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Psychosocial and sexual characteristics associated with sexualised drug use and chemsex among men who have sex with men (MSM) in the UK

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Objective To understand how the emerging public health issue of chemsex relates to broader patterns of sexualised drug use (SDU) among men who have sex with men (MSM), which has been understudied. Methods Potential participants were invited to take part in an anonymous, cross-sectional online survey through Facebook advertising and community organisations’ social media posts (April–June 2018). Multivariable logistic regression was used to compare MSM who engaged in recent SDU (past 12 months) with those who did not, and those who engaged in chemsex (γ-hydroxybutyrate/γ-butyrolactone, crystal methamphetamine, mephedrone, ketamine) with those who engaged in other SDU (eg, poppers, cocaine, cannabis). Results Of the 1648 MSM included, 41% reported recent SDU; 15% of these (6% of total, n=99) reported chemsex. Factors associated with SDU were recent STI diagnosis (aOR=2.44, 95% CI 1.58 to 3.76), sexual health clinic attendance (aOR=2.46, 95% CI 1.90 to 3.20), image and performance-enhancing drug use (aOR=3.82, 95% CI 1.87 to 7.82), greater number of condomless anal male partners, lower satisfaction with life and greater sexual satisfaction. Predictors of chemsex compared with other SDU were not being UK-born (aOR=2.02, 95% CI 1.05 to 3.86), living in a densely populated area (aOR=2.69, 95% CI 1.26 to 5.74), low sexual self-efficacy (aOR=4.52, 95% CI 2.18 to 9.40) and greater number of condomless anal male partners. Living with HIV, taking pre-exposure prophylaxis (PrEP), and experiencing or being unsure of experiencing sexual contact without consent were significantly associated with SDU and chemsex in bivariate analyses but not in the multivariable. Conclusion Health and behavioural differences were observed between MSM engaging in chemsex, those engaging in SDU and those engaging in neither. While some MSM engaging in chemsex and SDU appeared content with these behaviours, the association with life satisfaction and sexual self-efficacy indicates psychosocial support is needed for some. The association with sexual risk and sexual consent also indicates the importance of promoting harm reduction among this population (eg, condoms, PrEP, drug knowledge).
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HibbertMP, etal. Sex Transm Infect 2019;0:1–9. doi:10.1136/sextrans-2018-053933
Behaviour
ORIGINAL ARTICLE
Psychosocial and sexual characteristics associated
with sexualised drug use and chemsex among men
who have sex with men (MSM) in theUK
Matthew Peter Hibbert, 1 Caroline E Brett,2 Lorna A Porcellato,1 Vivian D Hope1
To cite: HibbertMP,
BrettCE, PorcellatoLA, etal.
Sex Transm Infect Epub ahead
of print: [please include Day
Month Year]. doi:10.1136/
sextrans-2018-053933
1Public Health Institute,
Liverpool John Moores
University, Liverpool, UK
2Department of Psychology,
Liverpool John Moores
University, Liverpool, UK
Correspondence to
Mr Matthew Peter Hibbert,
Public Health Institute, Liverpool
John Moores University,
Liverpool L2 2QP, UK; m. p.
hibbert@ 2017. ljmu. ac. uk
Received 11 December 2018
Revised 25 February 2019
Accepted 24 March 2019
© Author(s) (or their
employer(s)) 2019. No
commercial re-use. See rights
and permissions. Published
by BMJ.
ABSTRACT
Objective To understand how the emerging public
health issue of chemsex relates to broader patterns of
sexualised drug use (SDU) among men who have sex
with men (MSM), which has been understudied.
Methods Potential participants were invited to
take part in an anonymous, cross-sectional online
survey through Facebook advertising and community
organisations’ social media posts (April–June 2018).
Multivariable logistic regression was used to compare
MSM who engaged in recent SDU (past 12 months)
with those who did not, and those who engaged in
chemsex (γ-hydroxybutyrate/γ-butyrolactone, crystal
methamphetamine, mephedrone, ketamine) with those
who engaged in other SDU (eg, poppers, cocaine,
cannabis).
Results Of the 1648 MSM included, 41% reported
recent SDU; 15% of these (6% of total, n=99) reported
chemsex. Factors associated with SDU were recent STI
diagnosis (aOR=2.44, 95% CI 1.58 to 3.76), sexual
health clinic attendance (aOR=2.46, 95% CI 1.90 to
3.20), image and performance-enhancing drug use
(aOR=3.82, 95% CI 1.87 to 7.82), greater number of
condomless anal male partners, lower satisfaction with
life and greater sexual satisfaction. Predictors of chemsex
compared with other SDU were not being UK-born
(aOR=2.02, 95% CI 1.05 to 3.86), living in a densely
populated area (aOR=2.69, 95% CI 1.26 to 5.74), low
sexual self-efficacy (aOR=4.52, 95% CI 2.18 to 9.40)
and greater number of condomless anal male partners.
Living with HIV, taking pre-exposure prophylaxis (PrEP),
and experiencing or being unsure of experiencing sexual
contact without consent were significantly associated
with SDU and chemsex in bivariate analyses but not in
the multivariable.
Conclusion Health and behavioural differences were
observed between MSM engaging in chemsex, those
engaging in SDU and those engaging in neither. While
some MSM engaging in chemsex and SDU appeared
content with these behaviours, the association with
life satisfaction and sexual self-efficacy indicates
psychosocial support is needed for some. The association
with sexual risk and sexual consent also indicates the
importance of promoting harm reduction among this
population (eg, condoms, PrEP, drug knowledge).
INTRODUCTION
The use of drugs among men who have sex with
men (MSM) has historically been researched in the
context of the HIV epidemic, due to the increased
sexual risk as well as the increased risk of blood-
borne viruses associated with needle sharing when
injecting drugs.1 2 Sexualised drug use (SDU) refers
to the use of drugs before or during sex to facili-
tate or enhance sexual activity, pleasure or intimacy.
Estimates of the prevalence of SDU among MSM
vary greatly depending on definition, measurement
and recruitment methods used.3 Chemsex (some-
times referred to as ‘party and play’) is a partic-
ular form of SDU among MSM where men engage
in sex for long periods of time, with multiple
sexual partners, with crystal methamphetamine,
γ-hydroxybutyrate/γ-butyrolactone (GHB/GBL),
mephedrone, cocaine and/or ketamine taken imme-
diately before or during sex.4 The rise of chemsex
as a public health issue may be due to an increase
in the number of people engaging in this behaviour
and its associated sexual risk-taking, which has
been reported by sexual health services and men
who engage in chemsex,5 6 both suggesting geospa-
tial networking applications and online sites to
meet sexual partners have enabled this increase.
Quantitative research has also found a higher use
of ‘barebacking’ (condomless sex) geospatial sexual
networking applications among MSM engaging in
chemsex.7
The European MSM Internet Survey found that
the three European cities with the highest preva-
lence of use of chemsex-associated drugs were
Brighton (16.3%), Manchester (15.5%) and London
(13.2%).8 Behaviourally, engaging in chemsex has
been associated with more sexual partners, group
sex, condomless anal intercourse, fisting, sharing
sex toys, injecting drug use and higher alcohol
consumption.4 7 9 While MSM reporting chemsex
are more likely to be living with HIV, MSM who
do not have HIV and report engaging in chemsex
are more likely to have accessed postexposure
prophylaxis.7 10 In Amsterdam, a higher proportion
of MSM engaging in chemsex were taking pre-ex-
posure prophylaxis (PrEP) compared with MSM
not engaging in chemsex.11 Among MSM living
with HIV, illicit drug use has been associated with
reduced antiretroviral therapy adherence and a
detectable viral load, making transmission of HIV
possible, and polydrug use was associated with
increased condomless anal intercourse with a sero-
discordant partner.12 13 When MSM have specified
particular drug use, GHB, crystal methamphetamine
on 13 April 2019 by guest. Protected by copyright.http://sti.bmj.com/Sex Transm Infect: first published as 10.1136/sextrans-2018-053933 on 12 April 2019. Downloaded from
2HibbertMP, etal. Sex Transm Infect 2019;0:1–9. doi:10.1136/sextrans-2018-053933
Behaviour
and non-chemsex-related drugs (eg, erectile dysfunction drugs,
poppers) have been associated with condomless anal intercourse
among MSM in England.14
Reasons for engagement in chemsex that have been suggested
in qualitative interviews are the stigma around HIV, internalised
homophobia and the intense sexual experience of chemsex.15
However, quantitative research recruiting MSM through Face-
book advertising did not find an association between inter-
nalised homophobia, experiences of discrimination and sex
under the influence of drugs in the UK.16 Research to date into
understanding SDU and its associated implications for sexual
health has had a focus on health protection and health promo-
tion, whereas the impact on mental health and psychological
well-being has been somewhat neglected. During qualitative
interviews with MSM engaging in chemsex in London, it was
reported that chemsex was having an impact on some men’s
personal relationships and professional conduct.17 In Australia,
being dependent on methamphetamine was associated with
depression and anxiety compared with non-dependent users, but
this was not measured in a sexual context.18 In Dublin, a quarter
of MSM attending a sexual health clinic reported that chemsex
was having a negative impact on their lives, 17% reported losing
consciousness while engaging in chemsex, and 6% reported their
partners had lost consciousness,19 and MSM have reported in
qualitative interviews feeling uncomfortable in these situations,
due to issues regarding a person’s ability to consent to sex.17
Research into chemsex and other forms of SDU among
MSM in the UK to date has mostly focused on sexual health
outcomes.3 To inform public health responses, this study exam-
ines both chemsex and SDU across the UK, comparing differ-
ences in sexual and psychosocial characteristics between MSM
who do not engage in any form of SDU, those who engage in
SDU and those who engage in chemsex.
