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Abstract
Social norms can greatly influence people’s health-related choices and behaviours. In the last few years, scholars and practitioners working in low- and mid-income countries (LMIC) have increasingly been trying to harness the influence of social norms to improve people’s health globally. However, the literature informing social norm interventions in LMIC lacks a framework to understand how norms interact with other factors that sustain harmful practices and behaviours. This gap has led to short-sighted interventions that target social norms exclusively without a wider awareness of how other institutional, material, individual and social factors affect the harmful practice. Emphasizing norms to the exclusion of other factors might ultimately discredit norms-based strategies, not because they are flawed but because they alone are not sufficient to shift behaviour. In this paper, we share a framework (already adopted by some practitioners) that locates norm-based strategies within the wider array of factors that must be considered when designing prevention programmes in LMIC.
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Affiliation(s)
- Beniamino Cislaghi
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Lori Heise
- Johns Hopkins Bloomberg School of Public Health and Johns Hopkins School of Nursing, Baltimore, MD, USA
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Griffin M, Callander D, Duncan DT, Palamar JJ. Differential Risk for Drug Use by Sexual Minority Status among Electronic Dance Music Party Attendees in New York City. Subst Use Misuse 2020; 55:230-240. [PMID: 31530057 PMCID: PMC6980202 DOI: 10.1080/10826084.2019.1662811] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background: Drug use among electronic dance music (EDM) party attendees is common; however, studies are needed to examine associations between drug use and sexual orientation as this can inform prevention and harm reduction efforts in the lesbian, gay, and bisexual (LGB) community. Methods: Data were examined from a repeated cross-sectional study of 3066 young adult EDM party attendees surveyed entering nightclubs and dance festivals in New York City between 2016 and 2018. Of these participants, 277 identified as gay/lesbian, 293 identified as bisexual, and 83 identified as other sexuality. We examined how sexual orientation relates to past-year use of various 'traditional' drugs (e.g., ecstasy/MDMA/Molly) and new psychoactive substances (NPS; e.g., "bath salts") in a bivariable and multivariable manner, stratified by sex. Results: Compared to heterosexual males, gay males were at higher odds for use of ecstasy, GHB, and methamphetamine; bisexual males were at higher odds for use of LSD and unknown powders, and males identifying as "other" sexuality were at higher odds for use of mushrooms and 2C drugs. Compared to heterosexual females, lesbians were at higher odds for use of mushrooms and GHB; bisexual females were at higher odds for use of cocaine, LSD, mushrooms, and tryptamines, and females identifying as "other" sexuality were at higher odds for use of cocaine and tryptamines. Conclusions: We determined differential risk of use of different drugs among those who attend EDM parties according to sexual orientation. Findings can be used to tailor prevention messaging to specific groups within the LGB community.
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Affiliation(s)
- Marybec Griffin
- School of Public Health, Rutgers University, Newark, New Jersey, USA
| | - Denton Callander
- Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - Dustin T Duncan
- Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - Joseph J Palamar
- Department of Population Health, New York University School of Medicine, New York, New York, USA
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O'Halloran C, Rice B, White E, Desai M, Dunn DT, McCormack S, Sullivan AK, White D, McOwan A, Gafos M. Chemsex is not a barrier to self-reported daily PrEP adherence among PROUD study participants. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 74:246-254. [PMID: 31739177 PMCID: PMC6913514 DOI: 10.1016/j.drugpo.2019.10.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/12/2019] [Accepted: 10/15/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) is a novel HIV prevention method whereby HIV-negative individuals take the drugs tenofovir and emtricitabine to prevent HIV acquisition. Optimal adherence is critical for PrEP efficacy. Chemsex describes sexual activity under the influence of psychoactive drugs, in the UK typically; crystal methamphetamine, gamma-hydroxybutyrate(GHB) and/or mephedrone. Chemsex drug use has been associated with increased HIV transmission risk among gay, bisexual and other men who have sex with men (GBM) and poor ART adherence among people living with HIV. This study assessed whether self-reported chemsex events affected self-reported daily PrEP adherence among PROUD study participants. METHODS The PROUD study was an open-label, randomised controlled trial, conducted in thirteen English sexual health clinics, assessing effectiveness of TruvadaⓇ-PrEP among 544 HIV-negative GBM. The study reported an 86% risk-reduction of HIV from daily PrEP. Participants were asked about chemsex engagement at follow-up visits. Monthly self-reports of missed PrEP tablets were aggregated to assess adherence between visits. Univariable and multivariable regression analyses were performed to test for associations between chemsex and reporting less than seven out of seven intended doses(<7/7ID) in the 7 days before and/or after last condomless anal intercourse(CAI). RESULTS 1479 follow-up visit forms and 2260 monthly adherence forms from 388 participants were included in the analyses, with 38.5% visit forms reporting chemsex since last visit and 29.9% follow-up periods reporting <7/7ID. No statistically significant associations were observed between reporting <7/7ID and chemsex (aOR=1.29 [95% CI 0.90-1.87], p = 0.168). Statistically significant associations were seen between reporting <7/7ID and participants perceiving that they would miss PrEP doses during the trial, Asian ethnicity, and reporting unemployment at baseline. CONCLUSIONS These analyses suggest PrEP remains a feasible and effective HIV prevention method for GBM engaging in chemsex, a practise which is prevalent in this group and has been associated with increased HIV transmission risk.
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Affiliation(s)
- Charlotte O'Halloran
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom.
| | - Brian Rice
- LSHTM, Faculty of Public Health and Policy, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom.
| | - Ellen White
- Medical Research Council Clinical Trials Unit, 90 High Holborn, London WC1V 6LJ, United Kingdom.
| | - Monica Desai
- University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom.
| | - David T Dunn
- Medical Research Council Clinical Trials Unit, 90 High Holborn, London WC1V 6LJ, United Kingdom.
| | - Sheena McCormack
- Medical Research Council Clinical Trials Unit, 90 High Holborn, London WC1V 6LJ, United Kingdom.
| | - Ann K Sullivan
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, United Kingdom.
| | - David White
- Department of Infection, Hawthorn house, Heartlands Hospital, University of Birmingham Hospitals NHS Trust, Birmingham B9 5SS, United Kingdom.
| | - Alan McOwan
- Chelsea and Westminster Hospital NHS Foundation Trust, 56 Dean Street, London W1D 6AE, United Kingdom.
| | - Mitzy Gafos
- LSHTM, Faculty of Public Health and Policy, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom.
