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Muschialli L, Yang JC, Engstrom T, Puljevic C, Beltazar E, Beltazar E, Siddique O, Ferris J, Connolly DJ. Sexualized drug use and chemsex: A bibliometric and content analysis of published literature. J Psychoactive Drugs 2024:1-12. [PMID: 38961638 DOI: 10.1080/02791072.2024.2367614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 03/28/2024] [Indexed: 07/05/2024]
Abstract
Sexualized drug use (SDU) describes drug-facilitated sexual enhancement, and chemsex is an SDU subculture involving the use of specific drugs by men who have sex with men (MSM). This study aimed to identify research trends, foci, and themes within the SDU and chemsex-specific literature. The Web of Science Core Collection was searched with a list of SDU synonyms. All SDU-related articles were analyzed using the R package, bibliometrix. Full text review identified chemsex-specific records, and text was extracted verbatim for content analysis in Leximancer. The search returned 1,866 unique records. A total of 521 addressed SDU, and 301 papers specifically addressed chemsex. The small but growing SDU literature primarily addressed consensual encounters between MSM, and drug-facilitated assault experienced by women, in Western settings. Little attention was given to transgender communities or consensual SDU in cisgender heterosexual individuals. The literature primarily viewed SDU through a public health lens, specifically focusing on the risk conferred to sexual health.The SDU and chemsex-specific literature are potentially limited in scope and may inadequately capture the geographical, demographic, and cultural diversity of these phenomena. Future research should address the myriad social and health implications of SDU and chemsex participation across all relevant communities and settings.
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Affiliation(s)
- Luke Muschialli
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Justin C Yang
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Teyl Engstrom
- Queensland Digital Health Centre, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Cheneal Puljevic
- School of Public Health, Faculty of Medicine, The University of Queensland, Hesrtone, Queensland, Australia
| | | | | | - Owais Siddique
- UCL Medical School, Faculty of Medical Sciences, London, UK
| | - Jason Ferris
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Dean J Connolly
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- National Addiction Centre, King's College London, London, UK
- Institute of Epidemiology and Health Care, University College London, London, UK
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Gertzen M, Karcher S, Schwarz J, Rosenberger C, Strasburger M, Rabenstein A, Strasser AM, Palm U, Rüther T. "I Can't Get No Satisfaction"-Psychosocial Aspects and Awareness of Negative Impacts in Chemsex Users: Results from an Anonymous Online Survey. Brain Sci 2024; 14:666. [PMID: 39061406 PMCID: PMC11275116 DOI: 10.3390/brainsci14070666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 06/24/2024] [Accepted: 06/27/2024] [Indexed: 07/28/2024] Open
Abstract
Chemsex is the interplay of substance use by men who have sex with men (MSM) in sexual contexts. The minority stress model and the identity process theory are explanatory models. In this study, we investigated whether (i) differences in certain psychosocial aspects (i.e., shame, aspects of queer identity, and sexual self-concepts) exist between chemsex users and non-users, and (ii) which factors influence an awareness of negative impacts in chemsex users. We conducted an anonymous, cross-sectional, online survey, including sociodemography, sexual history, history of substance use, validated scales for shame-proneness, aspects of queer identity, and sexual self-concepts. Our analysis comprised descriptive statistics, t-tests, Spearman's correlations, and a multiple linear regression model. We recorded a total of 3257 datasets with 107 chemsex users. Chemsex users showed higher rates for risky sexual behavior. Values for shame proneness, more negative aspects of queer identity, and sexual self-concepts were elevated in chemsex users with an awareness of negative impacts. Sexual anxiety, intravenous substance use, and having had a difficult process coming out were significant predictors of feeling negative impacts. Aspects of shame, queer identity aspects, and sexual self-concepts play an important role in the field of chemsex. Different explanatory models seem to be relevant for different subgroups of chemsex users. Chemsex users with an awareness of a problem were particularly vulnerable and distressed but had the highest motivation for change. Prevention, counseling, and care might profit from the inclusion of these aspects. Further anti-stigma campaigns and a specialization of the healthcare system are needed. Registration: DRKS00022336, date: 29th of October, 2020.