METHODS
Design
This analysis uses data from a sample of MSM recruited via a
national, cross-sectional online questionnaire aimed at lesbian,
gay, bisexual and transgender (LGBT) people aged 18 or over
in the UK. A convenience sample was obtained using spon-
sored Facebook advertising and promotion on social media via
relevant LGBT organisations. Four LGBT organisations across
the UK promoted the survey on their social media accounts
(COAST, London Friend, Gay Men’s Health Collective and
National LGB&T Partnership). A sample size calculation using
the Public Health England estimate that 2.5% of the population
in England are lesbian, gay or bisexual,20 a margin of error of
5% and 95% CI indicated that a minimum target sample size for
MSM was 384.
Participants
Four sponsored adverts were run on Facebook for 6 weeks
between April and June 2018, targeting MSM, women who
have sex with women, trans people or LGBT people generally.
Facebook users were shown the sponsored advert for the ‘Sex
and Lifestyles survey’ if they engaged with one or more MSM
or LGBT topics on Facebook. Participants were invited to take
part in the survey if they had ever had a sexual partner of the
same gender and/or they identified as trans. Participants would
then be directed to the online survey and asked two screening
questions, ensuring that participants were aged 18 or over and
currently lived in the UK. To aid recruitment participants had
the option to enter a prize draw for a £50 or one of two £25
Amazon vouchers.
Measures
The questionnaire was divided into three areas: demographics,
sexual health and drug use, and psychological well-being. MSM
participants were those who identified as male and who gave
their sexual orientation as gay or bisexual, or who stated they
had sex with men. Sexual health questions were adapted from
research on similar topics.21 Aligned with previous research,
questions about drug use and SDU were asked with regard to
specific drugs.22 Participants were first asked if they had taken
any of the 14 listed drugs (including alcohol) in the past 12
months. SDU was grouped as participants who had stated they
had been under the influence of cannabis during sex in the past
12 months, or stated having taken amphetamine, cocaine, crack
cocaine, ecstasy, heroin, GHB/GBL, ketamine, mephedrone,
methamphetamine, Viagra or other erectile dysfunction drug,
poppers, or another unspecified drug just before or during sex in
the past 12 months. The chemsex group was defined as having
taken GHB/GBL, ketamine, mephedrone and/or methamphet-
amine just before or during sex.
Sexual satisfaction was measured using an adapted version
of the New Sexual Satisfaction Scale,23 and sexual self-efficacy
(participants’ confidence in practising safer sex consistently) was
measured using a previously validated tool for use with MSM.24
Questions regarding motivations for engaging in SDU and sex
under the influence of alcohol were adapted from motivations
and attitudes towards chemsex questions.9 Psychological well-
being was measured using a variety of previously validated
scales: the Internalised Homophobia Scale,25 the Objectified
Body Consciousness Scale to measure body image satisfaction,26
a Three-Item Loneliness Scale,27 the Satisfaction With Life
Scale,28 and the Kessler Psychological Distress Scale.29
Analysis
All analyses were conducted using SPSS V.25. Forward step-
wise multivariable logistic regression analyses were used to
explore factors associated with engaging in SDU compared with
not engaging in SDU, and factors associated with engaging in
chemsex as opposed to SDU (entry p<0.05, removal p>0.10).
Factors significant at the univariate level (p<0.05) were included
in the multivariable model. Descriptive χ2 analyses were used to
compare motivations for and effects of engaging in, chemsex,
other types of SDU and sex under the influence of alcohol.
RESULTS
Of the 4690 surveys started, 96 participants did not meet the
eligibility criteria, and 1014 did not complete the survey suffi-
ciently to be included in analyses (completion rate of 78%).
Overall, the median time taken to complete the survey was 12
min. Of the 3676 participants included, 1663 were identified
as MSM, and 1649 of these MSM (99%) had completed the
drug use and sex questions to be included in the analysis. MSM
who completed the survey were more likely to be university-ed-
ucated (53% vs 61%, p<0.05), but did not differ on any other
demographic variables where data were available. One MSM
identified as heterosexual and was therefore not included in the
analysis. The majority of MSM identified as gay/homosexual
(86%), were of white ethnicity (95%), with a mean age of 30.7
(SD=10.4, range 18–76), and 43% stated they were single/not in
a relationship. Half of participants had attended a genitourinary
medicine (GUM) clinic in the past 12 months, 4% were living
on 13 April 2019 by guest. Protected by copyright.http://sti.bmj.com/Sex Transm Infect: first published as 10.1136/sextrans-2018-053933 on 12 April 2019. Downloaded from
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HibbertMP, etal. Sex Transm Infect 2019;0:1–9. doi:10.1136/sextrans-2018-053933
Behaviour
Table 1 Univariate and multivariable analyses for factors associated with sexualised drug use in the past 12 months
Univariate Adjusted model
MSM not engaged in sexualised
drug use (n=978) MSM engaged in sexualised drug use (n=670)
OddsRatio (95% CI)
