDU plus poppers (15.6%); PDU preferring chemsex drugs (6.2%); Heavy PDU (13.5%). MSM should be considered a priority group for the prevention of the use of all drugs but the heterogeneity of PDU typologies regarding users’ preference towards conventional and/or sexualised drugs needs to be taken into account.
... It refers to the intentional use of drugs, commonly observed in gay men and other men who have sex with men (MSM) to enhance, disinhibit, or facilitate the sexual experience (European Chemsex Forum, 2018;Stuart, 2019). While SDU may encompass the use of different substances, whether traditional (alcohol, cannabis, or tobacco) or club drugs (ecstasy, cocaine, amphetamines), the substances often used in chemsex are quite specific (Rosińska et al.,2018). According to the literature, chemsex drugs usually include crystal methamphetamine, GHB/GBL (γ-hydroxybutyrate acid/γ-butyrolactone), cathinones such as mephedrone, 3-MMC, 4-CMC, alpha-PVP, and alpha-PHP (Bourne et al.,2015;Maxwell et al., 2019;Stuart, 2013). ...
Research on chemsex, the intentional use of certain drugs in sexual contexts by gay men and other men who have sex with men (MSM), has been growing in recent years although, even today, much of it
focuses on drug use and its consequences, rather than on the sexual and social experiences of users. This study aimed to explore the influence of social support and sexual functioning on the frequency of
chemsex and sober sex. A sample of 160 MSM was recruited through social media and NGOs. Through regression analysis, it was found that lower perceived social support and greater number of routes of
drug administration predicted a higher frequency of chemsex practice. On the other hand, higher perceived social support, higher levels of desire and arousal, and fewer routes of drug administration predicted a higher frequency of engaging in sober sex. This study provides empirical evidence that both social support and sexual functioning are key elements in chemsex and have an impact on both the of chemsex and sober sex. Given the importance of these elements, we suggest that interventions should be framed holistically. Nevertheless, not all chemsex is problematic and it is a free choice
in sexuality.
... It has also been shown that those who practice chemsex have closer ties to the LGBT community than other MSM (6,19,42), which has a positive effect on well-being (16,17). ...
Ziel der Studie: Sexualisierter Substanzkonsum beschreibt den Konsum von psychotropen Substanzen zum Sex. Als spezifische Variante gilt „Chemsex“, der mit Männern, die Sex mit Männern haben (MSM), und Substanzen wie Methamphetamin, Mephedron, GHB/GBL und Ketamin assoziiert ist. Sexualisierter Substanzkonsum kann mit multiplen negativen physischen, psychischen und sozialen Folgen einhergehen. Zur Veränderungsmotivation und Inanspruchnahme des Suchthilfesystems von MSM mit sexualisiertem Substanzkonsum ist wenig bekannt. Das Ziel der Studie war es, die Gruppe der Chemsex-Konsumenten näher zu beschrei- ben, deren Konsummotive und Konsumkontexte sowie die Veränderungsmotivation der MSM in Bezug auf den Substanzkonsum abzubilden und deren Inanspruchnahme von Hilfeleistungen auszuführen.
Methodik Im „German Chemsex Survey“ wurde online eine Stichprobe von MSM (N = 1583) befragt. Die Umfrage umfasste 420 Items zu Substanzkonsum im sexuellen Kontext, Konsummotiven, Aspekten psychischer Gesundheit, sexuell übertragbaren Infektionen, negativen psychosozialen Folgen von „Chemsex“, und Schadensminimierungsstrategien. Zudem wurden die Veränderungsmotivation sowie die Inanspruchnah- me von psychosozialen Hilfsangeboten erfragt.
Ergebnisse 54,3 % der Männer gab an, Substanzen im Zusammenhang von Sexualität konsumiert zu haben, 28,5 % berichteten von typischen Chemsex Substanzen. Die 30-Tage-Prävalenz für Chemsex-Substanzen betrug: 14,4 % für GHB/GBL, 11,2 % für Ketamin, 8,2 % für Methamphetamin und 6,1 % für Mephedron. Die Prävalenz von HIV lag bei 24,6 % und für Hepatitis C bei 1,6 %. Ein Drittel bis die Hälfte der Konsumenten äußerten einen Veränderungswunsch bezüglich ihres Konsums, 9,3 % äußerten professionellen Unterstützungsbedarf. Lediglich ein Prozent nahm aktuell Angebote der Suchthilfe in Anspruch. Schlussfolgerung Ein Drittel bis die Hälfte der Befragten gab an, dass sie eine Veränderung des Substanzkonsums im sexuellen Kontext anstreben. Die geringe Nutzung von Suchthilfeangeboten spricht für eine Versorgungslücke für MSM mit sexualisiertem Substanzkonsum.
... A national report on sexual diversity and substance use calculated a last year prevalence of 46% among gay, bisexual, and other men who have sex with men (gbMSM) (Baruch-Dominguez et al., 2015). As in other contexts (Lafortune et al., 2021;Rosińska et al., 2018), in Mexico polysubstance use among gbMSM has been associated with living with HIV (Algarin et al., 2023). ...
Internationally, HIV-related stigma and crystal methamphetamine (meth) use have been described as barriers to treatment adherence among gay, bisexual, and other men who have sex with men (gbMSM). Crystal meth use has been increasing among gbMSM in the Metropolitan Area of Mexico City (MAMC). Therefore, this study aimed to determine the association between HIV-related stigma and HIV treatment adherence among gbMSM who use crystal meth in the MAMC. This study was undertaken as part of an exploratory study of crystal meth use in the MAMC. The data were collected from September to December 2021 through an encrypted online survey. Participants (n = 89) were gbMSM adults living with HIV who reported crystal meth use in the past month that were recruited through an online snowball sampling. The online survey included questions about HIV treatment adherence, sexual behaviors, the Alcohol, Smoking, and Substance Involved Screening Test, and the HIV-Related Stigma Mechanisms Scale. Logistic regression analyses assessed the association between HIV-related stigma and HIV treatment adherence. The multivariate logistic regression model showed that, controlling for health insurance [adjusted odds ratio (AOR) = 0.13; 95% confidence intervals (CI) = 0.02–0.59] and educational level (AOR = 0.16; 95% CI = 0.02–0.88), non-adherence to HIV treatment was independently associated with higher HIV-related stigma (AOR = 1.06; 95% CI = 1.01–1.12). Public health policies must include HIV-related stigma and substance use in treating gbMSM with HIV.
... and the high prevalence of chemsex detected in this group (49.3%) is slightly higher than described so far in our environment (15). Previous research in MSM living with HIV has reported a chemsex prevalence of 29.1% (16), and data from a study in 13 European cities showed a prevalence of sex-related drug consumption of 30% between MSM, including alcohol and erectile dysfunction medications (17). Recent data have contributed to the knowledge of this issue in other settings. ...
Sex-related drug consumption and its health-related consequences have gained relevance in the assessment of patients with sexually transmitted infections (STIs), which pose a significant challenge to public health. We aim to assess the prevalence and characteristics of drug consumption and chemsex practices, describe the associated risk factors among general individuals attending an STI clinic, and evaluate the psychological impact associated with these behaviors. We conducted an online anonymous survey offered to patients with a diagnosis of STI in a tertiary hospital in Spain. Data included sociodemographic characteristics, sexual preferences and behavior, and assessment of drug use, chemsex, and psychological and mental health symptoms. Data from 145 subjects was collected, with a higher proportion of cis-gender men (71%), and a median age of 32 years. 64 participants (44%) reported drug use in the last year, with an observed 33.8% prevalence of chemsex consumption. Drug use and chemsex were more frequent among cis-gender men, Men who have Sex with Men (MSM), people living with HIV (PLHIV), and those reporting previous group sex. Poppers and cannabis were the most frequently reported drugs, with a prevalence close to 20% for cocaine, mephedrone, extasis, and GHB. Consequences related to drug use included unpleasant physical sensations, sexual dysfunction, and impaired sexual experience after reduction or drug discontinuation. The prevalence of drug use and chemsex practices are high among patients evaluated for STIs, especially between men, MSM, and subjects practicing group sex. The study highlights the urgent need for targeted interventions on prevention and reduction of their impact on health and social well-being.
... Auckland has a much smaller population than comparative gay meccas of London, Sydney and Berlin [9], likely without the critical mass of GBM to organise and sustain regular chemsex sessions. GBM in NZ might therefore travel to engage in chemsex [31,32], or local practices of chemsex could be shaped by those visiting NZ. ...
Introduction
New Zealand has a unique illicit drug market, gay cultures and drug use patterns. Minimal attention has been given to how drug use shapes sexual practice, especially in the era of biomedical HIV prevention among gay and bisexual men (GBM).
Methods
An online cross‐sectional study of GBM (‘Flux NZ’) adapted from an Australian study was undertaken to explore connections between drug use, sexual practice, health and community. We describe drug use patterns, then identify three discrete groups determined by intensity of recent (past 6 months) sexual practice: no recent sex, recent sex and recent sexualised drug use. We examine factors associated with these groups and identify factors independently predicting sexualised drug use.
Results
Of 739 participants, almost a third had engaged in group sex (29%), 17.5% were taking pre‐exposure prophylaxis (PrEP), 6.5% were HIV positive. Overall, 59.5% had recently used illicit drugs (16.9% methylenedioxymethamphetamine, 6% methamphetamine, 3.3% gamma‐hydroxybutyrate acid, 1.4% ketamine). Sexualised drug use was common (35.7%). Those engaged in sexualised drug use were connected to gay community and had a high uptake of biomedical HIV prevention. Independent predictors of sexualised drug use included being sexually adventurous, knowing their HIV status, having more than 10 recent sexual partners, engaging in group sex and sex at a sex‐on‐site venue.
Discussion and Conclusions
Many GBM engaging in sexualised drug use manage HIV transmission risks through regular testing, PrEP and HIV treatment. HIV prevention efforts should target GBM with less intensive sexual behaviour but who may be at comparatively higher risk of HIV transmission.
... Other research showed that polydrug use did not positively predict sexual compulsivity and the opposite relationship was not significant among gay and bisexual men, although here drug use was not measured specifically in a sexual context (Parsons et al., 2012). Moreover, some studies showed that MSM who engaged in sexualized drug use had closer ties to their sexual minority group (Graf et al., 2018;Pollard et al., 2018;Rosińska et al., 2018). In our study, however, chemsex did not correlate with social support. ...
Compulsive Sexual Behavior Disorder (CSBD), recently recognized in the ICD-11 as an independent disorder, has been shown to be more prevalent in sexual minorities. However, we still lack studies investigating which factors contribute to CSBD and related behaviors in this group. In our cross-sectional study, we investigated the relationships between characteristics potentially contributing to CSBD and problematic pornography use (PPU) in sexual minority individuals: sexual minority stress (internalized sexual stigma, discrimination experiences, and openness about one's sexual orientation), perceived social support, and sexualized drug use (also more prevalent in sexual minorities). We adjusted for gender, age, sexual orientation, and the frequency of sexual behaviors. Cisgender sexual minority participants (n = 198, 72.7% men, 27.3% women; Mage = 27.13, SD = 7.78) completed an online survey. We conducted a two-step linear regression. In the first step, we introduced sociodemographic variables and the frequency of sexual activities. In the second step, we placed the predictors of main interest: perceived social support, minority stress measures, and the frequency of sexualized drug use. Our results showed that social support was negatively related to CSBD, while experiences of discrimination due to sexual orientation and engagement in sexualized drug use were associated with higher CSBD symptom severity. Internalized sexual stigma related to greater PPU severity. The discussed relationships were weak to moderate in strength. Implications of current results for therapy and diagnosis of CSBD in sexual minorities are discussed. The role of minority stressors and other factors specific to sexual minorities requires further exploration to design well-suited therapeutic interventions.
