Drug-related and psychopathological symptoms in HIV-positive men who have sex with men who inject drugs during sex (slamsex): Data from the U-SEX GESIDA 9416 Study

Abstract

ObjectivesSexualized intravenous drug use, also known as slamsex, seems to be increasing among HIV-positive men who have sex with men (MSM). Physical and psychopathological symptoms have previously been reported in this population, although research on the subject of slamsex is scarce. The objectives of our study were to describe the psychopathological background of a sample of HIV-positive MSM who engaged in slamsex during the previous year and to compare physical, psychopathological, and drug-related symptoms between these participants and those who engaged in non-injecting sexualized drug use.Design and methodsParticipants (HIV-positive MSM) were recruited from the U-Sex study in 22 HIV clinics in Madrid during 2016–17. All participants completed an anonymous cross-sectional online survey on sexual behavior and recreational drug use. When participants met the inclusion criteria, physicians offered them the opportunity to participate and gave them a card with a unique code and a link to access the online survey. The present analysis is based on HIV-positive MSM who had engaged in slamsex and non-injecting sexualized drug use.ResultsThe survey sample comprised 742 participants. Of all the participants who completed the survey, 216 (29.1%) had engaged in chemsex, and of these, 34 (15.7%) had engaged in slamsex. Participants who engaged in slamsex were more likely to have current psychopathology (depression, anxiety, and drug-related disorders) than participants who engaged in non-injecting sexualized drug use. In addition, participants who engaged in slamsex more frequently reported high-risk sexual behaviors and polydrug use and were more often diagnosed with sexually transmitted infections (STIs) and hepatitis C than those who did not inject drugs. Compared with participants who did not inject drugs, participants who engaged in slamsex experienced more severe drug-related symptoms (withdrawal and dependence), symptoms of severe intoxication (loss of consciousness), and severe psychopathological symptoms during or after slamsex (eg, paranoid thoughts and suicidal behaviors).ConclusionSlamsex is closely associated with current psychiatric disorders and severe drug-related and psychiatric symptoms.

Chemsex Practices and Health-Related Quality of Life in Spanish Men with HIV Who Have Sex with Men

“…The Antiretrovirals, Sexual Transmission Risk and Attitudes (ASTRA) study, which recruited HIV participants aged 18 years or older from eight HIV outpatient clinics, reported a 51% prevalence of Chemsex practices in a sample of 2248 patients [ 47 ]. A Spanish study from Madrid in HIV-positive people reported that 29.1% of the sample were Chemsex practitioners [ 48 ]. These results show a high prevalence of sexualized drug use in HIV-infected MSM, even higher than in HIV-negative people [ 17 ].…”

Slam Practice: A Review of the Literature

“…Other studies focused on more specific subpopulations: MSM attending addiction management services [44,61], MSM drug users [10,31,32,44,61], MSM admitted to HIV care units [33,34,38,41,[45][46][47][48], MSM consulting in sexual health clinics [2,35,37,41,42,46,47], MSM infected with HCV [33,37], MSM infected with Shigella [17,19]; MSM being reported to national surveillance systems [36,39,40], MSM attending gay venues (bar, sauna, and backroom) [49], and MSM using gay social networks [29,30,46,47].…”

“…Regarding other sexually active subjects (excluding MSM), the prevalence was of 8% among heterosexual men, 14% among WSW, and 7% among heterosexual women [43] (Table 1). Reference periods assessed included current [29, 33, 35-37, 39, 40, 44, 45, 50, 61], current and past [2,31,34,46], the last month [41], the last 3 months [38,42], the last 6 months [10,30,32], the last 12 months [43,[47][48][49], the 2 weeks preceding a Shigella infection [19], and time span of the practice in subjects' lives [17].…”

“…The type of psychostimulant substances used was noted in only 11 studies, and they were mainly methamphetamine [2,10,32,33,38,45,47,48] and mephedrone [36,43,45,48,49]. Polydrug use was found in three-fifths to four-fifths of users [36,48]. The risk of injecting mephedrone and ketamine among MSM and WSW was 2-10 times higher than among heterosexual men and women [43].…”

“…Regarding the origin of injection equipment, almost one-third came from community associations, one-third from sex- ual partners, and the last third from needle exchange programmes [32]. Compared with participants who had engaged in non-injecting sexualized drug use, those who engaged in slam were 5 times more likely to have experienced withdrawal symptoms, 7 times more likely to have experienced intense craving [48], and more than half injected more than once per hour during a typical slamming session [49].…”