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Herrijgers C, Verboon P, Florence E, Vandebosch H, Poels K, Platteau T. Assessing the Effectiveness of an mHealth Intervention to Support Men Who Have Sex With Men Engaging in Chemsex (Budd): Single-Case and Pre-Post Experimental Design Study. JMIR Form Res 2024; 8:e56606. [PMID: 39365642 DOI: 10.2196/56606] [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: 01/22/2024] [Revised: 05/29/2024] [Accepted: 06/27/2024] [Indexed: 10/05/2024] Open
Abstract
BACKGROUND This study focuses on the Budd app, a mobile health intervention designed for gay, bisexual, and other men who have sex with men who participate in chemsex. Chemsex, the use of psychoactive drugs in a sexual context, presents substantial health risks including increased HIV transmission and mental health issues. Addressing these risks requires innovative interventions tailored to the unique needs of this population. OBJECTIVE This study aims to evaluate the effectiveness of the Budd app in promoting drug harm reduction practices among its users, focusing on knowledge, behavioral intention, risk behavior awareness, and self-efficacy. METHODS The study used a mixed methods approach, combining a single-case experimental design and a pre-post study. A total of 10 participants from an outpatient clinic were recruited, and each attended the clinic 3 times. During the first visit, participants installed a restricted version of the Budd app, which allowed them to report daily mood and risk behavior after chemsex sessions. Phase A (baseline) lasted at least 2 weeks depending on chemsex participation. In the second visit, participants gained full access to the Budd app, initiating phase B (intervention). Phase B lasted at least 6 weeks, depending on chemsex participation, with identical data input as phase A. Participants completed pre- and postintervention surveys assessing behavioral determinants during the first and third visit. RESULTS The study observed an increased knowledge about chemsex substances postintervention, with a mean percentage improvement in knowledge scores of 20.59% (SD 13.3%) among participants. Behavioral intention and self-efficacy showed mixed results, with some participants improving while others experienced a decrease. There was also a variable impact on awareness of risk behavior, with half of the participants reporting a decrease postintervention. Despite these mixed results, the app was generally well-received, with participants engaging with the app's features an average of 50 times during the study. CONCLUSIONS The Budd app showed effectiveness in enhancing knowledge about chemsex substances among gay, bisexual, and other men who have sex with men. However, its impact on safe dosing behavior, behavioral intention, self-efficacy, and risk behavior awareness was inconsistent. These findings suggest that while educational interventions can increase knowledge, translating this into behavioral change is more complex and may require more participants, a longer follow-up period, and additional strategies and support mechanisms.
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Affiliation(s)
- Corinne Herrijgers
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Peter Verboon
- Department of Psychology, Open Universiteit, Heerlen, Belgium
| | - Eric Florence
- General Internal Medicine, Infectious Diseases & Tropical Medicine, Antwerp University Hospital, Antwerpen, Belgium
| | - Heidi Vandebosch
- Department of Communication Studies, University of Antwerp, Antwerpen, Belgium
| | - Karolien Poels
- Department of Communication Studies, University of Antwerp, Antwerpen, Belgium
| | - Tom Platteau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
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Gómez W, Lee JS, Organista KC, Carrico AW. Mapping a psychosocial syndemic among methamphetamine-using sexual minority men living with HIV. Drug Alcohol Rev 2024. [PMID: 39351805 DOI: 10.1111/dar.13941] [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: 02/05/2024] [Revised: 08/13/2024] [Accepted: 08/14/2024] [Indexed: 10/03/2024]
Abstract
INTRODUCTION While research with sexual minority men (SMM) has focused on disparities related to HIV, substance use and mental health, synergistic psychosocial pathways driving these epidemics remain underexplored. We used syndemic theory to assess how psychosocial factors sustain methamphetamine use and hinder recovery efforts for SMM living with HIV. METHODS A triangulation of network analyses and constructivist grounded theory approaches is utilised to elucidate pathways through which psychosocial factors influence methamphetamine use among this population. Survey data (N = 129) are used for quantitative analyses and a purposive sub-sample (n = 24) was recruited for semi-structured interviews for qualitative analyses. FINDINGS The network analysis revealed two statistically significant bivariate associations: between post-traumatic stress disorder and depression symptoms (b = 0.37, SD = 0.07, 95% confidence interval [0.23, 0.49]) and between depression symptoms and negative affect (b = 0.26, SD = 0.07, 95% confidence interval [0.12, 0.38]). Findings from the constructivist grounded theory analysis supplement the network analysis by offering a nuanced take on how negative affect, post-traumatic stress disorder, and depression symptoms operate synergistically to promote methamphetamine use and impede recovery efforts. DISCUSSION AND CONCLUSIONS Participants relay experiences of using methamphetamine to cope with these psychosocial factors through avoidance, escapism, mood elevation, and numbing of emotions. Findings suggest that centring these psychosocial factors may inform more effective, holistic interventions for this high-priority population.
