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Lemain L, Lever D, Therene-Mouden C, Verdeau R, Barais M, Guillou-Landreat M. Chemsex Among Men Having Sex with Men: A Scoping Review on Management, Support, and Harm Reduction Strategies. JOURNAL OF SEX RESEARCH 2024:1-11. [PMID: 39093301 DOI: 10.1080/00224499.2024.2377592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
Chemsex defines the practice of sexual activity under the influence of psychoactive substances, mainly by Men who have Sex with Men (MSM). This activity can be associated with negative health consequences, yet there are no recommendations to guide management of individuals who engage in chemsex. The aim of this scoping review was to identify and describe the existing treatments (pharmacological or not) and risk/harm reduction strategies for MSM who engage in chemsex. This scoping review was performed using PubMed and Embase databases and according to the PRISMA Extension for Scoping Review criteria. Overall, 19 studies were included in the review. Among these studies, four main themes were identified: management and harm reduction strategies, key actors involved in managing MSM who engage in chemsex, perceived barriers to care and the role of pre-exposure prophylaxis, and medical information sought by MSM who engage in chemsex. This scoping review concludes with the need to develop multidisciplinary approaches to improve communication about chemsex, and to design interventional studies that target MSM who engage in chemsex.
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Affiliation(s)
- Loic Lemain
- Addictology Service, University Hospital of Brest, Université de Bretagne occidentale
- ER 7479 SPURBO, University of Western Brittany
| | - Delphine Lever
- Addictology Liaison, University Hospital of Brest, CHU de Brest
| | | | - Romain Verdeau
- Department of General Practice, University of Western Brittany
| | - Marie Barais
- ER 7479 SPURBO, University of Western Brittany
- Department of General Practice, University of Western Brittany
| | - Morgane Guillou-Landreat
- ER 7479 SPURBO, University of Western Brittany
- Addictology Liaison, University Hospital of Brest, CHU de Brest
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Pozo-Herce PD, Martínez-Sabater A, Sanchez-Palomares P, Garcia-Boaventura PC, Chover-Sierra E, Martínez-Pascual R, Gea-Caballero V, Saus-Ortega C, Ballestar-Tarín ML, Karniej P, Baca-García E, Juárez-Vela R. Effectiveness of Harm Reduction Interventions in Chemsex: A Systematic Review. Healthcare (Basel) 2024; 12:1411. [PMID: 39057554 PMCID: PMC11275498 DOI: 10.3390/healthcare12141411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 07/05/2024] [Accepted: 07/11/2024] [Indexed: 07/28/2024] Open
Abstract
The phenomenon of chemsex has emerged as an essential public health issue in recent years. This systematic review aimed to investigate currently available harm reduction strategies and to evaluate the efficacy of the corresponding interventions. METHODS A systematic review of the scientific literature related to harm and risk reduction strategies and the effectiveness of chemsex interventions. Between January 2024 and May 2024, the articles were retrieved from the electronic databases Pubmed, Web of Science, Scopus, PsycInfo, Cochrane, Dialnet, CUIDEN, and SciELO. The review protocol was registered in the PROSPERO database (registration number CRD42024508953). The inclusion criteria were as follows: (I) original studies published in peer-reviewed journals, (II) studies exploring harm reduction interventions for chemsex, and (III) studies reflecting the efficacy of harm reduction interventions for chemsex. Two reviewers independently selected articles by title, abstract, and full paper review and extracted data. Two authors described the selected studies and assessed their methodological quality. RESULTS The systematic review comprised six scientific papers that met the selection criteria and were obtained from five countries. Although a limited number of studies were included, it was observed that they presented a medium-high methodological quality. Programs evaluated interventions to reduce harm from chemsex, such as a web-based intervention that improved self-efficacy to refuse risky behaviors and accept HIV testing. The studies suggested that peer-led programs can be effective, especially with facilitators who have experienced chemsex dependence. CONCLUSION Harm reduction strategies in chemsex are effective and should be promoted by health professionals. Interventions should be accessible, personalized, and non-judgmental to provide appropriate care and support, ensuring a comprehensive and effective public health response.
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Affiliation(s)
- Pablo Del Pozo-Herce
- Department of Psychiatry, Fundación Jiménez Díaz University Hospital, 28040 Madrid, Spain; (P.D.P.-H.); (E.B.-G.)
- Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz, 28040 Madrid, Spain
- School of Nursing, Fundación Jiménez Díaz, Madrid Autonomous University, 28049 Madrid, Spain;
| | - Antonio Martínez-Sabater
- Nursing Care and Education Research Group (GRIECE), GIUV2019-456, Nursing Department, Facultat d’Infermeria i Podologia, University of Valencia, 46010 Valencia, Spain; (A.M.-S.); (R.M.-P.); (M.L.B.-T.)
- Care Research Group (INCLIVA), Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain
| | | | | | - Elena Chover-Sierra
- Nursing Care and Education Research Group (GRIECE), GIUV2019-456, Nursing Department, Facultat d’Infermeria i Podologia, University of Valencia, 46010 Valencia, Spain; (A.M.-S.); (R.M.-P.); (M.L.B.-T.)
- Internal Medicine, Consorci Hospital Universitari de Valencia, 46014 Valencia, Spain
| | - Raquel Martínez-Pascual
- Nursing Care and Education Research Group (GRIECE), GIUV2019-456, Nursing Department, Facultat d’Infermeria i Podologia, University of Valencia, 46010 Valencia, Spain; (A.M.-S.); (R.M.-P.); (M.L.B.-T.)
- Care Research Group (INCLIVA), Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain
| | - Vicente Gea-Caballero
- Research Group Community Health and Care, Faculty of Health Sciences, International University of Valencia, 46002 Valencia, Spain;
| | - Carles Saus-Ortega
- Nursing Care and Education Research Group (GRIECE), GIUV2019-456, Nursing Department, Facultat d’Infermeria i Podologia, University of Valencia, 46010 Valencia, Spain; (A.M.-S.); (R.M.-P.); (M.L.B.-T.)
- Nursing School La Fe, Adscript Centre, University of Valencia, 46026 Valencia, Spain
- Research Group GREIACC, Health Research Institute La Fe, 46016 Valencia, Spain
| | - María Luisa Ballestar-Tarín
- Nursing Care and Education Research Group (GRIECE), GIUV2019-456, Nursing Department, Facultat d’Infermeria i Podologia, University of Valencia, 46010 Valencia, Spain; (A.M.-S.); (R.M.-P.); (M.L.B.-T.)
- Nursing Department, Jaume I University, 12006 Castellón, Spain;
| | - Piotr Karniej
- Faculty of Finance and Management, WSB MERITO University in Wroclaw, 53-609 Wroclaw, Poland;
| | - Enrique Baca-García
- Department of Psychiatry, Fundación Jiménez Díaz University Hospital, 28040 Madrid, Spain; (P.D.P.-H.); (E.B.-G.)
- Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz, 28040 Madrid, Spain
| | - Raúl Juárez-Vela
- Research Group in Care, Department of Nursing, Faculty of Health Sciences, University of La Rioja, 26006 Logroño, Spain;
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Schwarz J, Gertzen M, Rabenstein A, Straßburger M, Horstmann A, Pogarell O, Rüther T, Karch S. What Chemsex does to the brain - neural correlates (ERP) regarding decision making, impulsivity and hypersexuality. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-024-01856-2. [PMID: 38969754 DOI: 10.1007/s00406-024-01856-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 06/17/2024] [Indexed: 07/07/2024]
Abstract
Chemsex describes the use of specific substances (methamphetamine, GHB/GBL, mephedrone, ketamine) which initiate or enhance sexual experiences and is mainly prevalent among men who have sex with men. Many Chemsex users experience somatic complications (for example sexually transmitted diseases) and sometimes adverse sociological, psychological, and neurological symptoms, such as depression, impulse control disorders or hypersexuality. Changes in impulsivity and deficits in executive functions have demonstrated to be associated with addiction and impulse control disorders as well as frontal brain dysfunction and behavioral control deficits. This study aims to explore the effects of neurophysiological correlates of inhibition and decision making in Chemsex users with an EEG paradigm using event-related potentials (N2, P3). 15 Chemsex users and 14 matched control subjects, all of them men who have sex with man, participated in an auditory Go/NoGo/Voluntary Selection EEG paradigm. In addition, clinical data (e.g. regarding depression), demographic information as well as measures of well-being and sexual behavior were collected. The results demonstrated that clinical symptoms, hypersexuality, and sexual risk behavior were more pronounced in Chemsex users compared to non-users. P3 amplitudes did not differ significantly between groups. However, the Chemsex users showed decreased electrophysiological N2 responses in fronto-central brain regions during decision-making, indicating compromised executive function and inhibitory control. The observed impairments may lead to increased risk behavior regarding drug abuse and hypersexuality. Understanding the neurobiological mechanisms can contribute to targeted interventions in order to mitigate the negative consequences of engaging in Chemsex and improve general well-being.
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Affiliation(s)
- Johanna Schwarz
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Germany.
| | - Marcus Gertzen
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Andrea Rabenstein
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Germany
| | - Moritz Straßburger
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Germany
| | - Alana Horstmann
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Germany
| | - Oliver Pogarell
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Germany
| | - Tobias Rüther
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Germany
| | - Susanne Karch
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Germany
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Muschialli L, Yang JC, Engstrom T, Puljevic C, Beltazar E, Beltazar E, Siddique O, Ferris J, Connolly DJ. Sexualized drug use and chemsex: A bibliometric and content analysis of published literature. J Psychoactive Drugs 2024:1-12. [PMID: 38961638 DOI: 10.1080/02791072.2024.2367614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 03/28/2024] [Indexed: 07/05/2024]
Abstract
Sexualized drug use (SDU) describes drug-facilitated sexual enhancement, and chemsex is an SDU subculture involving the use of specific drugs by men who have sex with men (MSM). This study aimed to identify research trends, foci, and themes within the SDU and chemsex-specific literature. The Web of Science Core Collection was searched with a list of SDU synonyms. All SDU-related articles were analyzed using the R package, bibliometrix. Full text review identified chemsex-specific records, and text was extracted verbatim for content analysis in Leximancer. The search returned 1,866 unique records. A total of 521 addressed SDU, and 301 papers specifically addressed chemsex. The small but growing SDU literature primarily addressed consensual encounters between MSM, and drug-facilitated assault experienced by women, in Western settings. Little attention was given to transgender communities or consensual SDU in cisgender heterosexual individuals. The literature primarily viewed SDU through a public health lens, specifically focusing on the risk conferred to sexual health.The SDU and chemsex-specific literature are potentially limited in scope and may inadequately capture the geographical, demographic, and cultural diversity of these phenomena. Future research should address the myriad social and health implications of SDU and chemsex participation across all relevant communities and settings.
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Affiliation(s)
- Luke Muschialli
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Justin C Yang
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Teyl Engstrom
- Queensland Digital Health Centre, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Cheneal Puljevic
- School of Public Health, Faculty of Medicine, The University of Queensland, Hesrtone, Queensland, Australia
| | | | | | - Owais Siddique
- UCL Medical School, Faculty of Medical Sciences, London, UK
| | - Jason Ferris
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Dean J Connolly
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- National Addiction Centre, King's College London, London, UK
- Institute of Epidemiology and Health Care, University College London, London, UK
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Olete RA, Strong C, Leyritana K, Bourne A, Ko NM. ChemsexPH: The association between chemsex, HIV status and adherence to antiretroviral therapy among men who have sex with men in the Philippines. J Int AIDS Soc 2024; 27:e26323. [PMID: 38982574 PMCID: PMC11233270 DOI: 10.1002/jia2.26323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 06/10/2024] [Indexed: 07/11/2024] Open
Abstract
INTRODUCTION Chemsex, the use of psychotropic drugs before or during sexual intercourse, is associated with various HIV risk factors, including condomless sex and reduced adherence to pre-exposure prophylaxis or antiretroviral therapy (ART). In the Philippines, there are still limited studies exploring the associations between chemsex, HIV status and ART adherence. This study aims to compare recent and lifetime chemsex engagement in association with self-reported HIV status among Filipino men who have sex with men (MSM). We further explored the association between chemsex and ART adherence among people living with HIV engaged in chemsex. METHODS A cross-sectional online survey of 479 Filipino MSM was conducted from 3 August to 1 December 2019. Demographic profiles, sexual behaviours, drug use, history of sexually transmitted infections (STIs), chemsex engagement and HIV status were collected and analysed. Bivariable and multivariable logistic regression were employed to assess the association between self-reported HIV status and chemsex engagement. RESULTS Among the 479 respondents, Filipino MSM engaged in drug use and chemsex were generally older compared to those not engaged in drug use and chemsex (average age 31-33 vs. 29 years old; p<0.05). Methamphetamine was the most common drug for people who reported using drugs. An HIV-positive status was associated with recent chemsex engagement (aOR = 5.18, p<0.05) and a history of STIs (aOR = 2.09, p<0.05). The subgroup analysis showed that 79% (166/200) of persons living with HIV were adherent to ART. There was no significant association found between chemsex and ART adherence in the logistic regression analyses. CONCLUSIONS Chemsex behaviour, particularly recent chemsex engagement, is significantly associated with self-reported HIV status. The emerging data on MSM engaged in chemsex require integration of a more person-centred, comprehensive and robust harm reduction programmes into the existing combination prevention strategies in the country. Health education for Filipino MSM engaged in chemsex should prioritize raising awareness about methamphetamine effects and overdose risks, alongside proper medical management.
