Polydrug Use, Sexual Risk, and HIV Testing Among Cisgender Gay, Bisexual, and Other Men and Transgender and Nonbinary Individuals Who Have Sex With Men in Kazakhstan

"A way to liberate myself": A qualitative study of perceived benefits and risks of chemsex among gay, bisexual, and other men who have sex with men in Almaty, Kazakhstan

BACKGROUND

In Kazakhstan, the HIV epidemic has a significant impact on marginalized groups such as gay, bisexual and other men who have sex with men (GBMSM), exacerbated by homophobic attitudes (in society) and (resulting) minority stress. This stress often leads to coping behaviors such as chemsex - the use of synthetic stimulants to enhance sexual experiences. Our study explores the motivations and perceived risks associated with chemsex among GBMSM in Almaty.

METHODS

We conducted semi-structured in-depth interviews with 21 chemsex participants self-identified as GBMSM in Almaty, Kazakhstan. Participants were recruited through community-based organizations to ensure a diverse sample in terms of age and ethnicity. Thematic analysis was used to identify key themes related to motivations and risks.

RESULTS

Participants practiced chemsex to seek liberation from societal norms and personal inhibitions, increase sexual pleasure, and escape daily stressors. Chemsex sessions provided intensified sexual experiences, emotional comfort, and social connections, challenging constraints on sexual behavior. Participants recognized significant risks, including mental and physical health issues, social stigma, and violence victimisation. Despite these risks, the desire for the perceived benefits of chemsex, particularly feelings of freedom and happiness, underscored its appeal.

CONCLUSIONS

The study reveals a complex dynamic in which chemsex serves as a coping mechanism for minority stress, a source of sexual liberation, and a social connector for GBMSM in Kazakhstan, while also posing significant health risks. These findings emphasize the need for targeted harm reduction strategies, mental health support, and community-building efforts that are responsive to the experiences and needs of GBMSM who engage in chemsex.

Trans Health is Public Health: The Prevalence of HIV Among Trans and Gender Expansive People in Kazakhstan

Introduction

Trans and gender expansive (TGE) individuals around the world are at increased risk for contracting HIV and sexually transmitted infections (STIs), yet the combination of stigma, accessibility challenges, and a lack of trans-specific, trans-affirming interventions perpetuates rates of infection. Due to the severe paucity of data on TGE communities and HIV in Central Asia, this study describes HIV infections (both known and newly detected) and STIs among TGE in a multicity Kazakhstan study.

Methods

This study utilized behavioral and biological assay data collected in a NIDA-funded clinical trial of a behavioral HIV preventive intervention for substance using cis and trans gay and bisexual men who have sex with men (GBMSM) across three Kazakhstan cities (Almaty, Astana, and Shymkent). We specifically focus on HIV infection, as well as three other STIs (chlamydia, gonorrhea, and syphilis), among 68 TGE individuals who participated in the trial from August 2018 to March 2022.

Results

Findings reveal that while the majority (69%) of TGE participants have undergone HIV testing in their lifetime-with 32% having completed an HIV test in the prior 6 months-over a third (37%) of participants did not know their current HIV status. Fourteen (21%) of the participants were confirmed to be living with HIV, and 11 (79%) of these confirmed infections were reportedly unknown prior to testing. STI testing revealed that 47% of the TGE sample tested positive for chlamydia, gonorrhea, or syphilis, with almost 10% testing positive for more than one of these STIs.

Conclusions

Findings from this study demonstrate high rates of HIV and STIs among TGE individuals in this sample population in Kazakhstan, as well as a discrepancy between HIV status awareness and confirmed HIV diagnosis (with higher rates of confirmed HIV diagnosis). Additionally, the HIV testing rates fall short of the 90-90-90 and 95-95-95 UNAIDS targets for 2020 and 2030, respectively. These results underscore the need for additional research, interventions, and services to address HIV and other STIs and increase testing-concomitantly redressing the conditions leading to marginalization-among TGE in Kazakhstan.

Clinical Trial Number

NCT02786615.

