Exploring the role of trauma in underpinning sexualised drug use (‘chemsex’) among gay, bisexual and other men who have sex with men in Singapore

Tan, Rayner Kay Jin; Phua, Krish; Tan, Alaric; Gan, David Chong Jin; Ho, Lai Peng; Ong, Eleanor J; See, Mary Lok Man

doi:10.1016/j.drugpo.2021.103333

Cited by 24 publications

(19 citation statements)

References 59 publications

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“…However, no significant predictive association was found between post-traumatic stress and psychotic symptoms in the chemsex group. These findings could be related to the mediating role of chemsex in coping with trauma [ 17 ]. On the other hand, this review also reflects the situations of sexual abuse that can occur in chemsex sessions, especially in situations of overdose, a factor that has been related to the development of psychosis through the trauma generated [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…Several risk factors associated in the scientific literature with the development of psychotic disorders are found in the practice of chemsex: drug use [ 4 ], sexually transmitted infections [ 12 , 13 ], stressful events and circumstances [ 14 , 15 ], experiences of trauma and post-traumatic stress [ 16 , 17 , 18 , 19 ], and loneliness [ 20 ], among others. Nevertheless, the relationship between psychosis and chemsex has been poorly investigated.…”

Section: Introductionmentioning

confidence: 99%

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Chemsex and Psychosis: A Systematic Review

Moreno-Gámez

Hernández-Huerta

Lahera

2022

Behavioral Sciences

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Chemsex is presented as a major challenge in public health, with numerous physical and mental consequences. The general objective of this review was to analyze the relationship between the practice of chemsex and the development of psychosis. A mixed systematic review model was chosen. PubMed, PsycINFO, and Web of Science databases were searched following a predetermined search strategy. The studies were selected, and their information was extracted following a systematic method. A total of 10 articles were included. Psychotic symptoms ranged from 6.7% to 37.2%, being one of the most frequent psychiatric diagnoses. Slamsex, polydrug use and smoked methamphetamine posed up to a 3-fold increased risk of psychosis within this practice. The risk factors found were foreign or ethnic minority status, location in large cities, stress and anxiety, trauma, loneliness, sexually transmitted infections (STIs), hepatitis, and previous psychotic history. In conclusion, chemsex is associated with psychosis development; we found numerous converging risk factors and a clear mediating role of drugs. It is important, in approaching the prevention and treatment of this addiction, to take into account motivations and psychosocial circumstances.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Chemsex and Psychosis: A Systematic Review

Moreno-Gámez

Hernández-Huerta

Lahera

2022

Behavioral Sciences

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“…This consideration of a broader array of substances, including non‐specific drug definitions, such as “recreational” or “illicit,” is also likely to be influenced by different motivational contexts related to drug policy and/or sex between men in Asia compared to Europe. Besides “heights of pleasure” that are said to motivate engagement in chemsex , MSM in Asia also report engaging in SDU to prolong sex, cope with social and cultural marginalization and traumatic experiences, enhance body image and because of the popularity and normalization of SDU [ 106 , 116 , 117 ]. Taking account of the inclusion of broader drug types, SDU practice among MSM in East and South Asia is common and the prevalence is comparable with other regions [ 8 , 119 ].…”

Section: Discussionmentioning

confidence: 99%

Prevalence of sexualized drug use and risk of HIV among sexually active MSM in East and South Asian countries: systematic review and meta‐analysis