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Affiliation(s)
- Rodenie Arnaiz Olete
- Department of Public HealthCollege of MedicineNational Cheng Kung UniversityTainanTaiwan
- Sustained Health Initiatives of the PhilippinesMandaluyong CityPhilippines
| | - Carol Strong
- Department of Public HealthCollege of MedicineNational Cheng Kung UniversityTainanTaiwan
| | - Katerina Leyritana
- Sustained Health Initiatives of the PhilippinesMandaluyong CityPhilippines
| | - Adam Bourne
- Australia Research Centre in SexHealth and SocietyLa Trobe UniversityMelbourneVictoriaAustralia
- Kirby InstituteUNSW SydneySydneyNew South WalesAustralia
| | - Nai‐Ying Monica Ko
- Department of Public HealthCollege of MedicineNational Cheng Kung UniversityTainanTaiwan
- Department of Nursing, College of MedicineNational Cheng Kung UniversityTainanTaiwan
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Hillier B, Carthy E, Kalk N, Moncrieff M, Pakianathan M, Tracy D, Bowden-Jones O, Hickson F, Forrester A. Developing a coordinated response to chemsex across health, justice and social care settings: expert consensus statement. BJPsych Bull 2024:1-8. [PMID: 38916191 DOI: 10.1192/bjb.2024.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/26/2024] Open
Abstract
SUMMARY Chemsex occurs primarily among gay, bisexual and other men who have sex with men (GBMSM), and there is evidence of a subgroup of users who carry out chemsex-related criminal offences and experience harm. Challenges with chemsex can present to various settings; there are concerns that harm is increasing, including at interfaces between health, social care and criminal justice systems. The UK response to date has lacked a coordinated approach. An expert reference group was convened to share chemsex knowledge, articulate priorities for research and pathway development, and foster collaborative working between agencies. It made three key recommendations: develop and increase training and awareness across all services; implement a coordinated research programme with the development of a common data-set and assessment tool to fully characterise population-level needs; develop a professional network to share information, provide professional support and act as a knowledge hub. There was support for a unified multi-agency strategy incorporating the priorities identified as overarching principles.
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Affiliation(s)
- Bradley Hillier
- West London NHS Trust, London, UK
- London School of Hygiene and Tropical Medicine, London, UK
| | - Eliott Carthy
- West London NHS Trust, London, UK
- University of Oxford, Oxford, UK
| | - Nicola Kalk
- South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | | | | | | | | | - Ford Hickson
- London School of Hygiene and Tropical Medicine, London, UK
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Anastario M, Suarez A, Williamson O, Firemoon P, Roberts EFS, Barber J. Injection preparation filtration and health concerns among indigenous people who inject methamphetamine. Front Public Health 2024; 12:1390210. [PMID: 38932776 PMCID: PMC11201683 DOI: 10.3389/fpubh.2024.1390210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/31/2024] [Indexed: 06/28/2024] Open
Abstract
Introduction Injecting methamphetamine poses significant health risks, but little is known about how methamphetamine injectors filter their injection preparations and experience related health concerns. Methods A chain-referral sample of Indigenous people who inject methamphetamine (n = 30) was recruited and semistructured interviews were conducted to collect information on filtration practices and health concerns. Results Filtration of the injection preparation was described by 53% of injectors. Elevated levels of concern for kidney disease, cancer and heart disease were observed among those who filtered their preparations (ranging from 50 to 56.3%). Concern about liver disease was the most frequent concern among those who filtered their preparations (62.5%) and was elevated in comparison to those who did not use filters (7.1%). Grouped logistic regression revealed a positive association between filtration of the injection preparation and overall health concerns expressed by injectors, after adjusting for gender and age. The marginal posterior distribution of the adjusted odds ratio for filtration of the injection preparation had a posterior median = 35.7, and 95% HPD interval = (5.1, 512.4). Discussion Results illustrate a positive relationship between filtration of the injection preparation and health concerns among Indigenous people who inject methamphetamine. This likely reflects the use of filtration to reduce harms, and further research is needed to understand the full scope of prevention that may be associated with filtration of methamphetamine injection preparations.
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Affiliation(s)
- Michael Anastario
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, United States
| | - Andrea Suarez
- Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, United States
| | - Olivia Williamson
- Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, United States
| | | | | | - Jarrett Barber
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, United States
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Amundsen E, Muller AE, Reierth E, Skogen V, Berg RC. Chemsex Among Men Who Have Sex With Men: A Systematic Scoping Review of Research Methods. JOURNAL OF HOMOSEXUALITY 2024; 71:1392-1418. [PMID: 36939142 DOI: 10.1080/00918369.2023.2170757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Chemsex refers to the use of psychoactive substances with sex. We carried out a systematic scoping review of methodological characteristics of chemsex research among men who have sex with men (MSM), published between 2010 and 2020. For inclusion, chemsex had to be the main focus, and studies had to specify GHB/GBL, stimulant (amphetamine, crystal meth, ecstasy/MDMA, cathinones, cocaine) and/or ketamine use with sex as a variable. From 7055 titles/abstracts, 108 studies were included, mostly cross-sectional, and from Western countries. About one-third of studies recruited exclusively from clinical settings. A majority of these recruited from sexually transmitted infection (STI) clinics. The included quantitative studies analyzed possible associations between chemsex and STI health (40%), mental health (15%), drug health (12%), sexological health (10%), and post-diagnostic HIV health (7%). Most studies included GHB/GBL and crystal meth in their operationalization of chemsex. Definitions and operationalizations of chemsex vary greatly in the literature, and researchers of chemsex among MSM should consider ways in which this variation impacts the validity of their results. More studies are needed among MSM in non-high income and non-Western countries, and examination of possible links between chemsex and post-diagnostic HIV health, sexological health, and mental health.
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Affiliation(s)
- Eirik Amundsen
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | | | - Eirik Reierth
- Science and Health Library, UiT The Arctic University of Norway, Tromsø, Norway
| | - Vegard Skogen
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Infectious Diseases, Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Rigmor C Berg
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
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Hawkinson DE, Witzel TC, Gafos M. Exploring practices to enhance benefits and reduce risks of chemsex among gay, bisexual, and other men who have sex with men: A meta-ethnography. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 127:104398. [PMID: 38555721 DOI: 10.1016/j.drugpo.2024.104398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/16/2024] [Accepted: 03/18/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Chemsex is the intentional combining of specific drugs with sex, primarily by gay, bisexual, and other men who have sex with men (GBMSM), to enhance intimacy, pleasure, and prolong sexual sessions. Practices vary across geographic and social settings. Participants report benefits and risks of chemsex. Studies have previously reviewed chemsex practices and harm reduction interventions separately. This review aims to examine both together by describing and understanding practices that men employ to navigate the perceived benefits and risks of chemsex. METHODS We conducted a systematic meta-ethnographic review of published qualitative literature, screening titles, abstracts, and full texts on defined inclusion and exclusion criteria. Using reciprocal and refutational translation techniques, we analysed study participants' (first-order) and researchers' (second-order) accounts of benefit-enhancing and risk-reducing chemsex practices. Finally, we employed line-of-argument synthesis techniques to develop our own higher-level interpretations (third-order constructs) of these chemsex practices. RESULTS Our search yielded 6356 records, from which, we included 23 articles in our review. Most studies were conducted in high-income Western countries. Across studies, participants acted at the individual, interpersonal, and community levels to enhance benefits and reduce risks, which made up our third-order constructs. Eight themes emerged from first- and second-order constructs to describe these practices, which included personal preparation, personal boundaries, biomedical measures, structured use of drugs, leaning on partners, injecting practices, group organising, watching out for others, and teaching and learning. Contextual factors like trust, agency, access, stigma, and setting moderated whether and how participants engaged in these practices, and if practices enhanced benefits or reduced risks. CONCLUSION Health promotion programmes and research focused on chemsex must account for the benefits and the risks that GBMSM associate with this type of sexualised drug use and target the moderating factors that shape the practices they employ to navigate these benefits and risks.
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Affiliation(s)
- Drew E Hawkinson
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom
| | - T Charles Witzel
- Institute for Global Health, University College London, Gower Street, London, WC1E 6BT, United Kingdom; Center of Excellence in Research on Gender, Sexuality and Health, Mahidol University, 999 Phutthamonthon Sai 4 Rd, Nakhon Pathom, Thailand
| | - Mitzy Gafos
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom.
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Juyal D, Pal S, Joshi C, Dhawan N, Rawre J, Dhawan B. Chemsex and risk of sexually transmitted infections: a perspective from India. Sex Transm Infect 2024; 100:181-183. [PMID: 38565298 DOI: 10.1136/sextrans-2023-056045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 03/10/2024] [Indexed: 04/04/2024] Open
Affiliation(s)
- Deepak Juyal
- Department of Microbiology, Government Doon Medical College, Dehradun, Uttarakhand, India
- Microbiology (Ph.D Scholar), Hemwati Nandan Bahuguna Uttarakhand Medical Education University, Dehradun, Uttarakhand, India
| | - Shekhar Pal
- Department of Microbiology, Government Doon Medical College, Dehradun, Uttarakhand, India
| | - Chitra Joshi
- Department of Obstetrics & Gynaecology, Government Doon Medical College, Dehradun, Uttarakhand, India
| | - Neha Dhawan
- Department of Dermatology Venereology and Leprosy, Gandhi Medical College, Secunderabad-Padmarao Nagar, Telangana, India
| | - Jyoti Rawre
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Benu Dhawan
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, Delhi, India
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Rodríguez-Expósito B, Rieker JA, Uceda S, Beltrán-Velasco AI, Echeverry-Alzate V, Gómez-Ortega M, Positivo A, Reiriz M. Psychological characteristics associated with chemsex among men who have sex with men: Internalized homophobia, conscientiousness and serostatus as predictive factors. Int J Clin Health Psychol 2024; 24:100465. [PMID: 38737628 PMCID: PMC11088328 DOI: 10.1016/j.ijchp.2024.100465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 04/23/2024] [Indexed: 05/14/2024] Open
Abstract
Background Although significant progress has been made in the rights of the LGBTQ+ community, even today this population still faces stigma and discrimination that impacts their mental health. In the case of men who have sex with men, it has been demonstrated that the use of drugs in a sexual context (chemsex) is one of the coping mechanisms and means of escape to deal with these situations. Method We assessed 284 native Spanish speakers' participants, 45,4 % were not engaged in sexualised drug use (n = 129) while 54,6 % were chemsex users (n = 155) using 18,7 % of them the injected via. The participants completed six questionnaires about life and sexual satisfaction, depression, anxiety, internalised homophobia and personality. Bivariate and multivariable logistic regression were performed to assess the associations between sexual behaviour-related and psychological variables. Kruskal-Wallis H test was used to analysed the impact on mental health of the administration via. Results Aged, unprotected sexual relationships, positive serostatus, homonegativity and conscientiousness predicted the chemsex engagement. Furthermore, we found differences regarding the administration via. Conclusions We conclude that mental health significantly correlates with the practice of chemsex, highlighting the importance of integrating mental health considerations into the prevention of risky sexual behaviors.
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Affiliation(s)
- Benjamín Rodríguez-Expósito
- Nebrija University, Facultad de Lenguas y Educación, Universidad Antonio de Nebrija, Madrid 28240, Spain
- Departament of Psychology, UNED, Seville, Spain
| | - Jennifer A. Rieker
- NBC Group, Psychology Department, School of Life and Nature Sciences, Nebrija University, Madrid, Spain
| | - Sara Uceda
- NBC Group, Psychology Department, School of Life and Nature Sciences, Nebrija University, Madrid, Spain
| | | | - Víctor Echeverry-Alzate
- NBC Group, Psychology Department, School of Life and Nature Sciences, Nebrija University, Madrid, Spain
| | | | | | - Manuel Reiriz
- NBC Group, Psychology Department, School of Life and Nature Sciences, Nebrija University, Madrid, Spain
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Blanchette M, Flores-Aranda J, Bertrand K, Lemaître A, Jauffret-Roustide M, Goyette M. Sexualized substance use among gbMSM: Their perspectives on their intervention needs and counsellor competencies. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 159:209258. [PMID: 38128651 DOI: 10.1016/j.josat.2023.209258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 08/21/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Treatments for problematic substance use by gay, bisexual and other men who have sex with men (gbMSM) in sexualized contexts must be adapted to take sociocultural aspects of these sexual practices into account. When treatment programs factor in sexuality, they most commonly address it from a biological perspective (STTBIs, HIV). This article sets out to identify intervention needs related to sexualized substance use (SSU) from the perspective of gbMSM, taking into consideration different dimensions of sexuality to offer more effective support. METHODS Twenty adult gbMSM, each of whom had previously participated in addiction-related treatment programs, took part in this study. We recruited through medical clinics, community organizations, social media advertising and word of mouth. Through one-on-one semi-structured interviews, participants shared their perspectives on the treatment they had received, how their sexuality had been addressed during treatment, and their perceptions of their treatment-related needs and requirements. The study analyzed and interpreted the data gathered during these interviews using a conceptual framework of sexual health combined with The Competencies, a model for addiction counselling training. RESULTS When the study asked participants what they would consider beneficial in terms of SSU-related treatment, they identified certain key competencies. These can be broken down into three categories - knowledge, skills and attitudes - that, together, participants perceived as critical to the development of adequate programs and services. While participants reported addiction-related knowledge was important, so too was an understanding of sexuality (e.g., sexual practices, gbMSM communities, sociocultural norms). With regard to attitudes, the study identified respect, non-judgment, acceptance and empathy as themes for most participants. Lastly, the desired skills were those permitting counsellors and other treatment providers to better align programs and services with each individual's singular reality within the context of their substance use. CONCLUSIONS The results of this study suggest that, to provide treatment programs adapted to the needs of gbMSM in a context of SSU, knowledge must be consolidated and new skills developed. Furthermore, both knowledge and skills need to be placed within an overarching perspective of cultural humility. Overall, improving these various competencies should improve the continuum of care in addiction treatment.