The Experience of Chemsex and Accessing Medical Care for Gay, Bisexual and Other MSM in Russia: An Interpretive Phenomenological Analysis

The use of illicit drugs during sex (Chemsex) in gay, bisexual and men who have sex with men (GBMSM) has been a challenge for sexual health services globally. In Russia, HIV remains a significant public health concern and access to prevention and treatment services is limited. Little is known about the nature of Chemsex and the challenges GBMSM practicing Chemsex in Russia face when accessing medical care. This study explored GBMSM's experience with Chemsex and access to medical care. We conducted three focus groups with GBMSM (n = 19) based in Moscow and Yekaterinburg in December 2020. The focus groups explored their experience with Chemsex and accessing medical care. We used an Interpretative Phenomenological Analysis to analyze the data. GBMSM engaged in Chemsex through social networks and cited pleasure as one of their main reasons for engaging. The men described their addiction and perceiving many dangers at Chemsex group sessions. They reported using several self-care mechanisms to recover after a group session. Many reported feeling stigmatization from other members of the GBMSM community. Perceived barriers to medical care included legal barriers and stigmatization from medical professionals. To better support GBMSM, they felt there was a need for better access to sexual health and HIV prevention services, and psychological support. Our study highlights the unmet need in services for GBMSM engaging in Chemsex in Russia. It highlights how societal perceptions of homosexuality and drug use act as barriers to effective interventions for both sexual health and drug use.

Substance Use and Misuse among Sexual and Gender Minority Communities Living in Former Soviet Union Countries: A Scoping Review

Objectives

We reviewed literature examining substance use among sexual and gender minorities (SGM) living in the former Soviet Union (USSR) nations.

Methods

Searches were conducted across five databases (PubMed, SocINDEX, CINAHL, PscyInfo, LGBTQ + Source) to identify peer-reviewed literature.

Results

Across 19 studies, high hazardous substance use prevalence was documented. Substance use was correlated with (a) sexual health and behaviors and (b) mental wellbeing and the use of other substances.

Conclusion

We discuss minority stress implications and challenges presented by the paucity of evidence in the literature examining substance use among SGM women and SGM living in countries unrepresented in reviewed studies.

Earlier Sexual Debut and Anti-Gay Victimization Among Men Who Have Sex With Men (MSM) in Kazakhstan

Limited research has examined predictors of anti-gay victimization among men who have sex with men (MSM), despite anti-gay violence continuing to be a global problem. We conducted a secondary analysis of data from structured interviews with 600 MSM adults to examine anti-gay victimization and earlier sexual debut among MSM in Kazakhstan. Multiple linear regression was used to test for associations between earlier sexual debut-categorized as age of sexual onset between 13 and 15 years of age and prior to 13 years old, with ages 16 and older as the reference group-and recent and lifetime anti-gay victimization. Adjusted logistic regression models were used to assess earlier sexual debut and specific types of victimization. The majority of MSM reported lifetime (89%) or recent (68%) experiences of anti-gay victimization. Earlier sexual debut prior to 13 years of age was significantly associated with greater number of types of lifetime and recent reports of anti-gay victimization. Among specific types of anti-gay victimization, earlier sexual debut was associated with higher odds of experiencing verbal, physical, and sexual violence. Anti-gay violence in Kazakhstan is a significant and prevalent public health issue. Future research and clinical interventions addressing anti-gay victimization among MSM populations should consider the lifetime and current implications of consensual and non-consensual childhood and adolescent sexual experiences.

Compounding vulnerabilities: victimization and discrimination is associated with COVID-19 disruptions to HIV-related care among gay, bisexual, and other men and transgender and nonbinary people who have sex with men in Kazakhstan

Gay, bisexual, and other men and transgender and nonbinary people who have sex with men (MSM and TSM) are disproportionately impacted by the HIV epidemic in Kazakhstan. MSM and TSM in Kazakhstan also face high levels of discrimination and victimization, known barriers to engagement in HIV prevention and care. We examined data from surveys with 455 MSM and TSM collected May -- October 2020 to determine whether access to HIV testing and treatment was disproportionately limited among those exposed to victimization and discrimination during the early COVID-19 pandemic. Odds of reporting COVID-19 disruptions to HIV-related care access were significantly higher (OR: 1.96; 95% CI: 1.25-3.06; P = .003) among those who experienced recent sexual or gender-based victimization, and recent discrimination (OR: 2.93; 95% CI: 1.65-5.23; P < .001), compared to those who did not experience victimization or discrimination, respectively. Odds of reporting disruptions among those who experienced both victimization and discrimination were significantly higher (OR: 3.59; 95% CI: 1.88-6.86; P < .001) compared to those who experienced neither . Associations remained significant after adjustment for potentially confounding factors. Findings suggest the COVID-19 pandemic is compounding vulnerability among MSM and TSM in Kazakhstan - highlighting need for intervention efforts targeting the most marginalized groups.