et al. 2023

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Introduction Sexualized drug use (SDU), the use of psychoactive drugs in the context of sexual intercourse, has been identified as a risk factor for HIV among men who have sex with men (MSM) in Asia. Given the distinct social and cultural context of same‐sex relationships and drug‐using practice in Asia, we aimed to describe the prevalence of SDU in East and South Asian countries and its associations with condomless anal sex (CAI) and HIV status. Synthesizing SDU research in this region, including SDU definitions, prevalence and outcomes, provides insights to inform future research and improved programme planning, resourcing and advocacy. Methods We systematically searched OVID Medline, OVID EMBASE, OVID Global Health, CINAHL, PsycINFO and SCOPUS publication databases for scientific articles published from 1990 to 2022 measuring SDU among MSM in East and South Asian countries. A narrative synthesis was utilized to describe key study attributes and findings, and meta‐analyses using random pooled effect models were used to estimate SDU prevalence and its associations with CAI and HIV status. Subgroup meta‐analyses, sensitivity analysis and assessment of publication bias examined potential sources of heterogeneity for the pooled SDU prevalence estimates. Results and discussion Of the 1788 publications screened, 49 publications met the selection criteria and 18 were suitable for meta‐analyses. Findings highlight SDU definitions distinct from other regions but inconsistencies in the definition of SDU between studies that have been highlighted in research elsewhere. The pooled prevalence of recent SDU (past 12 months) was 13% (95% CI = 10–16%; I 2 = 97.6) but higher when studies utilized self‐administered surveys (15%; 95% CI = 12–19%; p <0.05). SDU was associated with greater odds of CAI (pooled odds ratio [OR] = 3.21; 95% CI = 1.82–5.66) and living with diagnosed HIV (OR = 4.73; 95% CI = 2.27–8.21). Conclusions SDU is common among MSM in East and South Asian countries, but varying SDU definitions limit between‐study comparisons. Responses to SDU‐related harms should consider local contexts, including specific drug types used and their relative risks.

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“…However, the perspectives of men engaged in such practices are largely absent from this corpus and even fewer studies have included the voices of current injectors (for exceptions, see Race et al, 2021;Schroeder et al, 2022a;Slavin, 2004). This absence has meant that drug discourses are shaped primarily by individuals in recovery (Race, 2009) and mainstream public health discourses (Schroeder et al, 2022b), which typically position 'problematic' drug use as individual pathology (Bryant et al, 2018), social deprivation (valentine & Fraser, 2008), and trauma (Amaro et al, 2021;Tan et al, 2021). Although IDU is not necessarily indicative of substance use disorders, the conflation of IDU with 'problem drug use' is a common discursive practice (EMCDDA, 2022;Schlag, 2020).…”

Section: Introductionmentioning

confidence: 99%

Pre-Empting Stigma and Complicating Trauma: Narratives of Gay and Bisexual Men who Inject Drugs in Australia

et al. 2023

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Gay and bisexual men (GBM) report higher rates of sexualised and injecting drug use (IDU) than heterosexual men. Injecting-related stigma is linked to negative health outcomes among people who inject drugs (PWID). This paper describes the ways in which stigmatisation manifests in the narratives of GBM who inject drugs. We conducted in-depth interviews with Australian GBM with IDU histories, exploring drug use, pleasure, risk, and relationality. Data were analysed using discourse analytical approaches. Interviewees (n = 19), aged 24–60 years, narrated their experiences of IDU practice over 2–32 years. Most (n = 18) injected methamphetamine, and used other (non-injected) drugs, in sexual contexts. From participants’ narratives, we developed two themes related to stigmatisation of PWID that illustrate the limitations of conventional drug discourses to narrate GBM’s experiences. The first theme captures participants’ attempts to pre-empt stigmatisation, outlining the layering of stigma faced by GBM who inject drugs. Linguistically, participants transformed injecting stigma by distinguishing their personal practice from that of more discreditable drug users. Practically, they mitigated stigmatisation by keeping discrediting information from others. The second theme illustrates how by complicating the stereotypes of IDU, participants took up prominent discursive practices linking IDU with trauma and pathology. Participants exerted agency by broadening available interpretive repertoires for understanding IDU among GBM, thus creating a counter-discourse. We argue that mainstream discursive practices reverberate through gay communities, perpetuating stigmatisation of PWID and inhibiting care-seeking. More narration of unconventional experiences, beyond insular social groups and critical scholarship, is needed in public discourse to effect destigmatisation.

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Exploring the role of trauma in underpinning sexualised drug use (‘chemsex’) among gay, bisexual and other men who have sex with men in Singapore

Cited by 24 publications

References 59 publications

Chemsex and Psychosis: A Systematic Review

Chemsex and Psychosis: A Systematic Review

Prevalence of sexualized drug use and risk of HIV among sexually active MSM in East and South Asian countries: systematic review and meta‐analysis

Pre-Empting Stigma and Complicating Trauma: Narratives of Gay and Bisexual Men who Inject Drugs in Australia

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