... In the United States (U.S.), this type of linked sex-drug behavior is known as Party and Play (PnP), and involves the substance methamphetamine (commonly called crystal meth or Tina). In Europe, it also involves other "designer drugs," such as synthetic cathinones: 3methylmethcathinone (3-MMC), mephedrone (4-MMC), and 4-methylethcathinone (4-MEC); gammahydroxybutyrate (GHB) and ketamine (K), with an important proportion of polydrug use (Batisse et al., 2022;Evers et al., 2020;Rosiń ska et al., 2018;Whitlock et al., 2021). ...
Chemsex, a phenomenon involving the use of psychoactive substances in sexual contexts to facilitate or enhance sexual experiences, is substantially increasing among men who have sex with men (MSM), and has been described as a significant risk factor for mental and physical illness. However, no specialized treatment approach has yet been established. Acceptance and commitment therapy (ACT) could potentially be an appropriate psychotherapeutic framework, especially considering the MSM and sexual minority unique challenges and the role of psychological flexibility in this context. The present paper describes the assessment and ACT interventions, reports and discusses the results, of 10 adult MSM who self-referred to an outpatient psychiatry and addiction department in France for self-reported problematic chemsex that interfered with their quality of life. They completed symptom- and process-based measures at three different timepoints. Results were quantitatively analyzed, and the clinician’s session notes and patients’ experiences/accounts, recorded verbatim, served as a support for evaluating the global effects of ACT interventions. Results on outcome measures showed clinically notable and statistically significative improvements in psychological flexibility, anxiety and depression symptoms, as well as sexual addiction intensity between pre- and posttreatment, which were all persistent at 3- to 4-month follow-up. Process measure results indicated a high and consistent therapeutic alliance throughout therapy. This exploratory study, directly derived from clinical practice, suggests promising preliminary results. It can provide clinicians with a useful resource for using ACT as a potentially effective approach for problematic chemsex and comorbidities, and may guide future investigation to inform treatment development efforts, especially for MSM and sexual minority communities.
... For example, of 199 studies covered by a systematic review (Ploderl & Tremblay, 2015), 76% were conducted in the US or Canada, 15% in Europe, 6% in Australia and New Zealand, and only 2% in Asia, Mexico or elsewhere. For instance, studies focusing on mental health of sexual minorities in Central and Eastern Europe (CEE) are rare or focus on other more established topics, such as sexual health (Grabski et al., 2019) or STD's and mostly HIV-related research (Burke et al., 2015;Leluţiu-Weinberger et al., 2019;Rosińska et al., 2018). Studies in CEE have only recently began focusing on understanding psychological distress in sexual minorities. ...
Sexuality and gender identity measures are rarely included in population-level health studies, even though research shows that sexual minorities are among the groups most vulnerable to psychological distress. In this study, we strive to make the first step towards overcoming this gap in data availability in Czechia. We used data from a recent Czech General population sample (N = 1,841) aged from 15 to 92 with mean = 46,53 and SD = 17,68 years and a Czech sexual minority community sample (N = 1,788) aged from 15 to 71 with mean = 24.2 and SD = 10.1 years that included 642 gay or lesbian men (either cis or trans), 427 gay or lesbian women (either cis or trans), and 450 bisexual individuals (94 men and 356 women, both either cis or trans). We found that all LGB+ subgroups had significantly higher levels of psychological distress compared to general population as measured by Brief Symptom Inventory. This effect was more pronounced in bisexual participants than in gay and lesbian participants. This is the first Czech study focused on comparison of the differences in psychological distress between the general population and sexual minorities. Our study shows that overcoming the lack of inclusion of sexuality and gender identity measures in relevant population health surveys needs to be addressed soon.
... La prevalencia del chemsex aparece en la literatura con cifras muy variadas que oscilan entre el 3% hasta el 29% de los HSH (Druckler, van Rooijen y de Vries, 2018;Frankis, Flowers, McDaid y Bourne, 2018;Glynn et al., 2018;Hammoud et al., 2018;Hegazi et al., 2017;Pakianathan et al., 2018;Rosińska et al., 2018) y siendo las sustancias mayormente consumidas la metanfetamina, mefedrona y GHB/GBL en contextos anglosajones (Druckler et al., 2018;Frankis et al., 2018;Glynn et al., 2018;Hegazi et al., 2017;Melendez-Torres, Hickson, Reid, Weatherburn y Bonell, 2016;Pakianathan et al., 2018). ...
Chemsex is defined as use of psychoactive drugs with the aim of having sexual relations between gay men, bisexuals and men who have sex with men for a long period of time. To study this phenomenon, this qualitative descriptive study was proposed with the objective of describing the practice of chemsex from the perspective of users, to determine the main factors associated with its practice, the perception of the impact on their health and to establish prevention needs. Data were obtained using conversational techniques: 12 semi-structured interviews and 3 focus groups. The purposive sample was made up of GBMSM with a mean age of 40.1 years, 78% born in Spain, and 68% with completed university studies. The qualitative analysis focused on three thematic areas: factors associated with the practice of chemsex, the impact of chemsex on health, and prevention and risk reduction needs. It is concluded that the practice of chemsex should be understood as multifactorial and multicausal, associated with the sociocultural context. Sexual satisfaction, increased libido and the search for more intense pleasure are identified as key factors among people who practice it. These men are still scared of being judged, even by specialists who may lack knowledge or training. A reanalysis and rethinking of the interventions and policies directed towards this population is necessary, putting the focus of action on shared decision-making, self-care, cultural competence and the humanization of care.
... We identified eight exemplar studies (Ahmed et al., 2016;Glynn et al., 2018;Hegazi et al., 2017;Melendez-Torres et al., 2016;Ottaway et al., 2017;Rich et al., 2016;Rosinska et al., 2018) from a previous review (Maxwell et al., 2019), that met our eligibility criteria. Next, we designed database-specific search strategies that were sensitive enough to find these exemplar studies and similar research, yet specific enough to exclude irrelevant records. ...
Open Access-Publication. https://doi.org/10.1080/00918369.2023.2170757
Chemsex refers to the use of psychoactive substances with sex.
We carried out a systematic scoping review of methodological
characteristics of chemsex research among men who have sex
with men (MSM), published between 2010 and 2020. For inclu-
sion, chemsex had to be the main focus, and studies had to
specify GHB/GBL, stimulant (amphetamine, crystal meth,
ecstasy/MDMA, cathinones, cocaine) and/or ketamine use with
sex as a variable. From 7055 titles/abstracts, 108 studies were
included, mostly cross-sectional, and from Western countries.
About one-third of studies recruited exclusively from clinical set-
tings. A majority of these recruited from sexually transmitted
infection (STI) clinics. The included quantitative studies analyzed
possible associations between chemsex and STI health (40%),
mental health (15%), drug health (12%), sexological health
(10%), and post-diagnostic HIV health (7%). Most studies included
GHB/GBL and crystal meth in their operationalization of chemsex.
Definitions and operationalizations of chemsex vary greatly in the
literature, and researchers of chemsex among MSM should con-
sider ways in which this variation impacts the validity of their
results. More studies are needed among MSM in non-high income
and non-Western countries, and examination of possible links
between chemsex and post-diagnostic HIV health, sexological
health, and mental health.
... The results obtained in this research also indicate that the prevalence of using an intoxicating substance before or during sex varies significantly according to the specific substance used. The consumption of alcohol, marijuana, and ecstasy had significantly higher prevalences than those referring to the use of cocaine, heroin, methamphetamine, and GHB, perhaps due to differences in their acceptance, accessibility, cost, addictive potential, and short-and medium-term health and social consequences (Bourne et al., 2014;Graupensperger et al., 2021;Jackson et al., 2021;Rosińska et al., 2018). It is also likely that higher prevalence rates and the decision to use one or another substance depends on the particular effects it causes during sex. ...
Drug use before or during sex is a high-risk sexual behavior associated with adverse health risks and outcomes, such as increasing the likelihood of overdoses and of acquiring sexually-transmitted diseases. This systematic review and meta-analysis of three scientific databases examines the prevalence of the use of intoxicating substances, those tending to excite or stupefy the user on a psychoactive level, before or during sex, among young adults (18 to 29 years old). A total of 55 unique empirical studies met the inclusion criteria (48,145 individuals; 39% males), were assessed for risk of bias using the tools of Hoy et al. (2012), and were analyzed via a generalized linear mixed-effects model. The results produced a global mean prevalence of this sexual risk behavior of 36.98% (95% CI: 28.28%, 46.63%). Nonetheless, significant differences were identified between different intoxicating substances, with the use of alcohol (35.10%; 95% CI: 27.68%, 43.31%), marijuana (27.80%; 95% CI: 18.24%, 39.92%), and ecstasy (20.90%; 95% CI: 14.34%, 29.45%) significantly more prevalent than that of cocaine (4.32%; 95% CI: 3.64%, 5.11%), heroin (.67%; 95% CI: .09%, 4.65%), methamphetamine (7.10%; 95% CI: 4.57%, 10.88%), and GHB (6.55%; 95% CI: 4.21%, 10.05%). Moderator analyses showed that the prevalence of alcohol use before or during sex differed according to geographical sample origin, and increased as the proportion of ethnic whites in samples increased. The remaining demographic (e.g., gender, age, reference population), sexual (e.g., sexual orientation, sexual activity), health (e.g., drug consumption, STI/STD status), methodological (e.g., sampling technique), and measurement (e.g., timeframe) variables that were examined did not moderate prevalence estimates. Finally, implications for sexual development interventions were discussed.
... It is characterized by the use of a distinct set of drugs-typically, methamphetamine, mephedrone, gamma hydroxybutyrate (GHB), and gamma-butyrolactone (GBL) [1,2]-before or during sexual activities to facilitate, enhance, and prolong them [3,4]. Prevalence of recent chemsex among MSM varies across geographic and recruitment settings [5,6], ranging from 3% engagement in the past month in a study recruiting MSM from Scotland, Wales, Northern Ireland, and the Republic of Ireland [7], to 29% in the past 6 months among users of an MSM dating app in Amsterdam [8]. In recent years, chemsex among MSM has coincided with the emergence of digital geosocial technologies (e.g., hookup apps), creating new opportunities for finding chemsex partners [5,9,10]. ...
Background:
Chemsex is the use of illicit drugs-particularly methamphetamine, gamma hydroxybutyrate (GHB), and gamma-butyrolactone (GBL)-to enhance sexual activity. Chemsex, which occurs primarily among communities of men who have sex with men (MSM), is associated with greater HIV risk behaviors, including multiple sex partners, group sex, condomless sex, and injection drug use. Despite evidence showing chemsex engagement among Malaysian MSM, there is a paucity of research on chemsex among MSM in Malaysia.
