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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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Huang P, Du SCS, Ku SWW, Li CW, Bourne A, Strong C. An object-oriented analysis of social apps, syringes and ARTs within gay Taiwanese men's chemsex practices. CULTURE, HEALTH & SEXUALITY 2024; 26:497-512. [PMID: 37435820 DOI: 10.1080/13691058.2023.2228859] [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: 10/11/2022] [Accepted: 06/20/2023] [Indexed: 07/13/2023]
Abstract
Critical drug studies explore the discursive and material dimensions of sexualised drug use to overcome individualised and often pathologising notions such as risk, safety, responsibility and pleasure. This article uses an object-oriented approach-following the use and flow of social apps, syringes and antiretroviral therapy (ART)-to analyse gay and bisexual Taiwanese men's drug practices. Interview data from fourteen men are used to articulate how objects were brought into gay and bisexual men's chemsex repertoire in ways that shaped individuals' safe-sex communication, intimacy maintenance and stigma negotiation. An object-oriented approach scrutinises risk, pleasure and identities in assemblages of the human and nonhuman, and can help identify new opportunities for implementing health promotion interventions and policies.
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Affiliation(s)
- Poyao Huang
- Institute of Health Behaviors and Community Sciences and Master of Public Health Program, National Taiwan University, Taipei, Taiwan
| | | | - Stephane Wen-Wei Ku
- Division of Infectious Diseases, Department of Medicine, Taipei City Hospital Renai Branch, Taipei, Taiwan
| | - Chia-Wen Li
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Adam Bourne
- Australian Research Centre in Sex Health and Society, La Trobe University, Melbourne, VIC, Australia
- Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Carol Strong
- Department of Public Health, National Cheng Kung University, Tainan, Taiwan
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Thain BK, Lu R, Fitzpatrick C, Richardson D. Beyond-66: A pilot evaluation of a novel, peer-led harm reduction intervention for chemsex dependant men who have sex with men in Kuala Lumpur, Malaysia. Int J STD AIDS 2024; 35:164-168. [PMID: 37938931 DOI: 10.1177/09564624231213113] [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: 11/10/2023]
Abstract
BACKGROUND There is little research exploring harm reduction interventions for men who have sex with men (MSM) who engage in chemsex. Beyond-66 is a novel, 132-day, peer-led intervention programme for MSM who are chemsex dependent in Kuala Lumpur, Malaysia. We aimed to evaluate the feasibility, retention and effect of Beyond-66 on: abstinence from chemsex, motivation for abstinence, and mental wellbeing. METHOD We collected data on demographics, retention and completion and abstinence between January 2021-August 2023 in MSM using Beyond-66. Using 10-point Likert scales, we compared motivation to remain abstinent and mental wellbeing at the beginning and end of Beyond-66. RESULTS 25 MSM have either completed or dropped out/referred out of Beyond-66, 12/25(48%) were living with HIV and the median duration of chemsex use was 5 years (IQR = 4-6). 19 (76%) completed programme; 3 were referred out for a psychiatry assessment and 3 dropped out of the programme. 14 (74%) remain abstinent and 5 relapsed. The median motivation for abstinence scores for the 19 completers increased significantly between the pre-programme and post-programme period (7/10 (IQR = 4-8) to 9/10 (IQR = 5-10), p = .04) and the median mental health score (Likert score out of 10 where 10 is poor mental health) reduced significantly (5/10 (IQR = 4-7) to 2/10 (IQR 1-6), p = .008). CONCLUSION This pilot evaluation suggests that MSM using Beyond-66 experience high completion (76%) and abstinence (74%) rates and increased motivation for abstinence and mental wellbeing scores. Further research is needed to design, develop, and deliver peer led interventions for MSM who are chemsex dependant.
