Our study found that 17.6% of all men who have sex with men visiting the sexually transmitted infection clinic of Amsterdam engage in chemsex and that in HIV-negative men who have sex with men, chemsex was a significant risk factor for a bacterial sexually transmitted infection.
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Background and Aims
Men who have sex with men (MSM) are at high risk for both drug use and sexually transmitted infections (STI). We aimed to (1) identify subgroups of drug use during sex among MSM in Amsterdam and after classifying participants and (2) compare sexual behaviour and STI across groups.
Design
Cross‐sectional study. Latent class analysis was used to identify subgroups with similar drug use patterns, between which sexual behaviour and STI prevalence were compared.
Setting
Four different studies conducted at the STI out‐patient clinic in Amsterdam, the Netherlands, between January 2014 and June 2016.
Participants
A total of 1130 self‐declared MSM, aged ≥ 18 years.
Measurements
Self‐reported drug use, laboratory‐confirmed STI, socio‐demographics, sexual behaviour (including number of partners), condom use.
Findings
Median age was 40 years [interquartile range (IQR) = 32–47]. We identified five latent classes of users, which we labelled: ‘no substance’ (n = 162), ‘alcohol’ (n = 159), ‘nitrites and erectile dysfunction drugs (EDD)’ (n = 286), ‘polydrug’ (n = 257) and ‘chems’ (n = 266). Median number of sex partners significantly differed across classes (P < 0.001), ranging from two (IQR = 1–6) in the ‘no substance’ class to 20 (IQR = 10–45) in the ‘chems’ class. The proportion of MSM reporting condomless anal sex also differed across classes (P < 0.001), ranging from 45.6% in the ‘no substance’ class to 86.5% in the ‘chems’ class. Compared with the ‘no substance’ class, the odds of STI were 3.9‐fold [95% confidence interval (CI) = 1.1–14.4] higher in the ‘alcohol’ class, 8.9‐fold (95% CI = 2.7–29.2) higher in the ‘nitrites and EDD’ class, 12.8‐fold (95% CI = 3.9–41.9) higher in the ‘polydrug’ class and 15.0‐fold (95% CI = 4.6–48.8) higher in the ‘chems’ class.
Conclusion
There are five distinct classes of drug use in a sexual context among men who have sex with men in Amsterdam, the Netherlands. Classes with higher levels of drug use appear to coincide with higher levels of sexual risk behaviour and sexually transmitted infections.
Objectives
Male and transgender women sex workers (TSWs) are vulnerable for sexually transmitted infections (STIs) and human immunodeficiency virus (HIV), and substance use might be a relevant contributing factor. We assessed sociodemographic characteristics and substance use among sex workers; divided into 3 groups: Transgender women sex workers, male sex workers who have sex with men only or also with females (MSW-M), male sex workers who have sex with females only (MSW-F).
Methods
A survey on substance use and sexual (risk) behavior was offered during routine STI screening at the Prostitution and Health Centre (P&G292) in Amsterdam. Bacterial STI positivity (chlamydia (including lymphogranuloma venereum), gonorrhea, and/or infectious syphilis), and substance use were compared (χ2 test, Fisher exact test).
Results
From 2014 until 2015, 99 (60.4%) of 164 eligible visitors participated (n = 69 MSW-M [69.7%], n = 15 TSW [15.2%], and n = 15 MSW-F [15.2%]). Transgender women sex workers reported the highest number of sex partners in the previous 6 months (median: MSW-M 60 vs. TSW 300 vs. MSW-F 12; P < 0.001). The 3 groups did not differ in having condomless anal or oral sex. Bacterial STI positivity was 29.0% in MSW-M, 26.7% in TSW, and 13.3% in MSW-F (P = 0.56). Three new HIV infections were diagnosed, all in MSW-M, whereas 20.3% of MSW-M and 20.0% of TSW were known HIV-positive compared with none of MSW-F (P = 0.14). Illicit substance use during working time in <6 months was 40.5% among MSW-M, 40.0% among TSW, and 20.0% among MSW-F (P = 0.02). The most reported reason for substance use was: “sex work becomes physically easier.”
Conclusions
Bacterial STI positivity and illicit substances use during work were high in all 3 sex worker groups, emphasizing the importance of combined and targeted interventions. In-depth qualitative research is needed to better understand intentions and reasons for substance use.
BackgroundChemsex (drug use to enhance sex) has emerged among men who have sex with men (MSM). Non-consensual sex (NCS) is hypothesised to occur frequently under the influence of chemsex, however data are scarce. In this cross-sectional study, it was aimed to assess whether NCS is associated with chemsex.MethodsWe offered a survey about chemsex in the past 6 months (crystal methamphetamine, mephedrone and/or gamma-hydroxybutyrate/gamma-butyrolacton use) and NCS (sexual experiences beyond one’s limits or unpleasant sexual experiences) in the past 5 years to Amsterdam-located gay dating platform users. Associations were assessed using χ² test, Fisher’s exact test and multivariable logistic regression.ResultsOf 891 participants, 30.6% (273 of 891) engaged in chemsex; 21.2% engaging and 16.7% not engaging in chemsex reported any NCS experiences (p=0.109).Among MSM who reported any NCS experiences, chemsex engagers reported being touched against one’s will less often compared with non-engagers (22.4% vs 39.8%; p=0.036). Yet, chemsex engagers reported passing out and not remembering what happened during drug use more often (41.4% vs 8.7%; p<0.001). The level of suffering from NCS experiences did not differ between chemsex engagers and non-engagers (p=0.539); and was rated by most participants with no suffering at all or low suffering (77.1%). In the multivariable regression analyses, chemsex engagement in the past 6 months was associated with NCS (adjusted OR 1.46; 95% CI 1.01 to 2.11).ConclusionsA substantial proportion of MSM (regardless of chemsex engagement) reported NCS in the past 5 years. In multivariate logistic regression analysis, chemsex engagement was associated with an NCS experience. Among participants who reported NCS, suffering related to NCS however, did not differ between chemsex engagers and non-engagers. Sexual healthcare professionals need to address chemsex and NCS during consultations involving MSM and refer men for specialised help if deemed necessary.
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