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Curtis TJ, Rodger AJ, Burns F, Nardone A, Copas A, Wayal S. Patterns of sexualised recreational drug use and its association with risk behaviours and sexual health outcomes in men who have sex with men in London, UK: a comparison of cross-sectional studies conducted in 2013 and 2016. Sex Transm Infect 2019; 96:197-203. [PMID: 31744928 PMCID: PMC7167300 DOI: 10.1136/sextrans-2019-054139] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 09/26/2019] [Accepted: 10/25/2019] [Indexed: 11/30/2022] Open
Abstract
Objective London has one of the highest identified prevalence of chemsex (sexualised recreational drug use) among men who have sex with men (MSM) in Europe. We examine MSM’s patterns of chemsex and its association with HIV/STI risk behaviours, STI diagnoses, and sexual healthcare-seeking behaviours, including if HIV testing behaviour met UK national guidelines (3-monthly if engaging in chemsex). Methods Cross-sectional survey data from 2013 (n=905) and 2016 (n=739) were collected using anonymous, self-administered questionnaires from MSM recruited in commercial gay venues in London, UK. Descriptive and multivariable analyses, stratified by self-reported HIV status, were conducted. Adjusted prevalence ratios (aPR) with 95% confidence intervals (CI) were calculated. Results Comparing the 2013 and 2016 surveys; chemsex prevalence in the past year remained stable, in both HIV-negative/unknown-status MSM (20.9% in 2013 vs 18.7% in 2016, p=0.301) and HIV-positive MSM (41.6% in 2013 vs 41.7% in 2016, p=0.992). Combined 2013-2016 data showed that compared to other MSM, those reporting chemsex were more likely to report HIV/STI risk behaviours, including condomless anal intercourse with serodifferent HIV-status partners (HIV-negative/unknown-status men: aPR 2.36, 95% CI 1.68-3.30; HIV-positive men: aPR 4.19, 95% CI 1.85-9.50), and STI diagnoses in the past year (HIV-negative/unknown-status men: aPR 2.10, 95% CI 1.64-2.69; HIV-positive men: aPR 2.56, 95% CI 1.57-4.20). 68.6% of HIV-negative/unknown-status men reporting chemsex attended sexual health clinics and 47.6% had tested for HIV more than once in the past year. Conclusions Chemsex in London MSM remained stable but high, particularly among HIV-positive men. Irrespective of HIV status, chemsex was associated with engagement in HIV/STI risk behaviours. Frequency of HIV testing in the past year among HIV-negative/unknown-status men was below national recommendations. Promoting combination prevention strategies, including 3-monthly HIV/STI testing, access to PrEP/ART, and behavioural interventions among MSM reporting chemsex, remain vital to address sexual health inequalities in MSM.
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Affiliation(s)
- Tyrone J Curtis
- Institute for Global Health, University College London, London, UK
| | - Alison J Rodger
- Institute for Global Health, University College London, London, UK
| | - Fiona Burns
- Institute for Global Health, University College London, London, UK
| | | | - Andrew Copas
- Institute for Global Health, University College London, London, UK
| | - Sonali Wayal
- Institute for Global Health, University College London, London, UK
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Graf N, Dichtl A, Deimel D, Sander D, Stöver H. Chemsex among men who have sex with men in Germany: motives, consequences and the response of the support system. Sex Health 2019; 15:151-156. [PMID: 29580377 DOI: 10.1071/sh17142] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 01/15/2018] [Indexed: 11/23/2022]
Abstract
Background In Germany, drug use in sexual settings (i.e. chemsex) among men who have sex with men (MSM) has increasingly been the subject of discussion for considerable time. At the same time, however, little is known about this practice. It is against this background that what is currently known about chemsex among MSM in Germany is discussed. METHODS The present study observations are essentially based on the results of two research projects of a qualitative-explorative nature. In-depth interviews with drug-using MSM (n=14), as well as qualitative, problem-centred interviews with drug-using MSM (n=75) and expert interviews (n=27) were conducted within these research projects. RESULTS Chemsex is a minority behaviour among MSM in Germany. The reasons for using drugs in sexual settings are manifold. For the most part, the effects of the drugs are used to intensify sexual feelings and to achieve greater intimacy. Men who consider their consumption to be problematic, in particular, report a range of negative consequences, such as sexually transmissible infections. Even though chemsex is a minority behaviour, suitable offers of support are, hence, necessary, especially for these men. However, such offers are not yet available in most German cities. CONCLUSIONS In order to close this gap in provision of support services, tangible practical steps, such as further training of people who work at drug and gay advisory services, are necessary, along with further research into the backgrounds and contexts of chemsex.
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Affiliation(s)
- Niels Graf
- Frankfurt University of Applied Sciences, Institute of Addiction Research, Nibelungenplatz 1, 60318 Frankfurt, Germany
| | - Anna Dichtl
- Frankfurt University of Applied Sciences, Institute of Addiction Research, Nibelungenplatz 1, 60318 Frankfurt, Germany
| | - Daniel Deimel
- Katholische Hochschule Nordrhein Westfalen, German Institute for Drug and Prevention Research (DISuP), Wörthstraße 10, 50668 Köln, Germany
| | - Dirk Sander
- Deutsche AIDS-Hilfe e. V., Wilhelmstraße 138, 10963 Berlin, Germany
| | - Heino Stöver
- Frankfurt University of Applied Sciences, Institute of Addiction Research, Nibelungenplatz 1, 60318 Frankfurt, Germany
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Power J, Mikołajczak G, Bourne A, Brown G, Leonard W, Lyons A, Dowsett GW, Lucke J. Sex, drugs and social connectedness: wellbeing among HIV-positive gay and bisexual men who use party-and-play drugs. Sex Health 2019; 15:135-143. [PMID: 29544599 DOI: 10.1071/sh17151] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 12/05/2017] [Indexed: 11/23/2022]
Abstract
Background This paper explores associations between use of party-and-play drugs, including crystal methamphetamine, and wellbeing among HIV positive gay and bisexual men (GBM) in Australia. This study considers whether use of drugs in a social or sex-based setting facilitates access to social and support networks, which may in turn support wellbeing. METHODS A cross-sectional survey of Australian people living with HIV (PLHIV) was conducted. There were 714 participants (79.7%) who identified as GBM. Differences between party-and-play drug users and non-users were examined using bivariate and multinomial logistic regressions. Mediation analysis examined the indirect effect of drug use on wellbeing via social connectedness and support. RESULTS One in three participants (29.7%) reported party-and-play drug use within the past 12 months. Only 5% reported regular use. There were no differences between users and non-users on self-reported measures of general health, wellbeing or general social support. Compared with non-users, party-and-play drug users reported higher levels of resilience and lower levels of perceived HIV-related stigma. This was associated with spending more time with other people living with HIV and friends in the gay and lesbian community. CONCLUSIONS While party-and-play drug use poses risks to the health of GBM, the social contexts in which these drugs are used may provide wellbeing benefits, particularly for HIV-positive GBM who may be subject to HIV-related stigma in other settings. Further research is needed to determine whether drug-use facilitates access to social networks or if people with more active social ties are more likely to engage in drug use.