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Affiliation(s)
- Maxime Blanchette
- École de travail social, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, QC, Canada.
| | - Jorge Flores-Aranda
- École de travail social, Université du Québec à Montréal, Montréal, QC, Canada
| | - Karine Bertrand
- Département des sciences de la santé communautaire, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - André Lemaître
- Faculté des Sciences sociales, Université de Liège, Liège, Belgium
| | - Marie Jauffret-Roustide
- Institut National de la Santé et de la Recherche Médicale, Paris, France; Baldy Center for Law and Social Policy, Buffalo University, Buffalo, USA; British Columbia Center on Substance Use, Vancouver, BC, Canada
| | - Mathieu Goyette
- Département de sexologie, Université du Québec à Montréal, Montréal, QC, Canada
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Norman T, Bourne A, Amos N, Power J, Anderson J, Lim G, Carman M, Meléndez-Torres GJ. Typologies of alcohol and other drug-related risk among lesbian, gay, bisexual, transgender (trans) and queer adults. Drug Alcohol Rev 2024; 43:551-561. [PMID: 38291714 DOI: 10.1111/dar.13814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/28/2023] [Accepted: 01/15/2024] [Indexed: 02/01/2024]
Abstract
INTRODUCTION Prevalence and patterns of alcohol and other drug (AOD) use among specific lesbian, gay, bisexual, transgender (trans) and queer (LGBTQ+) subpopulations are well established. However, patterns of substance-related risk have been less thoroughly explored. This study aimed to determine typologies AOD risk among LGBTQ+ adults in Australia. METHOD Latent class analyses were performed to determine distinct patterns of AOD risk (n = 6835), as measured by the Alcohol Use Disorder Identification Test and Drug Abuse Screening Tool. Demographic characteristics, experience of harassment, assault and/or threats, mental wellbeing and LGBTQ+ connectedness were compared across emergent classes. RESULTS AOD risk was characterised as 'no risk' (13.3% of sample), 'low risk' (15.1%), 'moderate risk' (alcohol + other drugs; 30.1%), or 'moderate alcohol only risk' (41.5%). The 'moderate risk' class was the most likely class to report recent sexual assault, verbal abuse, harassment and physical threats compared to other classes, while those in the 'moderate alcohol only risk' group were least likely to report these experiences of all classes. However, both the 'moderate risk' and 'moderate alcohol risk only' classes reported greater mental wellbeing and LGBTQ+ connectedness compared to the 'no risk' and 'low risk' classes. DISCUSSION AND CONCLUSIONS Our findings indicate that level of AOD risk is not uniform among some LGBTQ+ adults, nor is the distribution of harms experienced by them. Tailored harm-reduction interventions may be fruitful in attenuating harms based on risk profile; most specifically, LGBTQ+ individuals engaging in moderately risky concurrent AOD use.
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Affiliation(s)
- Thomas Norman
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
- Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Natalie Amos
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Jennifer Power
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Joel Anderson
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Gene Lim
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Marina Carman
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - G J Meléndez-Torres
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
- Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
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14
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Giacalone S, Barberi F, Ramoni S, Casazza G, Cusini M, Marzano AV. Sexualised drug use and chemsex in Italy: A questionnaire study based on a cohort of clients attending a STI outpatient service in Milan. Int J STD AIDS 2023; 34:1034-1041. [PMID: 37608639 DOI: 10.1177/09564624231193055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
BACKGROUND Chemsex is a heterogeneous phenomenon with differences in distribution, setting, motivations and type of substances consumed between countries. The lack of data at national level of the Italian situation creates a perception of reduced need for intervention. METHODS Anonymous paper questionnaires were distributed to patients who had registered themselves at the STI Department IRCCS Ca' Granda Policlinico in Milan. RESULTS A significant association was demonstrated between use of sexualised drugs, chemsex and the following variables: (1). Number of partners: in the group of clients with more than five partners, sexualised drug users were more than twice compared with those in the group with less than five partners (35.2% vs 16.2%) p<0.0001. (2). Use of dating apps: more than one out of two persons who used drugs during sex affirmed looking for partners on internet, p = 0.0059. (3). Low condom uses with occasional partners: percentage of individuals who declared not to use condoms or devices during their sexual encounters with occasional partners is more than twice as high in the sexualised drug users group with respect to controls (44.6% vs 21.4%); p = 0.0006). (4). Use of post exposure prophylaxis (PEP): among the PEP users, more than half participants belonged to the sexualised drug users' group; p = 0.0021. CONCLUSIONS Sexualised drug use and chemsex are frequently practiced in Milan. This survey identified a specific population with higher-risk sexual behaviours and increased incidence of acute bacterial STIs.
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Affiliation(s)
- Serena Giacalone
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - Francesco Barberi
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - Stefano Ramoni
- UOC Dermatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Casazza
- Dipartimento di Scienze Cliniche e di Comunità, Universita' degli Studi di Milano, Milan, Italy
| | - Marco Cusini
- UOC Dermatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Angelo Valerio Marzano
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
- UOC Dermatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Woerner J, Chadwick SB, Antebi-Gruszka N, Siegel K, Schrimshaw EW. Negative Sexual Experiences Among Gay, Bisexual, and Other Men Who Have Sex with Men Using GPS-Enabled Hook-Up Apps and Websites. JOURNAL OF SEX RESEARCH 2023:1-16. [PMID: 38016029 PMCID: PMC11130079 DOI: 10.1080/00224499.2023.2269930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
Gay, bisexual, and other men who have sex with men (GBMSM) often use GPS-enabled dating apps and websites to facilitate in-person sexual encounters. Many of these encounters are positive and enjoyable. However, there is limited research on GBMSM's negative experiences with partners from hookup and dating apps/websites, especially those characterized by threats to GBMSM's sexual, physical, and/or psychological safety. In this report, we investigated this matter. We analyzed data from interviews with GBMSM (N = 60) and identified four categories of negative sexual experiences, each of which were comprised by sub-categories: 1) sexual violence (physical sexual assault, verbal sexual coercion, intoxicated assault/coercion), 2) sexual health risk behaviors (condom use resistance and coercion, deception related to HIV/STI status), 3) non-negotiated behaviors (undiscussed/unexpected sex acts, rough sex, sexualized racism, undesired substance use by the partner), and 4) threats to physical safety beyond sexual violence (being blocked from leaving, stalked, robbed, drugged). These results can inform future research and interventions that aim to promote safety on dating apps/websites within the GBMSM community.
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Affiliation(s)
- Jacqueline Woerner
- Departments of Sociology and Psychology, University of Central Florida, Orlando, FL
| | - Sara B. Chadwick
- Department of Gender & Women’s Studies, University of Wisconsin-Madison, Madison, WI
| | | | - Karolynn Siegel
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY
| | - Eric W. Schrimshaw
- Department of Population Health Sciences, College of Medicine, University of Central Florida, Orlando, FL
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McGaughey G, Richardson D, Vera J. Harm reduction services for people engaging in chemsex in Brighton, UK: A pilot qualitative study. Int J STD AIDS 2023; 34:940-944. [PMID: 37438866 DOI: 10.1177/09564624231188752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
OBJECTIVE A broad range of stakeholders commission and provide harm reduction support for people who engage in chemsex, including public health, sexual health, mental health, HIV services and substance misuse services. Understanding the experiences of stakeholders could provide important insights and suggest ways to improve outcomes. We aimed to explore the experiences of stakeholders providing harm reduction support to people who engage in chemsex in Brighton, UK. METHODS We conducted semi structured interviews with chemsex harm reduction stakeholders who provide support for people in Brighton, UK. The semi-structured interviews were recorded, transcribed, and analysed thematically using NVivo 1.6.2: Braun & Clarke framework. RESULTS We recruited ten stakeholders with at least 6 months of experience in providing commissioning, managing or providing harm reduction services to people who engage in chemsex. Five themes emerged from the stakeholders: stakeholder perception of client pathways (inefficiency in client pathways, inequitable access to services, unmet client mental health needs) and stakeholder experiences (having to use an 'empathy', 'non judgement' and 'guiding hand' approach), and experiencing emotional burnout as a result of the chemsex harm reduction work. CONCLUSIONS This pilot study of stakeholders suggests that to improve chemsex harm reduction outcomes, a more integrated approach between providers with clear client pathways and a broader reach including services tailored towards non-MSM, and offering services outside of typical business hours is needed. Furthermore, the sustainability of services requires increased workplace support for chemsex service providers to prevent burnout and maintain service quality.
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Affiliation(s)
- Gigi McGaughey
- Department of Global health, Brighton and Sussex Medical School, Brighton, UK
| | - Daniel Richardson
- Department of Global health, Brighton and Sussex Medical School, Brighton, UK
- Department of sexual health and HIV medicine, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Jaime Vera
- Department of Global health, Brighton and Sussex Medical School, Brighton, UK
- Department of sexual health and HIV medicine, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
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Rosas Cancio-Suárez M, Ron R, Díaz-Álvarez J, Martínez-Sanz J, Serrano-Villar S, Moreno S, Sánchez-Conde M. Prevalence, characteristics, and associated risk factors of drug consumption and chemsex use among individuals attending an STI clinic (EpITs STUDY). Front Public Health 2023; 11:1285057. [PMID: 38026436 PMCID: PMC10644726 DOI: 10.3389/fpubh.2023.1285057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023] Open
Abstract
Sex-related drug consumption and its health-related consequences have gained relevance in the assessment of patients with sexually transmitted infections (STIs), which pose a significant challenge to public health. We aim to assess the prevalence and characteristics of drug consumption and chemsex practices, describe the associated risk factors among general individuals attending an STI clinic, and evaluate the psychological impact associated with these behaviors. We conducted an online anonymous survey offered to patients with a diagnosis of STI in a tertiary hospital in Spain. Data included sociodemographic characteristics, sexual preferences and behavior, and assessment of drug use, chemsex, and psychological and mental health symptoms. Data from 145 subjects was collected, with a higher proportion of cis-gender men (71%), and a median age of 32 years. 64 participants (44%) reported drug use in the last year, with an observed 33.8% prevalence of chemsex consumption. Drug use and chemsex were more frequent among cis-gender men, Men who have Sex with Men (MSM), people living with HIV (PLHIV), and those reporting previous group sex. Poppers and cannabis were the most frequently reported drugs, with a prevalence close to 20% for cocaine, mephedrone, extasis, and GHB. Consequences related to drug use included unpleasant physical sensations, sexual dysfunction, and impaired sexual experience after reduction or drug discontinuation. The prevalence of drug use and chemsex practices are high among patients evaluated for STIs, especially between men, MSM, and subjects practicing group sex. The study highlights the urgent need for targeted interventions on prevention and reduction of their impact on health and social well-being.
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Affiliation(s)
- Marta Rosas Cancio-Suárez
- Department of Infectious Diseases, Hospital Ramón y Cajal, Carretera de Colmenar, Madrid, Spain
- Ramón y Cajal Research Institute (IRYCIS), Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Raquel Ron
- Department of Infectious Diseases, Hospital Ramón y Cajal, Carretera de Colmenar, Madrid, Spain
- Ramón y Cajal Research Institute (IRYCIS), Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Jorge Díaz-Álvarez
- Department of Infectious Diseases, Hospital Ramón y Cajal, Carretera de Colmenar, Madrid, Spain
- Ramón y Cajal Research Institute (IRYCIS), Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Javier Martínez-Sanz
- Department of Infectious Diseases, Hospital Ramón y Cajal, Carretera de Colmenar, Madrid, Spain
- Ramón y Cajal Research Institute (IRYCIS), Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Sergio Serrano-Villar
- Department of Infectious Diseases, Hospital Ramón y Cajal, Carretera de Colmenar, Madrid, Spain
- Ramón y Cajal Research Institute (IRYCIS), Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Santiago Moreno
- Department of Infectious Diseases, Hospital Ramón y Cajal, Carretera de Colmenar, Madrid, Spain
- Ramón y Cajal Research Institute (IRYCIS), Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
- Department of Medicine, University of Alcalá de Henares, Madrid, Spain
| | - Matilde Sánchez-Conde
- Department of Infectious Diseases, Hospital Ramón y Cajal, Carretera de Colmenar, Madrid, Spain
- Ramón y Cajal Research Institute (IRYCIS), Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
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Berendes S, Gubijev A, French R, Hickson FCI, Free C. A qualitative study exploring experiences of the safetxt digital health intervention to reduce sexually transmitted infections in young people in the UK. BMJ Open 2023; 13:e072701. [PMID: 37879678 PMCID: PMC10603438 DOI: 10.1136/bmjopen-2023-072701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 08/22/2023] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVES People aged 16-24 are more likely than other age groups to acquire sexually transmitted infections (STI). Safetxt was a randomised controlled trial of a theory-based digital health intervention to reduce STIs among 16-24 year-old people in the UK. We report results of qualitative research regarding participants' perceptions and experiences of the intervention and trial participation. DESIGN Qualitative thematic analysis following a critical realist paradigm of written open feedback comments provided in the 12-month follow-up questionnaire and semistructured interviews. SETTING Safetxt trial participants were recruited from UK sexual health clinics. PARTICIPANTS Trial inclusion criteria: people aged 16-24 diagnosed with or treated for chlamydia, gonorrhoea or non-specific urethritis. Optional open feedback provided by 3526 of 6248 safetxt participants at 12 months and interviews with a purposive sample of 18 participants after the trial. RESULTS We summarise and report results in seven broad themes. According to recipients, the safetxt intervention increased awareness of the importance of avoiding STIs and ways to prevent them. Participants reported improved confidence, agency, sexual well-being and communication about sexual health with partners, friends and family. Recipients attributed increased condom use, increased STI testing after (rather than before) sex with new partners, and more confident partner notification to the intervention. Recipients described a reduced sense of isolation and stigma in having an STI. Control group participants reported that having had an STI and receiving control texts asking them to report any changes in contact details acted as reminders to use condoms and get tested. We also summarise participant recommendations for future interventions and studies. CONCLUSIONS While control group participants reported precautionary behaviours were 'triggered' by trial participation, intervention recipients reported additional benefits of the intervention in increasing precautionary behaviours and in broader aspects of sexual health such as confidence, communication, emotional well-being and agency. TRIAL REGISTRATION ISRCTN registry ISRCTN64390461.
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Affiliation(s)
- Sima Berendes
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Anasztazia Gubijev
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Rebecca French
- Department of Public Health, Environments & Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Ford Colin Ian Hickson
- Department of Public Health, Environments & Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Caroline Free
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
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19
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Connolly DJ, Eraslan E, Gilchrist G. Coronavirus (COVID-19) and sexualised drug use among men who have sex with men: a systematic review. Sex Health 2023; 20:375-384. [PMID: 37460309 DOI: 10.1071/sh23071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/27/2023] [Indexed: 10/12/2023]
Abstract
Drug-related harms, including harms from sexualised drug use (SDU), are disproportionately experienced by sexual and gender minority people, relative to their majority counterparts. Chemsex, a type of SDU practiced mainly by MSM, is associated with methamphetamine use and increased HIV seropositivity or risk of acquisition. Therefore, participants are at increased risk of immunocompromise. Existing evidence suggests that drug use increases following natural disasters. The impact of coronavirus disease 2019 (COVID-19) on chemsex is unknown. A PRISMA-adherent systematic review was conducted to synthesise reports of changes in the prevalence, frequency, or characteristics of drug use (and factors associated with these changes) following the onset of the COVID-19 pandemic. This report presents findings related to SDU/chemsex among MSM. A comprehensive search across nine databases, supplemented with backward-forward citation searching and contact with key opinion leaders, was conducted. Two reviewers carried out title-abstract screening, full-text screening, and data extraction. Following a final, single database search, nine studies were included in the narrative synthesis. More than half the sample were studies investigating HIV pre-exposure prophylaxis use. Twenty percent of participants in most studies reported chemsex participation. In four, participants reported a net increase or maintenance of chemsex participation during the pandemic and five reported a net decrease. Increased chemsex participation was associated with loneliness, cravings, and working during the pandemic. Decreased chemsex practice was associated with COVID-19-related fear. This synthesis suggests that chemsex practice continued, and for some MSM increased, throughout COVID-19 pandemic 'lockdowns'. This may have increased COVID-19 transmission and severity among potentially vulnerable MSM.
