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Consumption of sexualized and recreational drugs in HIV negative males: survey of a community HIV screening ABSTRACT
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Recreational drug use (RDU) has been reported to be disproportionately higher in men who have sex with men (MSM) when compared to their heterosexual counterparts. To identify RDU, links to risky sexual practices and infections for MSM attending three sexual health clinics across Manchester, United Kingdom, a retrospective case note review was conducted using a random powered sample of service users attending three sites during 2014. Three hundred and fifty-seven case notes were reviewed across three sites. Eighteen per cent of service users reported any type of RDU. Use of at least one of the three drugs associated with chemsex (crystal methamphetamine, mephedrone, gamma hydroxybutyrate/gamma butyrolactone) was reported by 3.6%. A statistically significant difference was identified between non-drug users and any-drug users reporting: group sex (odds ratio [OR] 5.88, p = 0.013), condomless receptive anal intercourse (CRAI) (OR 2.77, p = 0.003) and condomless oral intercourse (OR 2.52, p = 0.016). A statistically significant difference was identified between chemsex-related drug user and non-drug user groups reporting: group sex (OR 13.05, p = 0.023), CRAI (OR 3.69, p = 0.029) and condomless insertive anal intercourse (OR 1.27, p = 0.039). There was also a statistically higher incidence of gonorrhoea infection in chemsex-related drug use compared with those not using drugs (p = 0.002, OR 6.88). This study identifies that substance use is common in MSM attending sexual health clinics in Manchester. High-risk sexual practices and certain sexually transmitted infections are more common in MSM reporting RDU.
Introducción: En los últimos años se viene observando un incremento en el consumo de drogas entre hombres que tienen sexo con hombres (Folch et al., 2015), particularmente relacionado con fines sexuales (ChemSex). El ChemSex es el uso intencionado de cualquier droga que esté disponible para tener relaciones sexuales por un período largo de tiempo (que puede durar varias horas hasta varios días) (Fernández-Dávila, 2016). Diversos riesgos o daños pueden ocurrir por esta práctica a nivel de salud sexual, física y psicológica, así como a nivel social y material. En España, no se tiene información específica sobre el ChemSex por lo que uno de los objetivos de este estudio fue entender las motivaciones que hay detrás de esta práctica.
Método: Se realizó un estudio cualitativo, entrevistando individualmente a 26 hombres residentes en Barcelona (23-55 años; M: 37 años). El criterio de selección fue haber consumido alguna droga para tener relaciones sexuales con otro hombre en el último mes. Los participantes fueron captados a través de diferentes fuentes: Internet/apps, sauna, referidos por los propios entrevistados, terceras personas y unidad del VIH de un hospital. El enfoque de la Teoría Fundamentada fue utilizado para analizar los datos.
Resultados: Los motivos para consumir drogas con fines sexuales son diversos, y puede haber varios motivos a la vez. Los motivos se pueden agrupar en tres tipos: (1) motivos relacionados con el sexo: intensificar o potenciar el placer, desinhibirse sexualmente (lo que lleva a realizar ciertas prácticas sexuales que de sobrios no se atreverían a realizar), facilitar ciertas prácticas sexuales que de otra forma podrían ser incomodas o dolorosas (p.e. fisting), aguantar físicamente más tiempo (y, así, alargar una sesión de sexo), y mejorar la performance sexual (p.e., retardar la eyaculación); (2) motivos vinculados al contexto/situación, la pareja sexual o el grupo: buscar momentos de intimidad emocional, construir un clima de “buen rollo” con otros, facilitar la confianza personal para contactar y relacionarse con otros hombres en un contexto sexual, y acceder a espacios estimulantes sexualmente (p.e. sexo en grupo) y a las drogas; (3) motivos subyacentes o latentes. Detrás de los motivos manifiestos, pueden haber otros motivos: lidiar con momentos o situaciones complicadas que tienen un impacto emocional muy intenso (p.e., estar en paro, ruptura sentimental o pérdida de un ser querido), una situación psicológica personal (p.e. baja autoestima) en un momento determinado de sus vidas, escaparse de la soledad, evitar conectarse emocionalmente con aspectos dolorosos que no quiere afrontar o conflictos internos sin resolver (p.e. vinculados a las relaciones familiares), o acceder y conocer a otras personas para crear redes sociales.