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Affiliation(s)
- Marcus Gertzen
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical Faculty, University of Augsburg, 86156 Augsburg, Germany
| | - Sinan Karcher
- Department of Psychiatry and Psychotherapy, University Hospital Munich, 80336 Munich, Germany
| | - Johanna Schwarz
- Department of Psychiatry and Psychotherapy, University Hospital Munich, 80336 Munich, Germany
| | - Cornelia Rosenberger
- Department of Psychiatry and Psychotherapy, University Hospital Munich, 80336 Munich, Germany
| | - Moritz Strasburger
- Department of Psychiatry and Psychotherapy, University Hospital Munich, 80336 Munich, Germany
| | - Andrea Rabenstein
- Department of Psychiatry and Psychotherapy, University Hospital Munich, 80336 Munich, Germany
| | - Anna-Martina Strasser
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical Faculty, University of Augsburg, 86156 Augsburg, Germany
| | - Ulrich Palm
- Department of Psychiatry and Psychotherapy, University Hospital Munich, 80336 Munich, Germany
- P3 Clinic, 82327 Tutzing, Germany
| | - Tobias Rüther
- Department of Psychiatry and Psychotherapy, University Hospital Munich, 80336 Munich, Germany
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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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Alarcón Gutiérrez M, Palma Díaz D, Alberny Iglesias M, Ruiz Riera R, Guayta-Escolies R, García de Olalla P, Rius Gibert C. Response Rate, Acceptability and Effectiveness of an Intervention Offering HIV/STI Testing Via Apps Among Gay, Bisexual, and Other Men Who Have Sex With Men in Barcelona, Spain, from 2016 to 2020. AIDS Behav 2024; 28:1345-1355. [PMID: 37768426 PMCID: PMC10940395 DOI: 10.1007/s10461-023-04165-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 09/29/2023]
Abstract
We evaluated the response rate, acceptability, and effectiveness of a preventive programme offering rapid HIV and other STI testing, as well as sexual counselling to gay, bisexual, and other men who have sex with men (GBMSM) via dating apps over a 4-year period. The programme was carried out in 9 out of the 10 districts in the city of Barcelona, Spain. The response rate was defined as the proportion of people responding to the message sent, acceptability as the proportion of those responding favourably, and effectiveness as the proportion of users requesting a test. We performed univariate analysis and multivariate logistic regression in relation with the response rate, acceptability and effectiveness. A total of 5,254 messages were send to different users. The response rate was 33.1% (n = 1,741), acceptability was 86.2% (n = 1,500), and effectiveness was 10.1% (n = 532). The factors associated with user response were recent connection to the app (aOR = 1.85; CI:1.39-2.46) and the presence of a profile photograph (aOR = 1.34; CI:1.11-1.64). Acceptability was associated with recent connection to the app (aOR = 1.98; CI:1.09-3.58). Effectiveness was associated with lower reported age (aOR = 0.98; CI:0.97-0.99), contact before 14:00 (aOR = 2.47; CI: 1.77-3.46), and recent connection to the app (aOR = 4.89; CI:1.98-12.08). Effectiveness was also greater in districts that were more disadvantaged or had fewer sexual health services. This study demonstrates that the use of these apps is an acceptable and effective method of prevention and sexual health promotion in GBMSM in this setting and identifies the associated factors that could guide such interventions.
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Affiliation(s)
- Miguel Alarcón Gutiérrez
- Department of Paediatrics, Obstetrics and Gynaecology and Preventive Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
- Epidemiology service, Agència de Salut Pública de Barcelona, Barcelona, Spain.
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain.