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Affiliation(s)
- Dean J Connolly
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Windsor Walk, London, UK
| | - Ece Eraslan
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Windsor Walk, London, UK
| | - Gail Gilchrist
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Windsor Walk, London, UK
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20
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Field DJ, de Wit J, Davoren MP, O'Reilly EJ, Den Daas C. Chemsex, Anxiety and Depression Among Gay, Bisexual and Other Men Who have Sex with Men Living with HIV. AIDS Behav 2023; 27:3206-3212. [PMID: 36964835 PMCID: PMC10517029 DOI: 10.1007/s10461-023-04041-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 03/26/2023]
Abstract
Chemsex is common among gay, bisexual and other men who have sex with men (gbMSM). Although not always categorised as problematic, a link with psychological distress has been reported and might be exacerbated amongst gbMSM living with HIV, as HIV has been associated with anxiety and depression. A cross-sectional online survey of gbMSM living with HIV (n = 359) was performed incorporating the Hospital Anxiety and Depression Scale and sociodemographic variables including, HIV characteristics, chemsex and sexual behaviours. Logistic regression analysis was used to find associations with anxiety or depression. Many participants engaged in chemsex (48.5%, n = 174). Chemsex was associated with lower odds of depression (aOR 0.45, 95% CI 0.23-0.85) and not associated with anxiety (aOR 0.66, CI 0.40-1.09). Although chemsex is a public health concern; we found it was associated with lower levels of depression in gbMSM living with HIV. However, causal inference is not possible, as gbMSM with higher levels of depression might engage in chemsex less.
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Affiliation(s)
- David James Field
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland.
- Gay Men's Health Service, Health Service Executive, Heytesbury Street, Dublin 8, Ireland.
| | - John de Wit
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, the Netherlands
| | - Martin P Davoren
- The Sexual Health Centre, Cork City, Cork, Ireland
- School of Public Health, University College Cork, Cork, Ireland
| | | | - Chantal Den Daas
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland
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21
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Freestone J, Ezard N, Bourne A, Brett J, Roberts DM, Hammoud M, Nedanoski A, Prestage G, Siefried KJ. Understandings, attitudes, practices and responses to GHB overdose among GHB consumers. Harm Reduct J 2023; 20:121. [PMID: 37660058 PMCID: PMC10475182 DOI: 10.1186/s12954-023-00857-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 08/23/2023] [Indexed: 09/04/2023] Open
Abstract
BACKGROUND Gamma-hydroxybutyrate (GHB) is used at disproportionately high rates within sexuality and gender diverse communities and carries a high risk of overdose. GHB overdose can result in death. Internationally, recent increases in GHB overdoses have been observed. Coronial reviews of GHB-related death highlight the pivotal roles that bystanders to GHB overdose play in preventing fatality. No research has examined, in detail, how bystanders respond to GHB overdose. This qualitative study was conducted among people who use GHB and explored how they responded upon witnessing a GHB overdose experienced by someone else. METHODS Interviews were conducted with 31 sexuality and gender diverse Australian residents reporting three or more occasions of GHB use in the previous 12 months. Participants were asked questions about witnessed GHB overdose, their actions and decision-making processes throughout overdose. Data were analysed thematically. RESULTS Participants described witnessing GHB overdose, commonly in private settings involving sexualized GHB use. Variable definitions of GHB overdose were reported, ranging from GHB-induced symptoms of distress to comatose intoxication. Drastic actions to keep someone alert and responsive post-GHB ingestion were reported; these included the administration of stimulant substances and citrus. Decisions to call or not call for emergency medical services (EMS) were influenced by many circumstantial variables. In most instances, an EMS call was resisted and response practices deviated from established first aid protocols. CONCLUSIONS GHB overdose prevention and response training programs targeting people who use GHB are urgently required. These education interventions ought to address inaccuracies that inform street remedies for GHB overdose, teach people how to safely check breathing and response, promote basic first aid principles and address barriers to contacting EMS.
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Affiliation(s)
- Jack Freestone
- The Kirby Institute, University of New South Wales Sydney, Wallace Wurth Building, High St, Kensington, NSW, 2052, Australia.
- ACON, 414 Elizabeth Street, Surry Hills, NSW, 2010, Australia.
| | - Nadine Ezard
- National Centre for Clinical Research on Emerging Drugs, c/o the University of New South Wales, Sydney, 2052, Australia
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Darlinghurst, 2010, Australia
- The National Drug and Alcohol Research Centre (NDARC), The University of New South Wales, Sydney, 2052, Australia
| | - Adam Bourne
- The Kirby Institute, University of New South Wales Sydney, Wallace Wurth Building, High St, Kensington, NSW, 2052, Australia
- Australian Research Centre for Sex Health and Society, La Trobe University, Building NR6., Bundoora, VIC, 3086, Australia
| | - Jonathan Brett
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Darlinghurst, 2010, Australia
| | - Darren M Roberts
- Edith Collins Centre, Drug Health Services, Royal Prince Alfred Hospital, Sydney, NSW, 2050, Australia
| | - Mohamed Hammoud
- The Kirby Institute, University of New South Wales Sydney, Wallace Wurth Building, High St, Kensington, NSW, 2052, Australia
| | | | - Garrett Prestage
- The Kirby Institute, University of New South Wales Sydney, Wallace Wurth Building, High St, Kensington, NSW, 2052, Australia
| | - Krista J Siefried
- National Centre for Clinical Research on Emerging Drugs, c/o the University of New South Wales, Sydney, 2052, Australia
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Darlinghurst, 2010, Australia
- The National Drug and Alcohol Research Centre (NDARC), The University of New South Wales, Sydney, 2052, Australia
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22
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Witzel TC, Charoenyang M, Bourne A, Guadamuz TE. Hi-fun among men who have sex with men in Bangkok: A scoping study exploring key informants' perspectives on hi-fun contexts, harms and support strategies. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002295. [PMID: 37624762 PMCID: PMC10456137 DOI: 10.1371/journal.pgph.0002295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 07/21/2023] [Indexed: 08/27/2023]
Abstract
The use of specific drugs (e.g. methamphetamine, GHB/GBL and other stimulants) to enhance sex among men who have sex with men (MSM), is the focus of global public health concern because of links to social harms, poor mental and sexual health. Often called 'chemsex' in Western settings or 'hi-fun' in Southeast Asia, this type of sexualised drug use is increasingly visible in Thailand where the unique sociocultural and legislative environments shape sexual cultures and harms. This study aimed to develop an understanding of key informants' perspectives on hi-fun contexts, harms and current responses in Bangkok. In-depth interviews were conducted with thirteen key informants from clinical, community, policy and development organisations. Four key informants had personal experience of hi-fun. Interviews covered hi-fun contexts, harms and support, were transcribed verbatim, translated to English (where necessary) and analysed using a thematic framework. MSM hi-fun 'influencers' shape norms and provide support online, primarily through Twitter. Hi-fun was linked to Westernisation and wealth; complex hierarchies emerged from asymmetries in social/financial capital. Police coercion towards MSM engaged in hi-fun was a concern. Given the nature of their funding, HIV/HCV/STI transmission was the most pressing focus for many organisations, however key informants were concerned especially about drug overdoses and mental health/well-being impacts. The political and economic context means funding for MSM health in Thailand focuses primarily on HIV prevention/treatment; restrictions on development aid constrain holistic hi-fun focused service development. Most hi-fun support was informally developed; successful strategies relied on partnership working and peer developed/delivered services, some of which were adapted from high-income settings. Despite substantial barriers, organisations developed services responding to the needs of MSM engaged in hi-fun. Given that many were informally developed or adapted from high-income settings, establishing a theoretical basis for further interventions that is grounded in this unique context is a priority.
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Affiliation(s)
- T. Charles Witzel
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Faculty of Social Sciences and Humanities, Center of Excellence in Research on Gender, Sexuality and Health, Mahidol University, Bangkok, Thailand
- Institute for Global Health, University College London, London, United Kingdom
| | - Mookarpa Charoenyang
- Faculty of Social Sciences and Humanities, Center of Excellence in Research on Gender, Sexuality and Health, Mahidol University, Bangkok, Thailand
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Thomas E. Guadamuz
- Faculty of Social Sciences and Humanities, Center of Excellence in Research on Gender, Sexuality and Health, Mahidol University, Bangkok, Thailand
- John F. Kennedy School of Government, Harvard University, Cambridge, Massachusetts, United States of America
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23
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Palmer L, Maviglia F, Wickersham JA, Khati A, Kennedy O, Copenhaver NM, Uyer C, Halim MAA, Ikhtiaruddin WM, Azwa I, Gautam K, Shrestha R. Chemsex and Harm Reduction Practices Among Men Who Have Sex with Men in Malaysia: Findings from a Qualitative Study. J Psychoactive Drugs 2023:1-10. [PMID: 37610135 PMCID: PMC10884347 DOI: 10.1080/02791072.2023.2250342] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 07/10/2023] [Indexed: 08/24/2023]
Abstract
Chemsex is a form of sexualized drug use commonly practiced among MSM with psychoactive substances, such as methamphetamine. While this phenomenon has gained global attention in the past two decades, there is a dearth of empirical data to inform culturally competent interventions. The current work investigates the socio-contextual factors related to chemsex and harm reduction practices among Malaysian MSM. Between February and August 2022, we conducted six online focus group sessions with Malaysian MSM who had engaged in chemsex during the previous 6 months (N = 22). We queried participants about perceived benefits and harms, harm reduction practices, and informational needs. Most participants' first chemsex experience occurred in a casual sexual encounter, often facilitated by mobile technology. Participants reported engaging in harm reduction practices before (e.g. medication reminders), during (e.g. peer support), and after (e.g. rest) chemsex. These findings have implications for future efforts to develop and implement tailored interventions to address the specific and acute needs of Malaysian MSM engaging in chemsex.
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Affiliation(s)
- Lindsay Palmer
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | - Francesca Maviglia
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
| | - Jeffrey A Wickersham
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Antoine Khati
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | - Olivia Kennedy
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | | | - Christopher Uyer
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | - Mohd Akbar Ab Halim
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Wan Mohd Ikhtiaruddin
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Iskandar Azwa
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Infectious Diseases Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kamal Gautam
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | - Roman Shrestha
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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24
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Blair CS, Javanbakht M, Comulada WS, Bolan R, Shoptaw S, Gorbach PM, Needleman J. Comparing Factors Associated with Increased Stimulant Use in Relation to HIV Status Using a Machine Learning and Prediction Modeling Approach. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:1102-1114. [PMID: 37328629 PMCID: PMC10795486 DOI: 10.1007/s11121-023-01561-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 06/18/2023]
Abstract
Stimulant use is an important driver of HIV/STI transmission among men who have sex with men (MSM). Evaluating factors associated with increased stimulant use is critical to inform HIV prevention programming efforts. This study seeks to use machine learning variable selection techniques to determine characteristics associated with increased stimulant use and whether these factors differ by HIV status. Data from a longitudinal cohort of predominantly Black/Latinx MSM in Los Angeles, CA was used. Every 6 months from 8/2014-12/2020, participants underwent STI testing and completed surveys evaluating the following: demographics, substance use, sexual risk behaviors, and last partnership characteristics. Least absolute shrinkage and selection operator (lasso) was used to select variables and create predictive models for an interval increase in self-reported stimulant use across study visits. Mixed-effects logistic regression was then used to describe associations between selected variables and the same outcome. Models were also stratified based on HIV status to evaluate differences in predictors associated with increased stimulant use. Among 2095 study visits from 467 MSM, increased stimulant use was reported at 20.9% (n = 438) visits. Increased stimulant use was positively associated with unstable housing (adjusted [a]OR 1.81; 95% CI 1.27-2.57), STI diagnosis (1.59; 1.14-2.21), transactional sex (2.30; 1.60-3.30), and last partner stimulant use (2.21; 1.62-3.00). Among MSM living with HIV, increased stimulant use was associated with binge drinking, vaping/cigarette use (aOR 1.99; 95% CI 1.36-2.92), and regular use of poppers (2.28; 1.38-3.76). Among HIV-negative MSM, increased stimulant use was associated with participating in group sex while intoxicated (aOR 1.81; 95% CI 1.04-3.18), transactional sex (2.53; 1.40-2.55), and last partner injection drug use (1.96; 1.02-3.74). Our findings demonstrate that lasso can be a useful tool for variable selection and creation of predictive models. These results indicate that risk behaviors associated with increased stimulant use may differ based on HIV status and suggest that co-substance use and partnership contexts should be considered in the development of HIV prevention/treatment interventions.