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Affiliation(s)
- Jennifer Power
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Vic. 3086, Australia
| | - Gosia Mikołajczak
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Vic. 3086, Australia
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Vic. 3086, Australia
| | - Graham Brown
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Vic. 3086, Australia
| | - William Leonard
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Vic. 3086, Australia
| | - Anthony Lyons
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Vic. 3086, Australia
| | - Gary W Dowsett
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Vic. 3086, Australia
| | - Jayne Lucke
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Vic. 3086, Australia
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Hammoud MA, Bourne A, Maher L, Jin F, Haire B, Lea T, Degenhardt L, Grierson J, Prestage G. Intensive sex partying with gamma-hydroxybutyrate: factors associated with using gamma-hydroxybutyrate for chemsex among Australian gay and bisexual men - results from the Flux Study. Sex Health 2019; 15:123-134. [PMID: 29268075 DOI: 10.1071/sh17146] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 09/27/2017] [Indexed: 11/23/2022]
Abstract
Background Gamma-hydroxybutyrate (GHB) use among gay and bisexual men (GBM) has increased in recent years. It is commonly cited as a sexual-enhancement drug. There is, however, little evidence for factors associated with GHB use or the consequences of its use among GBM. AIM Factors associated with GHB use, its relationship to sexual risk behaviour, and the contexts, consequences, and motivations for its use were examined. METHODS The Following Lives Undergoing Change (Flux) Study is an online prospective observational study of Australian GBM. At baseline, a total of 3190 GBM provided details about their use of GHB. Data on frequency, methods, pleasures and consequences of their drug use, alongside key demographic variables were collected. RESULTS Mean age was 35.0 years. One in five men (19.5%) had a history of GHB use and 5.4% reported use within the past 6 months, with 2.7% having used it monthly or more frequently. Overdose had been experienced by 14.7%, this was more common among men who used GHB at least monthly. Being HIV-positive, having more gay friends, greater social engagement with gay men who use drugs, a greater number of sexual partners, group sex, and condomless anal intercourse with casual partners were independently associated with GHB use in the past 6 months. Greater social engagement with gay men who use drugs and group sex were independently associated with at least monthly use. More frequent GHB use was independently associated with experiencing overdose among GHB users. CONCLUSION Most men used GHB infrequently and it was often used explicitly to enhance sexual experiences, often in the context of intensive sex partying. Men who used GHB frequently, were at greater risk of overdose and other negative health outcomes. GHB use should be considered alongside other drugs that have been implicated in sexual risk behaviour and HIV transmission. Harm-reduction interventions need to consider the particular impact of frequent GHB use.
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Affiliation(s)
- Mohamed A Hammoud
- The Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Adam Bourne
- Australian Research Centre in Sex Health and Society, La Trobe University, 215 Franklin Street, Melbourne, VIC, 3000, Australia
| | - Lisa Maher
- The Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Fengyi Jin
- The Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Bridget Haire
- The Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Toby Lea
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Louisa Degenhardt
- The National Drug and Alcohol Research Centre, UNSW Sydney, 22-32 King St, Sydney, NSW 2052, Australia
| | - Jeffrey Grierson
- Anglia Ruskin University, Cambridge Campus. East Rd, Cambridge CB1 1PT, UK
| | - Garrett Prestage
- The Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia
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Pleasure and HIV biomedical discourse: The structuring of sexual and drug-related risks for gay and bisexual men who Party-n-Play. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 74:181-190. [PMID: 31627160 DOI: 10.1016/j.drugpo.2019.09.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 08/21/2019] [Accepted: 09/23/2019] [Indexed: 11/23/2022]
Abstract
Party-n-Play (PNP) is a social practice that refers to sex that occurs under the influence of drugs. This study critically examined the risk and pleasure discourses of gay and bisexual men who PNP to explore how epistemic shifts associated with advancements in HIV biomedical sciences influence gay and bisexual men's perceptions of HIV risks and their sexual and drug-related practices. This study also aims to provide a more nuanced understanding of how sexual and drug-related risk practices of gay and bisexual men are entangled with their search for pleasure. The study was framed within poststructural Critical Discourse Analysis (CDA) methodology. In-depth one-hour interviews were conducted with 44 self-identified gay, bisexual, queer, or Two-Spirit men, who lived in Toronto, and who reported using drugs before or during sex with another man. The findings from this study demonstrated the capacity of biomedical discourses to affect respondents' HIV risk perceptions and practices. The transition from condom-centered prevention to today's context where new highly effective biomedical tools for HIV prevention are available created possibilities for greater intimacy, increased pleasure, and less anxiety about HIV tranmission, while challenging many years of preventive socialization among gay and bisexual men. However, this new context also rekindled deep-seated fears about HIV risk and viral load verifiability, reinforced unequal forms of biomedical self-governance and citizenship, and reproduced practices of biopolitics. While discourses on risk and pleasure were interwoven within complex PNP assemblages, the notion of pleasure was mobilized as a discursive tactic of self-control, and the division between normative and non-normative pleasures highlighted the consequence of biopolitical forces governing the production of discourses on sex and drugs. Future HIV social science research needs to attend to the fluid nature of the discursive environments of HIV prevention science, and consider how both the material context of PNP and its social/discursive elements operate together.
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Recent epidemiology of sexually transmissible enteric infections in men who have sex with men. Curr Opin Infect Dis 2019; 31:50-56. [PMID: 29251673 DOI: 10.1097/qco.0000000000000423] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE OF REVIEW Sexual transmission of enteric pathogens in men who have sex with men (MSM) has been described since the 1970s. Recently, an increasing number of enteric infection outbreaks have been reported in MSM. This article summarizes recent outbreaks and discusses the key issues for prevention and control. RECENT FINDINGS Sexually transmissible enteric infections (STEIs) can spread rapidly and internationally within highly connected MSM populations and are often associated with antimicrobial resistance (AMR). The infections often cluster in high-risk groups of HIV-positive MSM who are more likely to engage in diverse sexual practices and chemsex, and to have multiple other sexually transmitted infections (STIs). SUMMARY The roles of asymptomatic and/or persistent infection and other contextual factors in STEI transmission are not well described. STEI-associated AMR is increasing and has potential to spread rapidly in MSM, warranting further public health attention. A better understanding of the factors associated with sexual transmission will enable the development of more effective control measures. A holistic approach that promotes health and wellbeing as well as infection prevention and management is needed.
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Gafos M, Horne R, Nutland W, Bell G, Rae C, Wayal S, Rayment M, Clarke A, Schembri G, Gilson R, McOwan A, Sullivan A, Fox J, Apea V, Dewsnap C, Dolling D, White E, Brodnicki E, Wood G, Dunn D, McCormack S. The Context of Sexual Risk Behaviour Among Men Who Have Sex with Men Seeking PrEP, and the Impact of PrEP on Sexual Behaviour. AIDS Behav 2019; 23:1708-1720. [PMID: 30306439 PMCID: PMC6570678 DOI: 10.1007/s10461-018-2300-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
There are still important gaps in our understanding of how people will incorporate PrEP into their existing HIV prevention strategies. In this paper, we explore how PrEP use impacted existing sexual risk behaviours and risk reduction strategies using qualitative data from the PROUD study. From February 2014 to January 2016, we conducted 41 in-depth interviews with gay, bisexual and other men who have sex with men (GBMSM) enrolled in the PROUD PrEP study at sexual health clinics in England. The interviews were conducted in English and were audio-recorded. The recordings were transcribed, coded and analysed using framework analysis. In the interviews, we explored participants' sexual behaviour before joining the study and among those using or who had used PrEP, changes to sexual behaviour after starting PrEP. Participants described the risk behaviour and management strategies before using PrEP, which included irregular condom use, sero-sorting, and strategic positioning. Participants described their sexual risk taking before initiating PrEP in the context of the sexualised use of drugs, geographical spaces linked with higher risk sexual norms, and digitised sexual networking, as well as problematic psychological factors that exacerbated risk taking. The findings highlight that in the main, individuals who were already having frequent condomless sex, added PrEP to the existing range of risk management strategies, influencing the boundaries of the 'rules' for some but not all. While approximately half the participants reduced other risk reduction strategies after starting PrEP, the other half did not alter their behaviours. PrEP provided an additional HIV prevention option to a cohort of GBMSM at high risk of HIV due to inconsistent use of other prevention options. In summary, PrEP provides a critical and necessary additional HIV prevention option that individuals can add to existing strategies in order to enhance protection, at least from HIV. As a daily pill, PrEP offers protection in the context of the sex cultures associated with sexualised drug use, digitised sexual applications and shifting social norms around sexual fulfilment and risk taking. PrEP can offer short or longer-term options for individuals as their sexual desires change over their life course offering protection from HIV during periods of heightened risk. PrEP should not be perceived or positioned in opposition to the existing HIV prevention toolkit, but rather as additive and as a tool that can and is having a substantial impact on HIV.