adjusted Odds Ratio
(95% CI) n or mean % or SD n or mean % or SD Row %
Sexuality
Homosexual 824 84% 587 88% 42 Ref
Bisexual 108 11% 44 7% 29 0.57 (0.40 to 0.83)**
Queer 24 2% 26 4% 52 1.52 (0.86 to 2.68)
Age group
18–24 359 37% 174 26% 33 Ref Ref
25–34 403 41% 240 36% 37 1.23 (0.97 to 1.56) 1.08 (0.81 to 1.44)
35–49 171 17% 186 28% 52 2.24 (1.70 to 2.96)*** 2.51 (1.81 to 3.50)***
≥50 44 4% 68 10% 61 3.19 (2.10 to 4.85)*** 4.00 (2.43 to 6.59)***
Ethnicity
White 934 96% 637 95% 41 Ref
Person of colour 42 4% 32 5% 43 1.12 (0.70 to 1.79)
Country of birth
UK 855 87% 577 86% 40 Ref
Not UK 106 11% 76 11% 42 1.06 (0.78 to 1.45)
Education
University or higher 578 59% 401 60% 41 Ref
Qualifications at 18 290 30% 176 26% 38 0.88 (0.70 to 1.10)
Qualifications at 16
or lower
87 9% 75 11% 46 1.24 (0.89 to 1.74)
Work status
Full time 615 63% 426 64% 41 Ref
Part-time 69 7% 44 7% 39 0.92 (0.62 to 1.37)
Student 185 19% 79 12% 30 0.62 (0.46 to 0.83)**
Unemployed 35 4% 24 4% 41 0.99 (0.58 to 1.69)
Other (sick leave,
retired, carer)
70 7% 91 14% 57 1.88 (1.34 to 2.62)***
Relationship status
Living with partner 355 36% 232 35% 40 Ref
Relationship not
living with partner
197 20% 120 18% 38 0.93 (0.70 to 1.23)
Relationship with
multiple
17 2% 18 3% 51 1.62 (0.82 to 3.21)
Single 408 42% 299 45% 42 1.12 (0.90 to 1.40)
Population density per hectare
<5 225 23% 136 20% 38 Ref
5–20 219 22% 127 19% 37 0.96 (0.71 to 1.30)
20–41 233 24% 166 25% 42 1.18 (0.88 to 1.58)
>41 287 29% 236 35% 45 1.36 (1.04 to 1.79)*
Internalised homophobia
Low 616 63% 444 66% 42 Ref
High 354 36% 213 32% 38 0.84 (0.68 to 1.03)
Discrimination
sexuality
None 534 55% 340 51% 39 Ref
Any setting 414 42% 297 44% 42 1.13 (0.92 to 1.38)
Perceived health
Fair/good/very good 877 90% 580 87% 40 Ref
Very poor/poor 101 10% 90 13% 47 1.35 (1.00 to 1.82)
Psychological
distress
Normal 206 21% 153 23% 43 Ref
Moderate 220 22% 154 23% 41 0.94 (0.70 to 1.26)
High 267 27% 152 23% 36 0.77 (0.57 to 1.02)
Continued
on 13 April 2019 by guest. Protected by copyright.http://sti.bmj.com/Sex Transm Infect: first published as 10.1136/sextrans-2018-053933 on 12 April 2019. Downloaded from
4HibbertMP, etal. Sex Transm Infect 2019;0:1–9. doi:10.1136/sextrans-2018-053933
Behaviour
Univariate Adjusted model
MSM not engaged in sexualised
drug use (n=978) MSM engaged in sexualised drug use (n=670)
OddsRatio (95% CI)
adjusted Odds Ratio
(95% CI) n or mean % or SD n or mean % or SD Row %
Very high 275 28% 203 30% 42 0.99 (0.75 to 1.31)
Diagnosed STI in the past 12 months
None 903 92% 511 76% 36 Ref Ref
STI diagnosis 42 4% 135 20% 76 5.68 (3.95 to 8.17)*** 2.44 (1.58 to 3.76)***
Not stated 33 3% 24 4% 42 1.29 (0.75 to 2.20) 1.45 (0.77 to 2.71)
Attended genitourinary medicine in the past 12 months
No 594 61% 199 30% 25 Ref Ref
Yes 368 38% 457 68% 55 3.71 (3.00 to 4.58)*** 2.46 (1.90 to 3.20)***
Not sure 9 1% 9 1% 50 2.99 (1.17 to 7.62)* 3.61 (1.15 to 11.34)*
Number of men anal intercourse in the past 12 months
0–1 622 63% 182 27% 23 Ref
2–5 261 27% 190 28% 42 2.49 (1.94 to 3.19)***
6–10 52 5% 126 19% 71 8.28 (5.76 to 11.90)***
>10 40 4% 171 26% 81 14.61 (9.97 to 21.40)***
Number of men without condom anal intercourse in the past 12 months
0–1 811 83% 362 54% 31 Ref Ref
2–5 137 14% 170 25% 55 2.79 (2.16 to 3.60)*** 1.77 (1.31 to 2.40)***
6–10 17 2% 63 9% 79 8.33 (4.80 to 14.43)*** 4.31 (2.38 to 7.80)***
>10 7 1% 74 11% 91 23.75 (10.83 to 52.06)*** 8.42 (3.67 to 19.29)***
Sexual contact without consent in the past 12 months
No 925 95% 595 89% 39 Ref
Yes 37 4% 41 6% 53 1.72 (1.09 to 2.72)*
Unsure 12 1% 24 4% 67 3.11 (1.54 to 6.26)**
HIV status
Negative 807 83% 496 74% 38 Ref
Negative, on PrEP 28 3% 71 11% 72 4.12 (2.63 to 6.48)***
Positive 19 2% 55 8% 74 4.71 (2.76 to 8.03)***
Don’t know 124 13% 48 7% 28 0.63 (0.44 to 0.90)*
Sexual self-efficacy
High 934 96% 615 92% 40 Ref
Low 34 3% 44 7% 56 2.03 (1.28 to 3.22)**
Taken image or performance-enhancing
drugs in the past 12 months?
No 959 98% 629 94% 40 Ref Ref
Yes 19 2% 36 5% 65 2.89 (1.64 to 5.08)*** 3.82 (1.87 to 7.82)***
Body satisfaction 42.0 11.8 41.3 12.7 1.00 (0.99 to 1.00)
Loneliness score 5.5 1.8 5.5 1.8 1.01 (0.96 to 1.07)
Satisfaction with life 20.6 7.1 19.6 7.6 0.98 (0.97 to 1.00)** 0.97 (0.95 to 0.99)***
Sexual satisfaction 40.6 9.2 42.5 8.7 1.02 (1.01 to 1.04)*** 1.03 (1.01 to 1.04)***
*P<0.05, **p<0.01, ***p<0.001.
MSM, men who have sex with men; PrEP, pre-exposure prophylaxis; Ref, reference.
Table 1 Continued
with HIV, 6% were taking PrEP, and 5% reported having had
sexual contact without consent in the past 12 months. There
was no statistical difference between London (45%, n=121/264)
and outside of London (39%, n=545/1375) for SDU, and no
statistical difference between MSM reporting recent chemsex
between London (11%, n=30/263) and other densely populated
areas (9%, n=25/287).
SDU was reported by 41% of MSM: 28% of MSM had taken
amyl nitrates (poppers) immediately before/during sex; 13%
had been under the influence of cannabis during sex; 12% had
taken Viagra before or during sex; and 10% had taken cocaine
before or during sex. Less prevalent drugs taken before or during
sex were ecstasy (4%), GHB/GBL (3%), mephedrone (3%),
methamphetamine (2%), ketamine (2%), amphetamines (1%)
and other drug not specified (1%). GHB/GBL, ketamine, meth-
amphetamine and mephedrone were grouped as chemsex drugs,
and 99 (6%) MSM had engaged in chemsex drug use just before
or during sex.