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Affiliation(s)
| | | | | | - Daniel Richardson
- University Hospitals NHS Foundation Trust, Brighton, UK
- Brighton and Sussex Medical School, Brighton, UK
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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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Li X, Cong J, Liu K, Wang P, Sun M, Wei B. Aberrant intrinsic functional brain topology in methamphetamine-dependent individuals after six-months of abstinence. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2023; 20:19565-19583. [PMID: 38052615 DOI: 10.3934/mbe.2023867] [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: 12/07/2023]
Abstract
Our aim was to explore the aberrant intrinsic functional topology in methamphetamine-dependent individuals after six months of abstinence using resting-state functional magnetic imaging (rs-fMRI). Eleven methamphetamines (MA) abstainers who have abstained for six months and eleven healthy controls (HC) were recruited for rs-fMRI examination. The graph theory and functional connectivity (FC) analysis were employed to investigate the aberrant intrinsic functional brain topology between the two groups at multiple levels. Compared with the HC group, the characteristic shortest path length ($ {L}_{p} $) showed a significant decrease at the global level, while the global efficiency ($ {E}_{glob} $) and local efficiency ($ {E}_{loc} $) showed an increase considerably. After FDR correction, we found significant group differences in nodal degree and nodal efficiency at the regional level in the ventral attentional network (VAN), dorsal attentional network (DAN), somatosensory network (SMN), visual network (VN) and default mode network (DMN). In addition, the NBS method presented the aberrations in edge-based FC, including frontoparietal network (FPN), subcortical network (SCN), VAN, DAN, SMN, VN and DMN. Moreover, the FC of large-scale functional brain networks revealed a decrease within the VN and SCN and between the networks. These findings suggest that some functions, e.g., visual processing skills, object recognition and memory, may not fully recover after six months of withdrawal. This leads to the possibility of relapse behavior when confronted with MA-related cues, which may contribute to explaining the relapse mechanism. We also provide an imaging basis for revealing the neural mechanism of MA-dependency after six months of abstinence.
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Affiliation(s)
- Xiang Li
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan 250355, China
- Center for Medical Artificial Intelligence, Shandong University of Traditional Chinese Medicine, Qingdao 266112, China
- Qingdao Academy of Chinese Medical Sciences, Shandong University of Traditional Chinese Medicine, Qingdao 266112, China
| | - Jinyu Cong
- Center for Medical Artificial Intelligence, Shandong University of Traditional Chinese Medicine, Qingdao 266112, China
- Qingdao Academy of Chinese Medical Sciences, Shandong University of Traditional Chinese Medicine, Qingdao 266112, China
| | - Kunmeng Liu
- Center for Medical Artificial Intelligence, Shandong University of Traditional Chinese Medicine, Qingdao 266112, China
- Qingdao Academy of Chinese Medical Sciences, Shandong University of Traditional Chinese Medicine, Qingdao 266112, China
| | - Pingping Wang
- Center for Medical Artificial Intelligence, Shandong University of Traditional Chinese Medicine, Qingdao 266112, China
- Qingdao Academy of Chinese Medical Sciences, Shandong University of Traditional Chinese Medicine, Qingdao 266112, China
| | - Min Sun
- Shandong Detoxification Monitoring and Treatment Institute, Zibo 255311, China
| | - Benzheng Wei
- Center for Medical Artificial Intelligence, Shandong University of Traditional Chinese Medicine, Qingdao 266112, China
- Qingdao Academy of Chinese Medical Sciences, Shandong University of Traditional Chinese Medicine, Qingdao 266112, China
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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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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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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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González-Baeza A, Barrio-Fernández P, Curto-Ramos J, Ibarguchi L, Dolengevich-Segal H, Cano-Smith J, Rúa-Cebrián G, García-Carrillo de Albornoz A, Kessel D. Understanding Attachment, Emotional Regulation, and Childhood Adversity and Their Link to Chemsex. Subst Use Misuse 2023; 58:94-102. [PMID: 36422467 DOI: 10.1080/10826084.2022.2148482] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: Although evidence shows that engaging in chemsex can be associated with poor mental health, little is known about the relationship between psychological factors and this type of drug use. We aim to explore associations between engagement in chemsex and several psychological variables (adverse life events, attachment styles, emotional regulation skills, self-care patterns) in a sample of gay, bisexual, and other men who have sex with men (GBMSM) with drug-related problems. Methods: A group of GBMSM engaged in chemsex (n = 41) and a control group of GBMSM (n = 39) completed an online survey to assess drug-related problems and the abovementioned psychological variables, in which both groups were compared. All analyses were adjusted for covariates showing significant differences between groups. Results: Compared to the control group, participants engaged in chemsex showed significantly higher frequencies of an avoidant-insecure attachment style and early adverse life events, regardless of all covariates (HIV status, job situation, and place of birth). Poorer emotional regulation and self-care patterns and a higher frequency of sexual abuse were also found in participants engaged in chemsex, though we cannot rule out the influence of HIV status on this second group of variables. Conclusions: Some people with drug-related problems engaged in chemsex might have suffered early adverse events and might have an avoidant-insecure attachment style. Moreover, those who have been diagnosed with HIV might show higher emotional dysregulation and poorer self-care patterns. These variables should be routinely evaluated in this population.