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Affiliation(s)
- Walter Gómez
- Jane Addams College of Social Work, University of Illinois Chicago, Chicago, Illinois, USA
| | - Jasper S Lee
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Kurt C Organista
- School of Social Welfare, University of California, Berkeley, California, USA
| | - Adam W Carrico
- Robert Stempel College of Public Health & Social Work, Florida International University, Miami, Florida, USA
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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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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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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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Marques Oliveira P, Sousa Reis C, Vieira-Coelho MA. Getting Inside the Mind of Gay and Bisexual Men Who Have Sex with Men with Sexualized Drug Use - A Systematic Review. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2023; 35:573-595. [PMID: 38601804 PMCID: PMC10903597 DOI: 10.1080/19317611.2023.2260372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 09/13/2023] [Indexed: 04/12/2024]
Abstract
Objectives Sexualized Drug Use (SDU) consists of using any drug purposely before or during sex with the intent of modifying sex experiences. SDU is especially practiced among Gay and Bisexual Men who have Sex with Men (GBMSM). This study aims to review the relevant literature to identify and summarize the reasons reported by GBMSM to engage in SDU. Methods A systematic review of the literature using PubMed/Medline, Scopus, Google Scholar, and PsycINFO, comprising qualitative and quantitative papers published between 2010 and 2022, was conducted with a narrative synthesis of the findings. PRISMA guidelines were followed. Results Our search identified 1400 publications, of which 23 were included. Reasons to engage in SDU were aggregated as follows: (1) Enhancing sexual sensations and performance, (2) Achieving hedonic mental and emotional states, (3) Tackling negative thoughts and feelings, and (4) Social motivations. Different sample methods and ways of asking for motivations may limit the internal validity of these conclusions. Conclusion Both individual and social factors are involved in the decision to engage in SDU. SDU practices should not be medicalized, however therapeutic support if needed should provide multidisciplinary, pleasure-centered, harm-reducing care interventions, specifically designed for these minorities of GBMSM.
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Affiliation(s)
- Pedro Marques Oliveira
- Department of Biomedicine, Pharmacology and Therapeutics Unit, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Cláudia Sousa Reis
- Department of Psychiatry and Mental Health, University Hospital Centre of São João, Porto, Portugal
| | - Maria Augusta Vieira-Coelho
- Department of Biomedicine, Pharmacology and Therapeutics Unit, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Psychiatry and Mental Health, University Hospital Centre of São João, Porto, Portugal
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Lisboa C, Stuardo V, Folch C. Sexualized drug use among gay men and other men who have sex with men in Latin America: A description of the phenomenon based on the results of LAMIS-2018. PLoS One 2023; 18:e0287683. [PMID: 37856552 PMCID: PMC10586662 DOI: 10.1371/journal.pone.0287683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 06/08/2023] [Indexed: 10/21/2023] Open
Abstract
INTRODUCTION Sexualized drug use (SDU) to enhance and extend sexual relations may involve risks of substances abuse (intoxication, interactions and overdose) and higher exposure to HIV and other sexually transmitted infections. There are inconsistencies in the methodology and findings of previous research on SDU in Latin America (LA), and more studies are required. The purpose of this research was to characterize SDU in gay men and other men who have sex with men from 18 LA countries, and describe the aspects by comparing people who practice and do not practice SDU, at the general and country levels. MATERIAL AND METHODS Cross-sectional study based on the data collected by LAMIS-2018. Dependent variable was SDU (last 12 months), and the independent variables were: drug use (in any context/in sexual context), sociodemographic, socioepidemiological, and psychosocial aspects. A descriptive analysis was carried out, comparing those who practiced and did not practice SDU. RESULTS LAMIS-2018 included 64,655 participants, averaging 30 years of age. 13.6% declared having practiced SDU (6.6% with multiple partners). In the last sexual encounter the most commonly used drugs were cannabis (9.3%), poppers (6%), and Viagra (5.4%), and in the last encounter with multiple partners, poppers (19.7%), cannabis (17%), and Viagra (13.2%). HIV diagnosis was reported by 27% of people practicing SDU, vs. 14.3% in the other group. Severe anxiety-depression symptoms were more common among people practicing SDU (9.2% vs. 7%), as were the episodes of homophobic intimidation (52.6% vs. 48.2%), insults (34.4% vs. 28.6%), and aggression (4.1% vs. 3.0%). CONCLUSIONS SDU was reported by a high percentage of people, with a predominance of the use of drugs related to sexual practice, and others for recreational use. Aspects described as the higher proportion of self-reported HIV diagnosis and severe symptoms of anxiety-depression among those who practiced SDU, show that is necessary to implement preventive strategies to reduce the harmful impacts that can sometimes result from this practice, including harm reduction policies, promote access to mental health services and support in situations of homophobia and stigma.