Table 1 displays the multivariable analysis describing the
sexual and psychosocial characteristics of MSM who had
engaged in any SDU in the past 12 months, compared with
MSM who did not report any SDU. Due to the strong associ-
ation between the number of male anal intercourse partners
and number of condomless male anal intercourse partners in
the past 12 months, only the latter was included in the multi-
variable analysis, due to greater sexual risk. Factors associated
on 13 April 2019 by guest. Protected by copyright.http://sti.bmj.com/Sex Transm Infect: first published as 10.1136/sextrans-2018-053933 on 12 April 2019. Downloaded from
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HibbertMP, etal. Sex Transm Infect 2019;0:1–9. doi:10.1136/sextrans-2018-053933
Behaviour
Table 2 Univariate and multivariable analyses for factors associated with engaging in chemsex in the past 12 months compared with other
sexualised drug use
Univariate Adjusted model
MSM engaged in other sexualised
drug use (n=570) MSM engaged in chemsex (n=99) Odds Ratio (95% CI)
adjusted Odds Ratio (95%
CI)
n or mean % or SD n or mean % or SD Row %
Sexuality
Homosexual 497 87% 90 91% 15 Ref
Bisexual 40 7% 4 4% 9 0.55 (0.19 to 1.58)
Queer 23 4% 3 3% 12 0.72 (0.21 to 2.45)
Age group
18–24 154 27% 20 20% 11 Ref
25–34 198 35% 42 42% 18 1.63 (0.92 to 2.90)
35–49 152 27% 34 34% 18 1.72 (0.95 to 3.13)
≥50 65 11% 3 3% 4 0.36 (0.10 to 1.24)
Ethnicity
White 548 96% 89 90% 14 Ref
Person of colour 22 4% 10 10% 31 2.80 (1.28 to 6.11)*
Country of birth
UK 497 87% 80 81% 14 Ref Ref
Not UK 57 10% 19 19% 25 2.07 (1.17 to 3.66)* 2.02 (1.05 to 3.86)*
Education
University or higher 337 59% 64 65% 16 Ref
Qualifications at 18 154 27% 22 22% 13 0.75 (0.45 to 1.27)
Qualifications at 16
or lower
63 11% 12 11% 16 1.00 (0.51 to 1.97)
Work status
Full time 356 62% 70 71% 16 Ref
Part-time 38 7% 6 6% 14 0.80 (0.33 to 1.97)
Student 73 13% 6 6% 8 0.42 (0.18 to 1.00)
Unemployed 20 4% 4 4% 17 1.02 (0.34 to 3.07)
Other (sick leave,
retired, carer)
78 14% 13 13% 14 0.85 (0.45 to 1.61)
Relationship status
Living with partner 202 35% 31 31% 13 Ref
Relationship not living
with partner
105 18% 15 15% 13 0.93 (0.48 to 1.80)
Relationship with
multiple
14 2% 4 4% 22 1.85 (0.57 to 6.00)
Single 250 44% 49 49% 16 1.27 (0.78 to 2.07)
Population density per hectare
<5 126 22% 10 10% 7 Ref Ref
5–20 120 21% 7 7% 6 0.74 (0.27 to 1.99) 0.59 (0.21 to 1.69)
20–41 139 24% 27 27% 16 2.45 (1.14 to 5.26)* 1.86 (0.82 to 4.21)
>41 181 32% 55 56% 23 3.83 (1.88 to 7.80)*** 2.69 (1.26 to 5.74)*
Internalised
homophobia
Low 373 65% 71 72% 16 Ref
High 189 33% 24 24% 11 0.67 (0.41 to 1.09)
Discrimination
sexuality
None 294 52% 46 46% 14 Ref
Any setting 248 44% 49 49% 16 1.26 (0.82 to 1.95)
Perceived health
Fair/good/very good 499 88% 81 82% 14 Ref
Very poor/poor 72 13% 18 18% 20 1.54 (0.87 to 2.72)
Psychological distress
Normal 130 23% 23 23% 15 Ref
Moderate 131 23% 23 23% 15 0.99 (0.53 to 1.86)
Continued
on 13 April 2019 by guest. Protected by copyright.http://sti.bmj.com/Sex Transm Infect: first published as 10.1136/sextrans-2018-053933 on 12 April 2019. Downloaded from
6HibbertMP, etal. Sex Transm Infect 2019;0:1–9. doi:10.1136/sextrans-2018-053933
Behaviour
Univariate Adjusted model
MSM engaged in other sexualised
drug use (n=570) MSM engaged in chemsex (n=99) Odds Ratio (95% CI)
adjusted Odds Ratio (95%
CI)
n or mean % or SD n or mean % or SD Row %
Sexuality
High 133 23% 19 19% 13 0.81 (0.42 to 1.55)
Very high 172 30% 31 31% 15 1.02 (0.57 to 1.83)
Diagnosed STI
None 448 79% 63 64% 12 Ref
STI diagnosis 99 17% 36 36% 27 2.59 (1.63 to 4.12)***
Not stated 24 4% 0 0% 0
Attended
genitourinary medicine
No 186 33% 13 13% 7 Ref
Yes 374 65% 83 84% 18 3.18 (1.72 to 5.85)***
Not sure 7 1% 2 2% 22 4.09 (0.77 to 21.70)
Number of men anal intercourse in the past 12 months
0–1 175 31% 7 7% 4 Ref
2–5 171 30% 19 19% 10 2.78 (1.14 to 6.78)
6–10 105 18% 21 21% 17 5.00 (2.06 to 12.16)***
>10 119 21% 52 53% 30 10.92 (4.80 to 24.87)
Number of men without condom anal intercourse in the past 12 months
0–1 338 59% 23 23% 6 Ref Ref
2–5 143 25% 27 27% 16 2.78 (1.54 to 5.00)** 2.15 (0.85 to 5.41)
6–10 49 9% 14 14% 22 4.20 (2.03 to 8.70)*** 4.02 (1.60 to 10.12)**
>10 39 7% 35 35% 47 13.19 (7.08 to 24.56)*** 7.86 (3.38 to 18.30)***
Sexual contact without consent in the past 12 months
No 512 90% 83 84% 14 Ref
Yes 34 6% 7 7% 17 1.27 (0.55 to 2.96)
Unsure 15 3% 9 9% 38 3.70 (1.57 to 8.73)**
HIV status
Negative 443 78% 53 54% 11 Ref
Negative, on PrEP 50 9% 21 21% 30 3.51 (1.96 to 6.29)***
Positive 35 6% 20 20% 36 4.78 (2.57 to 8.87)***
Don’t know 43 8% 5 5% 10 0.97 (0.37 to 2.56)
Sexual self-efficacy
High 538 94% 77 78% 13 Ref Ref
Low 25 4% 19 19% 43 5.31 (2.79 to 10.10)*** 4.52 (2.18 to 9.40)***
Taken image or performance-enhancing drugs
in the past 12 months?
No 538 94% 91 92% 14 Ref
Yes 30 5% 6 6% 17 1.18 (0.48 to 2.92)
Body satisfaction 41.0 12.6 42.9 13.1 1.01 (1.00 to 1.03)
Loneliness score 5.5 1.8 5.5 1.7 1.00 (0.89 to 1.13)
Satisfaction with life 19.7 7.7 19 7.1 0.99 (0.96 to 1.02)
Sexual satisfaction 42.3 8.9 43.6 7.5 1.02 (0.99 to 1.04)
*P<0.05, **p<0.01, ***p<0.001.
MSM, men who have sex with men; PrEP, pre-exposure prophylaxis; Ref, reference.
Table 2 Continued
with SDU in the multivariable analysis were being aged 35 years
and over, having a recent STI diagnosis, recently attending a
GUM clinic, having a greater number of condomless male anal
intercourse partners, recent image and performance-enhancing
drug use, having a lower satisfaction with life and greater sexual
satisfaction.
This analysis was then repeated for factors associated with
chemsex compared with other SDU in the past 12 months
(table 2). Factors associated with chemsex in the multivariable
analysis were being a person of colour, living in a more densely
populated area, having six or more condomless male anal inter-
course partners and having low sexual self-efficacy.
Three-quarters (74%) of the sample had engaged in any type
of SDU or sex under the influence of alcohol. Figure 1 compares
the motivations for and effects of engaging in chemsex, other
SDU and sex under the influence of alcohol in the past 12
months. χ2 analyses showed MSM engaging in chemsex were
more likely to do so because it gave them an intense sexual expe-
rience, allowed them to have sex for longer, were more likely
to have sex without a condom and do things they would not do
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Behaviour
Figure 1 Comparing reasons for engagement and effect of chemsex, other sexualised drug use, and sex under the influence of alcohol. *P<0.05,
**p<0.01, ***p<0.001.
sober, compared with other SDU and those having sex under
the influence of alcohol. MSM engaging in chemsex were also
more likely to report engagement was having a negative impact
on their life, and were doing so because of pressure from friends.
DISCUSSION
This study investigated the sexual and psychosocial character-
istics associated with engaging in SDU and chemsex among an
internet sample of UK MSM, and provides novel insights into
how the relationships with well-being and self-efficacy vary
between these groups. Engaging in SDU was associated with
more condomless anal intercourse with male partners than those
who did not engage in SDU, and engaging in chemsex was asso-
ciated with more condomless anal intercourse than other types
of SDU. Engaging in SDU was also associated with the use of
image and performance-enhancing drugs in the past 12 months,
but this difference was not observed when comparing those who
engage in chemsex with engaging in other SDU.
This cross-sectional study obtained a large sample of MSM
from across the UK to investigate chemsex and SDU. Previous
research into SDU and chemsex has mostly been based in densely
populated areas, usually recruiting from sexual health clinics.3
It was observed that broad SDU did not differ by population
density, but chemsex was reported more often in densely popu-
lated areas, highlighting geographical differences in the type of
SDU MSM engage in. This is of significance to sexual health
clinics nationally, as both SDU and chemsex were associated with
sexual risks and issues around sexual consent.
While using Facebook as a method of recruitment enabled the
large sample size, the sample was slightly young and the sample
is biased to participants with social media accounts. Due to the
large proportion of MSM identifying as white, the results may
not be representative of MSM of colour, which has been noted as
an issue in other UK-based LGBT research.30 A possible way for
future research to overcome this is to use organisations specific
to LGBT people of colour. Being born outside the UK was a
predictor of engaging in chemsex; therefore, future research in
this area should aim to recruit MSM of colour, as well as those
being born outside of the UK, to investigate the possible intersec-
tionality between sexuality, ethnicity and country of birth.