Methods:
This cross-sectional study was conducted through an online survey (August to September 2021) among 870 Malaysian MSM. Participants were recruited through targeted advertisements on social networks. We collected information regarding participants' recent (<6 months) engagement in chemsex, demographic characteristics, psychosocial factors, pre-exposure prophylaxis (PrEP) knowledge and history, and recent sexual- and drug-related behavior. Multivariable logistic regression was used to identify factors associated with recent (<6 months) chemsex engagement.
Results:
Just under 1 in 10 (9.0%) of participants reported having engaged in chemsex in the previous six months. More than two-thirds of participants (69.1%) had not disclosed their sexual orientation to anyone in their family and 35.2% reported moderate to severe depressive symptoms. Multivariable analysis found that recent injection drug use (adjusted odds ratio: aOR = 6.61; 95% confidence interval: CI, 2.30-19.03), having shared pre-exposure prophylaxis (PrEP) with someone else (aOR = 5.60; 95% CI, 1.76-17.77), higher perceived HIV risk (aOR = 3.15; 95% CI, 1.25-7.93), knowing someone using PrEP (aOR = 2.93; 95% CI, 1.62-5.31), recent engagement in transactional sex (aOR = 2.38; 95% CI, 1.06-5.39), having a recent STI diagnosis (aOR = 2.36; 95% CI, 1.25-4.44), recent engagement in anal sex (aOR = 2.21; 95% CI, 1.07-4.57), and recent sexual intercourse with an HIV-positive partner (aOR = 2.09; 95% CI, 1.07-4.08) were associated with recent engagement in chemsex.
Conclusions:
Malaysian MSM who practice chemsex are vulnerable to several HIV risk factors, such as transactional sex, HIV-positive sexual partners, and injection drug use. There is an urgent need for programs that integrate drug, sexual health, and mental health services, with a focus on harm reduction (e.g., condoms, access to and utilization of HIV testing and PrEP services, drug knowledge, and safer drug use) tailored for MSM who practice chemsex.
... Obtaining robust data on prevalence in relation to MSM with a substance use disorder of the chemsex-type pattern is hardly possible at this stage. Current European and German studies [2,4,10,12] on this topic provide information on the extent and frequency of substance use in MSM sexual practice, but do not provide reliable insight into the extent of dependence requiring treatment. Moreover, the chosen "community-based" access routes (e.g., via AIDS support, relevant internet portals) to respondents probably only reach a section of the target group [1]. ...
... These drugs are used to boost, prolong, and intensify sexual experiences [5]. However, in sexual settings, these drugs are linked to the acquisition Viruses 2022, 14 and transmission of HIV and other sexually transmitted diseases (STDs) [8][9][10]. Meth is a highly addictive central nervous system (CNS) stimulant that induces structural and biochemical alterations to the brain [11]. ...
Despite the success of combinational antiretroviral therapy (cART), the high pervasiveness of human immunodeficiency virus-1 (HIV)-associated neurocognitive disorders (HAND) poses a significant challenge for society. Methamphetamine (meth) and related amphetamine compounds, which are potent psychostimulants, are among the most commonly used illicit drugs. Intriguingly, HIV-infected individuals who are meth users have a comparatively higher rate of neuropsychological impairment and exhibit a higher viral load in the brain than infected individuals who do not abuse meth. Effectively, all cell types secrete nano-sized lipid membrane vesicles, referred to as extracellular vesicles (EVs) that can function as intercellular communication to modulate the physiology and pathology of the cells. This study shows that meth treatments on chronically HIV-infected promonocytic U1 cells induce the release of EVs that promote cellular clustering and syncytia formation, a phenomenon that facilitates HIV pathogenesis. Our analysis also revealed that meth exposure increased intercellular adhesion molecule-1 (ICAM-1) and HIV-Nef protein expression in both large (10 K) and small (100 K) EVs. Further, when meth EVs are applied to uninfected naïve monocyte-derived macrophages (MDMs), we saw a significant increase in cell clustering and syncytia formation. Furthermore, treatment of MDMs with antibodies against ICAM-1 and its receptor, lymphocyte function-associated antigen 1 (LFA1), substantially blocked syncytia formation, and consequently reduced the number of multinucleated cells. In summary, our findings reveal that meth exacerbates HIV pathogenesis in the brain through release of proadhesive EVs, promoting syncytia formation and thereby aiding in the progression of HIV infection in uninfected cells.
... This relationship is postulated to be attributed to the acute effects of drug use that can enhance sexual desire and increase intoxicating highs, thus stimulating risk-taking sexual behaviors, such as UAI, MSP [43,44]. In addition to illegal drugs, some popular recreational drugs that but not defined as illegal, such as rush poppers and erectile dysfunction medications, have similarly been confirmed to play a role in increasing rates of sexual risk behavior and HIV infection [45][46][47][48]. Furthermore, several epidemiological studies have also shown a positive dose-response relationship between frequency and number of drugs used or polydrug use and HIV risk to support our findings [49][50][51]. ...
The impact of psychosocial factors on increasing the risk of HIV infection among men who have sex with men (MSM) has attracted increasing attention. We aimed to develop and validate an integrated prediction model, especially incorporating emerging psychosocial variables, for predicting the risk of HIV infection among MSM. We surveyed and collected sociodemographic, psychosocial, and behavioral information from 547 MSM in China. The participants were split into a training set and a testing set in a 3:1 theoretical ratio. The prediction model was constructed by introducing the important variables selected with the least absolute shrinkage and selection operator (LASSO) regression, applying multivariate logistic regression, and visually assessing the risk of HIV infection through the nomogram. Receiver operating characteristic curves (ROC), Kolmogorov–Smirnov test, calibration plots, Hosmer–Lemeshow test and population stability index (PSI) were performed to test validity and stability of the model. Four of the 15 selected variables—unprotected anal intercourse, multiple sexual partners, involuntary subordination and drug use before sex—were included in the prediction model. The results indicated that the comprehensive prediction model we developed had relatively good predictive performance and stability in identifying MSM at high-risk for HIV infection, thus providing targeted interventions for high-risk MSM.
... PSEs were conducted using SS-PSE. 14,21 The approach approximates the RDS sampling structure via the successive sampling model of Gile,22 which treats the sample as a without-replacement random walk through the population network. SS-PSE uses a Bayesian framework, where the population size N is unknown but specified by a prior distribution and, conditional on the observed data, the likelihood of N can be computed. ...
Background:
Although men who have sex with men (MSM) are considered at high risk for transmission of sexually transmitted infections, including HIV, there are few studies estimating the population size of MSM in Europe. We used network data from a survey of MSM in four cities to perform successive sampling-population size estimations (SS-PSE) to estimate MSM population sizes.
Methods:
Data were collected in 2013-14 in Bratislava, Bucharest, Verona and Vilnius using respondent-driven sampling (RDS). SS-PSE uses a Bayesian framework to approximate the RDS sampling structure via a successive sampling model and uses the selection order of the sample to provide information about the distribution of network sizes over the population members of MSM.
Results:
We estimate roughly 4600 MSM in Bratislava, 25 300 MSM in Bucharest, 7200 in Verona and 2900 in Vilnius. This represents 2.9% of the estimated adult male population in Bratislava, 2.3% in Bucharest, 2.7% in Verona and 1.5% in Vilnius. The number of MSM living with HIV would roughly be 200 in Bratislava, 4554 in Bucharest, 690 in Verona and 100 in Vilnius.
Conclusions:
Benefits of this method are that no additional information from an RDS survey needs to be collected, that the sizes can be calculated ex post facto a survey and that there is a software programme that can run the SS-PSE models. However, this method relies on having reliable priors. Although many countries are estimating the sizes of their vulnerable populations, European countries have yet to incorporate similar and novel methods.
Zusammenfassung: Zielsetzung: Chemsex bedeutet Substanzkonsum im sexuellen Kontext und ist mit Männern, die Sex mit Männern haben assoziiert. Typische Substanzen sind Methamphetamine, GHB/GBL, Ketamin und Mephedron. Chemsex ist mit psychischer Belastung assoziiert. Internalisierte Homonegativität gilt als Erklärungsansatz. Die Studie überprüft die Hypothese, ob Chemsex-Verhalten mit einem höheren Ausmaß an psychischer Belastung und internalisierter Homonegativität einhergeht und welche Rolle georeferenzierte Dating-Apps bei Chemsex-Konsumenten spielen. Methodik: Die Datenerhebung erfolgte als Onlineumfrage. Es wurden Daten zu Depressivität (PHQ-9), Somatisierung (PHQ-15) und generalisierter Angst (GAD 7) und internalisierter Homonegativität (Reaction to Homosexuality Scale) erhoben. Ergebnisse: N=280 berichteten von Chemsex (CS), N=534 konsumierten andere Substanzen im sexuellen Kontext, N= 170 konsumierten im sexuellen Kontext nicht (NSSK). Es zeigten sich signifikante Unterschiede zwischen CS und NSSK bei der Somatisierung. CS wies ein signifikant geringeres Ausmaß internalisierter Homonegativität auf. CS nutzten signifikant häufiger georeferenzierte Dating-Apps. Schlussfolgerung: Internalisierte Homonegativität war unter Chemsex-Konsumenten am geringsten ausgeprägt und scheint Chemsex-Verhalten nicht zu begünstigen. Die psychische Belastung war erhöht. Möglicherweise tragen soziale Normierungsprozesse, verstärkt durch die Verwendung von Dating-Apps, zur Erklärung von Chemsex bei.
Gay and bisexual men (GBM) engaging in chemsex can face various health and well-being-related challenges, the extent of which remains unknown given the limited research in the context of the COVID-19 pandemic. This paper examines the pandemic impacts on the health needs of GBM who engaged in chemsex and their experiences with related services. We applied interpretive description to produce knowledge with direct implications for improving practices and policies. Data were collected between July 2020 and January 2021 using in-depth semi-structured interviews with eight key informants who held chemsex expertise and 13 GBM with chemsex lived experiences. Interviews were transcribed, anonymized, and analyzed thematically, yielding three interrelated themes. First, participants argued that the COVID-19 public health response was heteronormative and moralizing, reinforcing feelings of shame among GBM who engaged in chemsex and further isolating them. This added a layer of stigma and exposed them to increased drug-related risks by obstructing harm reduction practices. Second, participants contended how the pandemic worsened the scarcity and shortcomings of chemsex-specialized services. The mandatory shift to online services made it harder to form meaningful therapeutic relationships, especially given the unique sensitivity and stigma associated with chemsex, further heightened during the pandemic. Third, this online shift simultaneously facilitated access to personalized and culturally sensitive care, especially for those with less urgent needs. Our findings’ implications emphasize the importance of adopting a comprehensive approach in chemsex care, integrating both in-person and online methods, to counteract health iniquities reinforced by the pandemic and the institutional responses to it.