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Affiliation(s)
- Cheríe S Blair
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, CHS 52-215, Los Angeles, CA, 90095, USA.
| | - Marjan Javanbakht
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - W Scott Comulada
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Robert Bolan
- Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, CA, USA
| | - Steven Shoptaw
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Pamina M Gorbach
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, CHS 52-215, Los Angeles, CA, 90095, USA
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Jack Needleman
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
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25
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Gómez-Núñez MI, Molla-Esparza C, Gandia Carbonell N, Badenes Ribera L. Prevalence of Intoxicating Substance Use Before or During Sex Among Young Adults: A Systematic Review and Meta-Analysis. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:2503-2526. [PMID: 36897426 PMCID: PMC10501956 DOI: 10.1007/s10508-023-02572-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 02/21/2023] [Accepted: 02/21/2023] [Indexed: 06/18/2023]
Abstract
Drug use before or during sex is a high-risk sexual behavior associated with adverse health risks and outcomes, such as increasing the likelihood of overdoses and of acquiring sexually-transmitted diseases. This systematic review and meta-analysis of three scientific databases examined the prevalence of the use of intoxicating substances, those tending to excite or stupefy the user on a psychoactive level, before or during sex, among young adults (18-29 years old). A total of 55 unique empirical studies met the inclusion criteria (48,145 individuals; 39% males), were assessed for risk of bias using the tools of Hoy et al. (2012), and were analyzed via a generalized linear mixed-effects model. The results produced a global mean prevalence of this sexual risk behavior of 36.98% (95% CI: 28.28%, 46.63%). Nonetheless, significant differences were identified between different intoxicating substances, with the use of alcohol (35.10%; 95% CI: 27.68%, 43.31%), marijuana (27.80%; 95% CI: 18.24%, 39.92%), and ecstasy (20.90%; 95% CI: 14.34%, 29.45%) significantly more prevalent than that of cocaine (4.32%; 95% CI: 3.64%, 5.11%), heroin (.67%; 95% CI: .09%, 4.65%), methamphetamine (7.10%; 95% CI: 4.57%, 10.88%), and GHB (6.55%; 95% CI: 4.21%, 10.05%). Moderator analyses showed that the prevalence of alcohol use before or during sex differed according to geographical sample origin, and increased as the proportion of ethnic whites in samples increased. The remaining demographic (e.g., gender, age, reference population), sexual (e.g., sexual orientation, sexual activity), health (e.g., drug consumption, STI/STD status), methodological (e.g., sampling technique), and measurement (e.g., timeframe) variables that were examined did not moderate prevalence estimates. Implications for sexual development interventions were discussed.
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Affiliation(s)
- María Isabel Gómez-Núñez
- Department of Research Methods and Diagnostics in Education, International University of La Rioja, UNIR, Logroño, La Rioja, Spain
| | - Cristian Molla-Esparza
- Department of Research Methods and Diagnostics in Education, University of Valencia, UVEG, Av. de Blasco Ibáñez, 30, 46010, Valencia, Spain.
| | - Natalia Gandia Carbonell
- Llaurant la Llum Therapeutic Community, Center for the Treatment, Withdrawal and Detoxification of Addictions and Other Associated Disorders, Valencia, Spain
- Department of Psychobiology and Health Sciences Methodology, Autonomous University of Barcelona, UAB, Bellaterra, Spain
| | - Laura Badenes Ribera
- Department of Methodology of the Behavioural Sciences, University of Valencia, UVEG, Valencia, Spain
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26
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Goodyear T, Oliffe JL, Parent N, Mniszak C, Jenkins E, Knight R. Differentiating the role of alcohol in young men's use of substances with sex: A qualitative study. Harm Reduct J 2023; 20:100. [PMID: 37525205 PMCID: PMC10388500 DOI: 10.1186/s12954-023-00835-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 07/21/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Alcohol consumption is common among young men and occurs in many contexts. The sexualized substance use literature has generated some insight into the role of alcohol alongside other substances in the context of sex, though there remain opportunities for targeted and context-sensitive studies to examine the sexual practices and outcomes associated with alcohol, specifically. METHODS This interpretive description study explores how experiences and contexts of alcohol use feature in the sexual lives of young men who use substances with sex. Data collection involved in-depth interviews conducted between 2018 and 2021 in Vancouver, Canada, with N = 76 young men (ages 18-30; mean = 23.9 years) who use substances with sex, including men with diverse sexual identities. Data were analyzed in an iterative manner through a social constructivist lens and an interpretive description framework, leveraging constant comparison techniques. FINDINGS This analysis yielded three interconnected themes: (1) using alcohol for sexual(ity) freedoms; (2) backgrounding alcohol within a sexualized polysubstance milieu; and (3) navigating the risks and consequences of using alcohol with sex. Alcohol use was found to reduce inhibitions and support experimentation, including by facilitating the transgression of conservative or restrictive social and sexual norms. Alcohol was seldom explicitly classified as a sexualized substance, though it was evidently a widespread and normative social practice. This practice was associated with important risk and consequences, including with respect to consent, pregnancy and sexually transmitted and bloodborne infection risk, and sexual dysfunction. CONCLUSIONS Findings from this study position alcohol as a backgrounded yet significantly influential substance that young men use with sex. The sexualized use of substances must be understood, and responded to, in a manner that is grounded in harm reduction and that considers the full spectrum of substances-inclusive of but not limited to alcohol-and associated benefits and risks that feature in young men's sexual lives. Specifically, sexual health and primary care providers working with young men should invite and open up meaningful conversation about how they may be using substances (including alcohol) with sex, while offering de-stigmatizing, sex-positive, and affirming education and supports to promote safer sex and substance use.
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Affiliation(s)
- Trevor Goodyear
- British Columbia Centre on Substance Use, 400-1045 Howe St, Vancouver, BC, V6Z 2A9, Canada
- School of Nursing, University of British Columbia, Vancouver, Canada
| | - John L Oliffe
- School of Nursing, University of British Columbia, Vancouver, Canada
- Department of Nursing, University of Melbourne, Melbourne, VIC, Australia
| | - Natasha Parent
- British Columbia Centre on Substance Use, 400-1045 Howe St, Vancouver, BC, V6Z 2A9, Canada
| | - Caroline Mniszak
- British Columbia Centre on Substance Use, 400-1045 Howe St, Vancouver, BC, V6Z 2A9, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Emily Jenkins
- School of Nursing, University of British Columbia, Vancouver, Canada
| | - Rod Knight
- British Columbia Centre on Substance Use, 400-1045 Howe St, Vancouver, BC, V6Z 2A9, Canada.
- Department of Medicine, University of British Columbia, Vancouver, Canada.
- École de Santé Publique, Université de Montréal, Montréal, Canada.
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27
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Daly FP, O'Donnell K, Davoren MP, Noone C, Weatherburn P, Quinlan M, Foley B, Lyons F, Igoe D, Barrett P. Recreational and sexualised drug use among gay, bisexual, and other men who have sex with men (gbMSM) in Ireland-Findings from the European MSM internet survey (EMIS) 2017. PLoS One 2023; 18:e0288171. [PMID: 37506129 PMCID: PMC10381075 DOI: 10.1371/journal.pone.0288171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/20/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Gay, bisexual, and other men who have sex with men (gbMSM) report a higher prevalence of drug use in comparison to the general male population. However, in Ireland, there is a paucity of literature regarding the prevalence of drug use and its determinants among gbMSM. AIMS/OBJECTIVES To quantify the prevalence of (i) recreational drug use (RDU) and (ii) sexualised drug use (SDU) among gbMSM in Ireland, and to identify the factors associated with these drug use practices. METHODS The European MSM Internet Survey (EMIS) 2017 was an online, anonymous, internationally-promoted questionnaire. Two binary outcomes were included in our analyses: (1) RDU and (2) SDU in the previous year. Multivariable-adjusted logistic regression explored factors associated with these outcomes, and all independent covariates were adjusted for one another. RESULTS Among gbMSM without HIV (n = 1,898), 40.9% and 13.1% engaged in RDU and SDU in the previous year, respectively. Among diagnosed-positive gbMSM (n = 141), the past-year respective prevalence estimates were 51.8% and 26.2%. Increased odds of RDU were observed among gbMSM who were younger (vs. 40+ years) (18-24 years; AOR 2.96, 95% CI 2.05-4.28, 25-39 years; AOR 1.66, 95% CI 1.27-2.16), lived in Dublin (vs. elsewhere) (AOR 1.47, 95% CI 1.17-1.83), and engaged in condomless anal intercourse (CAI) in the previous year (vs. none) (1-2 partners; AOR 1.79, 95% CI 1.34-2.38, 6+ partners; AOR 1.79, 95% CI 1.18-2.71). Greater odds of SDU were identified among those who lived in Dublin (vs. elsewhere) (AOR 1.50, 95% CI 1.07-2.10), and engaged in CAI (vs. none) (1-2 partners; AOR 3.16, 95% CI 2.05-4.88, 3-5 partners; AOR 2.50, 95% CI 1.47-4.26, and 6+ partners; AOR 3.79, 95% CI 2.23-6.43). CONCLUSION GbMSM report a high prevalence of drug use in Ireland. Targeted interventions, including harm reduction campaigns, may be needed to support healthier drug use choices among this community.
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Affiliation(s)
- Fionn P Daly
- School of Medicine and Health, University College Cork, Cork, Ireland
- School of Public Health, University College Cork, Cork, Ireland
| | - Kate O'Donnell
- HSE Health Protection Surveillance Centre, Dublin, Ireland
| | - Martin P Davoren
- School of Public Health, University College Cork, Cork, Ireland
- Sexual Health Centre, Cork, Ireland
| | - Chris Noone
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Peter Weatherburn
- Sigma Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | - Fiona Lyons
- St. James's Hospital, James St, Saint James' (part of Phoenix Park), Dublin 8, Dublin, Ireland
| | - Derval Igoe
- HSE Health Protection Surveillance Centre, Dublin, Ireland
| | - Peter Barrett
- School of Public Health, University College Cork, Cork, Ireland
- Department of Public Health HSE-South, St. Finbarr's Hospital, Cork, Ireland
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28
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Platteau T, Herrijgers C, Florence E, Poels K, Verboon P, Apers L, Vandebosch H. Drug behaviors, sexually transmitted infection prevention, and sexual consent during chemsex: insights generated in the Budd app after each chemsex session. Front Public Health 2023; 11:1160087. [PMID: 37275478 PMCID: PMC10234121 DOI: 10.3389/fpubh.2023.1160087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/28/2023] [Indexed: 06/07/2023] Open
Abstract
Chemsex refers to the intentional use of drugs before or during sex in a specific context, typically involving prolonged sex sessions with multiple partners. Engaging in chemsex is associated with a wide range of health risks and related risk behaviors. We developed a mobile phone application ('Budd-app') to support and inform chemsex participants, reduce potential negative impacts associated with chemsex (e.g., physical, psychological and social health harms), and encourage more reasoned participation. During Budd's development process, 11 participants completed a survey after each chemsex session they attended. This data collection approach provided precise experiences on drug related behavior, prevention measures for sexually transmitted infection and sexual consent on 63 chemsex sessions. The mean duration of chemsex sessions was 17.5 h. Polydrug use was reported during 95% of chemsex sessions with an average of 3.5 agents per session. Unsafe dosing occurred at 49% of chemsex sessions, and 9/11 participants dosed unsafely at least once. Seven participants did not consistently take measures to prevent STI transmission. Nine had experienced peer pressure, both regarding drug use and sexual health. The same number reported sex without consent, not respecting others' boundaries as well as their own boundaries not being respected. Many participants experienced negative impact of their chemsex behavior during (7/9) and after (8/9) chemsex. Through participants' behavior assessment during multiple chemsex sessions, 'within-person' variability can be clarified. This clarification provides valuable insights in personal, emotional and contextual vulnerabilities. These insights can direct an individualized care and support trajectory aimed at addressing those vulnerabilities.
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Affiliation(s)
- Tom Platteau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Corinne Herrijgers
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Eric Florence
- Department of General Internal Medicine, Infectious Diseases and Tropical Medicine, Antwerp University Hospital, Edegem, Belgium
| | - Karolien Poels
- Department of Communication Studies, University of Antwerp, Antwerp, Belgium
| | - Peter Verboon
- Faculty of Psychology, Open University, Heerlen, Netherlands
| | - Ludwig Apers
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Heidi Vandebosch
- Department of Communication Studies, University of Antwerp, Antwerp, Belgium
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29
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Gaudette M, Hesse CL, Kia H, Chanady T, Carson A, Knight R, Ferlatte O. "A Double-Edged Sword": Health Professionals' Perspectives on the Health and Social Impacts of Gay Dating Apps on Young Gay, Bisexual, Trans and Queer Men. JOURNAL OF SEX RESEARCH 2023; 60:656-667. [PMID: 36519734 DOI: 10.1080/00224499.2022.2153786] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Gay dating apps (GDAs) play a central role in partner-seeking for many men. The purpose of the present study was to explore health professionals' perceptions of the effects of GDAs on young gay, bisexual, trans and queer men (YGBTQM). Because health professionals have access to privileged information about YGBTQM's experiences with GDAs, they can provide unique insights about their impacts on YGBTQM health and well-being. This study drew on 28 in-depth semi-structured qualitative interviews with health professionals who provide services to YGBTQM in British Columbia, Canada. Using thematic content analysis, we identified three themes showing participants' conflicting perceptions of GDAs' impacts on YGBTQM: (1) the accessibility of sex on GDAs as either transactional or pleasurable; (2) the building of community and increased safety, which at times corresponds with increased exposure to rejection and discrimination; and (3) a perceived escalation in sexual and drug-related risk-taking in conjunction with the opportunity for education, prevention and intervention. In response to the often polarizing literature on GDAs, this study is among the first to contribute empirical evidence into the perceptions of health professionals working with YGBTQM who use GDAs, while simultaneously providing actionable insights and strategies to help identify potential harms and maximize benefits.
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Affiliation(s)
- Maxim Gaudette
- Département de Medecine Sociale et préventive, École de Santé Publique, Université de Montréal
- Centre de Recherche en Santé Publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal
| | - Cassandra L Hesse
- Providence Health Care, British Columbia Centre on Substance Use
- Department of Education, University of British Columbia
| | - Hannah Kia
- School of Social Work, University of British Columbia
- Department of Medicine, University of British Columbias
| | - Tara Chanady
- Département de Medecine Sociale et préventive, École de Santé Publique, Université de Montréal
- Centre de Recherche en Santé Publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal
| | - Anna Carson
- Providence Health Care, British Columbia Centre on Substance Use
| | - Rod Knight
- Providence Health Care, British Columbia Centre on Substance Use
- Department of Medicine, University of British Columbias
| | - Olivier Ferlatte
- Département de Medecine Sociale et préventive, École de Santé Publique, Université de Montréal
- Centre de Recherche en Santé Publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal
- Providence Health Care, British Columbia Centre on Substance Use
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30
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Stein O, Sang JM, Wang L, Cui Z, Zhu J, Lal A, Card KG, Lachowsky NJ, Hogg R, Moore DM. Factors associated with improvements in symptoms of anxiety and depression among gay, bisexual and other men who have sex with men (gbMSM) in Vancouver, Canada: A prospective cohort study. J Affect Disord 2023; 328:334-340. [PMID: 36806593 DOI: 10.1016/j.jad.2023.02.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 01/27/2023] [Accepted: 02/12/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Depression and anxiety are commonly experienced among gay, bisexual and other men-who-have-sex-with-men (gbMSM). We explored factors associated with improvements in mental health symptoms among gbMSM with abnormal depression and anxiety scores over a period of four years, in Vancouver, Canada. METHODS Sexually active gbMSM ≥16 years of age were recruited using respondent-driven sampling from February 2012 to February 2015. Participants completed a computer-assisted questionnaire which included the Hospital Anxiety and Depression Scale (HADS), and psychometric scales to measure loneliness, self-esteem and social connectedness, every 6 months until July 2019. Generalized linear mixed models were used to assess factors associated with normal/borderline HADS scores (<11) following a previous abnormal score (≥11) for each of anxiety and depression subscales. RESULTS We recruited 694 participants, of whom 580 had at least one follow-up visit. Across all visits, 43.6 % of participants ever had abnormal anxiety scores and 16.2 % ever had abnormal depression scores. Among those with abnormal anxiety scores, 34.9 % of follow-up visits demonstrated reductions in anxiety scores. Among those with abnormal depression scores 51.0 % of follow-up visits demonstrated reductions in depression scores. Reductions in anxiety scores were associated with increased self-esteem, decreased loneliness and the number of gbMSM seen/spoken to in the previous month. Reductions in depression scores were associated with increased self-esteem, decreased loneliness and having a regular partner. CONCLUSION Improvements in mental health symptoms were frequently observed. Social connectedness was related with improved anxiety and depression symptoms. Interventions to improve social connectedness may help to improve mental health for gbMSM.