| | - David Palma Díaz
- Epidemiology service, Agència de Salut Pública de Barcelona, Barcelona, Spain
- Department of International Health, Care and Public Health Research Institute - CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - Rafael Ruiz Riera
- Direcció Estratègica d'Atenció Primària i Comunitària, Health Department, Generalitat de Catalunya, Barcelona, Spain
| | - Rafael Guayta-Escolies
- Projects and Research Directorate, Council of Pharmacists Colleges of Catalonia, Barcelona, Spain
| | - Patricia García de Olalla
- Epidemiology service, Agència de Salut Pública de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomédica Sant Pau, Barcelona, Spain
| | - Cristina Rius Gibert
- Epidemiology service, Agència de Salut Pública de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomédica Sant Pau, Barcelona, Spain
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Giacalone S, Barberi F, Ramoni S, Casazza G, Cusini M, Marzano AV. Sexualised drug use and chemsex in Italy: A questionnaire study based on a cohort of clients attending a STI outpatient service in Milan. Int J STD AIDS 2023; 34:1034-1041. [PMID: 37608639 DOI: 10.1177/09564624231193055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
BACKGROUND Chemsex is a heterogeneous phenomenon with differences in distribution, setting, motivations and type of substances consumed between countries. The lack of data at national level of the Italian situation creates a perception of reduced need for intervention. METHODS Anonymous paper questionnaires were distributed to patients who had registered themselves at the STI Department IRCCS Ca' Granda Policlinico in Milan. RESULTS A significant association was demonstrated between use of sexualised drugs, chemsex and the following variables: (1). Number of partners: in the group of clients with more than five partners, sexualised drug users were more than twice compared with those in the group with less than five partners (35.2% vs 16.2%) p<0.0001. (2). Use of dating apps: more than one out of two persons who used drugs during sex affirmed looking for partners on internet, p = 0.0059. (3). Low condom uses with occasional partners: percentage of individuals who declared not to use condoms or devices during their sexual encounters with occasional partners is more than twice as high in the sexualised drug users group with respect to controls (44.6% vs 21.4%); p = 0.0006). (4). Use of post exposure prophylaxis (PEP): among the PEP users, more than half participants belonged to the sexualised drug users' group; p = 0.0021. CONCLUSIONS Sexualised drug use and chemsex are frequently practiced in Milan. This survey identified a specific population with higher-risk sexual behaviours and increased incidence of acute bacterial STIs.
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Affiliation(s)
- Serena Giacalone
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - Francesco Barberi
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - Stefano Ramoni
- UOC Dermatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Casazza
- Dipartimento di Scienze Cliniche e di Comunità, Universita' degli Studi di Milano, Milan, Italy
| | - Marco Cusini
- UOC Dermatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Angelo Valerio Marzano
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
- UOC Dermatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Rosas Cancio-Suárez M, Ron R, Díaz-Álvarez J, Martínez-Sanz J, Serrano-Villar S, Moreno S, Sánchez-Conde M. Prevalence, characteristics, and associated risk factors of drug consumption and chemsex use among individuals attending an STI clinic (EpITs STUDY). Front Public Health 2023; 11:1285057. [PMID: 38026436 PMCID: PMC10644726 DOI: 10.3389/fpubh.2023.1285057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023] Open
Abstract
Sex-related drug consumption and its health-related consequences have gained relevance in the assessment of patients with sexually transmitted infections (STIs), which pose a significant challenge to public health. We aim to assess the prevalence and characteristics of drug consumption and chemsex practices, describe the associated risk factors among general individuals attending an STI clinic, and evaluate the psychological impact associated with these behaviors. We conducted an online anonymous survey offered to patients with a diagnosis of STI in a tertiary hospital in Spain. Data included sociodemographic characteristics, sexual preferences and behavior, and assessment of drug use, chemsex, and psychological and mental health symptoms. Data from 145 subjects was collected, with a higher proportion of cis-gender men (71%), and a median age of 32 years. 64 participants (44%) reported drug use in the last year, with an observed 33.8% prevalence of chemsex consumption. Drug use and chemsex were more frequent among cis-gender men, Men who have Sex with Men (MSM), people living with HIV (PLHIV), and those reporting previous group sex. Poppers and cannabis were the most frequently reported drugs, with a prevalence close to 20% for cocaine, mephedrone, extasis, and GHB. Consequences related to drug use included unpleasant physical sensations, sexual dysfunction, and impaired sexual experience after reduction or drug discontinuation. The prevalence of drug use and chemsex practices are high among patients evaluated for STIs, especially between men, MSM, and subjects practicing group sex. The study highlights the urgent need for targeted interventions on prevention and reduction of their impact on health and social well-being.