Conclusión: El sexo es la vía principal por la cual muchos hombres gais se relacionan en el sentido más amplio de la palabra. A través del sexo se expresan muchas necesidades no-sexuales. Aparte de los motivos relacionados con mejorar la experiencia sexual, varias de las motivaciones para hacer ChemSex estuvieron relacionadas a la búsqueda de colmar ciertas necesidades psico-sociales. Conocer esto es importante para el abordaje de este fenómeno a nivel individual.
Objectives
Drug interactions, poor adherence to medication and high-risk sexual behaviour may occur in individuals with HIV using recreational drugs. Thus, we aimed to assess the prevalence of recreational drugs use and to explore its clinical impact in HIV patients on treatment.
Methods
Observational, cross sectional, study conducted in a 700 bed university hospital, Barcelona, Spain. A total of 208 adults living with HIV on treatment were included. A questionnaire was administered by clinical pharmacists, including evaluation of sociodemographic variables, past 12-month drug consumption, adherence to antiretrovirals (Simplified Medication Adherence Questionnaire) and high-risk sexual behaviour (condomless sex/multiple partners). Additional data were obtained from clinical records. Recreational drug-antiretroviral interactions were checked in reference databases. Prevalence was calculated for 5% precision and 95% CI. Crude and adjusted binary logistic regressions were performed to identify associations between recreational drug use and adherence problems, and between recreational drug use and high-risk sexual behaviour.
Results
From the overall sample, 92 participants (44.2%) consumed recreational drugs over the past 1 year. Of these, 44 (48.8%) had used different types of recreational drugs in this period. We detected 11 recreational substances, including sildenafil and nitrites. The most consumed drugs were: cannabis (68.5%), cocaine (45.5%), nitrites (31.5%), sildenafil (28.3) and ecstasy (19.6%). Relevant interactions occurred in 46 (50%) of the individuals consuming drugs. Recreational drug consumption was found to be related to adherence problems with antiretrovirals (OR: 2.51 (95% CI 1.32 to 4.77) p=0.005) and high-risk sexual behaviour (OR: 2.81 (95% CI 1.47 to 5.39) p=0.002).
Conclusions
Recreational drugs are frequently used by HIV patients on treatment. Classical drugs and new substances consumed in sexual context are usual. Recreational drug consumption interferes with several clinical outcomes, including potentially relevant interactions between drugs and antiretrovirals, adherence problems and high-risk sexual behaviour. Thus, there is the urgent need of implementing patient-centred care involving recreational drug consumption.
The sexualised use of recreational drugs (Mephedrone, GBL/GHB, Crystal Meth) generally known as ‘chemsex’ in men who have sex with men (MSM) is thought to be associated with sexually transmitted infection (STI) acquisition; however there is little data showing a direct relationship. We reviewed 130 randomly selected cases of MSM with an STI attending our STI service and 130 controls (MSM attending the STI service who did not have an STI) between 5 May 2015 and 2 November 2015. Reported condomless anal sex was significantly higher in cases 90/121 (74%) compared with controls 65/122 (53%); (χ2 = 11.71, p < 0.005, OR 2.54). Recreational drug use in the cases 38/122 (31%) was significantly greater than in controls 20/125 (16%); (χ2 = 7.88, p < 0.005, OR 2.37). This demonstrates a link between STI acquisition and recreational drug use in MSM. Harm reduction initiatives identifying and addressing party drug use can help to improve the sexual health of MSM, including reducing risk-taking behaviours.