Similar to previous research, MSM engaging in SDU were
more likely to have engaged in condomless anal intercourse.4 7 9 14
MSM engaging in SDU were also more likely to have attended
a GUM clinic in the past 12 months and received an STI diag-
nosis.7 10 11 However, when comparing MSM engaging in
chemsex with MSM engaging in other types of SDU, this differ-
ence did not hold at the multivariable level, possibly due to the
overlap with the number of condomless anal intercourse part-
ners. MSM engaging in chemsex were more likely to be taking
PrEP compared with MSM engaging in other SDU, which is
similar to the findings in Amsterdam,11 but possibly due to the
overlap between taking PrEP and number of condomless anal
intercourse partners; this was not significant at the multivariable
level.
Although the stigma of living with HIV has been suggested as
motivation for engaging in chemsex,15 living with HIV was not
significantly associated with SDU or chemsex once other factors
were controlled for, similar to other UK research.7 However,
this could be due to an overlap with confounding variables, and
due to the higher proportion of MSM living with HIV engaging
in chemsex, support services for MSM living with HIV need to
be aware of the possible impact of this behaviour. A previous
qualitative study had suggested internalised homophobia and
experiences of discrimination as possible reasons for engaging in
chemsex,15 but these were not observed here.
Engaging in SDU was associated with lower life satisfac-
tion, but there was no significant difference in life satisfaction
between those engaging in chemsex and those engaging in other
types of SDU. Previous research has mostly focused on the phys-
ical health effects of SDU and neglected possible psychological
associations. Additionally, MSM engaging in chemsex were more
likely to report their SDU having a negative impact on their life.
The proportion of MSM engaging in chemsex reporting a nega-
tive impact is similar to research in Ireland9; however, this is
the first study to investigate how this differs between chemsex,
other forms of SDU and sex under the influence of alcohol.
Those engaging in SDU reported greater sexual satisfaction,
compared with those not engaging in SDU, but no difference
was observed between engaging in chemsex and in other SDU,
although MSM engaging in chemsex were more likely to report
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8HibbertMP, etal. Sex Transm Infect 2019;0:1–9. doi:10.1136/sextrans-2018-053933
Behaviour
doing so because of the intense sexual experience and being able
to have sex for longer. This suggests the perceived benefits, risks
and possible negative impact from engaging in SDU and chemsex
are complex.
In the bivariate analyses, MSM engaging in SDU were more
likely to report having experienced or being unsure of having
sexual contact without consent in the past 12 months, and when
comparing chemsex with other SDU, MSM engaging in chemsex
were more likely to report being unsure of sexual contact without
consent. These associations did not remain in the multivariable
analyses, possibly due to small numbers reporting recent sexual
contact without consent, and this being associated with other
factors. Despite this, these findings still highlight a possible issue
of how consent is affected during SDU and chemsex.
These results highlighted how SDU and chemsex can impact
the health and well-being of MSM, and differences in motiva-
tions for engaging in these behaviours. While it is encouraging to
find a higher percentage of MSM engaging in SDU and chemsex
were more likely to take PrEP, further research is needed to
understand possible interactions between PrEP adherence, drug
interactions and possible barriers for MSM engaging in SDU and
chemsex to taking PrEP, due to the elevated sexual risk associ-
ated with these behaviours. Furthermore, these results should
promote awareness among clinicians around the issue of consent
and SDU, and ensure referral pathways and patient safeguarding
strategies are in place.
In conclusion, this research highlights a complex interaction
between motivations, perceived benefits and negative impact
for engaging in SDU and chemsex. Despite the vast majority of
participants stating they were content and in control of their sex
life, engaging in SDU was associated with a lower life satisfac-
tion and engaging in chemsex was associated with lower sexual
self-efficacy. Due to the associated sexual risk-taking, issues
around sexual consent and possible harms from drug use, it is
important to promote harm reduction among this population
(eg, condoms, PrEP, drug knowledge and safer drug use), while
having support services in place for anyone wanting to stop
or who are experiencing negative effects of engaging in these
behaviours.
Key messages
Motivations for and associated benefits and risks of
engagement in sexualised drug use and chemsex among men
who have sex with men (MSM) are complex.
Sexual assault was associated with sexualised drug use and
chemsex; therefore, greater awareness of this risk should be
promoted among MSM and support services.
Harm reduction should be promoted among MSM engaging
in sexualised drug use and chemsex, as well as referral
pathways for those experiencing negative effects.
Handling editor Dr Adam Huw Bourne
Acknowledgements The researchers would like to thank everyone who
participated in the survey, as well as CliniQ, COAST, GALOP, Gay Men’s Health
Collective and the National LGB&T Partnership for their contribution to the design
and recruitment for the survey.
Contributors MPH conducted the literature review and drafted the manuscript.
Design of the survey, data collection and statistical analysis were conducted by MPH,
with input and supervision from CEB, LAP and VDH. All authors contributed to and
approved the final draft.
Funding This study was funded as a PhD project by Liverpool John Moores
University.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval Ethical approval for this study was obtained from the Liverpool
John Moores University Research Ethics Committee (approval reference: 18/PHI/011).
Provenance and peer review Not commissioned; externally peer reviewed.
REFERENCES
1 Stall R, Purcell DW. Intertwining epidemics: a review of research on substance use
among men who have sex with men and its connection to the AIDS epidemic. AIDS
Behav 2000;4:181–92.
2 Halkitis PN, Parsons JT, Stirratt MJ. A double epidemic: crystal methamphetamine
drug use in relation to HIV transmission among gay men. Journal Of Homosexuality
2001;41:17–35.
3 Edmundson C, Heinsbroek E, Glass R, etal. Sexualised drug use in the United
Kingdom (UK): a review of the literature. International Journal of Drug Policy
2018;55:131–48.
4 Bourne Aetal. The Chemsex study: drug use in sexual settings among gay and
bisexual men in Lambeth, Southwark and Lewisham. London School of Hygiene and
Tropical Medicine, 2014.
5 Stuart D. Sexualised drug use by MSM: background, current status and response. HIV
Nursing 2013;13:6–10.
6 Ahmed A-K, Weatherburn P, Reid D, etal. Social norms related to combining drugs
and sex (“chemsex”) among gay men in South London. International Journal of Drug
Policy 2016;38:29–35.
7 Hegazi A, Lee MJ, Whittaker W, etal. Chemsex and the city: sexualised substance use
in gay bisexual and other men who have sex with men attending sexual health clinics.
Int J STD AIDS 2017;28:362–6.
8 Schmidt AJ, Bourne A, Weatherburn P, etal. Illicit drug use among gay and
bisexual men in 44 cities: findings from the European MSM Internet Survey (EMIS).
International Journal of Drug Policy 2016;38:4–12.
9 Glynn RW, Byrne N, O’Dea S, etal. Chemsex, risk behaviours and sexually transmitted
infections among men who have sex with men in Dublin, Ireland. International
Journal of Drug Policy 2018;52:9–15.
10 Ottaway Z, Finnerty F, Buckingham T, etal. Increasing rates of reported chemsex/
sexualised recreational drug use in men who have sex with men attending for
postexposure prophylaxis for sexual exposure. Sex Transm Infect 2017;93.
11 Drückler S, van Rooijen MS, de Vries HJC. Chemsex among men who have sex with
men: a Sexualized drug use survey among clients of the sexually transmitted infection
outpatient clinic and users of a gay dating APP in Amsterdam, the Netherlands. Sex
Transm Dis 2018;45:325–31.
12 Daskalopoulou M, Rodger A, Phillips AN, etal. Recreational drug use, polydrug use,
and sexual behaviour in HIV-diagnosed men who have sex with men in the UK:
results from the cross-sectional ASTRA study. Lancet HIV 2014;1:e22–31.
13 Pufall EL, Kall M, Shahmanesh M, etal. Sexualized drug use (’chemsex’) and
high-risk sexual behaviours in HIV-positive men who have sex with men. HIV Med
2018;19:261–70.
14 Melendez-Torres GJ, Hickson F, Reid D, etal. Findings from within-subjects
comparisons of drug use and sexual risk behaviour in men who have sex with men in
England. Int J STD AIDS 2017;28:250–8.
15 Weatherburn P, Hickson F, Reid D, etal. Motivations and values associated with
combining sex and illicit drugs (’chemsex’) among gay men in South London: findings
from a qualitative study. Sex Transm Infect 2017;93:203–6.