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Affiliation(s)
- Mitzy Gafos
- London School of Hygiene and Tropical Medicine, London, UK.
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK.
| | - Rob Horne
- School of Pharmacy, University College London, London, UK
| | | | - Gill Bell
- Sheffield Health, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Caroline Rae
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Sonali Wayal
- Centre for Population Research in Sexual Health and HIV, Mortimer Market Centre, Institute for Global Health, UCL, London, UK
| | - Michael Rayment
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Amanda Clarke
- Claude Nicol Centre, Royal Sussex County Hospital, Brighton, UK
| | - Gabriel Schembri
- Manchester Centre for Sexual Health, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Richard Gilson
- The Mortimer Market Centre, Institute for Global Health, University College London, London, UK
| | - Alan McOwan
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Ann Sullivan
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Julie Fox
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Vanessa Apea
- Ambrose King Centre, Barts Health NHS Trust, London, UK
| | - Claire Dewsnap
- Sheffield Health, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - David Dolling
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Ellen White
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Elizabeth Brodnicki
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Gemma Wood
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - David Dunn
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Sheena McCormack
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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Stevens O, Moncrieff M, Gafos M. Chemsex-related drug use and its association with health outcomes in men who have sex with men: a cross-sectional analysis of Antidote clinic service data. Sex Transm Infect 2019; 96:124-130. [PMID: 31171592 DOI: 10.1136/sextrans-2019-054040] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/07/2019] [Accepted: 05/13/2019] [Indexed: 11/03/2022] Open
Abstract
PURPOSE Chemsex-related drug use (CDU) is an escalating public health issue among men who have sex with men (MSM), associated with significant physical, biomedical and psychosocial harm. Few interventions exist to help MSM engaging in chemsex and little data exist on which to build. This cross-sectional analysis, using data from Antidote, the UK's only lesbian, gay, bisexual, and transgender specialist drug service, aims to remedy this paucity of data. METHODS Modified Poisson regression was used to assess associations between CDU and a range of health outcomes; CDU+ subanalysis disaggregated MSM by primary chemsex drug of concern; and HIV+ subanalysis investigated whether CDU was associated with self-reported treatment adherence, HIV seroconversion and other HIV-specific issues. FINDINGS Compared with CDU- MSM, MSM presenting for CDU were more likely to be HIV+, current or previous injectors, to have used postexposure prophylaxis in the last year, and have had ≥6 sexual partners in the last 90 days, though less likely to be hazardous alcohol consumers or to have experienced previous suicidal ideation (all p<0.0005). CDU+ subanalysis revealed health outcome differences-those selecting mephedrone were less likely to be hepatitis C+, HIV+, current or previous injectors, or to have experienced previous suicidal ideation (all p<0.0005), whereas those selecting methamphetamine were more likely (all p<0.0005, except suicidal ideation p=0.009). IMPLICATIONS This analysis shows MSM presenting for CDU are a heterogeneous high-risk population with unmet health needs. There is a need for standardised chemsex surveillance and for improved intersectorial working between sexual health and drug treatment services. Future research should investigate typological differences between MSM presenting for CDU. ORIGINALITY/VALUE To date, this is the world's largest analysis of MSM seeking treatment for CDU. Further, the publication of 'real-world' service data is a valuable addition to the literature alongside surveys and recruited studies.
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Affiliation(s)
- Oliver Stevens
- Department for Infectious Disease Epidemiology, Imperial College London School of Public Health, London, UK
| | | | - Mitzy Gafos
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Latini A, Dona' MG, Alei L, Colafigli M, Frasca M, Orsini D, Giuliani M, Morrone A, Cristaudo A, Zaccarelli M. Recreational drugs and STI diagnoses among patients attending an STI/HIV reference clinic in Rome, Italy. Sex Transm Infect 2019; 95:588-593. [PMID: 31101722 DOI: 10.1136/sextrans-2019-054043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 04/30/2019] [Accepted: 05/05/2019] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND An observational study was conducted to assess recreational drug use in association with recent STIs among clients of an STI/HIV reference centre in Rome, Italy. METHODS Attendees self-compiled a questionnaire concerning sexual behaviours and drug use, including the nine drugs used for sex (amphetamines, poppers, cocaine, ketamine, erectile dysfunction agent (EDA), steroids and the three chemsex drugs, ie, chems: γ-hydroxybutyric acid/γ-butyrolactone, crystal and Mcat). RESULTS Overall, 703 patients participated, with men who have sex with men (MSM) accounting for 50.4% of the total and 73.2% of HIV-positive patients. Apart from condylomatosis, whose prevalence was higher among females (38.8%) and non-MSM (45.8%) than MSM (14.4%), STIs were more frequent among MSM, particularly syphilis (14.1%), gonorrhoea (4.8%), urethritis (3.4%) and hepatitis A (6.5%). Recreational drug use was significantly more frequent among MSM (39.8% vs 17.6% in females and 22.7% in non-MSM). A total of 26.3% of MSM used at least one of the nine drugs and 5.1% at least one of the three chems. Cocaine (13.3%) and poppers (13.0%) were the most used sex drugs in MSM.The use of any of the nine drugs was associated with being MSM (adjusted OR (AOR): 1.94, 95% CI 1.05 to 3.58), sex with partner contacted online (1.99, 95% CI 1.14 to 3.45), group sex (4.08, 95% CI 2.40 to 6.93) and STI in the last year (1.65, 95% CI 1.05 to 2.61). Use of any of the nine chems among MSM was associated with condomless sex (2.24, 95% CI 1.21 to 4.14), group sex (2.08, 95% CI 1.01 to 4.31) and STI diagnosis in the last year (4.08, 95% CI 2.32 to 7.19). CONCLUSIONS Our data suggest that recreational drug use is quite common among MSM in Italy. No evidence of association with STI was found among non-MSM and females, where only cannabis and cocaine use was reported. The use of chems is still limited, but cocaine, poppers and EDA are widely used among MSM. Recreational drug use appears associated with high-risk sexual behaviours and a higher risk of STI.
