Increase in recreational drug use between 2008 and 2018: results from a prospective cohort study among HIV‐negative men who have sex with men

Abstract

Aims To test whether recreational drug use (RDU) and sexualized drug use (SDU) changed in the Amsterdam area between 2008 and 2018 and quantify associations of SDU with condomless anal sex (CAS), recent human immunodeficiency virus (HIV) or sexually transmitted infections (STI) among human immunodeficiency virus (HIV)‐negative men who have sex with men (MSM). Design Open prospective cohort study. Setting Public Health Service of Amsterdam, the Netherlands. Participants A total of 976 HIV‐negative MSM, aged ≥ 18 years. Measurements Self‐reported RDU and sexual behaviour in the past 6 months. Laboratory‐confirmed HIV and STI (chlamydia, gonorrhoea and syphilis). We studied: any RDU; any SDU (i.e. any RDU during sex); specific SDU (i.e. use of mephedrone, methamphetamine, gamma‐hydroxybutyric acid/gamma‐butyrolactone, ketamine, amphetamine, cocaine and/or ecstasy during sex); use of individual drugs; and use of individual drugs during sex. We evaluated changes over calendar years in the proportion of individuals with these end‐points [using logistic regression with generalized estimating equations (GEE)] and number of drugs (using negative binomial regression with GEE), adjusted for current age, country of birth and education level. Findings Median age of participants in 2008 was 33.2 years (interquartile range = 27.8–40.1); 83.1% were born in the Netherlands. The proportion of any RDU increased from 67.2% in 2008 to 69.5% in 2018 [adjusted odds ratio (aOR) = 1.25; 95% confidence interval (CI) = 1.03–1.51]. Any SDU increased from 53.8% in 2008 to 59.8% in 2013 (aOR = 1.23; 95% CI = 1.07–1.42) and remained stable afterwards. Specific SDU increased from 25.0% in 2008 to 36.1% in 2018 (aOR = 2.10; 95% CI = 1.71–2.58). The average number of drugs used increased for those reporting any RDU, any SDU and specific SDU (all P < 0.05. Among those engaging in sex, any SDU was associated with CAS (aOR = 1.36; 95% CI = 1.19–1.55), HIV (aOR = 5.86; 95% CI = 2.39–14.4) and STI (aOR = 2.31; 95% CI = 1.95–2.73). Specific SDU was associated with CAS (aOR = 1.58; 95% CI = 1.37–1.81), HIV (aOR = 6.30; 95% CI = 3.28–12.1) and STI (aOR = 2.15; 95% CI = 1.81–2.55). Conclusions Among human immunodeficiency virus (HIV)‐negative men who have sex with men in Amsterdam, recreational drug use, including sexualized drug use, increased between 2008 and 2018. Sexualized drug use was strongly associated with condomless anal sex, HIV and sexually transmitted infections.

Running with Scissors: a Systematic Review of Substance Use and the Pre-exposure Prophylaxis Care Continuum Among Sexual Minority Men

“…In the same study, chemsex drug use was associated with the greatest elevations in multiple indicators of HIV risk [ 2 ]. Although some evidence showed the declining use of mephedrone and GHB in the UK [ 7 ], SDU and chemsex drug use increased in a cohort of SMM in Amsterdam, Netherlands, from 2008 to 2018 [ 8 ]. Other recent findings from this Dutch cohort demonstrated that SMM classified as engaging in chemsex drug use had 15-fold greater odds of a sexually transmitted infection (STI) relative to those reporting no substance use [ 9 ].…”

Comparison of Polydrug Use Prevalences and Typologies between Men Who Have Sex with Men and General Population Men, in Madrid and Barcelona

“…That said, while a very important factor, sex is only one of the reasons for using drugs, there are many others, and—with the exception of alkyl nitrites and the four chem drugs—psychoactive drugs are probably used more frequently by most MSM for purposes other than sex. In addition, some recent articles suggest that drug use, both for sex and recreational purposes, is increasing, in both HIV-positive [ 15 ] and HIV-negative MSM [ 16 ].…”

Trends in Sexual Behavior and Sexually Transmitted Infections After Initiating Human Immunodeficiency Virus Pre-Exposure Prophylaxis in Men Who Have Sex with Men from Amsterdam, the Netherlands: A Longitudinal Exposure-Matched Study

“…13 Moreover, a previous analysis within our cohort showed strong associations between specific SDU and CAS, HIV, and STI. 12 This suggests that MSM with these characteristics could be specifically targeted for sexual behavior counseling that targets the prevention and management of STI, including counseling on sexual behavior in the context of SDU.…”

“…Specific SDU was defined as the use of mephedrone, methamphetamine, gamma hydroxybutyrate (GHB)/gamma butyrolactone (GBL), ketamine, amphetamine, cocaine, and/or ecstasy (XTC)/methylenedioxy-methylamphetamine (MDMA) during sex. 12 Any STI was defined as having a newly diagnosed chlamydia, gonorrhea, or syphilis, whereas any anal STI was defined as having a newly diagnosed anal chlamydia or anal gonorrhea.…”