Sexualized drug use (SDU) has been associated with various motivations (e.g. coping with emotional distress, enhancing sexual functioning) and factors related to sexo-relational well-being (e.g., sexual satisfaction, performance anxiety). However, there is a lack of comprehensive models exploring associations between motivations for SDU and sexo-relational correlates. This study examined motivations related to SDU and their associations with sexo-relational correlates (e.g., sexual satisfaction, compulsivity). A community sample of 1,196 adults from Quebec completed an online survey on sexual health, including a questionnaire on SDU and related motivations and validated questionnaires on sexual satisfaction, sexual performance anxiety, body shame, discomfort with sexual communication, sexual compulsivity, and a history of childhood sexual abuse (CSA). Exploratory factor analyses (EFA) were performed on the SDU motivations questionnaire, followed by path analysis to test for sexo-relational correlates motivation domains. The EFA revealed four SDU motivations: increasing satisfaction and sensations (Factor 1), increasing sexual self-esteem (Factor 2), mitigating distress (Factor 3), and increasing sexual responsiveness and functioning (Factor 4). Higher performance anxiety and sexual compulsivity were associated with higher scores on all four motivation factors. Greater body shame was positively linked to Factors 2 and 3 and negatively to Factor 4. Sexual satisfaction, discomfort with sexual communication, and CSA were, respectively, uniquely associated with Factors 1, 3, and 4. The results provide insight into the heterogeneity of motivations for SDU and into the relationship between these motivations and sexo-relational well-being.
Background
Men who have sex with men (MSM) are a significant population contributing to human immunodeficiency virus (HIV) transmission. Nevertheless, few studies have focused on the heterogeneity in MSM. The characteristics of men who have sex with men and women (MSMW) may differ from men who have sex with men only (MSMO).
Methods
From October 2022 to March 2023, a cross-sectional study for MSM was conducted in Eastern China. An electronic questionnaire was used to collect the demographic characteristics and sexual behaviors of participants. A multivariable logistic regression model was used to assess the differences in HIV-related risky sexual behaviors between MSMO and MSMW.
Results
A total of 1993 MSM were enrolled in the study, with 1221 MSMO and 772 MSMW. Compared to MSMW, MSMO reported younger age at first anal sex, higher coerced homosexual experiences, and observed different characteristics of sexual behavior in the past six months. Multivariable analysis indicated that MSMW were more likely to seek casual partners and use stimulants online and offline. MSMW showed inconsistent condom use with online partners (aOR = 0.51, 95 %CI: 0.38–0.68) and more frequent anal sex after drinking (aOR = 2.27, 95 %CI: 1.54–3.35). They also had higher risks of commercial (aOR = 2.47, 95 %CI: 1.71–3.57) and group sexual behaviors (aOR = 1.88, 95 %CI: 1.24–2.83) compared to MSMO.
Conclusion
Our findings suggest that the differential factors may lead MSMW to become a subgroup at high risk of HIV infection. The gender identity and sexual orientation within MSM should be considered when formulating acquired immune deficiency syndrome (AIDS) prevention and control strategies.
Continuando con la línea de trabajo que iniciamos en 2002 con el proyecto «Energy Control: Observatorio de consumos, riesgos y cuidados«, financiado a través de la convocatoria 0,7 de subvenciones para la realización de actividades de interés general consideradas de interés social, correspondiente a la Secretaría de Estado de Derechos Sociales (Convocatoria 2022), y en adelante OEC2023, hemos buscado investigar para mejorar la atención que, desde los programas de reducción de riesgos y daños, se ofrece a las personas que consumen sustancias psicoactivas de manera recreativa mediante la identificación y estudio de sus prácticas y hábitos de ocio y consumo, con el fin último de orientar el diseño de acciones adaptadas y eficaces de reducción de riesgos.
Para ello, y como en otras investigaciones anteriores, hemos empleado un diseño de investigación no experimental, aplicado, descriptivo y sustentado en un método mixto cuantitativo (mediante una encuesta virtual) y cualitativo (mediante entrevistas semi estructuradas y grupos de discusión). En esta edición, 3059 personas completaron la encuesta y 50 participaron en 30 entrevistas y 4 grupos de discusión en las ciudades de Barcelona, Madrid, Palma y Sevilla. Los temas abordados en el OEC2023 fueron los siguientes:
1) Perfiles y prevalencias de consumo.
2) Participación en espacios de fiesta relacionados con la música electrónica.
3) Riesgos percibidos y utilización de estrategias de reducción de riesgos.
4) Usos, placeres, riesgos percibidos y estrategias de reducción de riesgos en el consumo de metanfetamina, 2C-B, poppers y cloretilo.
5) Encuentros con la policía, con una especial atención a las conductas puestas en marcha ante un control policial con perros detectores de sustancias psicoactivas.
Contexte : Le chemsex désigne la consommation de substances psychoactives dans le contexte sexuel, pratique concernant majoritairement les hommes ayant des relations sexuelles avec des hommes. / Objectif : Identifier les motivations à pratiquer le chemsex, ainsi que les attentes vis-à-vis des dispositifs d’aide existants. / Méthode : Étude qualitative basée sur des entretiens semi-directifs, analysés selon l’approche thématique inductive. Huit participants recrutés dans un centre de santé sexuelle d’approche communautaire. / Résultats : L’initiation au chemsex se fait par les pairs-proches en réel ou par le biais d’applications de rencontres. Les motivations sont notamment liées à la performance sexuelle et à la place prépondérante de cette pratique au sein de la communauté gay. La demande de soins est suscitée par la prise de conscience des risques somatiques et psychiques. L’attente première est l’accompagnement par des professionnels ayant une connaissance du sujet et de la communauté gay.
Asunción (Paraguay) 21(M):216-235, 2024 ISSN 2218-0559 (CD R), E-ISSN2220-9026 Consumo de alcohol, drogas ilícitas y la conducta sexual en hombres que tienen sexo con hombres Use of alcohol and drugs in sexual intercourse in men that have sex with men. Resumen Introducción: El uso de sustancias lícitas e ilícitas en los hombres que tienen sexo con hombres, durante las relaciones sexuales, son frecuentes y pueden incrementar las conductas de riesgo para VIH/SIDA. Objetivo: El estudio analizó la relación entre consumo de alcohol, drogas ilícitas y conducta sexual en hombres que tienen sexo con hombres en Guanajuato. Método: Estudio descriptivo y correlacional, con muestreo dirigido, muestra de 80 participantes. Resultados: El 88% consumió alcohol en el último mes, el 74.6% marihuana y el 10.3% cocaína. El sexo oral fue el más desprotegido, con alto porcentaje de no uso de condón en parejas estables y trabajadores sexuales. El consumo de sustancias se relacionó con mayor frecuencia de encuentros sexuales y falta de protección con parejas estables. Conclusión: Predominó el consumo de marihuana, con policonsumo de drogas y frecuencia significativa de relaciones desprotegidas en relaciones estables. Estos hallazgos sugieren la necesidad de estrategias preventivas y educativas enfocadas en la reducción de riesgos en esta población.
Asunción (Paraguay) 21(M):216-235, 2024 ISSN 2218-0559 (CD R), E-ISSN2220-9026 Consumo de alcohol, drogas ilícitas y la conducta sexual en hombres que tienen sexo con hombres Use of alcohol and drugs in sexual intercourse in men that have sex with men. Resumen Introducción: El uso de sustancias lícitas e ilícitas en los hombres que tienen sexo con hombres, durante las relaciones sexuales, son frecuentes y pueden incrementar las conductas de riesgo para VIH/SIDA. Objetivo: El estudio analizó la relación entre consumo de alcohol, drogas ilícitas y conducta sexual en hombres que tienen sexo con hombres en Guanajuato. Método: Estudio descriptivo y correlacional, con muestreo dirigido, muestra de 80 participantes. Resultados: El 88% consumió alcohol en el último mes, el 74.6% marihuana y el 10.3% cocaína. El sexo oral fue el más desprotegido, con alto porcentaje de no uso de condón en parejas estables y trabajadores sexuales. El consumo de sustancias se relacionó con mayor frecuencia de encuentros sexuales y falta de protección con parejas estables. Conclusión: Predominó el consumo de marihuana, con policonsumo de drogas y frecuencia significativa de relaciones desprotegidas en relaciones estables. Estos hallazgos sugieren la necesidad de estrategias preventivas y educativas enfocadas en la reducción de riesgos en esta población.
In sub-Saharan Africa (SSA), MSM – a high HIV prevalence group – experience strong social stigma and pressure to have female partners. Accordingly, they could constitute a bridging group for HIV transmission to cisgender women. We developed a multilevel summary of MSM sexual behaviors and risk with women in various SSA regions. Following PRISMA guidelines, we conducted a mixed-method systematic review of data of sex with women in MSM in SSA. We performed meta-analyses on quantitative data (i.e. percent of recent sex and condomless sex with women) for each SSA region (when proportions reported in ≥4 studies). Pooled proportions were calculated using random-effects models. Qualitative data were analyzed using the three-step thematic synthesis methodology. The pooled proportion of MSM who had sex with women was 58% (33–83%) in East Africa (in the previous 3 months), and 27% (13–48%) in Southern Africa and 50% (95% CI 39–62%) in West Africa (in the previous 6 months); 23% (16–32%) of MSM in West Africa had condomless sex with a woman (during the most recent encounter). Approximately one quarter of MSM had recent multiple female partners. MSM reported having sex with women because of heteronormative pressure, erotic/romantic attraction, or financial needs leading to transactional sex. MSM may act as a bridging population to women in SSA, as they commonly practice sex with women and risky sexual behaviors with them. HIV programmes and community-based support for MSM should be adapted to this population to reduce this risk.
Objectives: We reviewed literature examining substance use among sexual and gender
minorities (SGM) living in the former Soviet Union (USSR) nations.
Methods: Searches were conducted across five databases (PubMed, SocINDEX, CINAHL, PscyInfo, LGBTQ Source) to identify peer-reviewed literature.
Results: Across 19 studies, high hazardous substance use prevalence was documented. Substance use was correlated with (a) sexual health and behaviors and (b) mental wellbeing and the use of other substances.
Conclusion: We discuss minority stress implications and challenges presented by the paucity of evidence in the literature examining substance use among SGM women and SGM living in countries unrepresented in reviewed studies.
Introduction
Investigating drug trends among Australian gay and bisexual men (GBM) is crucial for understanding levels of use and the potential for harm, including HIV transmission risk.
Method
Using repeated, national, cross‐sectional survey data collected between 2012 and 2021 (69,567 surveys), trends of recent (previous 6 months) and frequent (weekly) drug use were analysed, using logistic regression models. The last round of data from each jurisdiction (6709 surveys) was used to compare GBM who reported no use, infrequent (less than weekly) use and frequent (at least weekly) use of party drugs to investigate the association between party drug use and HIV transmission risk, using multinomial logistic regression models.
Results
There was a significant upward trend in any recent drug use (from 58.4% in 2012 to 64.1% in 2021; p < 0.001). Frequent party drug use remained a minority practice over the period (consistently less than 3%). In cross‐sectional analysis, frequent party drug users were more likely to report behaviours with HIV transmission risks, such as condomless anal intercourse without biomedical prevention strategies (30.0% vs. 13.1%; adjusted relative risk ratio [aRRR], 2.08; 95% CI, 1.24–3.47), weekly group sex (16.3% vs. 0.6%; aRRR, 12.36; 95% CI, 5.75–26.56) and more than 20 recent sexual partners (42.5% vs. 5.0%; aRRR, 21.44; 95% CI, 5.82–78.89), compared with GBM who did not use party drugs.
Discussion and Conclusion
Our findings suggest that the frequent use of party drugs remains a marker of HIV transmission risk among Australian GBM, despite the increased adoption of biomedical HIV prevention strategies over the past few years.
In this chapter, we explore the use of substances amongst sexual minorities and the interplay with their mental health for those for whom it becomes problematic. After considering the nomenclature and prevalence of such use, and possible influences within this, we discuss the importance of culturally sensitive practice and specific therapeutic and ethical considerations we must take within this work.