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Affiliation(s)
- Alessandra Latini
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | | | - Lavinia Alei
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Manuela Colafigli
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Mirko Frasca
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Diego Orsini
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Massimo Giuliani
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Aldo Morrone
- Scientific Direction, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Antonio Cristaudo
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Mauro Zaccarelli
- Clinical Department, National Institute for the Infectious Diseases Lazzaro Spallanzani, Rome, Italy
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Chemsex among men who have sex with men living outside major cities and associations with sexually transmitted infections: A cross-sectional study in the Netherlands. PLoS One 2019; 14:e0216732. [PMID: 31086390 PMCID: PMC6516639 DOI: 10.1371/journal.pone.0216732] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 04/27/2019] [Indexed: 11/25/2022] Open
Abstract
Background The intentional use of drugs to have sex–chemsex–among men who have sex with men (MSM) might contribute to the high sexually transmitted infections (STI) prevalence in this group. Limited data is available on chemsex outside major cities. The current study investigated the use of a wide variety of drugs during sex among MSM living outside major cities in the Netherlands and their associations with STI. Methods In 2018, 350 MSM were recruited at STI clinics and 250 MSM completed an online questionnaire. Questionnaire data were linked to clients’ most recent STI laboratory test results. Chemsex was defined as using cocaine, crystal meth, designer drugs, GHB/GBL, ketamine, speed, or XTC/MDMA during sex in the preceding six months. The use of other drugs was also assessed. Determinants (chemsex, specific drugs, number of drugs, combining, and frequency) potentially associated with STI were assessed using multivariable logistic regression analyses adjusting for sociodemographic characteristics and sexual history. Results Chemsex was reported by 35% (95%CI: 29–41) of the 250 participants. XTC/MDMA (27%; 68/250) and GHB/GBL (26%; 64/250) were the most used drugs. STI positivity was 33% (29/87) in MSM engaging in chemsex and 12% (12/163) in MSM not engaging in chemsex (p<0.001). Half of MSM engaging in chemsex (45/87) used three of more different chemsex drugs; STI positivity in this group was 44% (20/45). The only factor independently associated with STI was the use of three or more chemsex drugs (aOR: 4.13, 95%CI: 1.77–9.62). Conclusion This study shows that chemsex is prevalent among MSM visiting the STI clinic outside major cities in the Netherlands, suggesting that health services in both urban and non-urban areas should be aware of and informed on chemsex. MSM who used multiple drugs are at particular risk for STI, indicating a special need for STI prevention and care in this group.
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Hibbert MP, Brett CE, Porcellato LA, Hope VD. Psychosocial and sexual characteristics associated with sexualised drug use and chemsex among men who have sex with men (MSM) in the UK. Sex Transm Infect 2019; 95:342-350. [PMID: 30979782 DOI: 10.1136/sextrans-2018-053933] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/25/2019] [Accepted: 03/24/2019] [Indexed: 01/07/2023] Open
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).
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Affiliation(s)
| | - Caroline E Brett
- Department of Psychology, Liverpool John Moores University, Liverpool, UK
| | - Lorna A Porcellato
- Public Health Institute, Liverpool John Moores University, Liverpool, UK
| | - Vivian D Hope
- Public Health Institute, Liverpool John Moores University, Liverpool, UK
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Abstract
Purpose
The purpose of this paper is to understand the dynamics of pleasure related to chemsex from the perspective of French gay men and other men who have sex with men (MSM). Recognising that participants in chemsex are social actors, the authors diverge from the prominent “pathology paradigm” used in public health.
Design/methodology/approach
In-depth interviews were conducted with gay men and other MSM engaging in chemsex via snowball sampling (n=33). The authors explored the definitions of pleasure and the role of stimulants, sexual activity, smartphones and partners in chemsex pleasures.
Findings
Chemsex pleasures encompass multiple dimensions that go far beyond bodily pleasures, such as love or romantic relationships, socializing with significant others and sexual discovery through disinhibition. Narratives of pleasure were also, simultaneously, stories of suffering and distress. This dissonance can pose challenges to the participants in chemsex, their entourages and care providers.
Practical implications
Given that the focus of care for gay men and other MSM is on risk behaviors, the findings of this paper help nurture discussions where pleasure is integrated into a new, value-neutral framework of care that incorporates chemsex pleasures.
Originality/value
This study examined the perspectives of those actually participating in chemsex, allowing gay men and other MSM to relate the entirety of their experiences, in which pleasure is often at the forefront, without restriction.
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Flores-Aranda J, Goyette M, Larose-Osterrath C. Online Intervention as Strategy to Reach Men Who Have Sex With Other Men and Who Use Substances in a Sexual Context. Development of the MONBUZZ.ca Project. Front Psychiatry 2019; 10:183. [PMID: 31024354 PMCID: PMC6465970 DOI: 10.3389/fpsyt.2019.00183] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 03/13/2019] [Indexed: 11/29/2022] Open
Abstract
Men who have sex with men (MSM) use more psychoactive substances and a greater variety of them compared to their heterosexual peers. In this population, substance use is particularly characterized by polydrug use, binge, and sexualized substance use. MSM who use substances do not recognize themselves in public health messages targeting substance users. In addition, they recognize their problematic substance use later than heterosexuals and, as a result, they use addiction services later in their addiction trajectories. When accessing addiction services, the links between drug use and sexual life are rarely considered. Because of this profile, online interventions are a promising way to reach this hard-to-reach population. Currently available online interventions targeting MSM address the topics of substance use and sexual life separately. To deal with this situation, our team wanted to develop an online intervention platform for MSM who use substances in a sexual context. Given that online addiction interventions do not address sex and that MSM drug use is highly related to sexual activity, we first explored the literature related to online interventions targeting MSM and HIV risk behaviors, as well as online interventions targeting general population in order to: (1) identify relevant (or personalized) intervention methods; (2) describe the approaches used; and (3) describe their effects. Second, we turned to the literature to develop the MONBUZZ.ca project in collaboration with community organizations. The results of the narrative review provided a critical portrait of online interventions for MSM and guided the development process of MONBUZZ.ca. We discuss issues of co-development of a research and brief intervention tool based on promising practices as well as challenges of its implementation and evaluation.
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Affiliation(s)
- Jorge Flores-Aranda
- Centre Intégré Universitaire de Santé et de Services Sociaux, Centre-Sud-de-l'Île-de-Montréal, Institut Universitaire sur les Dépendances, Montreal, QC, Canada
| | - Mathieu Goyette
- Département des Sciences de la Santé Communautaire, Université de Sherbrooke, Sherbrooke, QC, Canada
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Maxwell S, Shahmanesh M, Gafos M. Chemsex behaviours among men who have sex with men: A systematic review of the literature. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 63:74-89. [PMID: 30513473 DOI: 10.1016/j.drugpo.2018.11.014] [Citation(s) in RCA: 246] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/13/2018] [Accepted: 11/26/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND 'Chemsex' is the use of drugs before or during planned sexual events to facilitate, enhance, prolong and sustain the experience. Drugs associated with chemsex are methamphetamine, GHB/GBL, mephedrone, cocaine and ketamine. This review syntheses published research on the antecedents, behaviours and consequences associated with chemsex behaviours among men who have sex with men (MSM). METHODS Papers from high income countries which were published between January 2000 and September 2018 reporting the use of chemsex drugs before or during sex were identified through Medline, Web of Science, CINAHL and Central. Results were synthesised using a narrative approach and conceptualised using a behavioural analysis framework. RESULTS The search identified 2492 publications, of which 38 were included in the final synthesis. There were wide variations in chemsex prevalence estimates due to the heterogeneous sampling in the studies. Chemsex participants have expectations that the drugs will positively affect their sexual encounters and HIV positive MSM are more likely to engage in the behaviour than HIV negative MSM. There were wide ranging prevalence estimates on injecting drugs for sexual purposes and the sharing of injecting equipment with some evidence of unsafe injecting practices. Participants were more likely to engage in condomless anal intercourse than men who do not engage in chemsex. This may increase the risk of transmission for HIV and other sexually transmitted infections. CONCLUSION A minority of MSM appear to engage in chemsex behaviours but they are at risk of this negatively impacting on their health and well-being. Further research is required to examine high risk chemsex behaviours, impact of chemsex on psycho-social well-being and if chemsex influences uptake of PrEP, PEP and sexual health screening.