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Affiliation(s)
- Cristian Lisboa
- Escuela de Salud Pública, Universidad de Chile, Santiago, Chile
| | - Valeria Stuardo
- Instituto de Salud Pública, Universidad Andrés Bello, Santiago, Chile
| | - Cinta Folch
- Centro de Estudios Epidemiológicos sobre las Infecciones de Transmisión Sexual y SIDA de Cataluña (CEEISCAT), Cataluña, España
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, España
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Vock F, Johnson-Ferguson L, Bechtiger L, Stulz N, von Felten J, Eisner M, Hepp U, Ribeaud D, Shanahan L, Quednow BB. Substance use in sexual minority youth: prevalence in an urban cohort. Child Adolesc Psychiatry Ment Health 2023; 17:109. [PMID: 37716977 PMCID: PMC10505308 DOI: 10.1186/s13034-023-00657-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/08/2023] [Indexed: 09/18/2023] Open
Abstract
BACKGROUND Little comparative data on substance use (SU) between sexual minority youth (SMY) and heterosexual youth (HET) is available. This study compares the prevalence of SU in an urban cohort between SMY and HET and evaluates demographic and psychosocial predictors of SU. METHODS Data came from a prospective-longitudinal cohort study in an urban setting (N = 1297). SU and psychosocial variables such as internalizing symptoms, self-control, sensation-seeking, bullying-victimization, subjective stress, leisure activities, and peer influences were assessed with self-reports at age 17 and 20. SU was stratified by sex and sexual attraction, and the groups were compared using regression models, with demographic and psychosocial variables included as covariates. RESULTS SMY- and HET-youth displayed differences in a number of psychosocial variables. Overall, SMY- and HET-youth differed in their 12-months prevalence of SU: At age 17, SMY-females had significantly higher rates of SU than HET-females for cannabis (aOR = 2.14, p = 0.04), ecstasy/MDMA (aOR = 4.29, p = 0.01), and hallucinogens (aOR = 5.59, p = 0.02). At age 20, SMY-females had significantly higher rates of SU than HET-females for tobacco (aOR = 2.06, p = 0.03), cannabis (aOR = 2.24, p = 0.004), ecstasy/MDMA (aOR = 3.93, p < 0.001), stimulants (aOR = 3.45, p = 0.002), and hallucinogens (aOR = 6.65, p < 0.001). SMY-males reported significantly lower rates for tobacco and cannabis than HET-males at age 17. At age 20, they reported significantly higher rates for the use of ecstasy/MDMA (aOR = 2.30, p = 0.04) and hallucinogens (aOR = 2.43, p = 0.03). CONCLUSIONS Given that psychosocial variables were significant covariates of SMY-status and SU, our results underline the importance of accounting for these when explaining differences in SU between adolescents. While differentiation by sex is established in most studies, such standardized comparisons are lacking with regards to sexual identities. But knowledge about SU of SMY is critical for designing effective interventions. This is especially true for SMY-females: Thus, SU in SMY-females early in life needs to be explored more thoroughly and addressed with adequate prevention measures.
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Affiliation(s)
| | - Lydia Johnson-Ferguson
- Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
- Department of Psychology, Clinical and Developmental Psychology, University of Zurich, Zurich, Switzerland
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital of the University of Zurich, Zurich, Switzerland
| | - Laura Bechtiger
- Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
- Department of Psychology, Clinical and Developmental Psychology, University of Zurich, Zurich, Switzerland
| | - Niklaus Stulz
- Integrated Psychiatric Services Psychiatry Winterthur - Zürcher Unterland, Winterthur, Switzerland
| | - Joh von Felten
- Milchjugend, LGBTQ+ Youth Organization, Zurich, Switzerland
| | - Manuel Eisner
- Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
- Institute of Criminology, University of Cambridge, Cambridge, UK
| | - Urs Hepp
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Denis Ribeaud
- Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
| | - Lilly Shanahan
- Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
- Department of Psychology, Clinical and Developmental Psychology, University of Zurich, Zurich, Switzerland
| | - Boris B Quednow
- Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital of the University of Zurich, Zurich, Switzerland
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Irfan SD, Sarwar G, Emran J, Khan SI. An uncharted territory of sexualized drug use: exploring the dynamics of chemsex among young and adolescent MSM including self-identified gay men in urban Dhaka, Bangladesh. Front Psychol 2023; 14:1124971. [PMID: 37425169 PMCID: PMC10324373 DOI: 10.3389/fpsyg.2023.1124971] [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: 01/20/2023] [Accepted: 06/06/2023] [Indexed: 07/11/2023] Open
Abstract
Global and local literature depicted the pervasiveness of chemsex among men who have sex with men (MSM), yet there is limited evidence on adolescents and youth. Though literature showed their engagement in chemsex, further exploration is warranted about their socio-sexual contexts and implications. Therefore, this article explored the contexts and implications of chemsex on young and adolescent MSM. This article is extracted from qualitative research evidence, and research data are triangulated by programmatic evidence on adolescent and young MSM from two ongoing pilot interventions. The key motivational factors for engaging in chemsex were primarily rooted in the dynamics of their peer networks. Specifically, the onset of drug use is predominantly attributed to curiosity toward experimentation with methamphetamine, peer influence, propensity to lose weight, and increasing courage to approach potential sexual partners. Moreover, they continued taking drugs as it enhanced their sexual performance, thus perpetuating chemsex. Additionally, the findings revealed several sexual implications of methamphetamine, e.g., bolstering their sexual "stamina," increasing their propensity toward sexual violence, and reducing their decision-making abilities and judgment, thus collectively decreasing condom use. In essence, chemsex is considerably driven by their socio-sexual contexts, thus perpetuating sexual risk behaviors and compromising sexual health outcomes. Therefore, harm reduction interventions targeted need to be designed keeping in mind their socio-sexual dynamics and age.