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Affiliation(s)
- Olivia Stein
- Faculty of Land and Food Systems, University of British Columbia, Canada
| | - Jordan M Sang
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Lu Wang
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Zishan Cui
- Faculty of Medicine, University of British Columbia, Canada
| | - Julia Zhu
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Allan Lal
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Kiffer G Card
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Nathan J Lachowsky
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada; School of Public Health and Social Policy, University of Victoria, Victoria, Canada
| | - Robert Hogg
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - David M Moore
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada; Faculty of Medicine, University of British Columbia, Canada.
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Hung YR, Chuang TT, Chen TW, Chung AC, Wu MT, Hsu ST, Ko NY, Strong C. Utilization of mental health services in relation to the intention to reduce chemsex behavior among clients from an integrated sexual health services center in Taiwan. Harm Reduct J 2023; 20:52. [PMID: 37062840 PMCID: PMC10108506 DOI: 10.1186/s12954-023-00777-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 04/06/2023] [Indexed: 04/18/2023] Open
Abstract
INTRODUCTION The intention of chemsex-practicing gay and bisexual men and other men who have sex with men (GBMSM) to reduce their drug use is an important factor for the utilization of harm reduction services. This study aimed to examine data from an integrated sexual health services center to understand the relationship between the intention to reduce chemsex behavior and chemsex-related utilization of mental health services among GBMSM who engage in chemsex. METHOD We used data collected from Healing, Empowerment, Recovery of Chemsex (HERO), an integrated health center in Taiwan, between November 2017 and December 2021. As the baseline, clients were asked to rate the current and ideal proportions of their sexual activities that involved the use of MDMA, ketamine, methamphetamine, GHB/GBL, or mephedrone. Having the intention to reduce chemsex was defined as having a lower proportion of ideal engagement compared to actual engagement. The data on the use of the services provided at HERO were linked to the survey responses and compared to information gathered during regular follow-up visits. Univariable and multivariable logistic regression analyses and a Poisson regression analysis were performed on the data. RESULTS A total of 152 GBMSM reported engaging in chemsex, of whom 105 (69.1%) expressed the intention to reduce their chemsex behavior. Service utilization ranged from 23.0% for participating in meetings of a chemsex recovery group, 17.1% for visiting a mental health clinic, and 10.5% for using both of these services. The intention to reduce chemsex behavior significantly associated with visiting a mental health clinic (aOR = 4.68, p < 0.05), but its association with attending meetings of a chemsex recovery group was only marginally significant (aOR = 2.96, p < 0.1). Other factors that remained significantly associated with service use were a high frequency of substance use and living with HIV. CONCLUSION Comprehensive harm reduction strategies, which touch on mental health, drug use management and recovery, are needed for those who want to reduce their chemsex behavior. Public health practitioners should endeavor to raise awareness of resources that are available for people who engage in chemsex and to minimize the barriers blocking their access to the appropriate services.
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Affiliation(s)
- Yu-Ru Hung
- Department of Public Health, College of Medicine, National Cheng Kung University, 8F-8068, No. 138, ShengLi Rd., North Dist., Tainan City, 704, Taiwan
| | - Tsan-Tse Chuang
- Department of Public Health, College of Medicine, National Cheng Kung University, 8F-8068, No. 138, ShengLi Rd., North Dist., Tainan City, 704, Taiwan
| | - Tsai-Wei Chen
- Department of Public Health, College of Medicine, National Cheng Kung University, 8F-8068, No. 138, ShengLi Rd., North Dist., Tainan City, 704, Taiwan
| | - An-Chun Chung
- Taiwan Love and Hope Association, Kaohsiung, Taiwan
- Healing, Empowerment, Recovery of Chemsex (HERO) Health Center, HÉROS, Kaohsiung, Taiwan
| | - Meng-Tzu Wu
- Taiwan Love and Hope Association, Kaohsiung, Taiwan
- Healing, Empowerment, Recovery of Chemsex (HERO) Health Center, HÉROS, Kaohsiung, Taiwan
| | - Su-Ting Hsu
- Department of Community Psychiatry, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
| | - Nai-Ying Ko
- Taiwan Love and Hope Association, Kaohsiung, Taiwan
- Healing, Empowerment, Recovery of Chemsex (HERO) Health Center, HÉROS, Kaohsiung, Taiwan
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Carol Strong
- Department of Public Health, College of Medicine, National Cheng Kung University, 8F-8068, No. 138, ShengLi Rd., North Dist., Tainan City, 704, Taiwan.
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Choi EPH, Kwok JYY, Choi KWY, Lee JJ, Lok KYW, Wong JYH, Fong DYT, Wan EYF, Wong WCW, Chow EPF. Perceptions and experiences of sexual violence among Chinese men who have sex with men in Hong Kong. J Adv Nurs 2023; 79:1385-1398. [PMID: 35909096 PMCID: PMC10952851 DOI: 10.1111/jan.15391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 07/08/2022] [Accepted: 07/17/2022] [Indexed: 11/29/2022]
Abstract
AIM This study aimed to understand the perceptions and experiences of sexual violence among Chinese men who have sex with men (MSM) in Hong Kong. DESIGN The study adopted a qualitative descriptive design with thematic analysis. METHODS Thirty-one Chinese MSM were recruited in Hong Kong from May to June 2019 using purposive sampling. Individual semi-structured interviews were conducted with the participants. The interview data were transcribed verbatim from the recordings and analysed using Braun and Clarke's thematic analysis approach. RESULTS Four themes were identified: (1) different forms of sexual violence, from physical to virtual; (2) inner struggles with fears and worry; (3) low awareness and perceived risk of sexual violence - 'it has nothing to do with me' and (4) dilemma towards sexual violence prevention. CONCLUSION The study provided qualitative evidence regarding the experiences and perceptions of sexual violence among Chinese MSM in Hong Kong. Physical and image-based forms of sexual violence were identified, which led the participants to experience psychological distress, fear of contracting human immunodeficiency virus/other sexually transmitted infections, notoriety within the gay community, and discrimination and stigmatization within their family and workplace. To reduce the risk of sexual violence, some participants were cautious about the venue in which they engaged in sex and the habit of sharing sexually explicit photos with others. However, some participants had low awareness and perceived risk of sexual violence. IMPACTS This study was the first to fill the research gap on sexual violence issues among Chinese MSM using dating apps in Hong Kong. The qualitative findings enhanced the scholarly understanding of Chinese MSM's perceptions and experiences of sexual violence. The study findings can help nursing staff and other healthcare professionals to develop tailored primary, secondary and tertiary sexual violence prevention programmes for MSM or beyond.
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Affiliation(s)
| | | | - Kitty Wai Ying Choi
- School of NursingThe University of Hong KongPok Fu LamHong Kong
- Sticky Rice LoveHong Kong
| | - Jung Jae Lee
- School of NursingThe University of Hong KongPok Fu LamHong Kong
| | | | | | | | - Eric Yuk Fai Wan
- Department of Family Medicine and Primary Care, School of Clinical MedicineThe University of Hong KongPok Fu LamHong Kong
- Department of Pharmacology and PharmacyThe University of Hong KongPok Fu LamHong Kong
| | - William Chi Wai Wong
- Department of Family Medicine and Primary Care, School of Clinical MedicineThe University of Hong KongPok Fu LamHong Kong
| | - Eric Pui Fung Chow
- Melbourne Sexual Health CentreAlfred HealthMelbourneVictoriaAustralia
- Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Melbourne School of Population and Global HealthThe University of MelbourneMelbourneVictoriaAustralia
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Card KG, Shen T, Barath J, Sang J, Lal A, Moore DM, Lachowsky NJ. Patterns of Event-Level Concurrent Substance Use During Sex Among Gay, Bisexual, and Other Men Who Have Sex with Men in Metro Vancouver. AIDS Behav 2023:10.1007/s10461-023-04036-w. [PMID: 36943600 DOI: 10.1007/s10461-023-04036-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2023] [Indexed: 03/23/2023]
Abstract
This study identified patterns of sexualized substance use among gay, bisexual, and other men who have sex with men (gbMSM) and examined associated risk factors for sexually transmitted and blood borne infections (STBBI). Data were from a longitudinal cohort recruited using respondent-driven sampling between Feb-2017 and Feb-2019. Participants reported on events with up to five of their most recent sexual partners. Latent class analysis examined patterns of concurrent substance use 2 h prior to or during sex. Multinomial regression identified demographic, partner-level, and event-level factors associated across 11,877 sexual events reported by 757 participants. Most combinations of substance use were rare, but most drugs were frequently combined with other drugs when they were used prior to or during a sexual event. Six latent classes of concurrent event-level substance use were identified. The referent class (58.8% of events) was characterized by limited use of any drugs. The Common Drug Use class (12.1%) was characterized by use of alcohol, cannabis, and poppers and the Licit Drug Use class (21.6%) was characterized by use of alcohol alone. The Party 'N' Play (PnP) class (2.3%) was characterized by use of crystal methamphetamine GHB, Poppers, and Erectile Drugs; The Multi-use (3.5%) class was characterized by the PnP substances plus alcohol and ecstasy; and the Cannabis + class was characterized by use of Cannabis, Erectile Drugs, and Ecstasy. Relative to the referent class, all other classes were associated with events with more behavioural and network risk factors for STBBIs-highlighting the need for harm reduction interventions for gbMSM who use these drugs.
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Affiliation(s)
- Kiffer G Card
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.
| | - Tian Shen
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Justin Barath
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Jordan Sang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Allan Lal
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - David M Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Nathan J Lachowsky
- School of Public Health and Social Policy, University of Victoria, Victoria, Canada
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Íncera-Fernández D, Román FJ, Moreno-Guillén S, Gámez-Guadix M. Understanding Sexualized Drug Use: Substances, Reasons, Consequences, and Self-Perceptions among Men Who Have Sex with Other Men in Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2751. [PMID: 36768116 PMCID: PMC9916109 DOI: 10.3390/ijerph20032751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 01/28/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
Sexualized drug use (SDU) has been identified as a health risk factor among gay, bisexual, and other men who have sex with men (GBMSM). This study aimed to analyze the associations between SDU frequency and a broad set of substances, motives, consequences, and self-perceptions. Sampling was conducted through an online survey. The final sample consisted of 185 GBMSM aged between 18 and 78 years old (mean age = 38.38, SD = 11.52) who engaged in SDU. We analyzed the frequency of SDU in terms of practicing it "once," "moderately" ("once a month or less" or "a few times a month"), or "frequently" (from "once a week" to "daily") during the previous 18 months. A questionnaire was administered through which sociodemographic variables, substances, reasons, consequences, and self-perceptions of SDU practice were analyzed. Participants who did so frequently were significantly more likely to use mephedrone, methamphetamine, and GHB/GBL than those who performed SDU less often (large effect sizes). In addition, habitual SDU was associated with motivations to achieve pleasurable emotions and sensations and manage negative feelings. Health implications, such as blackout moments, were also significantly related to frequent SDUs. Finally, those who practiced frequent SDU perceived it as a severe problem and wanted to control it. These data indicate the importance of raising awareness of chemsex as a public health problem among GBMSM. Specific identification, education, and prevention programs need to be strengthened to reduce the incidence of the most undesirable implications of SDU among GBMSM.
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Affiliation(s)
- Daniel Íncera-Fernández
- Department of Biological and Health Psychology, Autonomous University of Madrid, 28049 Madrid, Spain
| | - Francisco J. Román
- Department of Biological and Health Psychology, Autonomous University of Madrid, 28049 Madrid, Spain
| | - Santiago Moreno-Guillén
- Department of Medicine and Medical Specialties, University of Alcalá de Henares, 28801 Alcalá de Henares, Spain
| | - Manuel Gámez-Guadix
- Department of Biological and Health Psychology, Autonomous University of Madrid, 28049 Madrid, Spain
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Strasser M, Halms T, Rüther T, Hasan A, Gertzen M. Lethal Lust: Suicidal Behavior and Chemsex-A Narrative Review of the Literature. Brain Sci 2023; 13:brainsci13020174. [PMID: 36831717 PMCID: PMC9954759 DOI: 10.3390/brainsci13020174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/06/2023] [Accepted: 01/13/2023] [Indexed: 01/22/2023] Open
Abstract
Chemsex is described as the use of certain drugs-commonly methamphetamine, gamma-butyrolactone (GBL)/gammahydroxybutyrate (GHB), and mephedrone-before or during planned sexual activity primarily among men who have sex with men (MSM). Evidence shows that MSM who engage in chemsex are at increased risk of physical harm, such as sexually transmittable infections (STIs), and are more likely to experience mental health symptoms. To further assess this, we reviewed the recent literature to evaluate whether the psychological impact of chemsex behavior includes suicidal ideation and suicidal attempts. Pubmed/MEDLINE was searched for articles reporting suicidal ideation and behavior among chemsex users with the terms "chemsex", "sexualized drug use", "suicide", and "mental health". Twelve articles (three case reports and nine cross-sectional studies) were included in the final narrative review. Overall, we retrieved mixed results regarding the relationship between chemsex practice and suicidality outcomes. Considering the inhomogeneous nature of the studies, the findings indicate that suicidality could be an issue of concern among MSM in general but among chemsex users in particular. Possible risk factors for suicidality among chemsex participants may include adversities experienced due to one's sexual orientation and an increased risk for HIV and other STI infections and the resulting negative impact on mental well-being. These aspects warrant further investigations.