The objective of this study was to analyse associations between sexualised substance use (chemsex), STI diagnoses and sexual behaviour among gay bisexual and other men who have sex with men accessing sexual health clinics to better inform clinical pathways. A retrospective case notes review was undertaken following the introduction of more detailed and holistic profomas for all gay bisexual and other men who have sex with men attending two London sexual health clinics between 1 June 2016 and 31 January 2015. Chemsex status was documented for 655/818. Overall, 30% disclosed recreational drug use of whom 113 (57%) disclosed chemsex and 27 (13.5%) injecting drugs. HIV-positive gay bisexual and other men who have sex with men were more likely to disclose chemsex (AOR 6.68; 95% CI 3.91–11.42; p < 0.001). Those disclosing chemsex had a higher incidence of acute bacterial STIs (AOR 2.83 CI 1.79–4.47; p < 0.001), rectal STIs (AOR 3.10 CI 1.81–5.32; p < 0.001) or hepatitis C (AOR 15.41 CI 1.50–158.17; p = 0.021). HIV incidence in the study period was 1.8% (chemsex) vs. 0.9% (no chemsex) (p = 0.61). Chemsex was associated with having more sexual partners, transactional sex, group sex, fisting, sharing sex toys, injecting drug use, higher alcohol consumption and the use of ‘bareback’ sexual networking applications (p < 0.004). Chemsex participants were also more likely to have accessed post-exposure prophylaxis for HIV in the study period and report sex with a discordant HIV or hepatitis C-infected partner (p < 0.001). Chemsex disclosure is associated with higher risk-taking behaviours, acute bacterial STIs, rectal STIs and hepatitis C incidence. HIV incidence was higher but not significantly so in the study period. Chemsex disclosure in sexual health clinics should prompt an opportunity for prevention, health promotion and wellbeing interventions.
. Synthetic cathinones (SCs), also known as “bath salts,” are
β
-ketone amphetamine compounds derived from cathinone, a psychoactive substance found in
Catha edulis
. Mephedrone is the most representative SC.
Slamming
is the term used for the intravenous injection of these substances in the context of
chemsex
parties, in order to enhance sex experiences. Using IV mephedrone may lead to diverse medical and psychiatric complications like psychosis, aggressive behavior, and suicide ideation.
Case
. We report the case of a 25-year-old man admitted into a psychiatric unit, presenting with psychotic symptoms after
slamming
mephedrone almost every weekend for the last 4 months. He presents paranoid delusions, intense anxiety, and visual and kinesthetic hallucinations. He also shows intense craving, compulsive drug use, general malaise, and weakness. After four weeks of admission and antipsychotic treatment, delusions completely disappear. The patient is reinfected with hepatitis C.
Discussion
. Psychiatric and medical conditions related to
chemsex
and
slamming
have been reported in several European cities, but not in Spain. Psychotic symptoms have been associated with mephedrone and other SCs’ consumption, with the IV route being prone to produce more severe symptomatology and addictive conducts. In the case we report, paranoid psychosis, addiction, and medical complications are described.
Objectives:
Rates of chlamydia and gonorrhoea have been rising in urban centres in Canada, particularly among HIV-positive men who have sex with men (MSM). Our objective was to identify behavioural risk factors for diagnosis with chlamydia and gonorrhoea in this population, with a focus on the HIV status of sexual partners.
Methods:
The OHTN Cohort Study follows people in HIV care across Ontario. We restricted the analysis to 1997 MSM who completed questionnaires in 2010-2013 at one of seven clinics that submit all chlamydia and gonorrhoea tests to the provincial public health laboratory; we obtained test results via record linkage. We estimated cumulative incidences using Kaplan-Meier methods and identified risk factors for diagnosis of a composite outcome (chlamydia or gonorrhoea infection) using Cox regression.
Results:
At follow-up, there were 74 new chlamydia/gonorrhoea diagnoses with a 12-month cumulative incidence of 1.7% (95% CI 1.1% to 2.2%). Risk factors for chlamydia/gonorrhoea diagnosis were: 5+ HIV-positive partners (HR=3.3, 95% CI 1.4 to 7.8; reference=none) and recreational drug use (HR=2.2, 95% CI 1.2 to 3.9).
Conclusions:
Heightened risks with recreational drug use and multiple HIV-positive partners suggest that chlamydia/gonorrhoea may have achieved high prevalence in certain sexual networks among HIV-positive MSM. Interventions to promote safer sex and timely testing among MSM are needed.
En España, durante los últimos meses del 2015, se ha hablado y discutido mucho, sobre todo en los medios de comunicación, acerca del fenómeno del ChemSex. Si bien el uso de drogas para tener sexo entre hombres gais no es nuevo ni reciente, el ChemSex hace alusión al consumo intencional de drogas para tener relaciones sexuales durante mucho tiempo. Sin embargo, incluso hasta ahora, mucha de la información que se vierte contiene una serie de imprecisiones respecto a la terminología, al alcance de este fenómeno, las drogas que se consumen y los espacios en que se consumen. Este artículo busca entender la emergencia de este fenómeno desde una visión integral y holística, así como plantea una definición desde una perspectiva de la reducción de riesgos para la prevención del VIH, de otras ITS y para el cuidado de la salud sexual y de la salud en general. Finalmente, se plantean algunas consideraciones para abordar el ChemSex a nivel preventivo.