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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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11
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Jaspal R. Chemsex, Identity and Sexual Health among Gay and Bisexual Men. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12124. [PMID: 36231424 PMCID: PMC9564711 DOI: 10.3390/ijerph191912124] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 09/19/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
This article focuses on some of the social, cultural and psychological aspects of drug use in sexualized settings in gay and bisexual men (referred to as "chemsex"). Using a narrative review approach, the article examines previous empirical research in this area and presents a novel theoretical approach for understanding and predicting chemsex behavior. Tenets of identity process theory from social psychology are drawn upon to offer an integrative theoretical framework within which the social, cultural and psychological underpinnings of chemsex can be collectively examined. Existing empirical research suggests that gay and bisexual men may experience sexuality-related stressors that can undermine feelings of self-esteem, self-efficacy, continuity and positive distinctiveness. Identity process theory examines how individuals react to threats to identity brought about by these stressors. In response to identity threat, gay and bisexual men may engage in chemsex as a coping response that encompasses and facilitates various, largely maladaptive, coping strategies and tactics. The more chemsex is perceived as enhancing identity processes and as averting identity threat, the more central it is likely to be to the identities of participants. The centrality of chemsex to one's identity may preclude self-withdrawal from the practice. Several directions for future research are presented based on existing work on chemsex viewed through the lens of identity process theory. These should form the basis of future empirical research in the sphere of sexual health among gay and bisexual men and the outcomes of this research should inform policy and practice in this area.
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Affiliation(s)
- Rusi Jaspal
- Vice-Chancellor's Office, University of Brighton, Brighton BN2 4GJ, UK
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12
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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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13
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Nguyen H, Hampel B, Nuñez DG, Battegay M, Hachfeld A, Bernasconi E, Calmy A, Cavassini M, Vernazza P, Fellay J, Rudolph H, Huber M, Leuzinger K, Perreau M, Scherrer A, Ramette AN, Yerly S, Günthard HF, Kouyos RD, Kusejko K. Identifying and Characterizing Trans women in the Swiss HIV Cohort Study as an Epidemiologically Distinct Risk Group. Clin Infect Dis 2021; 74:1468-1475. [PMID: 34282827 DOI: 10.1093/cid/ciab628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND As trans women are disproportionately affected by the HIV epidemic, and are still understudied, we aimed to identify and characterize the trans women in the Swiss HIV Cohort Study (SHCS). METHODS A combination of criteria from pre-existing cohort data was used to identify trans women. Information on socioeconomic factors, clinical data, risk behaviors, and mental health was collected. We also described their phylogenetic patterns within HIV transmission networks in relation to other risk groups. RESULTS We identified 89 trans women out of a total 20925 cohort participants. Trans women were much more likely to be Asian (30.3%) and Hispanic (15.7%) compared to men-who-have-sex with-men/MSM (2.5% and 4.1%, P value<0.001) and cis heterosexual (HET) women (7.0% and 3.3%, P value<0.001). Trans women were more similar to cis HET women in some measures like education level (post-secondary education attainment: 22.6% and 20.7% [P value =0.574], vs. 46.5% for MSM [P value<0.001]), while being more similar to MSM for measures like prior syphilis diagnosis (36.0% and 44.0% [P value=0.170], vs. 6.7% for cis HET women [P value <0.001]). 11.2% of trans women have been priorly hospitalized for psychological reasons, compared to 4.2% of MSM (P value=0.004) and 5.1% of cis HET women (P value=0.025). An analysis of transmission clusters containing trans women suggested greater affinity within the transmission networks to MSM compared to cis HET women. CONCLUSIONS Trans women are epidemiologically distinct in the setting of the Swiss HIV epidemic, warranting better identification and study to better serve this underserved risk group.
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Affiliation(s)
- Huyen Nguyen
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Benjamin Hampel
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Department of Public Health, Epidemiology, Biostatistics and Public Health Institute, University of Zurich, Zurich, Switzerland
| | | | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Anna Hachfeld
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Enos Bernasconi
- Division of Infectious Diseases, Regional Hospital Lugano, Lugano, Switzerland
| | - Alexandra Calmy
- Laboratory of Virology and Division of Infectious Diseases, Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - Matthias Cavassini
- Division of Infectious Diseases, Lausanne University Hospital, Lausanne, Switzerland
| | - Pietro Vernazza
- Division of Infectious Diseases, Cantonal Hospital St Gallen, St. Gallen, Switzerland
| | - Jacques Fellay
- School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Hannes Rudolph
- Transgender Network Switzerland, Checkpoint Zurich, Zurich, Switzerland
| | - Michael Huber
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Karoline Leuzinger
- Clinical Virology Division, Laboratory Medicine, University Hospital Basel, Basel, Switzerland
| | - Matthieu Perreau
- Department of Immunology and Allergy, University of Lausanne, Lausanne, Switzerland
| | - Alexandra Scherrer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Sabine Yerly
- Laboratory of Virology and Division of Infectious Diseases, Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - Huldrych F Günthard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Roger D Kouyos
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Katharina Kusejko
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
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14
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Latent Profile Analysis of a Syndemic of Vulnerability Factors on Incident Sexually Transmitted Infection in a Cohort of Black Men Who Have Sex With Men Only and Black Men Who Have Sex With Men and Women in the HIV Prevention Trials Network 061 Study. Sex Transm Dis 2021; 47:571-579. [PMID: 32496390 DOI: 10.1097/olq.0000000000001208] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sexually transmitted infections (STIs) are important public health concerns among black men who have sex with men only (BMSMO), as well as those who have sex with both men and women (BMSMW). Sexually transmitted infections also increase risk of acquiring and HIV, which is also a critical concern. Compared with BMSMO, research shows that BMSMW experience elevated levels of HIV/STI vulnerability factors occurring at the intrapersonal, interpersonal, and social/structural levels. These factors may work independently, increasing one's risk of engaging in high-risk sexual behaviors, but often work in a synergistic and reinforcing manner. The synergism and reinforcement of any combination of these factors are known as a syndemic, which increases HIV/STI risk. METHODS Data from the HIV Prevention Trials Network (HPTN) 061 study (n = 799) was used to conduct a latent profile analysis to identify unique combinations of risk factors that may form a syndemic and that may vary between BMSMO and BMSMW. We hypothesized that the convergence of syndemic factors would differ between groups and predict sexual risk and subsequent incident STI. RESULTS For BMSMO who had a high sexual risk profile, the syndemic factors characterizing this group included perceived racism, incarceration, intimate partner violence, depression, and binge drinking. For BMSMW with a high sexual risk profile, the syndemic factors that characterized this group were incarceration, depression, and binge drinking. CONCLUSIONS The current analysis highlights syndemic profiles that differentiated BMSMO and BMSMW from one another and supports the need for tailored interventions that address specific syndemic factors for both subpopulations of black men who have sex with men.