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Affiliation(s)
- Alicia González-Baeza
- Biological and Health Psychology Department, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Javier Curto-Ramos
- Apoyo Positivo, Psychological Department, Apoyo Positivo, Madrid, Spain.,Psychiatry Service, Hospital Universitario La Paz, Madrid, Spain
| | - Lorena Ibarguchi
- Apoyo Positivo, Psychological Department, Apoyo Positivo, Madrid, Spain
| | | | - Joanna Cano-Smith
- HIV Unit, Internal Medicine Service, Hospital Universitario La Paz, Madrid, Spain
| | | | | | - Dominique Kessel
- Biological and Health Psychology Department, Universidad Autónoma de Madrid, Madrid, Spain
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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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Lin CY, Huang YT, Lee CH, Fan CW, Yen CF. Gay Community Stress Scale with Its Cultural Translation and Adaptions in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11649. [PMID: 36141909 PMCID: PMC9517012 DOI: 10.3390/ijerph191811649] [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] [Received: 08/02/2022] [Revised: 09/04/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
The present study aimed to adapt the Gay Community Stress Scale (GCSS) into the traditional Chinese version for measuring gay community stress experienced. Additionally, we examined its psychometric propensities among gay and bisexual men (GBM) in Taiwan. In total, 736 GBM participated in this study and completed the 35-item traditional Chinese version of the GCSS (29 items from the original GCSS and six items from the results of the focus group interviews among GBM in Taiwan); the Measure of Internalized Sexual Stigma for Lesbians and Gay Men (MISS-LG); the State-Trait Anxiety Inventory (STAI); and the Center for Epidemiological Studies Depression Scale (CES-D). Exploratory factor analysis results suggest a five-factor structure (i.e., Sex, Status, Competition, Exclusion, and Externals) for the 32-item traditional Chinese version of the GCSS among Taiwanese GBM; three items were deleted due to low factor loadings (i.e., <0.3). The five-factor "Externals" were not observed in the original GCSS. Moreover, the concurrent validity of the traditional Chinese version was supported by the positive correlations with MISS-LG, STAI, and CES-D. In conclusion, the traditional Chinese version of the GCSS showed relatively satisfactory psychometric properties. However, further research is needed to investigate the reasons for the possible etiology account for the different factor structures between the traditional Chinese version and the original GCSS.