16 Chard AN, Metheny NS, Sullivan PS, etal. Social stressors and intoxicated sex among
an online sample of men who have sex with men (MSM) drawn from seven countries.
Subst Use Misuse 2018;53:42–50.
17 Bourne A, Reid D, Hickson F, etal. "Chemsex" and harm reduction need among gay
men in South London. Int J Drug Policy 2015;26:1171–6.
18 Prestage G, Hammoud M, Jin F, etal. Mental health, drug use and sexual risk behavior
among gay and bisexual men. Int J Drug Policy 2018;55:169–79.
19 Glynn RW, Byrne N, O’Dea S, O’Dea S, etal. Chemsex, risk behaviours and sexually
transmitted infections among men who have sex with men in Dublin, Ireland. Int J
Drug Policy 2018;52:9–15.
20 PHE, Producing modelled estimates of the size of the lesbian, gay and bisexual (LGB)
population of England2017
21 Weatherburn P, Schmidt AJ, Hickson F, etal. The European Men-Who-Have-Sex-With-
Men Internet Survey (EMIS): design and methods. Sexuality Research and Social Policy
2013;10:243–57.
22 Ryan KE, Wilkinson AL, Pedrana A, etal. Implications of survey labels and
categorisations for understanding drug use in the context of sex among gay and
bisexual men in Melbourne, Australia. Int J Drug Policy 2018;55:183–6.
23 Stulhofer A, Buško V, Brouillard P. Development and bicultural validation of the new
sexual satisfaction scale. J Sex Res 2010;47:257–68.
24 Alvy LM, McKirnan DJ, Mansergh G, etal. Depression is associated with sexual risk
among men who have sex with men, but is mediated by cognitive escape and self-
efficacy. AIDS Behav 2011;15:1171–9.
on 13 April 2019 by guest. Protected by copyright.http://sti.bmj.com/Sex Transm Infect: first published as 10.1136/sextrans-2018-053933 on 12 April 2019. Downloaded from
9
HibbertMP, etal. Sex Transm Infect 2019;0:1–9. doi:10.1136/sextrans-2018-053933
Behaviour
25 Herek GMetal. Correlates of internalized homophobia in a community sample
of lesbians and gay men. Journal of the Gay and Lesbian Medical Association
1998;2:17–26.
26 Hyde JS, McKinley NM. A measure of objectified body consciousness for preadolescent
and adolescent youth. Psychology of Women Quarterly 2006;30:65–76.
27 Hughes ME, Waite LJ, Hawkley LC, etal. A short scale for measuring loneliness in
large surveys: results from two population-based studies. Res Aging 2004;26:655–72.
28 Diener E, Emmons RA, Larsen RJ, etal. The satisfaction with life scale. J Pers Assess
1985;49:71–5.
29 Andrews G, Slade T. Interpreting scores on the Kessler psychological distress scale
(K10). Aust N Z J Public Health 2001;25:494–7.
30 McNeil Jetal. Trans mental health study 2012. Scottish Transgender Alliance, 2012.
on 13 April 2019 by guest. Protected by copyright.http://sti.bmj.com/Sex Transm Infect: first published as 10.1136/sextrans-2018-053933 on 12 April 2019. Downloaded from
... 16,17 Therefore, it should be recognized that the sexualized use of chems may constitute a satisfactory experience for some men. 18 Although pleasure represents a major component of substance consumption in general, in chemsex-related contexts it may acquire specific meanings. Pleasure is expressed not only in using chems themselves, but also in their combination with sex. ...
... Thus, the difficulties related to desire, arousal, and performance anxiety could be made worse in some cases, increasing the gap between wanted and acted-out sex. 18 Many men find it difficult, especially after a period of exclusive chemsex behavior, to restore their sexual desire and accomplish a good enough level of arousal, necessary to have a satisfactory sexual experience. This element may be central for sexual health professionals, as the difficulty in regaining a satisfying sexuality without substances can represent one of the main reasons for clinical requests in this cohort of men. ...
... Thus, the possibility for specific counseling for tailored safer sex practice should be suggested in MSM who engage in chemsex. 18 A novel experience that emerged in the narratives is the "solo chemsex," practiced as an element of discovery and selfexploration during masturbation. It is possible to speculate that there may be additional risks related to the consumption of substances alone, because the group or the partner can act as support and first aid in the case of adverse effects. ...
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Objectives Most studies on chemsex focus on the health risks associated with the practice, whereas less attention has been paid to the perception of sexual gratification.The purpose of this study was to explore the effects of chemsex substances on sexual response, motivations to engage in chemsex and the relationship with sober sex. Methods Thirty-one Italian cisgender MSM involved in sexualized drug use were interviewed and transcripts were thematically analysed. An ad hoc grid exploring sociodemographic data, chemsex sexual experience, motives, and relationships with sober sex was used during telephone-based interviews. Results Participants showed significant individual differences in how chems may affect their sexual experience. The most reported effects were an increase in sexual desire and subjective arousal, access to higher disinhibition, possible erection and ejaculation difficulties, significant extension of the sexual experience duration, and an intensified perception of intimacy and pleasure. All the positive outcomes of substances on sex creates a great curiosity around chemsex, which is among the primary motives to engage in chemsex for the first time. Over time, other motives may emerge, also connected to substance abuse and craving. Some men reported to be motivated by their partners and friends and to use chemsex to cope with depressive mood/anxiety symptoms, stress and sexual problems. Many differences were reported between chemsex and sober sex. Chemsex seems to embody the idea of transgressive and exciting sex, while sober sex is outlined as a more intimate encounter, that can be significantly affected by performance anxiety. Conclusions These results offer some new perspectives that may add interesting information to the literature and be fundamental for future prevention and harm-reduction projects. The promotion of safer sexual behaviour should contemplate an in-depth discussion and recognition of both pleasurable and distressing aspects of chemsex sexual experience, its motivations over time and perceived differences with sober sex. Conflicts of Interest none
... Chemsex is defined by the voluntary use of specific drugs before or during planned sex to initiate, facilitate, prolong, and/or intensify sexual activity and pleasure. The effects sought in the practice of chemsex are mainly as follows (Ahmed et al. 2016;Deimel et al. 2016;Weatherburn et al. 2017;Bui et al. 2018;Glynn et al. 2018;Hammoud et al. 2018;Lim et al. 2018;Tan et al. 2018;Hibbert et al. 2019): ...
... Living with HIV has been linked to chemsex in many studies (for review see Incera-Fern andez et al. 2021). Individuals with HIV who engage in chemsex are typically slightly older than those who engage without HIV (Hibbert et al. 2019;Blomquist et al. 2020). Regarding sexual practices, two-thirds of HIVpositive individuals reported any anal intercourse with casual partners; of these men, three-quarters reported one or more condomless acts in the previous year. ...
... Most individuals engaging in chemsex do not self-identify with problematic drug use and often report no negative consequences in everyday life. However, the frequent association of chemsex with lower life and sexual satisfaction suggests that psychosocial support or treatment may be needed for some individuals engaging in chemsex (Hibbert et al. 2019). Chemsex is not a psychiatric disorder and may be considered a syndromal description. ...
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Objectives The current guidelines aim to evaluate the role of pharmacological agents in the treatment of patients with compulsive sexual behaviour disorder (CSBD). They are intended for use in clinical practice by clinicians who treat patients with CSBD. Methods An extensive literature search was conducted using the English-language-literature indexed on PubMed and Google Scholar without time limit, supplemented by other sources, including published reviews. Results Each treatment recommendation was evaluated with respect to the strength of evidence for its efficacy, safety, tolerability, and feasibility. Psychoeducation and psychotherapy are first-choice treatments and should always be conducted. The type of medication recommended depended mainly on the intensity of CSBD and comorbid sexual and psychiatric disorders. There are few randomised controlled trials. Although no medications carry formal indications for CSBD, selective-serotonin-reuptake-inhibitors and naltrexone currently constitute the most relevant pharmacological treatments for the treatment of CSBD. In cases of CSBD with comorbid paraphilic disorders, hormonal agents may be indicated, and one should refer to previously published guidelines on the treatment of adults with paraphilic disorders. Specific recommendations are also proposed in case of chemsex behaviour associated with CSBD. Conclusions An algorithm is proposed with different levels of treatment for different categories of patients with CSBD.