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15
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LoSchiavo C, Acuna N, Halkitis PN. Evidence for the Confluence of Cigarette Smoking, Other Substance Use, and Psychosocial and Mental Health in a Sample of Urban Sexual Minority Young Adults: The P18 Cohort Study. Ann Behav Med 2021; 55:308-320. [PMID: 32720976 PMCID: PMC8025086 DOI: 10.1093/abm/kaaa052] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Sexual minority men (SMM) and transgender women (TW) are more likely to smoke cigarettes than heterosexual and cisgender peers, which may exacerbate existing disparities in mental and psychosocial health and substance use. PURPOSE As few existing studies have examined the confluence of these factors, we sought to examine tobacco use in a diverse sample of SMM and TW and describe its relationship with other substance use and health. METHODS Data were drawn from a study of syndemic conditions among SMM and TW, which included measures assessing tobacco use, substance use, and mental, psychosocial, and general health. RESULTS A majority of the racially/ethnically and socioeconomically diverse sample (n = 665) reported ever smoking a cigarette, and more than half of them were current smokers. Current smoking was associated with more frequent recent substance use and poorer mental, psychosocial, and general health. In multivariable analyses, current smoking was predicted by more frequent substance use and more severe anxiety, when adjusting for demographic, substance use, and health factors. CONCLUSIONS A syndemic approach to health conditions such as substance use, mental health, and psychosocial burden dictates a framework of interrelation and mutual exacerbation. In doing so, we found that current cigarette use was associated with more frequent alcohol and marijuana use and more severe anxiety, suggesting a confluence of cigarette smoking, other substance use, and mental health burden. We recommend a holistic approach to treating tobacco use in sexual and gender minority populations that addresses both substance use and the myriad psychosocial burdens that sexual and gender minority communities experience.
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Affiliation(s)
- Caleb LoSchiavo
- Center for Health, Identity, Behavior and Prevention Studies, Rutgers School of Public Health, Newark, NJ
- Department of Health Behavior, Society and Policy, School of Public Health, Rutgers University, Piscataway, NJ
| | - Nicholas Acuna
- Center for Health, Identity, Behavior and Prevention Studies, Rutgers School of Public Health, Newark, NJ
- Departments of Biostatistics and Epidemiology, School of Public Health, Rutgers University, Piscataway, NJ
| | - Perry N Halkitis
- Center for Health, Identity, Behavior and Prevention Studies, Rutgers School of Public Health, Newark, NJ
- Departments of Biostatistics and Epidemiology, School of Public Health, Rutgers University, Piscataway, NJ
- Department of Urban-Global Public Health, School of Public Health, Rutgers University, Newark, NJ
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16
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Li CW, Ku SWW, Huang P, Chen LY, Wei HT, Strong C, Bourne A. Factors associated with methamphetamine dependency among men who have sex with men engaging in chemsex: Findings from the COMeT study in Taiwan. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 93:103119. [PMID: 33468444 DOI: 10.1016/j.drugpo.2021.103119] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/16/2020] [Accepted: 12/31/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Sexualized drug use or "chemsex" in Taiwan commonly incorporates the use of methamphetamine. Our study aimed to assess the extent of severity of dependence of methamphetamine among MSM in Taiwan as well as motivations for engagement in chemsex. METHODS Direct messages were sent to users of a large MSM social networking application in Taiwan between November 2018 and January 2019. MSM who had at least one experience of using drugs during sex in the preceding 12 months were invited to complete an online survey that assessed their sexual behavior, substance use and motivations for engaging in chemsex. The Severity of Dependence Scale was used to assess methamphetamine dependency. Multivariable logistic regression was used to determine the factors associated with methamphetamine dependency. RESULTS From a total of 1906 responses, 517 had used methamphetamine in their lifetime and were included in the analysis. The majority (87.2%) used more than one substance when engaging in chemsex in the past six months, while a quarter reported injection of methamphetamine within the last six months. The most commonly reported motivations for participants to engage in chemsex were to have fun, for relaxation, and to increase the intensity of the sexual experience. Nearly half (46.0%) exhibited signs of methamphetamine dependency. Lower monthly income, injection of methamphetamine, ever feeling lonely in the past 3 months and concerns about their substance use expressed by others were significantly associated with methamphetamine dependency. CONCLUSION A high proportion of MSM population who engaged in chemsex were at risk of developing methamphetamine dependency. While motivations for engaging in chemsex were diverse and suggest potential for enhanced sexual experience for some, community health organization for gay men's health and healthcare providers should be vigilant at identifying the risk of methamphetamine dependency and provide in-time, brief intervention or referrals when needed.