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Affiliation(s)
- Martina Strasser
- Psychiatry and Psychotherapy, Faculty of Medicine, University of Augsburg, Geschwister-Schönert-Str. 1, 86156 Augsburg, Germany
| | - Theresa Halms
- Psychiatry and Psychotherapy, Faculty of Medicine, University of Augsburg, Geschwister-Schönert-Str. 1, 86156 Augsburg, Germany
| | - Tobias Rüther
- Department of Psychiatry, Ludwig-Maximilians-University Hospital Munich, 80336 Munich, Germany
| | - Alkomiet Hasan
- Psychiatry and Psychotherapy, Faculty of Medicine, University of Augsburg, Geschwister-Schönert-Str. 1, 86156 Augsburg, Germany
| | - Marcus Gertzen
- Psychiatry and Psychotherapy, Faculty of Medicine, University of Augsburg, Geschwister-Schönert-Str. 1, 86156 Augsburg, Germany
- Correspondence:
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Marqués-Sánchez P, Bermejo-Martínez D, Quiroga Sánchez E, Calvo-Ayuso N, Liébana-Presa C, Benítez-Andrades JA. Men who have sex with men: An approach to social network analysis. Public Health Nurs 2023; 40:73-79. [PMID: 36217564 PMCID: PMC10092328 DOI: 10.1111/phn.13138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/05/2022] [Accepted: 09/13/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Dating apps for men who have sex with men (MSM) have favored unprotected sexual encounters; other unsafe practices, including drug use, are widespread. No evidence is available from the perspective of the structure of their relationships, a personal aspect included in all nursing meta-paradigms. AIM To study the structure of MSM networks through dating and contact applications and this relationship to risky sexual activities such as condom use, chemsex (sex while using drug), and group sex. DESIGN Descriptive cross-sectional study. SAMPLE A total of 32 MSM participants from Madrid (Spain). MEASUREMENTS Socio-demographic and structural variables with Social Network Analysis (SNA) metrics. Data on condom use, drug use during encounters, and group sex were included. RESULTS Twenty-five percent of respondents practiced chemsex, and 75% of these used poppers. MSM with higher socioeconomic status participated in group sex sessions more frequently than those with lower socioeconomics. Within the network analysis, the relationships strong showed greater ease in having unprotected anal intercourse. CONCLUSION SNA can be effective in the study of MSM sexual networks and their risk behaviors for community nurses to improve their interventions in sexual health promotion.
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Affiliation(s)
- Pilar Marqués-Sánchez
- SALBIS Research Group, Department of Nursing and Physiotherapy, Campus de Ponferrada s/n, Universidad de León, Ponferrada, Spain
| | - David Bermejo-Martínez
- Department of Nursing and Physiotherapy, Campus de Ponferrada s/n, Universidad de León, Ponferrada, Spain
| | - Enedina Quiroga Sánchez
- SALBIS Research Group, Department of Nursing and Physiotherapy, Campus de Ponferrada s/n, Universidad de León, Ponferrada, Spain
| | - Natalia Calvo-Ayuso
- Department of Nursing and Physiotherapy, Campus de Ponferrada s/n, Universidad de León, Ponferrada, Spain
| | - Cristina Liébana-Presa
- SALBIS Research Group, Department of Nursing and Physiotherapy, Campus de Ponferrada s/n, Universidad de León, Ponferrada, Spain
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Nevendorff L, Schroeder SE, Pedrana A, Bourne A, Stoové M. Prevalence of sexualized drug use and risk of HIV among sexually active MSM in East and South Asian countries: systematic review and meta-analysis. J Int AIDS Soc 2023; 26:e26054. [PMID: 36600479 DOI: 10.1002/jia2.26054] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 12/05/2022] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Sexualized drug use (SDU), the use of psychoactive drugs in the context of sexual intercourse, has been identified as a risk factor for HIV among men who have sex with men (MSM) in Asia. Given the distinct social and cultural context of same-sex relationships and drug-using practice in Asia, we aimed to describe the prevalence of SDU in East and South Asian countries and its associations with condomless anal sex (CAI) and HIV status. Synthesizing SDU research in this region, including SDU definitions, prevalence and outcomes, provides insights to inform future research and improved programme planning, resourcing and advocacy. METHODS We systematically searched OVID Medline, OVID EMBASE, OVID Global Health, CINAHL, PsycINFO and SCOPUS publication databases for scientific articles published from 1990 to 2022 measuring SDU among MSM in East and South Asian countries. A narrative synthesis was utilized to describe key study attributes and findings, and meta-analyses using random pooled effect models were used to estimate SDU prevalence and its associations with CAI and HIV status. Subgroup meta-analyses, sensitivity analysis and assessment of publication bias examined potential sources of heterogeneity for the pooled SDU prevalence estimates. RESULTS AND DISCUSSION Of the 1788 publications screened, 49 publications met the selection criteria and 18 were suitable for meta-analyses. Findings highlight SDU definitions distinct from other regions but inconsistencies in the definition of SDU between studies that have been highlighted in research elsewhere. The pooled prevalence of recent SDU (past 12 months) was 13% (95% CI = 10-16%; I2 = 97.6) but higher when studies utilized self-administered surveys (15%; 95% CI = 12-19%; p<0.05). SDU was associated with greater odds of CAI (pooled odds ratio [OR] = 3.21; 95% CI = 1.82-5.66) and living with diagnosed HIV (OR = 4.73; 95% CI = 2.27-8.21). CONCLUSIONS SDU is common among MSM in East and South Asian countries, but varying SDU definitions limit between-study comparisons. Responses to SDU-related harms should consider local contexts, including specific drug types used and their relative risks.
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Affiliation(s)
- Laura Nevendorff
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- HIV AIDS Research Center, Atma Jaya Catholic University of Indonesia, South Jakarta, Indonesia
| | - Sophia E Schroeder
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Alisa Pedrana
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Stoové
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Herrijgers C, Platteau T, Vandebosch H, Poels K, Florence E. Using Intervention Mapping to Develop an mHealth Intervention to Support Men Who Have Sex With Men Engaging in Chemsex (Budd): Development and Usability Study. JMIR Res Protoc 2022; 11:e39678. [PMID: 36542451 DOI: 10.2196/39678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/25/2022] [Accepted: 10/25/2022] [Indexed: 12/24/2022] Open
Abstract
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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Affiliation(s)
- Corinne Herrijgers
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Tom Platteau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Heidi Vandebosch
- Department of Communication Studies, University of Antwerp, Antwerpen, Belgium
| | - Karolien Poels
- Department of Communication Studies, University of Antwerp, Antwerpen, Belgium
| | - Eric Florence
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
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Chemsex and Psychosis: A Systematic Review. Behav Sci (Basel) 2022; 12:bs12120516. [PMID: 36546999 PMCID: PMC9774634 DOI: 10.3390/bs12120516] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Chemsex is presented as a major challenge in public health, with numerous physical and mental consequences. The general objective of this review was to analyze the relationship between the practice of chemsex and the development of psychosis. A mixed systematic review model was chosen. PubMed, PsycINFO, and Web of Science databases were searched following a predetermined search strategy. The studies were selected, and their information was extracted following a systematic method. A total of 10 articles were included. Psychotic symptoms ranged from 6.7% to 37.2%, being one of the most frequent psychiatric diagnoses. Slamsex, polydrug use and smoked methamphetamine posed up to a 3-fold increased risk of psychosis within this practice. The risk factors found were foreign or ethnic minority status, location in large cities, stress and anxiety, trauma, loneliness, sexually transmitted infections (STIs), hepatitis, and previous psychotic history. In conclusion, chemsex is associated with psychosis development; we found numerous converging risk factors and a clear mediating role of drugs. It is important, in approaching the prevention and treatment of this addiction, to take into account motivations and psychosocial circumstances.
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Turner D, Briken P, Grubbs J, Malandain L, Mestre-Bach G, Potenza MN, Thibaut F. The World Federation of Societies of Biological Psychiatry guidelines on the assessment and pharmacological treatment of compulsive sexual behaviour disorder. DIALOGUES IN CLINICAL NEUROSCIENCE 2022; 24:10-69. [PMID: 37522807 PMCID: PMC10408697 DOI: 10.1080/19585969.2022.2134739] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/18/2022] [Accepted: 10/03/2022] [Indexed: 11/18/2022]
Abstract
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.
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Affiliation(s)
- Daniel Turner
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Joshua Grubbs
- Department of Psychology, Bowling Green State University, Bowling Green, OH, USA
| | - Leo Malandain
- Department of Psychiatry and Addictive Disorders, University Hospital Cochin (site Tarnier) AP-HP, Paris, France
| | - Gemma Mestre-Bach
- Facultad de Ciencias de la Salud, Universidad Internacional de La Rioja, La Rioja, Spain
| | - Marc N. Potenza
- Departments of Psychiatry and Neuroscience and Child Study Center, Yale School of Medicine, New Haven, CT, USA
- Connecticut Mental Health Center, New Haven, CT, USA
- Connecticut Council on Problem Gambling, Wethersfield, CT, USA
- Wu Tsai Institute, Yale University, New Haven, CT, USA
| | - Florence Thibaut
- Department of Psychiatry and Addictive Disorders, University Hospital Cochin (site Tarnier) AP-HP, Paris, France
- INSERM U1266, Institute of Psychiatry and Neurosciences, University of Paris Cité, Paris, France
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De La Mora L, Nebot MJ, Martinez-Rebollar M, De Lazzari E, Tuset M, Laguno M, Ambrosioni J, Miquel L, Blanch J, Ugarte A, Torres B, González-Cordón A, Inciarte A, Chivite I, Short D, Salgado E, Martinez E, Blanco JL, Mallolas J. Do ART and Chemsex Drugs Get Along? Potential Drug-Drug Interactions in a Cohort of People Living with HIV Who Engaged in Chemsex: A Retrospective Observational Study. Infect Dis Ther 2022; 11:2111-2124. [PMID: 36173594 PMCID: PMC9669299 DOI: 10.1007/s40121-022-00694-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/05/2022] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION People living with HIV (PLWH) who engaged in chemsex are at risk of potential drug-drug interactions (pDDIs) with recreational drugs. This study aimed to characterize pDDIs between antiretroviral treatment (ART) and chemsex drugs and evaluate their association with unscheduled relevant hospital consultations. METHODS We conducted a single-center, retrospective, observational study in a series of gay, bisexual, and other men who have sex with men (gbMSM) living with HIV who engaged in chemsex and who attended a tertiary hospital in Barcelona, Spain, from February 2018 through August 2019. Associations between all recorded pDDIs and relevant unscheduled consultations were estimated using the incidence rate (IR) per 100 person-years of those events compared between patients with no pDDI (green flag) or moderate severity pDDI (orange flag) with patients with high severity pDDI (red flag) using the incidence rate ratio (IRR). RESULTS Among 172 PLWH engaged in chemsex, 249 ART regimens were prescribed: 44% based on integrase inhibitors, 30% on boosted ART, and 26% based on non-nucleoside reverse transcriptase inhibitors. The substances and recreational drugs most frequently used were erectile dysfunction agents (83%), methamphetamine (79%), GHB (77%), and alkyl nitrites (71%). Polydrug use was reported in 52%. We observed 2048 pDDIs. Of these, 23% were orange flag pDDIs; 88% related to boosted ARTs. The IR of the 285 unscheduled relevant episodes in patients with orange flag pDDIs was 64.67 (95% CI 40.07-89.28). The IRR of green flag pDDIs was 1.05 (95% CI 0.60-1.8; p = 0.876). CONCLUSION One in four pDDIs were of moderate severity but no significant increase in the incidence of unscheduled relevant consultations was observed. A high number of unscheduled consultations, predominantly for psychiatric events and intoxication, were observed. Beyond using non-boosted ART to minimize pDDIs, other factors related to the practice of chemsex must be addressed, in order to offer a better approach.