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Affiliation(s)
- Marta Rosas Cancio-Suárez
- Department of Infectious Diseases, Hospital Ramón y Cajal, Carretera de Colmenar, Madrid, Spain
- Ramón y Cajal Research Institute (IRYCIS), Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Raquel Ron
- Department of Infectious Diseases, Hospital Ramón y Cajal, Carretera de Colmenar, Madrid, Spain
- Ramón y Cajal Research Institute (IRYCIS), Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Jorge Díaz-Álvarez
- Department of Infectious Diseases, Hospital Ramón y Cajal, Carretera de Colmenar, Madrid, Spain
- Ramón y Cajal Research Institute (IRYCIS), Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Javier Martínez-Sanz
- Department of Infectious Diseases, Hospital Ramón y Cajal, Carretera de Colmenar, Madrid, Spain
- Ramón y Cajal Research Institute (IRYCIS), Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Sergio Serrano-Villar
- Department of Infectious Diseases, Hospital Ramón y Cajal, Carretera de Colmenar, Madrid, Spain
- Ramón y Cajal Research Institute (IRYCIS), Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Santiago Moreno
- Department of Infectious Diseases, Hospital Ramón y Cajal, Carretera de Colmenar, Madrid, Spain
- Ramón y Cajal Research Institute (IRYCIS), Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
- Department of Medicine, University of Alcalá de Henares, Madrid, Spain
| | - Matilde Sánchez-Conde
- Department of Infectious Diseases, Hospital Ramón y Cajal, Carretera de Colmenar, Madrid, Spain
- Ramón y Cajal Research Institute (IRYCIS), Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
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Daly FP, O'Donnell K, Davoren MP, Noone C, Weatherburn P, Quinlan M, Foley B, Lyons F, Igoe D, Barrett P. Recreational and sexualised drug use among gay, bisexual, and other men who have sex with men (gbMSM) in Ireland-Findings from the European MSM internet survey (EMIS) 2017. PLoS One 2023; 18:e0288171. [PMID: 37506129 PMCID: PMC10381075 DOI: 10.1371/journal.pone.0288171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/20/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Gay, bisexual, and other men who have sex with men (gbMSM) report a higher prevalence of drug use in comparison to the general male population. However, in Ireland, there is a paucity of literature regarding the prevalence of drug use and its determinants among gbMSM. AIMS/OBJECTIVES To quantify the prevalence of (i) recreational drug use (RDU) and (ii) sexualised drug use (SDU) among gbMSM in Ireland, and to identify the factors associated with these drug use practices. METHODS The European MSM Internet Survey (EMIS) 2017 was an online, anonymous, internationally-promoted questionnaire. Two binary outcomes were included in our analyses: (1) RDU and (2) SDU in the previous year. Multivariable-adjusted logistic regression explored factors associated with these outcomes, and all independent covariates were adjusted for one another. RESULTS Among gbMSM without HIV (n = 1,898), 40.9% and 13.1% engaged in RDU and SDU in the previous year, respectively. Among diagnosed-positive gbMSM (n = 141), the past-year respective prevalence estimates were 51.8% and 26.2%. Increased odds of RDU were observed among gbMSM who were younger (vs. 40+ years) (18-24 years; AOR 2.96, 95% CI 2.05-4.28, 25-39 years; AOR 1.66, 95% CI 1.27-2.16), lived in Dublin (vs. elsewhere) (AOR 1.47, 95% CI 1.17-1.83), and engaged in condomless anal intercourse (CAI) in the previous year (vs. none) (1-2 partners; AOR 1.79, 95% CI 1.34-2.38, 6+ partners; AOR 1.79, 95% CI 1.18-2.71). Greater odds of SDU were identified among those who lived in Dublin (vs. elsewhere) (AOR 1.50, 95% CI 1.07-2.10), and engaged in CAI (vs. none) (1-2 partners; AOR 3.16, 95% CI 2.05-4.88, 3-5 partners; AOR 2.50, 95% CI 1.47-4.26, and 6+ partners; AOR 3.79, 95% CI 2.23-6.43). CONCLUSION GbMSM report a high prevalence of drug use in Ireland. Targeted interventions, including harm reduction campaigns, may be needed to support healthier drug use choices among this community.