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Affiliation(s)
- Chia-Wen Li
- Division of Infectious Diseases, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Stephane Wen-Wei Ku
- Division of Infectious Diseases, Department of Medicine, Taipei City Hospital Renai Branch, Taipei, Taiwan
| | - Poyao Huang
- Fairbank Center for Chinese Studies, Harvard University, Cambridge, MA, United States
| | - Lian-Yu Chen
- Kumming Prevention and Control Center, Taipei City Hospital, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Han-Ting Wei
- Kumming Prevention and Control Center, Taipei City Hospital, Taipei, Taiwan; Department of Psychiatry, Branch of Linsen, Chiniese Medicine, and Kumming, Taipei City Hospital, Taipei, Taiwan
| | - Carol Strong
- Department of Public Health, College of Medicine, National Cheng Kung University, 8F-8068, No. 138, ShengLi Rd., North Dist, Tainan 704, Taiwan.
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia; Kirby Institute, UNSW Sydney, Australia
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17
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Berg RC, Amundsen E, Haugstvedt Å. Links between chemsex and reduced mental health among Norwegian MSM and other men: results from a cross-sectional clinic survey. BMC Public Health 2020; 20:1785. [PMID: 33238948 PMCID: PMC7690186 DOI: 10.1186/s12889-020-09916-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 11/18/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The use of specific drugs to facilitate, enhance or prolong sexual sessions is referred to as 'chemsex'. The popularity of the behavior seems to be growing, but there is a paucity of information on the mental health aspects associated with chemsex and no data on chemsex from Nordic countries. We investigated the link between chemsex and mental health among men who have sex with men (MSM) and other men in Norway. METHODS We recruited participants from a walk-in sexually transmitted infections (STI) clinic. Participants completed a piloted, anonymous self-administered survey. It consisted of questions about men's sociodemographic characteristics, mental health, sexual behaviors, substance use, and chemsex. The outcome we investigated was reduced mental health, measured with the validated Hopkins Symptom Check List. We obtained descriptive statistics and performed univariate and multivariate logistic regression analyses. RESULTS 1013 (96%) of the surveys were complete and could be analysed. The mean age of the sample was 33, 51% were MSM, and 21.7% had reduced mental health. More MSM than other men engaged in chemsex in the past year (17% vs 12%). The most frequently reported chemsex drugs were cocaine and gamma hydroxybutyrate/gamma butyrolactone (GHB/GBL). Men engaged in chemsex primarily to enhance sexual pleasure and excitement, and about half reported almost never or never using condoms for chemsex. In univariate analyses, significant predictors of reduced mental health was chemsex (Odds Ratio [OR] = 1.82), being unemployed (OR = 3.54), and having sex with only women (OR = 0.58). In multivariate analyses, two variables remained significantly associated with reduced mental health: chemsex (adjusted OR = 2.18, 95%CI = 1.25-3.78) and being unemployed (adjusted OR = 4.10, 95%CI = 2.13-7.87). CONCLUSIONS In our sample of men from an STI clinic in Norway, about 14% self-reported engaging in chemsex in the past year and about a fifth of the men had reduced mental health. Men who engaged in chemsex, which more MSM engaged in than other men, had two times greater odds of reduced mental health. These findings suggest that mental health assistance should be among the interventions offered to men engaging in chemsex.
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Affiliation(s)
- Rigmor C Berg
- Norwegian Institute of Public Health, Postboks 222 Skøyen, 0213, Oslo, Norway. .,University of Tromsø, Hansine Hansens veg 18, N-9019, Tromso, Norway.
| | - Eirik Amundsen
- University of Tromsø, Hansine Hansens veg 18, N-9019, Tromso, Norway
| | - Åse Haugstvedt
- Oslo University Hospital, Nasjonal kompetansetjeneste for seksuelt overførbare infeksjoner, Postboks 4763, 0506, Oslo, Norway
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18
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Review of sexualized drug use associated with sexually transmitted and blood-borne infections in gay, bisexual and other men who have sex with men. Drug Alcohol Depend 2020; 216:108237. [PMID: 33091811 DOI: 10.1016/j.drugalcdep.2020.108237] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 01/06/2023]
Abstract
PURPOSE The aim of the present study was to quantify associations between sexualized drug use (SDU) and sexually-transmitted and blood-borne infection (STBBI) diagnoses in gay, bisexual and other men who have sex with men (GBMSM) with defined temporal proximity between SDU exposure and STBBI diagnoses. METHODS In May 2018 and June 2019, we searched the literature for primary studies that quantified the association between STBBI and SDU among GBMSM. A random-effects model was used to meta-analyze the data and estimate the association between SDU and STBBIs. RESULTS Nineteen studies met the inclusion criteria and fourteen studies were included in the meta-analyses. SDU was associated with higher odds of bacterial STI diagnoses, higher odds of HCV diagnoses, and higher odds of HIV diagnoses. Associations between SDU and diagnoses of bacterial STIs or HCV remained after adjustment for behavioral and sociodemographic factors. CONCLUSIONS Robust and consistent associations between SDU and STBBI identified in this review add to the evidence suggesting SDU is a potential contributor to bacterial STIs and HCV or a proxy indicator for other risk factors.