In Spain, during November and December 2015, the phenomenon of ChemSex was much talked about and discussed, especially in the media. Although the use of drugs for sex among gay men is not new, ChemSex refers to the intentional use of drugs to sustain sex for a long period of time. Even now, there are a number of misunderstandings about the terminology, the magnitude of this phenomenon, what drugs are consumed and the spaces where gay men consume them. This article seeks to understand the emergence of this phenomenon, using a comprehensive and holistic approach and providing a definition of ChemSex from the perspective of risk reduction for HIV, other STIs, sexual health, and health in general. Finally, some considerations on ChemSex from the perspective of prevention are presented.
Background
Rates of sexually transmitted infections (STI) and unplanned pregnancy are high among youth. While the intersection between drug and alcohol use and unprotected sex is well recognized, few studies have examined the relationship between substance use patterns and unprotected sex among high risk-populations such as street-involved youth.
Methods
Data were derived from the At-Risk Youth Study (ARYS), a prospective cohort of street-involved youth from Vancouver, Canada. Generalized estimating equations (GEE) were used to examine substance use patterns that were independently associated with unprotected sex, defined as (vaginal or anal) sexual intercourse without consistent condom use.
Results
Between September 2005 and May 2013, 1,026 youth were recruited into the ARYS cohort and 75 % (n = 766) reported engaging in recent unprotected sex at some point during the study period. In a multivariable analysis, female gender (adjusted odds ratio [AOR] = 1.46, 95 % confidence interval [CI]: 1.18-1.81), Caucasian ancestry (AOR = 1.38, 95 % CI: 1.13-1.68), being in a stable relationship (AOR = 4.64, 95 % CI: 3.82-5.65), having multiple sex partners (AOR = 2.60, 95 % CI: 2.18-3.10) and the following substance use patterns were all independently associated with recent unprotected sex: injection or non-injection crystal methamphetamine use (AOR = 1.21, 95 % CI: 1.03-1.43), injection or non-injection cocaine use (AOR = 1.20, 95 % CI: 1.02-1.41), marijuana use (AOR = 1.23, 95 % CI: 1.02-1.49), ecstasy use (AOR = 1.23, 95 % CI: 1.01-1.48) and alcohol use (AOR = 1.31, 95 % CI: 1.11-1.55) (all p < 0.05).
Conclusions
Unprotected sex was prevalent among street-involved youth in this setting, and independently associated with female gender and a wide range of substance use patterns. Evidence-based and gender-informed sexual health interventions are needed in addition to increased access to youth-centered addiction treatment services. STI testing and linkages to healthcare professionals remain important priorities for street-involved youth, and should be integrated across all health and social services.
Background:
Anecdotal evidence suggests that men who have sex with men (MSM) are increasingly combining sex and illicit drugs (an activity referred to as 'chemsex'), in particular GHB/GBL, ketamine, crystal meth, or mephedrone (here called 4-chems). Use of such drugs has been associated with mental health and sexual health harms. We aim to compare patterns of illicit drug use among MSM in 44 European urban centres.
Methods:
In 2010, EMIS recruited 174,209 men from 38 countries to an anonymous online questionnaire in 25 languages. As harm reduction services for drugs and sex are organised at a local level, we chose to compare cities rather than countries. We defined 44 cities based on region/postal code and settlement size. For multivariable regression analyses, three comparison groups of MSM not living in these cities were applied: MSM living in Germany, the UK, and elsewhere in Europe.
Results:
Data from 55,446 MSM living in 44 urban centres were included. Use of 4-chems (past 4 weeks) was highest in Brighton (16.3%), Manchester (15.5%), London (13.2%), Amsterdam (11.2%), Barcelona (7.9%), Zurich (7.0%) and Berlin (5.3%). It was lowest in Sofia (0.4%). The rank order was largely consistent when controlling for age, HIV diagnosis, and number of sexual partners. City of residence was the strongest demographic predictor of chemsex-drug use.
Conclusion:
Use of drugs associated with chemsex among MSM varies substantially across European cities. As city is the strongest predictor of chemsex-drug use, effective harm reduction programmes must include structural as well as individual interventions.