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Affiliation(s)
- Fionn P Daly
- School of Medicine and Health, University College Cork, Cork, Ireland
- School of Public Health, University College Cork, Cork, Ireland
| | - Kate O'Donnell
- HSE Health Protection Surveillance Centre, Dublin, Ireland
| | - Martin P Davoren
- School of Public Health, University College Cork, Cork, Ireland
- Sexual Health Centre, Cork, Ireland
| | - Chris Noone
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Peter Weatherburn
- Sigma Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | - Fiona Lyons
- St. James's Hospital, James St, Saint James' (part of Phoenix Park), Dublin 8, Dublin, Ireland
| | - Derval Igoe
- HSE Health Protection Surveillance Centre, Dublin, Ireland
| | - Peter Barrett
- School of Public Health, University College Cork, Cork, Ireland
- Department of Public Health HSE-South, St. Finbarr's Hospital, Cork, Ireland
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De La Mora L, Ugarte A, Martínez-Rebollar M, De Lazzari E, García-Hernández D, Font G, De Loredo N, Solbes E, Miquel L, Blanch J, Torres B, Riera J, Chivite I, Ambrosioni J, Inciarte A, González-Cordón A, Martínez E, Blanco JL, Mallolas J, Laguno M. Chemsex Practices in PrEP: Beyond Addiction and Risk Toward a Healthy Sex Life-Baseline Experiences from a Hospital-Based PrEP Program in Barcelona, Spain. AIDS Behav 2022; 26:4055-4062. [PMID: 35732910 PMCID: PMC9640403 DOI: 10.1007/s10461-022-03730-5] [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] [Accepted: 05/20/2022] [Indexed: 11/26/2022]
Abstract
Pre-exposure prophylaxis (PrEP) is a biomedical intervention that has demonstrated efficacy in HIV prevention in individuals at high-risk, among them chemsex users. Out of 190 PrEP users followed at Hospital Clinic of Barcelona until October 2020, 89% reported drug use, and 63% disclosed that they had engaged in chemsex practices, initiated in 64% of cases within the past year. Twenty-one percent used 3 or more drugs simultaneously, being GHB/GBL, nitrites, sildenafil, and methamphetamine the most prevalent combination. Eight percent reported slamming. Forty-one percent described having had negative experiences and 8% did not remember the last time they had sober sex. Methamphetamine, mephedrone, GHB/GBL, and having had open relationships, group sex, double penetration, and fisting were significantly more prevalent. Forty-nine percent admitted being worried about chemsex use, and 18% said they needed help. A comprehensive, interdisciplinary approach is mandatory to enable the attainment of a healthy approach to one's sex life.
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Affiliation(s)
- Lorena De La Mora
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Ainoa Ugarte
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Maria Martínez-Rebollar
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain.
| | - Elisa De Lazzari
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - David García-Hernández
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Guillermo Font
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Nicolás De Loredo
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Estela Solbes
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Laia Miquel
- Addiction Unit (GRAC). Psychiatry and Psychology Department, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, Barcelona University, Barcelona, Spain
| | - Jordi Blanch
- Addiction Unit (GRAC). Psychiatry and Psychology Department, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, Barcelona University, Barcelona, Spain
| | - Berta Torres
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Josep Riera
- Dermatology Service, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Iván Chivite
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Juan Ambrosioni
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Alexy Inciarte
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Ana González-Cordón
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Esteban Martínez
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - José Luis Blanco
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Josep Mallolas
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Montserrat Laguno
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
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D'Avanzo PA, LoSchiavo CE, Krause KD, Karr A, Halkitis PN. Biological, Behavioral, and Demographic Drivers of Recent Syphilis Infection Among Emerging Adult Sexual Minority Men in New York City: The P18 Cohort Study. AIDS Patient Care STDS 2022; 36:416-424. [PMID: 36367994 PMCID: PMC9700354 DOI: 10.1089/apc.2022.0148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The rate of syphilis infections among sexual minority men (SMM) has continued to increase in recent decades. As such, this analysis sought to identify demographic, biological, and behavioral factors associated with recent syphilis infection in emerging adult SMM. Data were drawn from a 3-year cohort study of emerging adult SMM (n = 665), from July 2014 to March 2019. Biannual study assessments included rapid HIV testing and behavioral surveys. At baseline, and at the 18- and 36-month time points, participants underwent chlamydia, gonorrhea, and syphilis screening. Generalized estimating equations were used to generate four models of repeated syphilis screening. In this racially/ethnically and socioeconomically diverse sample of SMM, 5.0% of participants tested positive for syphilis at baseline and 9.0% had an infection at the subsequent time points. Across all models, racial/ethnic minority SMM had higher odds of syphilis. Higher odds of syphilis infection were also significantly associated with more frequent condomless anal sex, more frequent marijuana use, HIV seropositivity, not currently using pre-exposure prophylaxis (PrEP), and not receiving syphilis testing in the previous 6 months; lower odds were associated with more frequent oral sex and more frequent alcohol use. These findings support current screening guidelines based on SMM who may be at increased risk for sexually transmitted infection (STI) acquisition, such as people living with HIV or those who engage in condomless sex. Further, our findings of reduced syphilis incidence among those who are on PrEP and engaged in regular STI testing support existing efforts to increase the availability and accessibility of preventive sexual health care for SMM.