... Íncera-Fernández et al. demonstrated in a recent review that MSM who combine drugs with sex report higher levels of depression, anxiety, and dependence symptoms, although some studies did not confirm these results [18]. Additionally, an online survey of 1648 MSM in the UK showed a significant association between sexualized substance use and low life satisfaction, as well as sexual self-efficacy [19]. Furthermore, a recently published systematic review revealed a significant link between the practice of chemsex and the development of psychosis [20]. ...
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... Psychoactive substances adversely affect users' capacity to perceive and respond to risks during sexual encounters, leading to high-risk sexual practices 51 and infection with HIV and other STIs 52 . In the present study, onethird of MSM took sexualized drug within six months, which is higher than the reported value in Hong Kong 2018 (14.1%) 53 and lower than those in UK (41%) 54 and Australia (54%) 55 . Mathematical models suggested that achieving 75% PrEP coverage among high-risk HIV-negative MSM in China would prevent 25.7% of new HIV infections among all MSM 56 . ...
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... Numerous studies have shown that self-efficacy plays an important role in abstinence, substance relapse, and adopting harm reduction measures [84,85]. More specifically, a UK study shows that engaging in chemsex is associated with lower sexual self-efficacy [86]. A study among MSM who had tested positive for HIV and who were using methamphetamine shows that being convinced to be able to say no to drugs (drug assertiveness skills) was associated with reduced frequency and amount of drug use as well as less sexual sensation seeking and unprotected sex [87]. ...
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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
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This chapter provides HIV advanced clinical practitioners (ACP) with a foundation to working with patients to improve and maintain their sexual health (SH). It will draw in on the knowledge, skills, and behaviours that advanced clinical practitioner should have in relation to sexual health, considering not just Sexually Transmitted Infections (STIs) and contraception, but other aspects of sexual health, including sexual dysfunction (SD) and sexualised drug use (SDU). It will also focus on the advanced nursing role in promoting, developing, and leading sexual health services within the HIV setting, providing some examples service provision. It should be acknowledged however, that the confines of the chapter prevent detailed and contemporary guidance of the specific clinical management, and further information should be sought from the relevant national guidelines. The chapter begins by defining sexual health and exploring the effects and impact of poor sexual health sexual health for people living with HIV (PLWH). It goes on to provide an overview of the common sexually transmitted infections, contraceptive methods, and sexual dysfunction. Finally, it describes testing, screening, and the management of STIs, and explores service provision models to meet the sexual health needs of PLWHIV. To start with, it would be useful to understand what sexual health is, and why it is important.
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Background: The prevalence of chemsex has been reported by multiple systematic reviews among men who have sex with men (MSM) focussing predominantly on the Global North. An Asian perspective with meta-analytical evidence is missing. This meta-analysis summarised the prevalence of substance use associated with chemsex, and chemsex activity among MSM and MSM sub-populations in Asia, as well as the likelihood for chemsex among MSM living with or without HIV. Methods: We utilized PubMed, Web of Science and medRxiv to search for literature describing chemsex and its associated substance use among MSM and MSM sub-populations in Asia from January 1, 2010 to November 1, 2021 to conduct three meta-analyses with both frequentist and Bayesian approaches. Results: We identified 219 studies and included 23 in the meta-analysis. Based on the frequentist models, methamphetamine was the default substance associated with chemsex among MSM in Asia (prevalence = 0.16, 95 %CI:0.09-0.22), followed by GHB/GBL (prevalence = 0.15, 95 %CI:0.03-0.27) and ketamine (prevalence = 0.08, 95 %CI:0.04-0.12), but hardly any cocaine (prevalence = 0.01, 95 %CI:0.00-0.03). Compared to a general MSM population (prevalence = 0.19, 95 %CI:0.15-0.23), MSM engaging in transactional sex showed a higher prevalence of chemsex (MSM sex work clients [prevalence = 0.28, 95 %CI:0.11-0.45]; MSM sex worker [prevalence = 0.28, 95 %CI:0.17-0.26]). MSM living with HIV also showed higher odds of chemsex activity (OR = 3.35, 95 %CI:1.57-7.10), compared to MSM living without HIV. Both meta-analytic models converged, indicating robust evidence. Conclusions: Our meta-analyses showed that chemsex is not uncommon among MSM, and MSM engaging in transactional sex in Asia. We confirmed that MSM living with HIV have a higher likelihood of engaging in chemsex, too. Chemsex prevention and management strategies in Asia should be adjusted accordingly.
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Objectives: The incidence of sexually transmitted infections (STIs) and HIV infection remains high in gay, bisexual, and other men who have sex with men (MSM) in the UK, and sexualized drug use ("chemsex") and injecting drug use ("slamsex") may play a part in this. We aimed to characterize HIV-positive MSM engaging in chemsex/slamsex and to assess the associations with self-reported STI diagnoses and sexual behaviours. Methods: Data from a 2014 survey of people attending HIV clinics in England and Wales were linked to clinical data from national HIV surveillance records and weighted to be nationally representative. Multivariable logistic regression assessed the associations of chemsex and slamsex with self-reported unprotected anal intercourse (UAI), serodiscordant UAI (sdUAI) (i.e. UAI with an HIV-negative or unknown HIV status partner), sdUAI with a detectable viral load (>50 HIV-1 RNA copies/mL), hepatitis C, and bacterial STIs. Results: In the previous year, 29.5% of 392 sexually active participants engaged in chemsex, and 10.1% in slamsex. Chemsex was significantly associated with increased odds of UAI [adjusted odds ratio (AOR) 5.73; P < 0.001], sdUAI (AOR 2.34; P < 0.05), sdUAI with a detectable viral load (AOR 3.86; P < 0.01), hepatitis C (AOR 6.58; P < 0.01), and bacterial STI diagnosis (AOR 2.65; P < 0.01). Slamsex was associated with increased odds of UAI (AOR 6.11; P < 0.05), hepatitis C (AOR 9.39; P < 0.001), and bacterial STI diagnosis (AOR 6.11; P < 0.001). Conclusions: Three in ten sexually active HIV-positive MSM engaged in chemsex in the past year, which was positively associated with self-reported depression/anxiety, smoking, nonsexual drug use, risky sexual behaviours, STIs, and hepatitis C. Chemsex may therefore play a role in the ongoing HIV and STI epidemics in the UK.
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Objectives: Chemsex (i.e., drug use during sex) is practiced by some men who have sex with men (MSM) and is associated with high-risk behavior. In a cross-sectional study at the sexually transmitted infection (STI) clinic of Amsterdam, we explored chemsex practices, risk behavior, and STI prevalence. Method: A survey on chemsex (γ-hydroxybutyrate, crystal methamphetamine, and/or mephedrone) was offered to clinic clients during routine STI screening and to Amsterdam users of a gay online dating app. Associations were assed using χ test and multivariable regression. Results: Chemsex in the past 6 months was practiced by 866 (17.6%) of 4925 MSM clients and by 159 (1.5%) of 10857 non-MSM clients. Among gay dating app users, the proportion that reported chemsex engagement was higher than among MSM visiting the STI clinic (29.3% [537/1832] vs. 17.6%; P < 0.001). Chemsex was a significant risk factor for bacterial STI in HIV-negative MSM visiting the STI clinic (adjusted odd ratio, 1.5; 95% confidence interval, 1.2-1.8), but not in HIV-positive MSM. A majority practiced chemsex once a month or less, and 87.0% reported sex without drug use in the past month. Conclusions: In Amsterdam, chemsex is frequently practiced and significantly associated with bacterial STI in HIV-negative MSM but not in HIV-positive MSM. Future prevention strategies to reduce STI incidence should especially target HIV-negative MSM engaging in chemsex.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
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Sexualised recreational drug use or chemsex is associated with an increase in sexual risk-taking behaviours in men who have sex with men (MSM).1 Chemsex is associated with group sex and multiple sexual partners, serodiscordant condomless sex and STI transmission.1–3 Chemsex is, therefore, an important public health issue among MSM and may result in an increase in HIV-negative men attending for postexposure prophylaxis for sexual exposure (PEPSE). As part of a local audit into …
Article
Background: Sexualised drug use (SDU) refers to the use of drugs in a sexual context. This includes 'Chemsex'- the use of drugs (specifically crystal methamphetamine, GHB/GBL and mephedrone) before or during planned sexual activity to sustain, enhance, disinhibit or facilitate the experience. Here we aimed to synthesise available UK prevalence data for Chemsex, SDU and the use of Chemsex drugs in an undefined context (CDU) in men who have sex with men (MSM). Methods: Papers published between January 2007 and August 2017 reporting Chemsex, SDU and/or Chemsex drug use (CDU) prevalence in MSM were identified through PubMed. Citations were searched for further eligible publications. We also conducted a review of national surveillance data, extracting prevalence data for Chemsex, SDU or CDU. Synthesized data were then assessed to determine the time at which these drugs were taken, in this case just prior to or during sexual activity (event-level). Results: Our search identified 136 publications, of which 28 were included in the final data synthesis. Three of the four surveillance systems assessed provided SDU or CDU data in MSM. Few publications included event-level data for Chemsex (n = 4), with prevalence estimates ranging from 17% among MSM attending sexual health clinics (SHC) to 31% in HIV-positive MSM inpatients. Prevalence estimates for SDU (n = 7 publications) also varied considerably between 4% in MSM receiving HIV care to 41% among MSM attending SHC for HIV post-exposure prophylaxis (PEP). Eighteen publications provided data for CDU. Conclusion: Prevalence estimates varied considerably due to differences in the definition used and population assessed. Standardised definitions and studies with representative national samples of MSM are required to improve our understanding of the extent of Chemsex and its associated risks. Longitudinal event-level data for SDU and Chemsex are needed to monitor impact of interventions.