Mpox has become the most significant orthopoxviral infection among humans. Since May 2022, there has been a multicountry outbreak of mpox across six continents. Retrospective observational cohort study of 94 patients with probable or confirmed mpox of whom 86.2% were hospitalized in Hospital for Infectious Diseases in Warsaw, Poland between May 16 and October 30, 2022. Most patients were young (median age: 31, IQR: 25−43 years), predominantly (88.3%) Polish men who have sex with men exposed most commonly in Poland (82.7%), Spain (6.2%), or Germany (4.9%). The median observed mpox incubation period was 7 (IQR: 4−8) days with the median hospitalization time of 7 (range: 2−24, IQR: 5−11) days. History of sexually transmitted infections (STIs) was common in the group (previous syphilis or hepatitis C virus in 33.3% and 17.3%, respectively, 6.2% of early syphilis or gonorrhea). A significant proportion ( n = 43, 45.7%) of mpox cases were people with human immunodeficiency virus (HIV), all except one were on stable and virologically effective (88.4% with HIV viral load <50 copies/mL) antiretroviral treatment. Chemsex was reported in 34.6% of hospitalized cases, more commonly among people with HIV (48.5% vs. 25.0%, p = 0.029). None of the mpox infected patients presented with advanced HIV infection. Despite the fact that 6.3% of cases presented with >50 skin lesions the course of the disease was self‐limited with no severe cases or deaths. There were no significant clinical or laboratory differences or complication rates between patients with and without HIV coinfection. Epidemiological and clinical characteristics of mpox in Poland are similar to other countries, but there were no targeted, population oriented interventions or vaccination programs. Mpox diagnosis provided an opportunity to screen and diagnose other STIs. As Central European populations, including refugees from Ukraine, are largely unvaccinated against mpox access to preventive vaccinations and antiviral therapy should be maximized.
Background:
Chemsex is a heterogeneous phenomenon with differences in distribution, setting, motivations and type of substances consumed between countries. The lack of data at national level of the Italian situation creates a perception of reduced need for intervention.
Methods:
Anonymous paper questionnaires were distributed to patients who had registered themselves at the STI Department IRCCS Ca' Granda Policlinico in Milan.
Results:
A significant association was demonstrated between use of sexualised drugs, chemsex and the following variables: (1). Number of partners: in the group of clients with more than five partners, sexualised drug users were more than twice compared with those in the group with less than five partners (35.2% vs 16.2%) p<0.0001. (2). Use of dating apps: more than one out of two persons who used drugs during sex affirmed looking for partners on internet, p = 0.0059. (3). Low condom uses with occasional partners: percentage of individuals who declared not to use condoms or devices during their sexual encounters with occasional partners is more than twice as high in the sexualised drug users group with respect to controls (44.6% vs 21.4%); p = 0.0006). (4). Use of post exposure prophylaxis (PEP): among the PEP users, more than half participants belonged to the sexualised drug users' group; p = 0.0021.
Conclusions:
Sexualised drug use and chemsex are frequently practiced in Milan. This survey identified a specific population with higher-risk sexual behaviours and increased incidence of acute bacterial STIs.
Background:
Mobile voluntary counseling and testing (VCT) for HIV has been carried out to improve the targeting of at-risk populations and HIV case detection for men who have sex with men (MSM). However, the HIV-positive detection rate using this screening strategy has declined in recent years. This may imply unknown changes in risk-taking and protective features jointly influencing the testing results. These changing patterns in this key population remain unexplored.
Objective:
The aim of this study was to identify the nuanced group classification of MSM who underwent mobile VCT using latent class analysis (LCA), and to compare the difference in characteristics and testing results between subgroups.
Methods:
A cross-sectional research design and purposive sampling were applied between May 21, 2019, and December 31, 2019. Participants were recruited by a well-trained research assistant through social networking platforms, including the most popular instant messenger app Line, geosocial network apps dedicated to MSM, and online communities. Mobile VCT was provided to participants at an assigned time and place. Demographic characteristics and risk-taking and protective features of the MSM were collected via online questionnaires. LCA was used to identify discrete subgroups based on four risk-taking indicators-multiple sexual partners (MSP), unprotected anal intercourse (UAI), recreational drug use within the past 3 months, and history of sexually transmitted diseases-and three protective indicators-experience of postexposure prophylaxis, preexposure prophylaxis use, and regular HIV testing.
Results:
Overall, 1018 participants (mean age 30.17, SD 7.29 years) were included. A three-class model provided the best fit. Classes 1, 2, and 3 corresponded to the highest risk (n=175, 17.19%), highest protection (n=121, 11.89%), and low risk and low protection (n=722, 70.92%), respectively. Compared to those of class 3, class 1 participants were more likely to have MSP and UAI within the past 3 months, to be ≥40 years of age (odds ratio [OR] 2.197, 95% CI 1.357-3.558; P=.001), to have HIV-positive results (OR 6.47, 95% CI 2.272-18.482; P<.001), and a CD4 count ≤349/μL (OR 17.50, 95% CI 1.223-250.357; P=.04). Class 2 participants were more likely to adopt biomedical preventions and have marital experience (OR 2.55, 95% CI 1.033-6.277; P=.04).
Conclusions:
LCA helped derive a classification of risk-taking and protection subgroups among MSM who underwent mobile VCT. These results may inform policies for simplifying the prescreening assessment and more precisely recognizing those who have higher probabilities of risk-taking features but remain undiagnosed targets, including MSM engaging in MSP and UAI within the past 3 months and those ≥40 years old. These results could be applied to tailor HIV prevention and testing programs.
Background
Little is known about transactional sex (TS) (selling and buying sex) among men who have sex with men (MSM) in Sweden, especially among foreign-born MSM. This study aims to assess the prevalence and risk factors of TS (ever and in the previous five years) among MSM living in Sweden and to determine if there is a difference between Swedish-born MSM and foreign-born MSM.
Methods
Swedish data from a multicountry online banner survey (EMIS-2017) was used ( n = 4443). Multivariable regression analysis was applied to analyse the data.
Results
The prevalence of ever-selling sex among all MSM participants was 13.2% and 5.9% in the previous five years. Selling sex ever and in the previous five years was higher among foreign-born MSM (16% and 8.4%, respectively) than Swedish-born MSM (12.7% and 5.4%, respectively). Among all participants, younger age (aOR:3.19, 95% CI:1.57–6.45) and really struggling to live on current income (aOR:3.37, 95% CI:2.29–4.96) increased the odds of selling sex. Being foreign-born MSM (aOR:1.33, 95% CI:1.02–1.73) and having had sex with a woman in the previous 12 months increased the odds of selling sex (aOR:1.44, 95% CI:1.00–2.07).
The prevalence of ever buying sex among MSM participants in Sweden was 10.8% and 6.7% in the previous five years, with the same trend among foreign-born MSM (11.6% and 6.9%, respectively) and Swedish-born MSM (10.7% and 6.6%, respectively). Higher education and not having a current partner increased the odds of buying sex. Younger age was protective for buying sex (aOR:0.05, 95% CI:0.02–0.14). Among the foreign-born MSM, the length of stay in Sweden decreased the odds of buying sex (aOR: 0.98, 95% CI: 0.96–0.99).
Conclusions
The comparatively high prevalence of TS among MSM participants in Sweden, where buying sex is illegal, with a higher prevalence among foreign-born MSM participants, calls for sexual and reproductive health and rights interventions in this population. Increased attention, including HIV prevention programming and education, should be aimed at younger MSM, MSM struggling with their current income, and foreign-born MSM, as they are more likely to report selling sex.
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
IntroductionPre-exposure prophylaxis (PrEP) is effective for HIV prevention, but the PrEP care continuum also involves improving PrEP awareness, uptake, adherence, and retention in care. Users’ awareness is often compromised because of vulnerability factors and risk behaviors, such as chemsex practice or specific substance use, which could lead to risk compensation. Correct adherence and retention in care are essential to achieve the full effectiveness of PrEP. This study describes changes in users’ risk behaviors and sexually transmitted infections (STIs), as well also PrEP care continuum details.Methods
This was a descriptive single-center retrospective study including adults at high HIV risk screened between November 2019 and June 2021 in the PrEP program of our hospital. Demographic, behavioral, STI, adherence, and retention in care variables were assessed. Data were collected from medical records and self-report questionnaires.ResultsA total of 295 people were included, 94% men and 5% transgender women, with a mean age of 34 years (SD 10) and 10% sex workers. At baseline, 55% disclosed chemsex practice and 3% slamming. During follow-up, condom use for anal intercourse decreased from 41% to 13% (p ≤ 0.0001) and one HIV infection was detected; other risk behaviors and STIs remained stable. Chemsex, group sex, fluid exchange, and condomless anal intercourse were related to STI risk. Adherence was correct in 80% of users, and retention in care was 57%. Discontinuations and loss to follow-up were high, mainly affecting transgender women, sex workers, and people practicing fisting.Conclusion
PrEP program implementation in our hospital was adequate, since it allowed, in a population at high HIV risk, overall users’ risk behaviors and STIs to remain stable, with only one HIV diagnosis during the follow-up. We should target specific strategies to improve adherence and retention in care, as vulnerable subgroups at higher risk of loss to follow-up are identified.
Background
Sexual uses of alcohol and drugs are pervasive among men who have sex with men (MSM) and associated with increased risk of HIV infection. However, there are limited studies related to sexual uses of alcohol and drugs among MSM in China. This study aims to describe the pattern of alcohol use, drug use, and multi-drug use during sex among Chinese MSM and to examine the association between condomless anal intercourse, group sex, commercial sex and HIV infection.
Methods
We conducted an online cross-sectional survey in China. Characteristics on social-demographic, sexual behaviors, and sexual uses of alcohol and drugs were collected. The associations with high-risk sexual behaviors and HIV infection were analyzed with multivariable logistic regression.
Results
A total of 699 MSM were included in this study. About 39.5% (230/582) of men reported sexual alcohol use in the past three months and 50.8% (355/699) reported sexual drug use. Of those reporting sexual drug use, around 10.7% (38/355) reported having multi-drug use. Factors associated with both sexual uses of alcohol and drugs included: reporting more male sexual partners (alcohol: adjusted odds ratio [aOR] = 1.77; drug: aOR = 2.12), reporting condomless anal intercourse in the past three months (alcohol: aOR = 2.08; drug: aOR = 2.08), having ever engaged in group sex (alcohol: aOR = 2.04; drug: aOR = 5.22; multi-drug: aOR = 3.52) and commercial sex (alcohol: aOR = 4.43; drug: aOR = 4.22 multi-drug: aOR = 5.07). Sexual drug use was also correlated with reported HIV-positive status (drug: aOR = 2.53, 95% CI:1.31–4.90).
Conclusion
Sexual uses of alcohol and drugs are prevalent among Chinese MSM. Interventions to reduce the sexual use of alcohol and other drugs may be warranted among MSM in China.
Objectives:
Chemsex is a phenomenon highly relevant to public health concerns. Our primary aim is to describe the Czech chemsex scene regarding substances used, sexual behaviour, mental health, sexual life satisfaction, internalization of homonegative attitudes, and prevalent chemsex patterns.