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Affiliation(s)
- Paul A. D'Avanzo
- Center for Health, Identity, Behavior & Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, New Jersey, USA
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, New York, USA
| | - Caleb E. LoSchiavo
- Center for Health, Identity, Behavior & Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, New Jersey, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Kristen D. Krause
- Center for Health, Identity, Behavior & Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, New Jersey, USA
- Department of Urban-Global Health, Rutgers School of Public Health, Newark, New Jersey, USA
| | - Anita Karr
- Center for Health, Identity, Behavior & Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, New Jersey, USA
| | - Perry N. Halkitis
- Center for Health, Identity, Behavior & Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, New Jersey, USA
- Department of Urban-Global Health, Rutgers School of Public Health, Newark, New Jersey, USA
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, USA
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10
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Amundsen E, Haugstvedt Å, Skogen V, Berg RC. Health characteristics associated with chemsex among men who have sex with men: Results from a cross-sectional clinic survey in Norway. PLoS One 2022; 17:e0275618. [PMID: 36197878 PMCID: PMC9534388 DOI: 10.1371/journal.pone.0275618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 09/20/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Chemsex typically involves drugs such as GHB/GBL, crystal meth and mephedrone, and is increasingly common among MSM. The behaviour has been found to be associated with sexually transmitted infections (STIs) and mental health problems. We aimed to assess the extent of chemsex engagement and associations with different aspects of health, among MSM attending a free specialist walk-in clinic for STIs in Oslo, Norway. METHODS Anonymous cross-sectional survey data was collected from June to October 2016. Differences in STI health (chlamydia, gonorrhoea, syphilis, HIV diagnoses), mental health (depression/anxiety) and internalised homonegativity between MSM using and not using GHB/GBL, crystal meth, mephedrone, cocaine or ketamine with sex in the last year were assessed descriptively and in a multivariate logistic regression model. The predictors were number of self-reported chlamydia, gonorrhoea or syphilis diagnoses, HIV diagnosis, depression/anxiety, and degree of internalised homonegativity. We adjusted for age, education level and having lived abroad. RESULTS Of the 518 MSM respondents, 17% reported sexualised use of either GHB/GBL, crystal meth, mephedrone, cocaine or ketamine in the last year (chemsex). We found significant positive associations between chemsex and self-reported HIV diagnoses (adjusted odds ratio [aOR] = 3.26, 95%CI = 1.37-7.76), number of reported chlamydia, gonorrhoea or syphilis diagnoses in the last year (aOR = 1.63, 95%CI = 1.18-2.12), having lived more than one year abroad (aOR = 2.10, 95%CI = 1.20-3.65), but no significant association with depression/anxiety (aOR = 1.02, 95%CI = 0.53-1.93), nor internalised homonegativity (aOR = 0.62, 95%CI = 0.33-1.19). CONCLUSION Chemsex engagement in Norway is relatively low compared to findings from STI clinics in other European countries, and GHB/GBL and cocaine the two most commonly used drugs with sex. Chemsex was more common among MSM having lived more than one year abroad, reporting HIV diagnoses and a higher number of either chlamydia, gonorrhoea or syphilis diagnoses in the last year. Health care providers need to be made aware of chemsex as a behavioural phenomenon among MSM, and special care should be afforded to MSM living with HIV and being diagnosed with STIs.