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Platteau T, Herrijgers C, de Wit J. Digital chemsex support and care: The potential of just-in-time adaptive interventions. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 85:102927. [PMID: 32932125 DOI: 10.1016/j.drugpo.2020.102927] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/19/2020] [Accepted: 08/20/2020] [Indexed: 01/22/2023]
Abstract
Chemsex among gay, bisexual and other men who have sex with men (GBMSM) has received increasing attention as a public health concern in recent years. Chemsex can affect a variety of aspects of the lives of GBMSM and contribute to physical, social and emotional health burden. Starting from a continuum perspective of chemsex, rather than a binary view of problematic vs. non-problematic use, we argue that men engaging in chemsex at different points in their chemsex journey may benefit from tailored and personalized support to cope with the various and evolving challenges and concerns that may be related to their chemsex behavior. To date, interactive digital communication technologies are not much used to provide support and care for GBMSM engaging in chemsex, neither for community-based support and care nor by health services. This suggests potential for missed opportunities, as GBMSM are generally avid users of these technologies for social connections and hookups, including in relation to chemsex. Recent research has provided emerging evidence of the potential effects of so-called just in time adaptive interventions (JITAI) to provide effective support and care for a variety of health issues. JITAI hold much promise for the provision of appropriate, tailored support and care for GBMSM at different points in the chemsex journey. Co-designing JITAI with potential users and other stakeholders (co-design) is key to success. At the Institute for Tropical Medicine, in Antwerp (Belgium), we initiated the Chemified project to develop an innovative digital chemsex support and care tool for GBMSM. This project illustrates how current understanding of chemsex as a journey can be integrated with a JITAI approach and make use of co-design principles to advance the available support and care for GBMSM engaging in chemsex.
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Affiliation(s)
- T Platteau
- Institute of Tropical Medicine, Department of Clinical Sciences, Antwerp, Belgium; Open University, Department of Psychology, Heerlen, the Netherlands.
| | - C Herrijgers
- Institute of Tropical Medicine, Department of Clinical Sciences, Antwerp, Belgium
| | - J de Wit
- Utrecht University, Department of Social Sciences, Utrecht, the Netherlands
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20
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Halkitis PN, Maiolatesi AJ, Krause KD. The Health Challenges of Emerging Adult Gay Men: Effecting Change in Health Care. Pediatr Clin North Am 2020; 67:293-308. [PMID: 32122561 PMCID: PMC8690571 DOI: 10.1016/j.pcl.2019.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This article focuses on the health and health care challenges experienced by young and emerging adult gay men. Evidence is provided on the extent to which young and emerging adult gay men are disproportionally burdened by multidimensional health disparities, barriers to health care access, and inadequate provider-patient interactions. Recommendations are provided for health care providers and public health officials working with populations of emerging adult gay men that might have the greatest overall impact on improving this population's well-being and access to competent health care by increasing providers' awareness of the unique needs of young and emerging adult gay men.
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Affiliation(s)
- Perry N. Halkitis
- Center for Health, Identity, Behavior & Prevention Studies, Rutgers School of Public Health, One Riverfront Plaza, Newark, NJ 07102, USA,Department of Biostatistics, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ 08854, USA,Department of Urban-Global Health, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ 08854, USA,Corresponding author. Departments of Biostatistics, Epidemiology and Urban-Global Health, School of Public Health, Rutgers University, 683 Hoes Lane West, Piscataway, NJ 08854.
| | - Anthony J. Maiolatesi
- Center for Health, Identity, Behavior & Prevention Studies, Rutgers School of Public Health, One Riverfront Plaza, Newark, NJ 07102, USA,Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College Street, New Haven, CT 06510, USA,Center for Interdisciplinary Research on AIDS, Yale University, 135 College Street, New Haven, CT 06510, USA
| | - Kristen D. Krause
- Center for Health, Identity, Behavior & Prevention Studies, Rutgers School of Public Health, One Riverfront Plaza, Newark, NJ 07102, USA,Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ 08854, USA
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21
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Jaiswal J, Singer S, Lekas HK. Resilience and Beliefs in the Effectiveness of Current Antiretroviral Therapies Among Recently Disengaged Low-Income People of Color Living with HIV. Behav Med 2020; 46:75-85. [PMID: 30908162 PMCID: PMC7549317 DOI: 10.1080/08964289.2019.1570070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Consistent antiretroviral adherence is key to viral suppression, but many low-income people of color living with HIV are not optimally adherent due to a wide variety of interrelated social and structural factors. Previous studies have found that HIV medication beliefs are an important facet of adherence. In contrast to the AZT era , currently available antiretroviral therapies are significantly safer and more effective, but research suggests that negative beliefs may persist among racial and ethnic minority people. Twenty-seven semi-structured interviews were conducted with low-income Black and Latinx people living with HIV in New York City that were currently, or had been recently, disengaged from outpatient HIV medical care. This research suggests that socially and economically marginalized people living with HIV, many long-term survivors who lived through the AZT era, recognized that current treatments are very effective in making HIV a chronic, manageable illness and a significant improvement compared to the therapies early in the epidemic. Most importantly, the data suggests that people demonstrate great resilience despite their experiences of social and economic exclusion. Both clinical practice and public health interventions can benefit from these findings. HIV care providers should speak with patients about their beliefs related to HIV medication, and public health interventions should specifically address HIV medication-related beliefs in order to enhance adherence. In order to avoid reifying people's marginalization, public health should endeavor to recognize and support people's resilience.