Methods:
The data from the European Men Who Have Sex With Men Internet Survey (EMIS) 2017 were used. The mental health of chemsex users was assessed by the Patient Health Questionnaire 4 (PHQ4), internalized homonegativity was measured using the Short Internalized Homonegativity Scale. A sample of 87 men who have sex with men (MSM) chemsex users and a comparison group of 261 MSM were selected from the total sample of 1,688 respondents. Mann-Whitney and χ2 tests were used to compare groups.
Results:
Active chemsex users made up 5% of the sample (87 of 1,688), with an average age of 37 years. Chemsex users were more likely to engage in condomless sex with non-steady partners (χ2 = 46.8, p < 0.001), and had dramatically more STIs, such as HIV (χ2 = 52.9, p < 0.001), HCV (χ2 = 25.9, p < 0.001), and syphilis (χ2 = 41.5, p < 0.001). Chemsex users frequently injected drugs (n = 19, 20%). More than half (n = 48; 55%) of chemsex users had sober sex in the last 4 weeks. Chemsex culture was associated with riskier substance use, both in terms of mode and frequency. The mental health of chemsex users in our sample did not differ significantly from the comparison group (χ2 = 0.2, p < 0.7). Chemsex users did not conceal their sexual identity more often than the comparison group, on the contrary, 69% (n = 59) of them were out to most significant others, compared to 53% (n = 134) in the comparison group (χ2 = 8.8, p < 0.05). In addition, we did not find differences in the degree of internalized homonegativity (χ2 = 0.9, p < 0.4). Chemsex users were clearly and significantly more satisfied with their sex life than the comparison group (Mann-Whitney U test, p < 0.001).
Conclusions:
In our sample, chemsex use was not associated with a negative impact on health or wellbeing. Our results suggest that chemsex is not a homogeneous phenomenon. Many different patterns and subcultures exist, some of them are riskier, some safer than others.
This paper aimed to review the literature regarding the impact of discrimination on substance use disorders among Sexual Minorities (SM), with a focus on alcohol, opioids, stimulants, polydrug use, chemsex, cannabis and tobacco, as well as inequalities in the access to health care services. It is alarmingly clear that SM report higher rates of morbidity if compared to the general population. Health care delivery inequalities have also been reported in this special population.
Also, the lack of data from low- and middle-income countries on substance use among SM is a major concern. Certainly, discrimination play a key-role among leading factors to substance abuse, continued use, disorders, and lower levels of preventive and treatment interventions. However, it may be difficult to estimate the impact of discrimination because of the lack of research data and different methodologies of literature studies. Moreover, SM are differently categorized and defined and evidences may be not comparable between studies. There is an urgent need of strategic guidelines and research investments aimed at prioritizing these populations disproportionately impacted by substance use. Equity-oriented policies and programs can facilitate opportunities and decrease substance use in these vulnerable subgroups, including community- and peer-led initiatives and nonjudgmental and inclusive health services.
Chemsex, a specific form of sexualized drug use (SDU), has rapidly increased in the last decade. This phenomenon could result in a complex public health issue because of the heterogeneity amongst socio-psychological profiles of the practitioners, leading to the difficulty to target specific populations. Healthcare professionals need to be aware of this practice and its related risks to provide care adapted to the individual who consults. Here, we suggest that better knowledge of this field can help to improve prevention measures and provide information with a non-judgmental and respectful approach to those who practice chemsex.
Bolmont M, Tshikung ON, Trellu LT. Chemsex, a Contemporary Challenge for Public Health. J Sex Med 2022;XX:XXX–XXX.
Objectives: The study aims to investigate rates of sexualized drug use (SDU) and chemsex, a type of SDU involving specifically the use of crystal methamphetamine, mephedrone, or GHB/GBL and their association with the rates of negative sexual health outcomes among men who have sex with men (MSM) in Greece. Methods: Survey of 485 MSM in internal disease departments and community testing centers. Results: Twenty-eight percent of participants were involved in SDU and 20.4% in chemsex. HIV positive status and recent STI diagnoses were associated with SDU involvement. Conclusion: SDU and chemsex rates and their impact on health reveal the need for informed community-based services.
Young men who have sex with men (YMSM) have high rates of recreational drug use and binge drinking that are related to increases in unprotected sex and HIV risk. We describe the development of a community-level intervention focused on MSM ages 15 to 29 who identify as Black or White and who reported episodic use of alcohol and/or drugs. Intervention content included culturally-relevant role model stories and peer outreach. Outcome measures, including number of partners and a risk score indicating risk for HIV from protected or unprotected insertive or receptive anal sex, were examined over 36 months in a sample of YMSM in Philadelphia, the intervention site, and Baltimore, the comparison site. Decreases in risk scores over time were significantly larger in the intervention sample than in the comparison sample. Effects were greater for YMSM who engaged in binge drinking and/or marijuana use, compared to those who used other drugs.
Background
Men who have sex with men (MSM) constitute a risk group for sexual transmitted infections (STIs), including HIV. Despite counselling interventions, risk behaviour remains high. Syndemic theory holds that psychosocial problems often co-occur, interact and mutually reinforce each other, thereby increasing high risk behaviours and co-occurring diseases. Therefore, if co-occurring psychosocial problems were assessed and treated simultaneously, this might decrease high risk behaviour and disease.
Method
An open label randomized controlled trial will be conducted among 150 MSM with high risk behaviour recruited from the STI clinic of Amsterdam. Inclusion criteria are: HIV negative MSM with two STI and/or PEP treatment in the last 24 months, or HIV positive MSM with one STI in the last 24 months. All participants get questionnaires on the following syndemic domains: ADHD, depression, anxiety disorder, alexithymia and sex- and drug addiction. Participants in the control group receive standard care: STI screenings every three months and motivational interviewing based counselling. Participants in the experimental group receive standard care plus feedback based on the results of the questionnaires. All participants can be referred to co-located mental health or addiction services.
The primary outcome is help seeking behaviour for mental health problems and/or drug use problems. The secondary outcomes are STI incidence and changes in sexual risk behaviour (i.e. condom use, number of anal sex partners, drug use during sex).
Discussion
This study will provide information on syndemic domains among MSM who show high risk behaviour and on the effect of screening and referral on help seeking behaviour and health (behaviour) outcomes.
Trial registration
Trial Registration at clinicaltrail.gov, identifier NCT02859935.
The syndemics model of health focuses on the biosocial complex, which consists of interacting, co-present, or sequential diseases and the social and environmental factors that promote and enhance the negative effects of disease interaction. This emergent approach to health conception and clinical practice reconfigures conventional historical understanding of diseases as distinct entities in nature, separate from other diseases and independent of the social contexts in which they are found. Rather, all of these factors tend to interact synergistically in various and consequential ways, having a substantial impact on the health of individuals and whole populations. Specifically, a syndemics approach examines why certain diseases cluster (ie, multiple diseases affecting individuals and groups); the pathways through which they interact biologically in individuals and within populations, and thereby multiply their overall disease burden, and the ways in which social environments, especially conditions of social inequality and injustice, contribute to disease clustering and interaction as well as to vulnerability. In this Series, the contributions of the syndemics approach for understanding both interacting chronic diseases in social context, and the implications of a syndemics orientation to the issue of health rights, are examined.
Gay and bisexual men (GBM) report higher rates of methamphetamine use compared to heterosexual men, and thus have a heightened risk of developing problems from their use. We examined treatment outcomes among GBM clients receiving outpatient counseling at a lesbian, gay, bisexual, transgender and intersex (LGBTI)-specific, harm reduction treatment service in Sydney, Australia. GBM receiving treatment for methamphetamine use from ACON’s Substance Support Service between 2012–15 (n = 101) were interviewed at treatment commencement, and after 4 sessions (n = 60; follow-up 1) and 8 sessions (n = 32; follow-up 2). At each interview, clients completed measures of methamphetamine use and dependence, other substance use, injecting risk practices, psychological distress and quality of life. The median age of participants was 41 years and 56.4% identified as HIV-positive. Participants attended a median of 5 sessions and attended treatment for a median of 112 days. There was a significant reduction in the median days of methamphetamine use in the previous 4 weeks between baseline (4 days), follow-up 1 (2 days) and follow-up 2 (2 days; p = .001). There was a significant reduction in the proportion of participants reporting methamphetamine dependence between baseline (92.1%), follow-up 1 (78.3%) and follow-up 2 (71.9%, p < .001). There were also significant reductions in psychological distress (p < .001), and significant improvements in quality of life (p < .001). Clients showed reductions in methamphetamine use and improved psychosocial functioning over time, demonstrating the potential effectiveness of a LGBTI-specific treatment service.
Objectives:
Sexually transmitted infections (STIs) are significant public health and financial burdens in the United States. This manuscript examines the relationship between substance use and prevalent and incident STIs in HIV-negative adult patients at STI clinics.
Methods:
A secondary analysis of Project AWARE was performed based on 5012 patients from 9 STI clinics. STIs were assessed by laboratory assay and substance use by self-report. Patterns of substance use were assessed using latent class analysis. The relationship of latent class to STI rates was investigated using Poisson regression by population groups at high risk for STIs defined by participant's and partner's gender.
Results:
Drug use patterns differed by risk group and substance use was related to STI rates with the relationships varying by risk behavior group. Substance use treatment participation was associated with increased STI rates.
Conclusions:
Substance use focused interventions may be useful in STI clinics to reduce morbidity associated with substance use. Conversely, gender-specific sexual health interventions may be useful in substance use treatment.
While the prevalence of sexual identities and behaviors of men who have sex with men (MSM) varies across countries, no study has examined country-level structural stigma toward sexual minorities as a correlate of this variation. Drawing on emerging support for the context-dependent nature of MSM’s open sexual self-identification cross-nationally, we examined country-level structural stigma as a key correlate of the geographic variation in MSM’s sexual attraction, behavior, and identity, and concordance across these factors. Data come from the European MSM Internet Survey, a multi-national dataset containing a multi-component assessment of sexual orientation administered across 38 European countries (N = 174,209). Country-level stigma was assessed using a combination of national laws and policies affecting sexual minorities and a measure of attitudes toward sexual minorities held by the citizens of each country. Results demonstrate that in more stigmatizing countries, MSM were significantly more likely to report bisexual/heterosexual attractions, behaviors, and identities, and significantly less likely to report concordance across these factors, than in less stigmatizing countries. Settlement size moderated associations between country-level structural stigma and odds of bisexual/heterosexual attraction and behavior, such that MSM living in sparsely populated locales within high-structural stigma countries were the most likely to report bisexual or heterosexual behaviors and attractions. While previous research has demonstrated associations between structural stigma and adverse physical and mental health outcomes among sexual minorities, this study was the first to show that structural stigma was also a key correlate not only of sexual orientation identification, but also of MSM’s sexual behavior and even attraction. Findings have implications for understanding the ontology of MSM’s sexuality and suggest that a comprehensive picture of MSM’s sexuality will come from attending to the local contexts surrounding this important segment of the global population.
Background:
To date, research on men who have sex with men (MSM) has largely focused on their sexual health needs and on men recruited from gay-orientated venues. National probability survey data provide a rare opportunity to examine the broader sociodemographic, behavioural, and health profiles of MSM, defined as men who reported ≥1 male sexual partner(s) in the past 5 years, and thus regardless of their sexual identity, in comparison to men reporting sex exclusively with women (MSEW) during this time, and also the extent that health inequalities cluster.