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Affiliation(s)
- Steven Maxwell
- King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 9NN, United Kingdom.
| | - Maryam Shahmanesh
- Institute for Global Health, University College London, Capper Street, London, WC1E 6JB, United Kingdom.
| | - Mitzy Gafos
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SN, United Kingdom.
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Card KG, Armstrong HL, Carter A, Cui Z, Wang L, Zhu J, Lachowsky NJ, Moore DM, Hogg RS, Roth EA. A latent class analysis of substance use and culture among gay, bisexual and other men who have sex with men. CULTURE, HEALTH & SEXUALITY 2018; 20:1424-1439. [PMID: 29589798 PMCID: PMC6162168 DOI: 10.1080/13691058.2018.1439186] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 02/07/2018] [Indexed: 05/04/2023]
Abstract
Assessments of gay and bisexual men's substance use often obscures salient sociocultural and identity-related experiences related to how they use drugs. Latent class analysis was used to examine how patterns of substance use represent the social, economic and identity-related experiences of this population. Participants were sexually active gay and bisexual men (including other men who have sex with men), aged ≥ 16 years, living in Metro Vancouver (n = 774). LCA indicators included all substances used in the past six months self-reported by more than 30 men. Model selection was made with consideration to model parsimony, interpretability and optimisation of statistical criteria. Multinomial regression identified factors associated with class membership. A six-class solution was identified representing: 'assorted drug use' (4.5%); 'club drug use' (9.5%); 'street drug use' (12.1%); 'sex drug use' (11.4%); 'conventional drug use' (i.e. tobacco, alcohol, marijuana; 25.9%); and 'limited drug use' (36.7%). Factors associated with class membership included age, sexual orientation, annual income, occupation, income from drug sales, housing stability, group sex event participation, gay bars/clubs attendance, sensation seeking and escape motivation. These results highlight the need for programmes and policies that seek to lessen social disparities and account for social distinctions among this population.
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Affiliation(s)
- Kiffer G. Card
- Faculty of Health Science, Simon Fraser University, Burnaby, BC, Canada
| | | | - Allison Carter
- Faculty of Health Science, Simon Fraser University, Burnaby, BC, Canada
| | - Zishan Cui
- B.C. Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Lu Wang
- B.C. Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Julia Zhu
- B.C. Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Nathan J. Lachowsky
- School of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada
| | - David M. Moore
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Robert S. Hogg
- Faculty of Health Science, Simon Fraser University, Burnaby, BC, Canada
| | - Eric A. Roth
- Department of Anthropology, University of Victoria, Victoria, BA, Canada
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Zhao P, Liu L, Zhang Y, Cheng H, Cao B, Liu C, Wang C, Yang B, Wei C, Tucker JD, Tang W. The interaction between HIV testing social norms and self-efficacy on HIV testing among Chinese men who have sex with men: results from an online cross-sectional study. BMC Infect Dis 2018; 18:541. [PMID: 30376818 PMCID: PMC6208016 DOI: 10.1186/s12879-018-3454-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 10/23/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Increasing human immunodeficiency virus (HIV) testing is critical for HIV control. This study aimed to evaluate the interaction between social norms and self-efficacy on HIV testing among Chinese men who have sex with men (MSM). METHODS We conducted an online survey in eight Chinese cities in Shandong and Guangdong Provinces in July 2016. We included participants who were born as a male, at least 16 years old, currently living in one of the designated cities, and had ever engaged in anal sex with a man. We collected information regarding socio-demographics, high-risk behaviors, and history of HIV and other STI testing. We coded sensitivity to social norms using six items asking participants about their perceived social norm regarding HIV testing. We coded HIV testing self-efficacy using a separate six-item scale. We interpreted higher mean scores as higher sensitivity to social norms and higher self-efficacy, respectively. We conducted logistic regressions to evaluate the interaction between self-efficacy and social norms on HIV testing. RESULTS A total of 2105 men completed the survey. The mean age of the participants was 25.97 ± 6.42 years. Over four-fifths (85.9%) of participants were unmarried, 22.7% were students, and 64.6% at least had a college degree. 62.5 and 32.6% of participants ever and tested HIV in the last three months, respectively. With respect to uptake of HIV testing in the last three months, the adjusted odds ratio was 1.01(95% CI: 0.96-1.06) for higher sensitivity to social norms and 1.09 (95% CI: 1.05-1.14) for higher self-efficacy, with an interaction effect of 1.02 (95% CI: 1.01-1.03), respectively. With respect to uptake of lifetime HIV testing, the adjusted odds ratio was 1.03(95% CI: 0.99-1.07) for higher sensitivity to social norms and 1.15 (95% CI: 1.11-1.19) for higher self-efficacy, with an interaction effect of 1.02 (95% CI: 1.01-1.04), respectively. CONCLUSIONS Our survey demonstrated that there is a significant association between the uptake of HIV testing with sensitivity to the social norm, higher self-efficacy, as well as the interaction between them. Tailored studies for improving HIV testing among MSM in China can combine these two interventions together.
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Affiliation(s)
- Peizhen Zhao
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Li Liu
- Nanjing Municipal Center for Disease Control and Prevention, Jiangsu, China
| | - Ye Zhang
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Huanhuan Cheng
- The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Bolin Cao
- SESH study group of University of North Carolina at Chapel Hill, Guangzhou, China
- University of North Carolina at Chapel Hill Project-China, Guangzhou, 510095 China
| | - Chuncheng Liu
- SESH study group of University of North Carolina at Chapel Hill, Guangzhou, China
| | - Cheng Wang
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Bin Yang
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Chongyi Wei
- Social and Behavioral Health Sciences, School of Public Health, Rutgers University, Piscataway, NJ USA
| | - Joseph D. Tucker
- SESH study group of University of North Carolina at Chapel Hill, Guangzhou, China
- University of North Carolina at Chapel Hill Project-China, Guangzhou, 510095 China
- School of Medicine of University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Weiming Tang
- Dermatology Hospital, Southern Medical University, Guangzhou, China
- SESH study group of University of North Carolina at Chapel Hill, Guangzhou, China
- University of North Carolina at Chapel Hill Project-China, Guangzhou, 510095 China
- School of Medicine of University of North Carolina at Chapel Hill, Chapel Hill, USA
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Kenyon C, Wouters K, Platteau T, Buyze J, Florence E. Increases in condomless chemsex associated with HIV acquisition in MSM but not heterosexuals attending a HIV testing center in Antwerp, Belgium. AIDS Res Ther 2018; 15:14. [PMID: 30340607 PMCID: PMC6195714 DOI: 10.1186/s12981-018-0201-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 10/10/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It has been speculated that the prevalence of chemsex is increasing in men who have sex with men and that this may be playing a role in the spread of HIV. METHODS We assessed if the prevalence of reported chemsex was increasing and if chemsex was associated with HIV infection in clients attending the 'Helpcenter', Antwerp, between 2011 and 2017. This is a HIV/STI testing center that offers HIV/STI testing to HIV-uninfected individuals from key populations including MSM. RESULTS We found an increase in the reporting of condomless sex associated with the use of a number of drugs, including ecstasy, amphetamines, GHB and cocaine in MSM (from 8 to 17%) but not in heterosexuals. Reporting condomless chemsex was associated with HIV infection (adjusted odds ratio 5.7 [95% confidence interval 3.2-10.4]). CONCLUSIONS Our findings provide further evidence of the importance of asking MSM clients about the use of psychoactive substances during consultations and tailoring interventions such as pre exposure prophylaxis, more frequent STI screening and substance abuse counseling accordingly.