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Affiliation(s)
- Chung-Ying Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
- Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
| | - Yu-Te Huang
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong RM543, China
| | - Chiu-Hsiang Lee
- Department of Nursing, Chung Shan Medical University, Taichung 40201, Taiwan
- Department of Nursing, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
| | - Chia-Wei Fan
- Department of Occupational Therapy, AdventHealth University, Orlando, FL 32803, USA
| | - Cheng-Fang Yen
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
- Department of Psychiatry, School of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- College of Professional Studies, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan
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Chen WJ, Chen CY, Wu SC, Wu KCC, Jou S, Tung YC, Lu TP. The impact of Taiwan's implementation of a nationwide harm reduction program in 2006 on the use of various illicit drugs: trend analysis of first-time offenders from 2001 to 2017. Harm Reduct J 2021; 18:117. [PMID: 34798883 PMCID: PMC8603590 DOI: 10.1186/s12954-021-00566-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/03/2021] [Indexed: 03/24/2023] Open
Abstract
Background After implementing a nationwide harm reduction program in 2006, a dramatic decline in the incidence of human immunodeficiency virus (HIV) infection among people with injection drug use (IDU) was observed in Taiwan. The harm reduction program might have sent out the message discouraging the choice of IDU among illicit drug users in early stage. Based on the yearly first-time offense rates from 2001 to 2017, this study aimed to examine (1) whether the nationwide implementation of the harm reduction program in 2006 led to changes in first-time offenders’ use of heroin; (2) whether the intervention had a similar effect on the use of other illicit drugs; and (3) whether the effect of the intervention was limited to the first-time offenders of young age groups. Methods Yearly first-time illicit-drug offense rates from 2001 to 2017 in Taiwan were derived from two national databases for drug arrests that were verified using urine tests: the Criminal Record Processing System on Schedule I/II Drugs and the Administrative Penalty System for Schedule III/IV Substances. A hierarchy of mutually exclusive categories of drug uses was defined by the drug with the highest schedule level among those tested positive in an arrest. Segmented regression analyses of interrupted time series were used to test for the impact of the 2006 intervention. Results There was a decrease of 22.37 per 100,000 in the rate for heroin but no detectable level changes in that for methamphetamine or ecstasy after the 2006 intervention in Taiwan. There were baseline decreasing trends in the first-time offense rate from 2001 to 2017 for heroin and ecstasy and an increasing trend for methamphetamine, with the slopes not altered by the 2006 intervention. The postintervention decrease in the first-time offense rate for heroin was detectable among offenders less than 40 years old. Conclusions Our results indicate a diffusion effect of the 2006 intervention on decreasing heroin use among young offenders and have policy implications for better prevention and treatment for different age groups. Supplementary Information The online version contains supplementary material available at 10.1186/s12954-021-00566-5.
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Affiliation(s)
- Wei J Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, 17 Xu-Zhou Road, Taipei, 100, Taiwan. .,Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan. .,Department of Psychiatry, College of Medicine and National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan. .,Center for Neuropsychiatric Research, National Health Research Institutes, Zhunan Town, Miaoli County, Taiwan.
| | - Chi-Ya Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, 17 Xu-Zhou Road, Taipei, 100, Taiwan
| | - Shang-Chi Wu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, 17 Xu-Zhou Road, Taipei, 100, Taiwan
| | - Kevin Chien-Chang Wu
- Department of Psychiatry, College of Medicine and National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan.,Graduate Institute of Medical Education and Bioethics, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Susyan Jou
- Graduate School of Criminology, National Taipei University, New Taipei, Taiwan
| | - Yu-Chi Tung
- Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan.,Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Tzu-Pin Lu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, 17 Xu-Zhou Road, Taipei, 100, Taiwan.,Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan
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Yin W, Panakadan S, Shwe YY, Peters K, Sharma M, Murphy E. Enhance harm reduction programmes in responding to the changing trend of drug use and HIV transmission in Asia and the pacific. AIDS 2021; 35:2229-2232. [PMID: 34602593 DOI: 10.1097/qad.0000000000003011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Wenyuan Yin
- Regional Office for Asia and the Pacific, Joint United Nations Programme on HIV/AIDS (UNAIDS)
| | - Salil Panakadan
- Regional Office for Asia and the Pacific, Joint United Nations Programme on HIV/AIDS (UNAIDS)
| | - Ye Yu Shwe
- Regional Office for Asia and the Pacific, Joint United Nations Programme on HIV/AIDS (UNAIDS)
| | - Karen Peters
- Regional Office for Southeast Asia and the Pacific, United Nations Office for Drugs and Crime (UNODC), Bangkok, Thailand
| | - Mukta Sharma
- Regional Office for South-east Asia, World Health Organization (WHO), New Delhi, Delhi, India
| | - Eamonn Murphy
- Regional Office for Asia and the Pacific, Joint United Nations Programme on HIV/AIDS (UNAIDS)
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Tan RKJ, Phua K, Tan A, Gan DCJ, Ho LPP, Ong EJ, See MY. Exploring the role of trauma in underpinning sexualised drug use ('chemsex') among gay, bisexual and other men who have sex with men in Singapore. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 97:103333. [PMID: 34175526 DOI: 10.1016/j.drugpo.2021.103333] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/31/2021] [Accepted: 05/31/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sexualised drug use (SDU) has been identified as a major risk factor for HIV, as well as other mental health comorbidities among gay, bisexual and other men who have sex with men (GBMSM). While multiple studies have been conducted on the topic, few have explored the role of trauma in underpinning experiences of SDU among substance use treatment-experienced GBMSM. This qualitative study investigates life histories of trauma, and proposes a framework to better situate the factors driving SDU among treatment-experienced GBMSM. METHODS We conducted semi-structured in-depth interviews with 33 purposively-sampled GBMSM with a history of SDU, and seeking treatment for it in Singapore. Interview topics included participants' experiences and life histories of SDU, substance use, incarceration, trauma, as well as stories of resilience and ongoing recovery from SDU. Interviews were audio-recorded, transcribed, coded, and analysed using inductive thematic analysis, from which a trauma-informed framework was developed. RESULTS Participants firstly articulated the positive and desired aspects of SDU, such as its utility in allowing them to achieve positive emotional states, sexual enhancement, and feelings of connectedness and intimacy. Participants also described how SDU, in contrast, was used as a coping mechanism to deal with emotional and situational 'precipitants', including dealing with loneliness and a low self-esteem, sexual shame and social anxiety, as well as general stressful situations. Participants also articulated how such precipitants were underpinned by experiences of trauma, including those relating to HIV-related stigma, racism, sexual violence, death and loss, neglect, as well as internalised homophobia. Next, participants illustrated how such trauma were in turn reinforced by several 'preconditions', including the accessibility of substances, emphasis on sexual capital, and lack of access to mainstream support structures in the gay male community, alongside general sociolegal barriers to accessing care. CONCLUSIONS This study proposes the role of trauma and the preconditions underpinning them in motivating SDU among a sample of largely substance use treatment-experienced GBMSM in Singapore. Interventions that provide support for GBMSM seeking treatment for SDU should provide trauma-informed care to address the complex barriers to treatment effectiveness.
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Affiliation(s)
- Rayner Kay Jin Tan
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, Tahir Foundation Building #10-01, 117549, Singapore; The Greenhouse Community Services Limited, 531A Upper Cross Street #04-98 Hong Lim Complex, 051531, Singapore.
| | - Krish Phua
- The Greenhouse Community Services Limited, 531A Upper Cross Street #04-98 Hong Lim Complex, 051531, Singapore
| | - Alaric Tan
- The Greenhouse Community Services Limited, 531A Upper Cross Street #04-98 Hong Lim Complex, 051531, Singapore
| | - David Chong Jin Gan
- The Greenhouse Community Services Limited, 531A Upper Cross Street #04-98 Hong Lim Complex, 051531, Singapore
| | - Lai Peng Priscilla Ho
- Care and Counselling, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore
| | - Eleanor J Ong
- The Greenhouse Community Services Limited, 531A Upper Cross Street #04-98 Hong Lim Complex, 051531, Singapore
| | - Maha Yewtuck See
- The Greenhouse Community Services Limited, 531A Upper Cross Street #04-98 Hong Lim Complex, 051531, Singapore
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