Methods:
Britain's third National Survey of Sexual Attitudes and Lifestyles (Natsal-3), a probability sample survey, interviewed 15,162 people aged 16-74 years (6,293 men) during 2010-2012 using computer-assisted personal-interviewing with a computer-assisted self-interview. We used multivariable regression to compare MSM relative to MSEW in their reporting of variables, individually and collectively, corresponding to three domains: physical, mental, and sexual health.
Results:
Among all men, 2.6 % (n = 190) were defined as MSM, of whom 52.5 % (95 % CI: 43.6 %-61.2 %) identified as gay. MSM were as likely as MSEW (n = 5,069) to perceive their health was 'bad'/'very bad', despite MSM being more likely to report a long-standing illness/disability/infirmity (adjusted odds ratio, AOR: 1.46, 95 % CI:1.02-2.09), treatment for depression/past year (2.75, 1.69-4.47), and substance use (e.g., recreational drug use/past year: 3.46, 2.22-5.40). MSM were more likely to report harmful sexual health behaviours, e.g., condomless sex with ≥2 partners/past year (3.52, 2.13-5.83), and poor sexual health outcomes, including STI diagnosis/es (5.67, 2.67-12.04), poorer sexual function (2.28, 1.57-3.33), both past year, and ever-experience of attempted non-volitional sex (6.51, 4.22-10.06). MSM were also more likely than MSEW to report poor health behaviours and outcomes both within and across the three health domains considered. Of all MSM, 8.4 % had experienced poor health outcomes in all three domains - physical, mental, and sexual health - in contrast to 1.5 % of all MSEW.
Conclusions:
MSM are disproportionately affected by a broad range of harmful health behaviours and poor health outcomes. Although often observed for a minority of MSM, many health inequalities were seen in combination such that policies and practices aimed at improving the health and well-being of MSM require a holistic approach, regardless of clinical specialty.
Background
Public health HIV-service providers, including Medical Case Managers (case managers) and Disease Intervention Specialists (DIS) have a key role to play in identifying and addressing clients' complex mental health needs and substance use which contribute to sexual risk behaviors, yet their understanding and its consensus with HIV-infected men who have sex with men (MSM) have not been well characterized.
Methods
Together with an AIDS Service Organization and the Connecticut State Department of Public Health in 2011–2012, we conducted a focus group of case managers (n = 14) and interviewed DIS (n = 7) and HIV-infected MSM (n = 17) in Connecticut. We used the constant comparison method, grounded theory, and a community-based participatory approach to guide analysis.
Results
We identified three themes characterizing public health HIV-service providers' and MSM's perspectives regarding factors contributing to substance use and sexual risk behaviors in the context of HIV infection: 1) While both MSM and providers described a co-occurrence of HIV, stigma, substance use, and sexual risk behaviors, only MSM identified a causal relationship between these factors; 2) MSM and providers both described varying levels of self-efficacy in readiness to decrease substance use and sexual risk behaviors among MSM; both identified the social network as the key barrier to overcome; 3) Providers described how the co-occurrence of HIV, stigma and sexual risk behaviors leads to multi-faceted client needs for which they lacked sufficient training and collaboration.
Conclusions
Provider education, skills-based training, and interventions targeting social networks may decrease sexual risk behaviors among HIV-infected MSM.
In order to efficiently direct efforts and resources required for the prevention of HIV and other sexually transmitted infection among men who have sex with men (MSM) in Israel, it is necessary to define their particular behaviors, estimate their size, and asses the HIV-burden. This cross-sectional study included a sub-sample from a random representative National study performed in Israel, which included Jewish males aged 18-44 who completed online anonymous questionnaires regarding their sexual attraction and practices, commercial sex-work, as well as condom and substances' use. Additionally, participants were asked to identify themselves as gay, bisexual, or heterosexual. National estimates regarding prevalence of risk-behaviors and HIV-infection among MSM were based on the Statistical Abstract of Israel and the National HIV Registry, respectively. Of the total sample of 997 men, 11.9% reported lifetime male sex encounters, while 4.5% and 3.7% self-identified as gay or bisexual, respectively. The estimated population of self-identified Jewish gays/bisexuals aged 18-44 in Israel was 94,176, and in Tel-Aviv 33,839. HIV prevalence among MSM was estimated at 0.7% in Israel and 1.0% in Tel-Aviv. MSM were more likely to live in Tel-Aviv, had higher levels of education, and were scored higher on several determinants of sexual risk in comparison to those attracted to women, including early sexual debut, greater number of sexual partners, ever paid/been paid for sex, sexually coerced, and substance use. In conclusion, MSM were involved in greater risk behaviors than those who only had female sex partners. Most MSM were living in Tel-Aviv and their estimated HIV prevalence was 1.0%.
Background
Globally, the HIV epidemic continues to represent a pressing public health issue in Europe and elsewhere. There is an emerging and progressively urgent need to harmonise HIV and STI behavioural surveillance among MSM across European countries through the adoption of common indicators, as well as the development of trend analysis in order to monitor the HIV-STI epidemic over time. The Sialon II project protocols have been elaborated for the purpose of implementing a large-scale bio-behavioural survey among MSM in Europe in line with a Second Generation Surveillance System (SGSS) approach.
Methods/Design
Sialon II is a multi-centre biological and behavioural cross-sectional survey carried out across 13 European countries (Belgium, Bulgaria, Germany, Italy, Lithuania, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, and the UK) in community settings. A total of 4,966 MSM were enrolled in the study (3,661 participants in the TLS survey, 1,305 participants in the RDS survey). Three distinct components are foreseen in the study protocols: first, a preliminary formative research in each participating country. Second, collection of primary data using two sampling methods designed specifically for ‘hard-to-reach’ populations, namely Time Location Sampling (TLS) and Respondent Driven Sampling (RDS). Third, implementation of a targeted HIV/STI prevention campaign in the broader context of the data collection.
Discussion
Through the implementation of combined and targeted prevention complemented by meaningful surveillance among MSM, Sialon II represents a unique opportunity to pilot a bio-behavioural survey in community settings in line with the SGSS approach in a large number of EU countries. Data generated through this survey will not only provide a valuable snapshot of the HIV epidemic in MSM but will also offer an important trend analysis of the epidemiology of HIV and other STIs over time across Europe. Therefore, the Sialon II protocol and findings are likely to contribute significantly to increasing the comparability of data in EU countries through the use of common indicators and in contributing to the development of effective public health strategies and policies in areas of high need.
Substantial country-level variation exists in prejudiced attitudes towards male homosexuality and in the extent to which countries promote the unequal treatment of MSM through discriminatory laws. The impact and underlying mechanisms of country-level stigma on odds of diagnosed HIV, sexual opportunities, and experience of HIV-prevention services, needs and behaviours have rarely been examined, however.
Data come from the European MSM Internet Survey (EMIS), which was administered between June and August 2010 across 38 European countries (N = 174 209).
Country-level stigma was assessed using a combination of national laws and policies affecting sexual minorities and a measure of attitudes held by the citizens of each country. We also assessed concealment, HIV status, number of past 12-month male sex partners, and eight HIV-preventive services, knowledge, and behavioural outcomes.
MSM living in countries with higher levels of stigma had reduced odds of diagnosed HIV and fewer partners but higher odds of sexual risk behaviour, unmet prevention needs, not using testing services, and not discussing their sexuality in testing services. Sexual orientation concealment mediated associations between country-level stigma and these outcomes.
Country-level stigma may have historically limited HIV transmission opportunities among MSM, but by restricting MSM's public visibility, it also reduces MSM's ability to access HIV-preventive services, knowledge and precautionary behaviours. These findings suggest that MSM in European countries with high levels of stigma are vulnerable to HIV infection. Although they have less opportunity to identify and contact other MSM, this might change with emerging technologies.
This article presents a systematic review of qualitative studies focusing on HIV/AIDS among Black men who have sex with men (BMSM) in the United States. . We reviewed qualitative studies that were published between 1980-2014. Studies included in the review employed the following qualitative methods: in-depth interviewing, focus group interviews, participant observation, and other ethnographic approaches (e.g., case studies). The following databases were searched: PubMed, PsychINFO, JSTOR, ERIC, Sociological Abstracts, and Google Scholar Databases were searched for relevant articles using the following broad terms: "Black men" and/or "Black men who have sex with men," and "qualitative" and/or "ethnography." Sixty-one studies were included in this review. Key themes observed across studies were: (1) heterogeneity among BMSM, (2) layered stigma, including homophobia and racism, (3) risk behaviors including condomless sex and substance use, (4) mental health, (5) resilience, and (6) community engagement. The review suggests that same-sex sexual behavior and HIV-status disclosure, sexual risk-taking and substance use behaviors, and psychological well-being were contextually situated. Diverse interventions occurring at multiple levels and within multiple contexts are needed in order to reduce stigma within the Black community. Similarly, structural interventions targeting religious groups, schools, and health care systems are needed to improve health outcomes among BMSM. Community engagement and the use of community-based participatory research methods may facilitate the development and implementation of culturally appropriate HIV/AIDS interventions targeting BMSM.
Objectives:
We surveyed men who have sex with men (MSM) to determine whether sexual risk behaviors, recent drug use, and other psychosocial problems differed between men who engaged in one-on-one and group sexual encounters.
Methods:
We conducted an Internet-based cross-sectional survey of 7158 MSM aged 18 years or older in the United States recruited from a gay-oriented sexual networking Web site in 2008. Among MSM who engaged in group sexual encounters, we compared their past-60-day sexual behaviors in one-on-one encounters and group sexual encounters. We also compared risk profiles and syndemic production between men who did and did not participate in group sex.
Results:
Men reporting a group-sex encounter had significantly higher polydrug use and sexual risk than did the men not reporting group sex in the past 60 days. The odds of engaging in group sex with 4 or more sexual partners significantly increased with the number of psychosocial problems, supporting evidence of syndemic production.
Conclusions:
We identified a particularly high-risk subgroup in the MSM population with considerable psychosocial problems that may be reached online. Research is needed on how to engage these high-risk men in combination prevention interventions.
Objective:
Mounting evidence suggests a syndemic relation between methamphetamine use and depression to increase sexual risk taking (i.e., HIV transmission risk behavior) among men who have sex with men. This prospective analysis of longitudinal data collected from an outpatient methamphetamine abuse treatment program for gay and bisexual men assessed whether symptoms of depression mediated and/or moderated the associations between methamphetamine use and unprotected insertive/receptive anal intercourse.
Method:
From November 2005 through October 2007, 167 treatment-seeking gay and bisexual men (63% HIV-positive) enrolled in and attended a 16-week methamphetamine abuse outpatient treatment program. Participants' depressive symptoms, biomarker-confirmed methamphetamine use, and self-reported sexual risk taking were assessed at baseline and follow-up evaluations. Path analysis tested the mediating and moderating effects of depression on the associations between methamphetamine use and unprotected insertive/receptive anal intercourse.
Results:
Methamphetamine use during the treatment period had a significant indirect (Coef. = -.15; 95% CI [-.23, -.06]), but no direct (Coef. = .11; ns) or total effect (Coef. = -.04; ns) on participants' sexual risk taking after accounting for the significant mediating (Coef. = .56; 95% CI [.33, .78]) and moderating (Coef. = -.03; 95% CI [-.04, -.02]) effects of depression.