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Affiliation(s)
- J. Jaiswal
- Center for Health, Identity, Behavior and Prevention Studies, New York University,Department of Social and Behavioral Sciences, College of Global Public Health, New York University,Center for Interdisciplinary Research on AIDS, Yale University School of Public Health
| | - S.N. Singer
- Center for Health, Identity, Behavior and Prevention Studies, New York University,Graduate School of Applied and Professional Psychology, Rutgers University
| | - H-K Lekas
- Division of Social Solutions and Services Research, Nathan Kline Institute for Psychiatric Research, State of New York Office of Mental Health,Department of Psychiatry, School of Medicine, New York University
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22
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Pleasure and HIV biomedical discourse: The structuring of sexual and drug-related risks for gay and bisexual men who Party-n-Play. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 74:181-190. [PMID: 31627160 DOI: 10.1016/j.drugpo.2019.09.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 08/21/2019] [Accepted: 09/23/2019] [Indexed: 11/23/2022]
Abstract
Party-n-Play (PNP) is a social practice that refers to sex that occurs under the influence of drugs. This study critically examined the risk and pleasure discourses of gay and bisexual men who PNP to explore how epistemic shifts associated with advancements in HIV biomedical sciences influence gay and bisexual men's perceptions of HIV risks and their sexual and drug-related practices. This study also aims to provide a more nuanced understanding of how sexual and drug-related risk practices of gay and bisexual men are entangled with their search for pleasure. The study was framed within poststructural Critical Discourse Analysis (CDA) methodology. In-depth one-hour interviews were conducted with 44 self-identified gay, bisexual, queer, or Two-Spirit men, who lived in Toronto, and who reported using drugs before or during sex with another man. The findings from this study demonstrated the capacity of biomedical discourses to affect respondents' HIV risk perceptions and practices. The transition from condom-centered prevention to today's context where new highly effective biomedical tools for HIV prevention are available created possibilities for greater intimacy, increased pleasure, and less anxiety about HIV tranmission, while challenging many years of preventive socialization among gay and bisexual men. However, this new context also rekindled deep-seated fears about HIV risk and viral load verifiability, reinforced unequal forms of biomedical self-governance and citizenship, and reproduced practices of biopolitics. While discourses on risk and pleasure were interwoven within complex PNP assemblages, the notion of pleasure was mobilized as a discursive tactic of self-control, and the division between normative and non-normative pleasures highlighted the consequence of biopolitical forces governing the production of discourses on sex and drugs. Future HIV social science research needs to attend to the fluid nature of the discursive environments of HIV prevention science, and consider how both the material context of PNP and its social/discursive elements operate together.
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23
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Van Hout MC, Crowley D, O'Dea S, Clarke S. Chasing the rainbow: pleasure, sex-based sociality and consumerism in navigating and exiting the Irish Chemsex scene. CULTURE, HEALTH & SEXUALITY 2019; 21:1074-1086. [PMID: 30600787 DOI: 10.1080/13691058.2018.1529336] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 09/25/2018] [Indexed: 06/09/2023]
Abstract
Club drug use among gay, bisexual and other men who have sex with men is increasingly normalised within sexual contexts and is associated with increased sexual risk behaviours. The term Chemsex is used to describe sexualised drug use lasting several hours or days with multiple sexual partners. A small pilot study, underpinned by interpretative phenomenological analysis (IPA), was conducted in Dublin, Ireland. Interviews were conducted with 10 men who were experiencing physical and emotional health problems as a consequence of their participation in sexualised drug use and wished to exit the Chemsex scene. Interviews explored experiences of sexualised drug use, motives to partake, the organisation of Chemsex parties and group connectivity, drugs used, harm reduction, pleasure and consequences of participation over time. Four basic themes emerged from the analysis: social and cyber arrangements within the Dublin Chemsex scene; poly drug use and experiences of drug dependence; drug and sexual harm reduction within the Chemsex circle of novices and experts; and sexualised drug use, escapism and compulsive participation. Two higher-order themes were also apparent: first, the reinforcing aspects of drug and sexual pleasure; and second, the interplay between excess drug consumption and sex, and drug dependence.
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Affiliation(s)
| | - Des Crowley
- b Substance Misuse Programme, Irish College of General Practitioners , Dublin , Ireland
| | - Siobhan O'Dea
- c Gay Men's Health Service, Baggot Street Hospital , Dublin , Ireland
| | - Susan Clarke
- c Gay Men's Health Service, Baggot Street Hospital , Dublin , Ireland
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