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Affiliation(s)
- Lorena De La Mora
- grid.5841.80000 0004 1937 0247HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS AIDS and HIV Research Group, Barcelona University, Villarroel 170, 08036 Barcelona, Spain
| | - María J. Nebot
- grid.5841.80000 0004 1937 0247HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS AIDS and HIV Research Group, Barcelona University, Villarroel 170, 08036 Barcelona, Spain
| | - Maria Martinez-Rebollar
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS AIDS and HIV Research Group, Barcelona University, Villarroel 170, 08036, Barcelona, Spain.
| | - Elisa De Lazzari
- grid.5841.80000 0004 1937 0247HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS AIDS and HIV Research Group, Barcelona University, Villarroel 170, 08036 Barcelona, Spain
| | - Montserrat Tuset
- grid.410458.c0000 0000 9635 9413Department of Pharmacy, Hospital Clinic, Barcelona, Spain
| | - Montserrat Laguno
- grid.5841.80000 0004 1937 0247HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS AIDS and HIV Research Group, Barcelona University, Villarroel 170, 08036 Barcelona, Spain
| | - Juan Ambrosioni
- grid.5841.80000 0004 1937 0247HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS AIDS and HIV Research Group, Barcelona University, Villarroel 170, 08036 Barcelona, Spain
| | - Laia Miquel
- grid.5841.80000 0004 1937 0247Addiction Unit (GRAC), Psychiatry and Psychology Department, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, Barcelona University, Barcelona, Spain
| | - Jordi Blanch
- grid.5841.80000 0004 1937 0247Addiction Unit (GRAC), Psychiatry and Psychology Department, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, Barcelona University, Barcelona, Spain
| | - Ainoa Ugarte
- grid.5841.80000 0004 1937 0247HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS AIDS and HIV Research Group, Barcelona University, Villarroel 170, 08036 Barcelona, Spain
| | - Berta Torres
- grid.5841.80000 0004 1937 0247HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS AIDS and HIV Research Group, Barcelona University, Villarroel 170, 08036 Barcelona, Spain
| | - Ana González-Cordón
- grid.5841.80000 0004 1937 0247HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS AIDS and HIV Research Group, Barcelona University, Villarroel 170, 08036 Barcelona, Spain
| | - Alexy Inciarte
- grid.5841.80000 0004 1937 0247HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS AIDS and HIV Research Group, Barcelona University, Villarroel 170, 08036 Barcelona, Spain
| | - Iván Chivite
- grid.5841.80000 0004 1937 0247HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS AIDS and HIV Research Group, Barcelona University, Villarroel 170, 08036 Barcelona, Spain
| | - Duncan Short
- grid.476798.30000 0004 1771 726XViiV Healthcare, Brentford, Middlesex UK
| | - Emilio Salgado
- grid.410458.c0000 0000 9635 9413Medical Toxicology Unit, Emergency Department, Hospital Clinic Barcelona, Barcelona, Spain
| | - Esteban Martinez
- grid.5841.80000 0004 1937 0247HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS AIDS and HIV Research Group, Barcelona University, Villarroel 170, 08036 Barcelona, Spain
| | - José L. Blanco
- grid.5841.80000 0004 1937 0247HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS AIDS and HIV Research Group, Barcelona University, Villarroel 170, 08036 Barcelona, Spain
| | - Josep Mallolas
- grid.5841.80000 0004 1937 0247HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS AIDS and HIV Research Group, Barcelona University, Villarroel 170, 08036 Barcelona, Spain
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Amundsen E, Haugstvedt Å, Skogen V, Berg RC. Health characteristics associated with chemsex among men who have sex with men: Results from a cross-sectional clinic survey in Norway. PLoS One 2022; 17:e0275618. [PMID: 36197878 PMCID: PMC9534388 DOI: 10.1371/journal.pone.0275618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 09/20/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Chemsex typically involves drugs such as GHB/GBL, crystal meth and mephedrone, and is increasingly common among MSM. The behaviour has been found to be associated with sexually transmitted infections (STIs) and mental health problems. We aimed to assess the extent of chemsex engagement and associations with different aspects of health, among MSM attending a free specialist walk-in clinic for STIs in Oslo, Norway. METHODS Anonymous cross-sectional survey data was collected from June to October 2016. Differences in STI health (chlamydia, gonorrhoea, syphilis, HIV diagnoses), mental health (depression/anxiety) and internalised homonegativity between MSM using and not using GHB/GBL, crystal meth, mephedrone, cocaine or ketamine with sex in the last year were assessed descriptively and in a multivariate logistic regression model. The predictors were number of self-reported chlamydia, gonorrhoea or syphilis diagnoses, HIV diagnosis, depression/anxiety, and degree of internalised homonegativity. We adjusted for age, education level and having lived abroad. RESULTS Of the 518 MSM respondents, 17% reported sexualised use of either GHB/GBL, crystal meth, mephedrone, cocaine or ketamine in the last year (chemsex). We found significant positive associations between chemsex and self-reported HIV diagnoses (adjusted odds ratio [aOR] = 3.26, 95%CI = 1.37-7.76), number of reported chlamydia, gonorrhoea or syphilis diagnoses in the last year (aOR = 1.63, 95%CI = 1.18-2.12), having lived more than one year abroad (aOR = 2.10, 95%CI = 1.20-3.65), but no significant association with depression/anxiety (aOR = 1.02, 95%CI = 0.53-1.93), nor internalised homonegativity (aOR = 0.62, 95%CI = 0.33-1.19). CONCLUSION Chemsex engagement in Norway is relatively low compared to findings from STI clinics in other European countries, and GHB/GBL and cocaine the two most commonly used drugs with sex. Chemsex was more common among MSM having lived more than one year abroad, reporting HIV diagnoses and a higher number of either chlamydia, gonorrhoea or syphilis diagnoses in the last year. Health care providers need to be made aware of chemsex as a behavioural phenomenon among MSM, and special care should be afforded to MSM living with HIV and being diagnosed with STIs.
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Affiliation(s)
- Eirik Amundsen
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Åse Haugstvedt
- The Olafia Clinic and the National Advisory Unit on Sexually Transmitted Infections, Oslo University Hospital, Oslo, Norway
| | - Vegard Skogen
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Infectious Diseases, Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Rigmor C. Berg
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Division for Health Services, Norwegian Institute of Public Health (NIPH), Oslo, Norway
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HIV, chemsex, and the need for harm-reduction interventions to support gay, bisexual, and other men who have sex with men. Lancet HIV 2022; 9:e717-e725. [PMID: 35926550 DOI: 10.1016/s2352-3018(22)00124-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/11/2022] [Accepted: 04/11/2022] [Indexed: 11/21/2022]
Abstract
Numerous studies have identified an association between the use of drugs in sexual contexts (chemsex) and HIV among gay, bisexual, and other men who have sex with men (GBMSM), although whether a causal relationship exists is contentious. An intricate relationship exists between chemsex, HIV treatment and prevention, harm reduction, and the provision of community-grounded health services. Furthermore, potential harms exist beyond HIV, such as intoxication and overdose. Community-engaged responses to chemsex involve social and cultural strategies of harm reduction and sexual health promotion before, during, and after a chemsex session. Ultimately, this Review calls for actions and collaborations aimed at developing a greater understanding of chemsex as a practice within different GBMSM subpopulations and to develop tailored harm-reduction models that can accommodate GBMSM who engage in chemsex in various ways and with varied effects.
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44
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Cohen S, Shamri-Zeevi L, Honig O. Art therapy for chemsex: A pilot study of representations of memories among this subset of self-identified gay men as expressed in gouache painting. ARTS IN PSYCHOTHERAPY 2022. [DOI: 10.1016/j.aip.2022.101952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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45
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Playing at the edges, navigating sexual boundaries, and narrating sexual distress; Practices and perspectives of sexuality and gender diverse people who use GHB. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 108:103811. [PMID: 35939948 DOI: 10.1016/j.drugpo.2022.103811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND Research addressing sexualised use of GHB to date has largely focussed on gay and bisexual men's GHB use in the context of chemsex, this research has highlighted risks and experiences associated with sexual violence. No studies have included people of diverse sexualities and genders and documented reported practices to ensure mutually gratifying and consensual sex in the context of sexualised drug use (SDU). METHODS Semi-structured interviews were conducted with 31 people from sexuality and gender diverse communities living in Australia who reported three or more occasions of GHB use in the previous 12 months. Participants were asked about their use of GHB for sex, their experiences of GHB sex and their approaches to negotiating sexual boundaries. Data were analysed thematically. RESULTS Most participants valued the sexual possibilities enabled by disinhibitory components of GHB and were cognisant of respecting other's sexual boundaries in the context of GHB sex. Participants reported strategies to ensure communication prior to and throughout GHB sex. However, several participants narrated experiences of GHB sex that they felt were distressing and, in some circumstances, sexually violent. In most instances participant's resisted terminology of sexual violence or non-consent as descriptors of their experience and none reported accessing sexual violence services. CONCLUSION Positive strategies to facilitate sexual communication prior to and throughout GHB sex should be reflected in health promotion and service level responses to promote affirmative and continuous consent among people who use GHB for sex. Education initiatives to help people engaged in SDU to recognise and respond to sexual violence if it occurs ought to be prioritised.
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Bolmont M, Tshikung ON, Trellu LT. Chemsex, a Contemporary Challenge for Public Health. J Sex Med 2022; 19:1210-1213. [DOI: 10.1016/j.jsxm.2022.03.616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/18/2022] [Accepted: 03/25/2022] [Indexed: 11/30/2022]
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Birch R, Jollimore J, Howard T, Lal A, Cui Z, Rich AJ, Lachowsky N, Moore DM, Hogg RS, Roth EA. Hosts as Gatekeepers for North American Gay and Bisexual Men's Private Group Sex Parties. JOURNAL OF HOMOSEXUALITY 2022; 69:1398-1413. [PMID: 33989132 DOI: 10.1080/00918369.2021.1913919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Gay and bisexual men's (GBM) group sex parties are considered HIV risk environments due to their association with concurrent sexual partners, condomless anal sex, and polysubstance use. The possibility of group sex party hosts acting as gatekeepers to minimize risks has been suggested, but remains understudied. We analyzed qualitative data from 20 in-depth interviews with North American GBM who recently attended private group sex parties to determine if hosts' actions constitute harm reduction strategies. Results showed hosts acting as gatekeepers before parties by establishing and disseminating themes and rules, screening applicants, and selecting guests. During parties hosts enforced rules and rejected uninvited guests. By their actions, hosts established a more controlled environment compared to public sex-on-premises bathhouses, and facilitated boundary play, the paradoxical behavior of simultaneously desiring risk and safety, previously noted for GBM circuit parties. Results suggest initiating education programs focusing on private group sex party hosts as gatekeepers.
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Affiliation(s)
- Robert Birch
- Social Dimensions of Health, University of Victoria, Victoria, British Columbia, Canada
| | - Jody Jollimore
- Community-Based Research Centre for Gay Men's Health, Vancouver, British Columbia, Canada
| | - Terry Howard
- Community-Based Researcher with Lived Experience of HIV, Co-Chair of Momentum Community Engagement Committee, Vancouver, British Columbia, Canada
| | - Allan Lal
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Zishan Cui
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Ashleigh J Rich
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nathan Lachowsky
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- School of Public Health and Social Policy, Victoria, British Columbia
| | - David M Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert S Hogg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Eric Abella Roth
- Centre for Addiction Research of British Columbia, Department of Anthropology, University of Victoria, Victoria, British Columbia, Canada
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Freestone J, Prestage G, Bourne A, Ezard N, Race K, Nedanoski A, Murray J, Siefried KJ. Controlling for pleasure and risk: The experiences of sexuality and gender diverse people who use GHB. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 105:103747. [DOI: 10.1016/j.drugpo.2022.103747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/23/2022] [Accepted: 05/04/2022] [Indexed: 10/18/2022]
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Platteau T, Florence E, de Wit JBF. Self-Control as Conceptual Framework to Understand and Support People Who Use Drugs During Sex. Front Public Health 2022; 10:894415. [PMID: 35784207 PMCID: PMC9240261 DOI: 10.3389/fpubh.2022.894415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/24/2022] [Indexed: 11/18/2022] Open
Abstract
Few theory-informed interventions to support people who use drugs during sex have been conceptualized and developed. We conceptualize sexualized drug use, also referred to as chemsex or pharmacosex, as a self-control challenge, and draw on extant theory and research to propose intervention approaches that can be tailored to meet the differing needs of people who engage in sexualized drug use. We draw on a continuum perspective of sexualized drug use, in particular chemsex, and discuss the role of reasoned and automatic processes in behavioral decisions, as well as critical components of effective self-control of behavior. A self-control approach can empower people to tackle their sexualized drug use, and classify their experienced sex-related drug use as problematic. Self-control encompasses clarifying one's goals and identifying strategies to mitigate behaviors to achieve these goals, despite competing pharmacosex desires. Our approach to self-control sexualized drug use contains three critical components: goal setting, goal enactment, and goal progress appraisal and goal adjustment. Goals should be formulated specific, ambitious yet realistic, and tailored to the individual's needs and wishes. Goals may target aspects of drug use, protecting sexual health and mitigating negative impacts. Implementing goal enactment implies translating goals into concrete (short-term) actions to move toward the higher-order goal via goal intentions and action/coping plans. During the goal progress appraisal and adjustment stage, people compare their actual with their planned behavior. This reflection may result in goal adjustment through feedback loops to adjust their goals and action/coping plans. We propose that our self-control approach can guide the development of interventions to effectively support people to prevent or limit pharmacosex, and helps to effectively mitigate or reduce negative impacts via self-help, peer support or professional support, offered via personal counseling or digital tools.
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Affiliation(s)
- Tom Platteau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Faculty of Psychology, Open University, Heerlen, Netherlands
- *Correspondence: Tom Platteau
| | - Eric Florence
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - John B. F. de Wit
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, Netherlands
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Uholyeva X, Pitoňák M. Chemsex users in Czechia: EMIS survey. Cent Eur J Public Health 2022; 30:86-92. [PMID: 35876596 DOI: 10.21101/cejph.a6923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 05/13/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Chemsex is a phenomenon highly relevant to public health concerns. Our primary aim is to describe the Czech chemsex scene regarding substances used, sexual behaviour, mental health, sexual life satisfaction, internalization of homonegative attitudes, and prevalent chemsex patterns. METHODS The data from the European Men Who Have Sex With Men Internet Survey (EMIS) 2017 were used. The mental health of chemsex users was assessed by the Patient Health Questionnaire 4 (PHQ4), internalized homonegativity was measured using the Short Internalized Homonegativity Scale. A sample of 87 men who have sex with men (MSM) chemsex users and a comparison group of 261 MSM were selected from the total sample of 1,688 respondents. Mann-Whitney and χ2 tests were used to compare groups. RESULTS Active chemsex users made up 5% of the sample (87 of 1,688), with an average age of 37 years. Chemsex users were more likely to engage in condomless sex with non-steady partners (χ2 = 46.8, p < 0.001), and had dramatically more STIs, such as HIV (χ2 = 52.9, p < 0.001), HCV (χ2 = 25.9, p < 0.001), and syphilis (χ2 = 41.5, p < 0.001). Chemsex users frequently injected drugs (n = 19, 20%). More than half (n = 48; 55%) of chemsex users had sober sex in the last 4 weeks. Chemsex culture was associated with riskier substance use, both in terms of mode and frequency. The mental health of chemsex users in our sample did not differ significantly from the comparison group (χ2 = 0.2, p < 0.7). Chemsex users did not conceal their sexual identity more often than the comparison group, on the contrary, 69% (n = 59) of them were out to most significant others, compared to 53% (n = 134) in the comparison group (χ2 = 8.8, p < 0.05). In addition, we did not find differences in the degree of internalized homonegativity (χ2 = 0.9, p < 0.4). Chemsex users were clearly and significantly more satisfied with their sex life than the comparison group (Mann-Whitney U test, p < 0.001). CONCLUSIONS In our sample, chemsex use was not associated with a negative impact on health or wellbeing. Our results suggest that chemsex is not a homogeneous phenomenon. Many different patterns and subcultures exist, some of them are riskier, some safer than others.
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Affiliation(s)
| | - Michal Pitoňák
- National Institute of Mental Health, Klecany, Czech Republic
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