Conclusions:
Depression fully mediated and weakly moderated associations between methamphetamine use and sexual risk taking in this sample. Interventions and treatment programs to reduce sexual risk taking among gay and bisexual men should simultaneously address methamphetamine use and depression to optimize health outcomes. (PsycINFO Database Record
Background: Recreational drug use in men who have sex with men (MSM) is of concern because it might be linked to the transmission of HIV and other sexually transmitted infections. Evidence about drug use in HIV-diagnosed MSM in the UK is limited by representativeness of the study populations. We describe patterns of drug use and associations with sexual behaviours in HIV-diagnosed MSM in the UK.
Methods: We used data from the cross-sectional ASTRA study, which recruited participants aged 18 years or older with HIV from eight HIV outpatient clinics in the UK between Feb 1, 2011, and Dec 31, 2012. We examined data for MSM, assessing the prevalence of recreational drug use and polydrug use in the previous 3 months and associations with sociodemographic and HIV-related factors. We examined the association of polydrug use with measures of condomless sex in the previous 3 months and with other sexual behaviours.
Findings: Our analysis included data for 2248 MSM: 2136 (95%) were gay, 1973 (89%) were white, 1904 (85%) were on antiretroviral treatment (ART), and 1682 (76%) had a viral load of 50 copies per mL or lower. 1138 (51%) used recreational drugs in the previous 3 months; 608 (27%) used nitrites, 477 (21%) used cannabis, 460 (21%) used erectile dysfunction drugs, 453 (21%) used cocaine, 280 (13%) used ketamine, 258 (12%) used 3,4-methylenedioxy-N-methylamphetamine (MDMA), 221 (9%) used gamma-hydroxybutyrate or gamma-butyrolactone, 175 (8%) used methamphetamine, and 162 (7%) used mephedrone. In the 1138 individuals who used drugs, 529 (47%) used three or more drugs and 241 (21%) used five or more. Prevalence of injection drug use was 3% (n=68). Drug use was independently associated with younger age (p<0·0001), not being religious (p=0·001), having an HIV-positive stable partner (p=0·0008), HIV-serostatus disclosure (p=0·009), smoking (p<0·0001), evidence of harmful alcohol drinking (p=0·0001), and ART non-adherence (p<0·0001). Increasing polydrug use was associated with increasing prevalence of condomless sex (prevalence range from no drug use to use of five or more drugs was 24% to 78%), condomless sex with HIV-seroconcordant partners (17% to 69%), condomless sex with HIV-serodiscordant partners (10% to 25%), and higher-HIV-risk condomless sex after taking viral load into account (4% to 16%; p≤0·005 for all). Associations were similar after adjustment for sociodemographic and HIV-related factors. Methamphetamine was more strongly associated with higher-HIV-risk condomless sex than were other commonly used drugs.
Interpretation: Polydrug use is prevalent in HIV-diagnosed MSM and is strongly associated with condomless sex. Specialist support services for MSM with HIV who use recreational drugs might be beneficial in the reduction of harm and prevention of ongoing transmission of HIV and other sexually transmitted infections.
Funding: National Institute for Health Research.
Concurrent partnerships are a significant public health concern among men who have sex with men (MSM). This study describes the prevalence of concurrency and its association with serodiscordant/serostatus unknown unprotected anal or vaginal intercourse (SDUI) among MSM in New York City.
A total of 1458 MSM completed a social and sexual network inventory about their male and female sex partners, including concurrency, in the last 3 months. Logistic regression identified factors associated with SDUI.
Median age was 29 years. The proportion of participants who reported being HIV+ was 23.5%. The men reported a mean of 3.2 male partners in the last 3 months. The proportion of MSM who reported having recent SDUI was 16.6%. More than half (63.2%) described having concurrent sex partners (individual concurrency based on overlapping dates of relationships); 71.5% reported having partners whom they believed had concurrent partners (perceived partner concurrency); and 56.1% reported that both they and their partners had concurrent partners (reciprocal concurrency). Among HIV+ men by self-report, having SDUI was positively associated with individual concurrency, any alcohol use during sex, having more male sex partners, and not having a main partner. Among self-reported HIV- men, having SDUI was positively associated with perceived partner concurrency, lower education level, any alcohol and drug use during sex, having more male sex partners, and having an anonymous partner.
Concurrency was common among MSM. The association of SDUI with individual and perceived partner concurrency, along with substance use during sex, having an anonymous partner, and having many sex partners likely further increases HIV acquisition and transmission risk among MSM. HIV prevention interventions should address concurrency among MSM.
Lesbian, gay, bisexual, and other same-sex attracted young people have been shown to be at a higher risk of mental health problems, including depression, anxiety, suicidality, and substance abuse, compared to their heterosexual peers. Homophobic prejudice and stigma are often thought to underlie these disparities. In this study, the relationship between such experiences of social derogation and mental health and substance use in same-sex attracted young people was examined using Meyer's minority stress theory. An online survey recruited 254 young women and 318 young men who identified as same-sex attracted, were aged 18-25 years, and lived in Sydney, Australia. Multivariate logistic regression analyses showed that internalized homophobia, perceived stigma, and experienced homophobic physical abuse were associated with higher levels of psychological distress and self-reported suicidal thoughts in the previous month. Furthermore, perceived stigma and homophobic physical abuse were associated with reporting a lifetime suicide attempt. The association between minority stress and substance use was inconsistent. While, as expected, higher levels of perceived stigma were associated with club drug dependence, there was an inverse association between internalized homophobia and club drug use, and between perceived stigma and hazardous alcohol use. The findings of this study provide support for the minority stress theory proposition that chronic social stress due to sexual orientation is associated with poorer mental health. The high rates of mental health and substance use problems in the current study suggest that same-sex attracted young people should continue to be a priority population for mental health and substance use intervention and prevention.
We evaluated the relationship among syndemic conditions (defined as a cluster of interconnected psychosocial health conditions), sexual behaviours and self-reported HIV infection in a global sample of men who have sex with men (MSM).
We used generalised estimating equations logistic regression models with robust SEs to assess the relationships among cumulative number of syndemic conditions-including depression, substance use, violence, sexual stigma and homelessness-and unprotected anal intercourse (UAI) and HIV infection, while accounting for clustering within-country in a global cross-sectional survey of 3934 MSM across 151 countries.
We observed parallel, significant dose-response associations between the number of syndemic conditions and UAI, as well as number of syndemic conditions and HIV infection. Compared with participants without syndemics, the adjusted OR (aOR) for UAI among those with 1, 2 and 3 or more syndemic conditions were 1.44 (Bonferroni-adjusted 95% CI 1.23 to 1.68), 1.89 (1.51 to 2.36) and 2.03 (1.43 to 2.89), respectively. Compared with participants without syndemics, the aOR for HIV infection among those with 1, 2 and 3 or more syndemic conditions were 1.67 (1.24 to 2.26), 2.02 (1.44 to 2.85) and 2.35 (1.31 to 4.21), respectively.
This analysis provides evidence of intertwining syndemics that may operate synergistically to increase HIV risk among MSM globally. To curb HIV effectively and advance the health of MSM, multiple conditions must be addressed concurrently using multi-level approaches that target both individual and structural risk factors.
European men who have sex with men (MSM) continue to be disproportionally affected by the human immunodeficiency virus (HIV). Several factors are contributing to the rates of new HIV infections among MSM. The aim of this study was to investigate the potential role of travel behaviour and sexual mobility in the spread of HIV and sexually transmitted infections (STI) among European MSM.
Belgian data from the first pan-European MSM internet survey EMIS was used (n=3860) to explore individual and contextual determinants of sexual behaviour among MSM, who resided in Belgium at the time of data collection and who reported having had sexual contact abroad in the last 12 months. Descriptive and bivariate analyses were performed. Odds ratios and 95% confidence intervals were calculated by means of logistic regression.
MSM who practiced unprotected anal intercourse UAI during their last sexual encounter abroad were less likely to be living in a large city (OR:0.62, 95% CI:0.45-0,86, p<0.01) and more likely to be HIV positive (OR: 6.20, 95% CI:4.23-9.06, p<0.001) ), to have tested HIV positive in the last 12 months (OR:3.07, 95% CI:1.07-8.80, p<0.05), to have been diagnosed with any STI in the last 12 months (OR:2.55; 95% CI:1.77-3.67, p<0.05), to have used party drugs (OR:2.22, 95% CI :1.59-3.09, p<0.001), poppers (OR:1.52, 95% CI:1.07-2.14, p<0.001) and erection enhancing substances (OR:2.23, 95% CI:1.61-3.09, p<0.001) compared to MSM who did not have UAI with their last sexual partner abroad. Men having had UAI in the last 12 months were more likely to have done so in a neighbouring country of Belgium (OR: 1.66, 95% CI:1.21-2.29, p<0.001). Different sexual behavioural patterns related to condom use and drug use were identified according to HIV test status among travelling men.
The results of this study provide evidence for the role of international mobility and sexual behavior while travelling, in the spread of HIV and STI among MSM in Europe. Further, the findings underline the need for development of European cross-border HIV and STI interventions with coherent messages and prevention policies for MSM.
Using data from a large national representative survey on sexual behavior in France (Contexte de la Sexualité en France), this study analyzed the relationship between a multidimensional measure of sexual orientation and psychoactive substance use and depression. The survey was conducted in 2006 by telephone with a random sample of the continental French speaking population between the ages of 18 and 69 years. The sample used for this analysis consisted of the 4,400 men and 5,472 women who were sexually active. A sexual orientation measure was constructed by combining information on three dimensions of sexual orientation: attraction, sexual behavior, and self-definition. Five mutually exclusive groups were defined for men and women: those with only heterosexual behavior were divided in two groups whether or not they declared any same-sex attraction; those with any same-sex partners were divided into three categories derived from their self-definition (heterosexual, bisexual or homosexual). The consumption of alcohol and cannabis, which was higher in the non-exclusively heterosexual groups, was more closely associated with homosexual self-identification for women than for men. Self-defined bisexuals (both male and female) followed by gay men and lesbians had the highest risk of chronic or recent depression. Self-defined heterosexuals who had same-sex partners or attraction had levels of risk between exclusive heterosexuals and self-identified homosexuals and bisexuals. The use of a multidimensional measure of sexual orientation demonstrated variation in substance use and mental health between non-heterosexual subgroups defined in terms of behavior, attraction, and identity.
Many studies have found associations between crystal methamphetamine use and unsafe sexual behaviour. Researchers and also authors of relevant articles in popular media have often interpreted these associations as meaning that crystal directly causes unsafe sex (in the same sense that cyanide causes death), and that interventions should aim to reduce crystal use in order to reduce the prevalence of sexually transmitted diseases. However, nearly all relevant studies have provided only circumstantial evidence regarding a causal relationship. This paper examines the various types of study that have been published on this topic, focusing on their limitations in terms of demonstrating causality. There is strong evidence that crystal users are a high-risk group in terms of sexual behaviour. However, promoting the idea that crystal itself is a major cause of unsafe sex may iatrogenically promote crystal use, may create an excuse for engaging in unsafe sex, and may incur opportunity costs by preventing limited intervention resources from being directed more effectively. Researchers who investigate relationships between psychoactive drug use and behaviour, including sexual behaviour, should be careful about the wording of their conclusions and recommendations, and should be sensitive to the way in which their findings might be quoted and represented in the media.