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Affiliation(s)
- Chris Kenyon
- HIV/STI Unit, Institute of Tropical Medicine, Antwerp, Belgium
- Division of Infectious Diseases and HIV Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town, 7700 South Africa
| | - Kristien Wouters
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Tom Platteau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jozefien Buyze
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Eric Florence
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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Is on-Demand HIV Pre-exposure Prophylaxis a Suitable Tool for Men Who Have Sex With Men Who Practice Chemsex? Results From a Substudy of the ANRS-IPERGAY Trial. J Acquir Immune Defic Syndr 2018; 79:e69-e75. [DOI: 10.1097/qai.0000000000001781] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Leyva-Moral JM, Feijoo-Cid M, Moriña D, Caylà JA, Arando M, Vall M, Barbera MJ, Armengol P, Vives A, Martin-Ezquerra G, Alsina M, García Olalla P. Gay Circuit Parties in Barcelona and Their Impact on Gonorrhea Incidence. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:2027-2034. [PMID: 30014338 DOI: 10.1007/s10508-018-1220-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 04/10/2018] [Accepted: 04/17/2018] [Indexed: 06/08/2023]
Abstract
This study explored the role of circuit parties on the incidence of gonorrhea among men who have sex with men (MSM) in Barcelona (Spain). Specifically, it aimed to detect cyclic peaks in the number of reported diagnoses of gonorrhea after gay circuit parties. We analyzed monthly cases of gonorrhea reported from January 2007 through December 2016 after the main annual gay circuit parties in Barcelona. We used the integer autoregressive model for time series with discrete values. The performance of the model was tested in heterosexual men and women, in whom the circuit parties could be expected to have no impact. A sensitivity analysis was conducted, changing post-event diagnosis windows to 1 week later/1 week before. In the study period, a total of 4182 of gonorrhea cases were detected, of which 74.8% (n = 2181) occurred in men who identified themselves as MSM. The average annual increase in gonorrhea cases reported among MSM was 32.57%. In an independent analysis of each gay circuit party, cases increased significantly in two of them. The results were also similar for same-sex practices among men only. On controlling for the increasing trend over the study period and the seasonal effect, an average of 1.16 gonorrhea cases in MSM (95% CI: 0.68, 1.64) were attributable to the celebration of one of the gay circuit parties considered. During the expected outbreak, an average of 13 gonorrhea cases were detected and between 5 and 13% were attributable to one of the circuit parties. In view of these findings, participants should consider seeking advice from their healthcare provider and practice safer sex using condoms to prevent sexually transmitted infections. Local public health services should be reinforced to ensure care for participants during and after gay circuit parties. More research is needed to design and implement preventive programs.
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Affiliation(s)
- Juan M Leyva-Moral
- Department of Nursing, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, 08193, Spain
| | - Maria Feijoo-Cid
- Department of Nursing, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, 08193, Spain.
| | - David Moriña
- Unit of Infections and Cancer - Information and Interventions (UNIC-I&I), Catalan Institute of Oncology (ICO)-IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Joan A Caylà
- Epidemiology Service, Public Health Agency of Barcelona, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Maider Arando
- Sexually Transmitted Infection Unit-Vall Hebron, Hospital de la Vall d'Hebron, Barcelona, Spain
| | - Martí Vall
- Sexually Transmitted Infection Unit-Vall Hebron, Hospital de la Vall d'Hebron, Barcelona, Spain
| | - María Jesús Barbera
- Sexually Transmitted Infection Unit-Vall Hebron, Hospital de la Vall d'Hebron, Barcelona, Spain
| | - Pere Armengol
- Sexually Transmitted Infection Unit-Vall Hebron, Hospital de la Vall d'Hebron, Barcelona, Spain
| | - Alvaro Vives
- Sexually Transmitted Infection Unit, Fundació Puigvert, Barcelona, Spain
| | | | - Mercè Alsina
- Department of Dermatology, Hospital Clínic, Barcelona, Spain
| | - Patricia García Olalla
- Epidemiology Service, Public Health Agency of Barcelona, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Su S, Zhang L, Cheng F, Li S, Li S, Jing J, Fairley CK, Chen L, Zhao J, Mao L. Association between recreational drug use and sexual practices among people who inject drugs in Southwest China: a cross-sectional study. BMJ Open 2018; 8:e019730. [PMID: 29961003 PMCID: PMC6042564 DOI: 10.1136/bmjopen-2017-019730] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To describe the differences in sexual practices among individuals with various drug administration patterns. SETTING A detoxification centre in Southwest China, a part of the Chinese national sentential surveillance network for hepatitis C virus (HCV), HIV and syphilis infections, was recruited. PARTICIPANTS A total of 610 newly enrolled injection drug users (IDUs) from detoxification centre were included during 2015. PRIMARY AND SECONDARY OUTCOME MEASURES Self-reported sexual activities, drug-related practices and laboratory-confirmed HCV, HIV and syphilis infection status were collected. RESULTS Of the 610 IDU, 295 (48.4%) used heroin only, 277 (45.4%) poly-drug users reported the mixed use of synthetic drugs (SDs) with heroin and 38 (6.2%) used SDs only. The average daily drug injection frequency for poly-drug users (3.3±1.2 times) was the highest, followed by heroin-only (2.2±0.8 times) and SD-only users (1.2±0.4 time). SD-only drug users reported the highest proportion (86.8%) of engaging in sexual activities in the previous month, with more than half (54.5%) reporting any condomless sex. A higher frequency of daily injecting in heroin-only users was significantly correlated with the less likelihood of sex, condomless sex in the past month, having sex with fixed partners, condomless commercial sex in the previous 12 months (all p<0.01). In poly-drug users, who injected drugs two times per day was associated with the highest proportion of people who engaged in sex and commercial sex (p<0.05). For SD-only users, increased drug use was not associated with reducing sexual risk (p>0.05). Different patterns of HCV, HIV and syphilis infections prevalence rates were shown among the IDU depending on the roles and length of exposure. CONCLUSIONS The daily drug injecting frequency of heroin-only and poly-drug users was negatively associated with sexual activities, but SD-only users kept a high frequent engagement in sex. The interventions for relevant diseases should adapt to characteristics of IDU.