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Affiliation(s)
- Eirik Amundsen
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Åse Haugstvedt
- The Olafia Clinic and the National Advisory Unit on Sexually Transmitted Infections, Oslo University Hospital, Oslo, Norway
| | - Vegard Skogen
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Infectious Diseases, Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Rigmor C. Berg
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Division for Health Services, Norwegian Institute of Public Health (NIPH), Oslo, Norway
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11
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Orviz E, Negredo A, Ayerdi O, Vázquez A, Muñoz-Gomez A, Monzón S, Clavo P, Zaballos A, Vera M, Sánchez P, Cabello N, Jiménez P, Pérez-García JA, Varona S, Del Romero J, Cuesta I, Delgado-Iribarren A, Torres M, Sagastagoitia I, Palacios G, Estrada V, Sánchez-Seco MP. Monkeypox outbreak in Madrid (Spain): Clinical and virological aspects. J Infect 2022; 85:412-417. [PMID: 35830908 PMCID: PMC9534097 DOI: 10.1016/j.jinf.2022.07.005] [Citation(s) in RCA: 97] [Impact Index Per Article: 48.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 07/05/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Monkeypox is the most prevalent Orthopoxvirus zoonosis infection since the eradication of smallpox. The current multi-country outbreak involves five WHO regions affecting mainly Europe. Accurate clinical and virological aspects of the disease outside endemic areas are needed. METHODS We performed an observational study of cases diagnosed in Madrid (Spain) (May/June 2022). Confirmation from vesicular lesions swabs, Orthopoxvirus real-time PCR, sequencing, phylogenetic analysis, and direct detection by Electron microscopy was performed. In addition, a structured epidemiological questionnaire was completed systematically to gather sociodemographic, clinical, and behavioral data from all confirmed cases. FINDINGS We extracted data from 48 patients, all cisgender men. The median age was 35 years (IQR 29 - 44), and 87.5% were MSM. The most prevalent symptoms were the presence of vesicular-umbilicated and pseudo-pustular skin lesions (93.8%), asthenia (66.6%), and fever (52.1%). In addition, the location of the lesions in the genital or perianal area was related to the role in sexual intercourse (p<0.001). Sequencing analysis indicated the virus circulating in Spain belongs to the western African clade. Like the other European cases in the outbreak, the Spanish isolates are a direct descendant of viruses previously detected in Nigeria, the UK, Singapore, and Israel in 2017-2018. CONCLUSIONS Monkeypox is an emerging infectious disease in Europe where community transmission is reported, mainly in MSM. The first symptom was skin lesions instead of classical fever and rash. The disease follows a self-limited course, and there have been no cases with a serious presentation or severe complications.
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Affiliation(s)
- Eva Orviz
- Centro Sandoval/Hospital Clínico San Carlos, IdISSC
| | - Anabel Negredo
- Laboratorio de Arbovirus y Enfermedades Víricas importadas, Centro Nacional de Microbiología. Instituto de Salud Carlos III; CIBERINFEC
| | - Oskar Ayerdi
- Centro Sandoval/Hospital Clínico San Carlos, IdISSC
| | - Ana Vázquez
- Laboratorio de Arbovirus y Enfermedades Víricas importadas, Centro Nacional de Microbiología. Instituto de Salud Carlos III; CIBERINFEC
| | | | - Sara Monzón
- Unidad de Bioinformática, Instituto de Salud Carlos III
| | | | | | - Mar Vera
- Centro Sandoval/Hospital Clínico San Carlos, IdISSC
| | - Patricia Sánchez
- Laboratorio de Arbovirus y Enfermedades Víricas importadas, Centro Nacional de Microbiología. Instituto de Salud Carlos III; CIBERINFEC
| | - Noemi Cabello
- Centro Sandoval/Hospital Clínico San Carlos, IdISSC; CIBERINFEC
| | | | | | - Sarai Varona
- Unidad de Bioinformática, Instituto de Salud Carlos III
| | | | - Isabel Cuesta
- Unidad de Bioinformática, Instituto de Salud Carlos III
| | | | - Montse Torres
- Centro Nacional de Microbiología, Instituto de Salud Carlos III
| | | | | | - Vicente Estrada
- Centro Sandoval/Hospital Clínico San Carlos, IdISSC; CIBERINFEC.