Article
Background: Compared to the general population, among gay and bisexual men (GBM) prevalence rates of anxiety and depression, and of drug use, are high. Objective: This paper explores the relationship between mental health, sexual risk behavior, and drug use among Australian GBM. We identify factors associated with indicators of poor mental health. Methods: Between September 2014 and July 2017, 3017 GBM responded to measures of anxiety and depression in an online cohort study of drug use. Results: Mean age was 35.3 years (SD 12.8). 17.9% screened positive for current moderate-severe anxiety and 28.3% for moderate-severe depression. The majority (52.2%) reported use of illicit drugs in the previous six months, including 11.2% who had used methamphetamine. One third had high (20.4%) or severe (10.6%) risk levels of alcohol consumption, and 18.3% who were current daily smokers. Most illicit drug use in general was not associated with either anxiety or depression, but men who used cannabis were more likely to show evidence of depression (p = 0.005). Among recent methamphetamine users, 28.0% were assessed as dependent: dependent users were more likely to show evidence of both depression and anxiety than were non-dependent users. High or severe risk drinking was associated with depression and daily tobacco use was associated with both anxiety and depression. Depression and anxiety was associated with: less personal support, viewing oneself as 'feminine', and being less socially engaged with gay men. Sexual risk behavior was not associated with either depression or anxiety. Conclusion: Prevalence of anxiety and depression was high, as was prevalence of licit and illicit drug use. Substance use was associated with anxiety and depression only when the use was considered problematic or dependent. Social isolation and marginalization are strong drivers of poor mental health, even within this population for whom anxiety and depression are common.
Article
Background: Reliably measuring drug use by gay, bisexual and other men who have sex with men (GBM) in the context of sex can inform sexual health service responses. We report changing drug use patterns among GBM testing for HIV at a community-based service in Melbourne in response to behavioural survey modifications. Methods: Surveys were completed by GBM prior to all HIV tests. Survey one asked about use of "party drugs for the purpose of sex" and survey two asked about specific drug use (alcohol, amyl nitrate, methamphetamine, cocaine, ecstasy, GHB, Viagra®/Cialis®) before or during sex. Differences in drug use prevalence and demographic and sexual risk correlates are reported. Results: Reported drug use increased from 16.9% in survey one to 54.0% in survey two. Among GBM completing both surveys, 45% who reported no drug use in survey one reported drug use in survey two. Drug use was associated with high HIV risk behaviours across both surveys. Conclusion: Survey modification improved ascertainment of drug use in the context of sex among GBM. Continued monitoring of drug use in this setting will improve our understanding the relationship between use of specific drugs and sexual health and help inform client focused health promotion.
Article
Background: Drug use for or during sex ('chemsex') among MSM has caused concern, because of the direct effects of the drugs themselves, and because of an increased risk of transmission of sexually transmitted infections (STIs). This study aimed to assess the prevalence of chemsex, associated behaviours and STIs among attendees at Ireland's only MSM-specific sexual health clinic in Dublin over a six week period in 2016. Methods: The questionnaire collected demographic data, information on sexuality and sexual practice, self-reported history of treatment for STIs, and chemsex use. Key variables independently associated with treatment for STIs over the previous 12 months were identified using multivariable logistic regression. Results: The response rate was 90% (510/568). One in four (27%) reported engaging in chemsex within the previous 12 months. Half had taken ≥2 drugs on his last chemsex occasion. One in five (23%) reported that they/their partners had lost consciousness as a result of chemsex. Those engaging in chemsex were more likely to have had more sexual partners(p<0.001), more partners for anal intercourse (p<0.001) and to have had condomless anal intercourse(p=0.041). They were also more likely to report having been treated for gonorrhoea over the previous 12 months (adjusted OR 2.03, 95% CI 1.19-3.46, p=0.009). One in four (25%) reported that chemsex was impacting negatively on their lives and almost one third (31%) reported that they would like help or advice about chemsex. Conclusion: These results support international evidence of a chemsex culture among a subset of MSM. They will be used to develop an effective response which simultaneously addresses addiction and sexual ill-health among MSM who experience harm/seek help as a consequence of engagement in chemsex.
Article
Background: Rates of drug and alcohol use are higher among men who have sex with men (MSM) than the general adult male population, and are often associated with increased sexual risk-taking. Objectives: We aim to examine the prevalence of drunk or high sex and their associations with socio-demographic characteristics, gay social network size, and social stress among an online sample of MSM drawn from seven countries. Methods: Sexually-active MSM aged over 18 residing in Australia, Brazil, Canada, South Africa, Thailand, the United Kingdom, or the United States were recruited through Facebook for a quantitative survey (n = 2,403) in 2012. Two outcomes were examined via logistic regression: reporting being buzzed/drunk at last sex, and reporting being high at last sex. Results: Results highlight the role of social stressors in shaping drug use among MSM. Results were context-specific, though commonalities were seen across countries. Being in a male-male sexual relationship was associated with lower odds of being buzzed/drunk at last sex in five countries. Higher scores on measures of external homonegative discrimination and internalized homonegativity were associated with greater odds of reporting being high at last sex in three countries. Conclusions/Importance: Social networks and minority stressors can have significant effects on drug use and sex while drunk or high. This points to the importance of focusing on structural issues when designing interventions for MSM aimed at reducing the transmission of HIV and other STIs.
Article
Background: 'Chemsex' refers to the combining of sex and illicit drugs, typically mephedrone, GHB/GBL, and crystal methamphetamine. While numerous studies have examined the role of illicit drugs in sexual risk taking, less attention has been paid to the broader social context and structures of their use among gay men. Given their established role in influencing health related behaviour, this study sought to examine the nature and operation of social norms relating to chemsex among gay men residing in South London. Methods: In-depth interviews were conducted with thirty self-identifying gay men (age range 21-53) who lived in three South London boroughs, and who had used either crystal methamphetamine, mephedrone or GHB/GBL either immediately before or during sex with another man during the previous 12 months. Data were subjected to a thematic analysis. In addition, two focus groups (n=12) were conducted with gay men from the community to explore group-level perceptions of drug use and chemsex. Results: Chemsex was perceived as ubiquitous amongst gay men by a majority of participants, who additionally described a variety of ways it is arranged (including mobile apps) and a variety of settings in which it occurs (including commercial and private settings). Chemsex was associated with unique sexual permissions and expectations, although participants also described having personal boundaries with respect to certain drug and sex practices, suggesting within-group stigmatisation. Conclusion: This study clearly documents exaggerated beliefs about the ubiquity of chemsex, shifts in the perceived normativity of certain settings and means to facilitate chemsex, and attitudes revealing stigma against certain types of chemsex and men who engage in it. There is a need for health promotion interventions to challenge social norms relating to drug use generally, and chemsex specifically, and for such interventions to make use of the online settings in which chemsex is often facilitated.
Article
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.