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Affiliation(s)
- Shu Su
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Lei Zhang
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Research Center for Public Health, Tsinghua University, Beijing, China
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Feng Cheng
- Research Center for Public Health, Tsinghua University, Beijing, China
| | - Shunxiang Li
- Division of HIV/AIDS and STI Control, Centers for Disease Control and Prevention, Yuxi Prefecture, Yunnan, China
| | - Shifu Li
- Division of HIV/AIDS and STI Control, Centers for Disease Control and Prevention, Yuxi Prefecture, Yunnan, China
| | - Jun Jing
- Research Center for Public Health, Tsinghua University, Beijing, China
- Division of HIV/AIDS and STI Control, Centers for Disease Control and Prevention, Yuxi Prefecture, Yunnan, China
| | - Christopher Kincaid Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Liang Chen
- Division of HIV/AIDS and STI Control, Centers for Disease Control and Prevention, Yuxi Prefecture, Yunnan, China
| | - Jinxian Zhao
- Division of HIV/AIDS and STI Control, Centers for Disease Control and Prevention, Yuxi Prefecture, Yunnan, China
| | - Limin Mao
- Center for Social Research in Health, Faculty of Arts and Social Science, University of New South Wales, Sydney, New South Wales, Australia
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Rosińska M, Gios L, Nöstlinger C, Vanden Berghe W, Marcus U, Schink S, Sherriff N, Jones AM, Folch C, Dias S, Velicko I, Mirandola M. Prevalence of drug use during sex amongst MSM in Europe: Results from a multi-site bio-behavioural survey. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 55:231-241. [PMID: 29402683 DOI: 10.1016/j.drugpo.2018.01.002] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 12/23/2017] [Accepted: 01/04/2018] [Indexed: 11/29/2022]
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.
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Affiliation(s)
- Magdalena Rosińska
- National Institute of Public Health, National Institute of Hygiene, Chocimska 24, 00-791 Warsaw, Poland.
| | - Lorenzo Gios
- CREMPE Regional Coordination Centre for European Project Management, Verona University Hospital, p.le Aristide Stefani 1, 37126 Verona, Veneto Region, Italy.
| | - Christiana Nöstlinger
- Institute of Tropical Medicine, Department of Public Health, Nationalestraat 155, 2000 Antwerp, Belgium; University of Vienna, Faculty of Psychologye, Liebiggasse 5, 1010 Vienna, Austria.
| | - Wim Vanden Berghe
- Institute of Tropical Medicine, Department of Public Health, Antwerp, Belgium; Department of Epidemiology of Infectious Diseases, Scientific Institute of Public Health, Brussels, Belgium.
| | - Ulrich Marcus
- Robert Koch Institute, Seestr. 10, 13353 Berlin, Germany.
| | - Susanne Schink
- Robert Koch Institute, Seestr. 10, 13353 Berlin, Germany.
| | - Nigel Sherriff
- School of Health Sciences, University of Brighton, Brighton, BN1 9PH, UK.
| | - Anna-Marie Jones
- School of Health Sciences, University of Brighton, Brighton, BN1 9PH, UK; Mill View Hospital, Sussex Education Centre, Research & Development, Brighton, UK.
| | - Cinta Folch
- Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Departament de Salut, Generalitat de Catalunya, Hospital Universitari Germans Trias i Pujol, Ctra de Canyet s/n, 08916 Badalona, Spain.
| | - Sonia Dias
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Portugal.
| | - Inga Velicko
- Public Health Agency of Sweden, Stockholm, Sweden.
| | - Massimo Mirandola
- CREMPE Regional Coordination Centre for European Project Management, Verona University Hospital, p.le Aristide Stefani 1, 37126 Verona, Veneto Region, Italy; Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
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75
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Patterns of injecting and non-injecting drug use by sexual behaviour in people who inject drugs attending services in England, Wales and Northern Ireland, 2013–2016. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018. [DOI: 10.1016/j.drugpo.2018.02.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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76
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Hammoud MA, Vaccher S, Jin F, Bourne A, Haire B, Maher L, Lea T, Prestage G. The new MTV generation: Using methamphetamine, Truvada™, and Viagra™ to enhance sex and stay safe. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018. [DOI: 10.1016/j.drugpo.2018.02.021] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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77
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Edmundson C, Heinsbroek E, Glass R, Hope V, Mohammed H, White M, Desai M. Sexualised drug use in the United Kingdom (UK): A review of the literature. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 55:131-148. [PMID: 29625796 DOI: 10.1016/j.drugpo.2018.02.002] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 01/22/2018] [Accepted: 02/08/2018] [Indexed: 10/17/2022]
Abstract
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.
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Affiliation(s)
- Claire Edmundson
- HIV & STI Department, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom.
| | - Ellen Heinsbroek
- HIV & STI Department, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Rachel Glass
- HIV & STI Department, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Vivian Hope
- HIV & STI Department, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom; Public Health Institute, Liverpool John Moores University, 2nd Floor Henry Cotton Campus, 15-21 Webster Street, Liverpool L3 2ET, United Kingdom
| | - Hamish Mohammed
- HIV & STI Department, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Martin White
- Alcohol, Drugs and Tobacco, Health Improvement, Public Health England, Skipton House, 80 London Road, London SE1 6LH, United Kingdom
| | - Monica Desai
- National Institute for Health and Care Excellence, Level 1A, City Tower, Picadilly Plaza, Manchester M1 4BT, United Kingdom
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78
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Hickson F. Chemsex as edgework: towards a sociological understanding. Sex Health 2018; 15:102-107. [DOI: 10.1071/sh17166] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 11/22/2017] [Indexed: 11/23/2022]
Abstract
Sexual sessions between men, organised through mobile technologies and combined with stimulants intended to extend and intensify the session have been reified into the phenomena of ‘chemsex’. Understanding chemsex requires multiple levels of analysis and interpretation. This paper considers chemsex through the lens of edgework, a sociological category for voluntary risk taking identified in 1990 by Stephen Lyng. Edgework activities involve a clear and present danger to the self, intense emotions and sensations and an opportunity to exercise specialist skills. Using published research and other cultural products, this paper demonstrates that chemsex fully exhibits all the defining features of edgework. Chemsex is then positioned as an activity that epitomises the (gay) citizen as consumer in a technocapitalist age of pharmacopornographic consumption.
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79
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Glynn RW, Byrne N, O'Dea S, Shanley A, Codd M, Keenan E, Ward M, Igoe D, Clarke S. Chemsex, risk behaviours and sexually transmitted infections among men who have sex with men in Dublin, Ireland. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 52:9-15. [PMID: 29223761 DOI: 10.1016/j.drugpo.2017.10.008] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 06/07/2017] [Accepted: 10/11/2017] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- Ronan W Glynn
- Department of Public Health Medicine, Dr. Steevens' Hospital, Dublin 8, Ireland; CTAR Biostatistics and Health Research, UCD School of Public Health, Physiotherapy and Sports Science, Belfield, Dublin 4, Ireland.
| | - Niamh Byrne
- Department of Public Health Medicine, Dr. Steevens' Hospital, Dublin 8, Ireland
| | - Siobhan O'Dea
- Gay Men's Health Service, Baggot Street Hospital, Dublin 2, Ireland
| | - Adam Shanley
- Gay Men's Health Service, Baggot Street Hospital, Dublin 2, Ireland
| | - Mary Codd
- CTAR Biostatistics and Health Research, UCD School of Public Health, Physiotherapy and Sports Science, Belfield, Dublin 4, Ireland
| | - Eamon Keenan
- Addiction Services, National Social Inclusion Office, Mill Lane, Palmerstown, Dublin 20, Ireland
| | - Mary Ward
- Department of Public Health Medicine, Dr. Steevens' Hospital, Dublin 8, Ireland
| | - Derval Igoe
- Health Protection Surveillance Centre,25-27 Middle Gardiner Street, Dublin 1, Ireland
| | - Susan Clarke
- Gay Men's Health Service, Baggot Street Hospital, Dublin 2, Ireland
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