| | - Maria Paz Sánchez-Seco
- Laboratorio de Arbovirus y Enfermedades Víricas importadas, Centro Nacional de Microbiología. Instituto de Salud Carlos III; CIBERINFEC
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Zeggagh J, Bauer R, Delaugerre C, Carette D, Fressard L, Charreau I, Chidiac C, Pialoux G, Tremblay C, Cua E, Robineau O, Raffi F, Capitant C, Spire B, Meyer L, Molina JM. Incidence and risk factors for recurrent sexually transmitted infections among men who have sex with men on HIV pre-exposure prophylaxis. AIDS 2022; 36:1129-1134. [PMID: 35142708 DOI: 10.1097/qad.0000000000003187] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE High rates of sexually transmitted infections (STIs) have been reported among PrEP users. We wished to assess the incidence and risk factors for recurrent STIs. DESIGN The ANRS IPERGAY trial was a prospective study investigating PrEP among MSM and transgender women in outpatient clinics in France and Canada. In all, 429 participants were enrolled, offered up to four years of PrEP and screened for bacterial STIs (syphilis, chlamydia, and gonorrhea) at baseline and every 6 months. METHODS STIs incidence was calculated yearly. Cox proportional hazards model regression was used to explore associations between participants characteristics at baseline and recurrent STI during follow-up. RESULTS Over a median follow-up of 23 months, bacterial STI incidence was 75, 33, 13, 32 and 30 per 100 person-years (PY) for all STIs, rectal STIs, syphilis, gonorrhoea and chlamydia, respectively. STI incidence significantly increased from the first year to the fourth year of the study (55 vs. 90 per 100 PY, p < 0.001). During the study period, 167 participants (39%) presented with more than one bacterial STIs which accounted for 86% of all STIs. Baseline risk factors associated with recurrent STIs in a multivariate analysis were an STI at baseline (HR: 1.48 (95% CI: 1.06-2.07, p = 0.02), more than 8 sexual partners in prior 2 months (HR: 1.72 (95% CI: 1.21-2.43, p = 0.002), and the use of GHB (HR: 1.66 (95% CI: 1.16-2.38, p = 0.005). CONCLUSIONS STI incidence was high and increased over time. Most STIs were concentrated in a high-risk group that should be targeted for future interventions.
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Justified Suspicion: Symptomatic Syphilitic Alopecia in a Patient with Well-Controlled HIV. Case Rep Infect Dis 2021; 2021:1124033. [PMID: 34820142 PMCID: PMC8608535 DOI: 10.1155/2021/1124033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/16/2021] [Indexed: 11/21/2022] Open
Abstract
Background An estimated 25% of primary and secondary syphilis, a sexually transmitted infection caused by the spirochete bacterium Treponema pallidum, occurs in patients coinfected with human immunodeficiency virus (HIV) (Chesson et al., 2005). This association is especially evident in men who have sex with men (MSM). In HIV-positive patients, primary syphilis infection may progress more rapidly to the tertiary, and most destructive, stage and reinfection can start with the latent or tertiary stage; in such patients, advanced syphilis may arise without clinical warning signs (Kenyan et al., 2018). It is important to note that neurosyphilis can occur during any stage of infection in all patients, regardless of immunocompetence status (CDC, 2021). Case Presentation. A 56-year-old male with a past medical history of well-controlled HIV with a CD4 count of 700 cells/mm3 and an undetectable viral load, psoriasis, and a remote episode of treated syphilis, presented with a two-week history of a diffuse desquamating rash, alopecia, sinusitis, unilateral conjunctivitis, and blurred vision. His last sexual encounter was over ten months ago. The diagnosis of syphilis was confirmed by microhemagglutination assay, and he was treated for presumed neuro-ocular infection with a two-week course of intravenous Penicillin G. Conclusion Syphilis has acquired a reputation as “the great masquerader” due to its protean manifestations. It may follow an unpredictable course, especially in HIV-positive patients, including those whose treatment has achieved undetectable serology. For example, ocular syphilis may present in an otherwise asymptomatic individual (Rein, 2020) and alopecia may arise as the sole indication of acute syphilitic infection (Doche et al., 2017). Therefore, a high index of suspicion is warranted in order to prevent severe and irreversible complications.
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