Sexualized Drug Use (Chemsex) Is Associated with High-Risk Sexual Behaviors and Sexually Transmitted Infections in HIV-Positive Men Who Have Sex with Men: Data from the U-SEX GESIDA 9416 Study

Abstract

The magnitude of sexualized drug use (SDU), also known as chemsex, and its association with sexually transmitted infections (STI) has not been systematically explored in HIV-positive patients. This study aimed to calculate the prevalence of SDU and associated factors in a sample of HIV-positive men who have sex with men (MSM) in Spain. We calculated the frequency of SDU in a sample of HIV-positive MSM who responded to an anonymous online survey on sexual behavior and recreational drug use. We also analyzed differences between those who responded and those who did not (data taken from the physician's registry). The association between SDU, sexual risk behaviors, and STI was evaluated using a univariate and a multivariate analysis. Data were collected and managed using Research Electronic Data Capture (REDCap). The survey was completed by 742 HIV-positive MSM, of whom 60% had had unprotected anal intercourse (UAI), 62% had been diagnosed with a STI, and 216 (29.1%) reported recent SDU (slamsex in 16% of cases). In the multivariate analysis, patients who engaged in SDU were more likely to have had high-risk sexual behaviors and a diagnosis of STI than participants who did not engage in SDU. A diagnosis of hepatitis C was independently associated with slamsex (5.2 [95% confidence interval (CI), 2.06-13.13]; p < 0.001), chemsex (2.51 [95% CI, 1.28-4.91]; p = 0.007), and UAI (1.82 [95% CI, 0.90-3.70]; p = 0.094). The magnitude of SDU or chemsex in our sample is relatively high. We found a clear association between SDU, high-risk sexual behaviors, and STI including hepatitis C.

“Slam Sex” - Sexualized Injecting Drug Use (“SIDU”) Amongst Men Who Have Sex with Men (MSM)—A Scoping Review

“…Those engaging in "SIDU" may identify themselves on dating apps through ideograms such as syringes and suggestive phrases such as "to the poinT" (Bourne et al, 2014;Gogarty & Fairman, 2015;Guadamuz & Boonmongkon, 2018;Knoops et al, 2015). They may also connect with fellow 'SIDUs' through online forums and porn sites devoted to "SIDU" and may inject communally whilst online (Bakker & Knoops, 2018;Frederick, 2016;Guadamuz & Boonmongkon, 2018;Mouneteney, Po, Oteo, & Griffiths, 2016;Pirona et al, 2017;Wendel, 2011).…”

“…People with HCV were found to be more likely to report to engage in SIDU in Madrid, Spain (Gonzalez-Baeza et al, 2018) and a minority of an English and Welsh population diagnosed with Shigellosis also reported engaging in SIDU (Gilbart & Gobin, 2013). HCV infection may occur from both injection and sexual practices (Gonzalez-Baeza et al, 2018).…”

“…Many people engaging in SIDU may not consider "SIDU" risky and/or may see themselves as different when compared with other people who inject drugs (Stuart & Weymann, 2015;Frankis & Clutterbuck, 2017;Gogarty & Fairman, 2015). As a result, it may be more appropriate to have SIDU services within existing gay-specific health services (Frankis & Clutterbuck, 2017).…”

HIV Prevention Concepts—Counter Movements Challenging Societies

“…When it comes to the use of recreational drugs, also referred to as "sexualized drug use," extreme situations may develop in such venues, in particular "chemsex" or swinger settings [66] [67]. That is, using increasing rates of "recreational" party drugs up to opioids when having sex [68] [69] [70] [71]. Such cluster meetings of the vulnerable groups mentioned here have consequences: As the relative compaction of HIV-infected people both with and without cART is higher during these meetings than in situations of casual dates, these cluster arrangements provide a favorable potential for more effective spread of HIV and other STIs.…”

The Disregarded HIV Prevention Strategies—Their Potential to Uphold the Pandemic, and the Challenges Facing Societies

“…And there are developments, expected ones, and additional new trends that could be hazardous for the goal set to end the HIV pandemic in general and af-To be related to most professionally organized chemsex parties, i.e., sexualized drug use: sex and co-consuming psychoactive drugs, also named recreational drugs[58] [59][60]. Such kinds of drugs like methamphetamine (crystal meth) are welcomed to "… initiate, enhance, and prolong sexual encounters"9 [61] and to reduce inhibitions and pains when having extreme "high-risk" sex including "sexual assault"[62].2) These settings can represent highly concentrated densities of people infected with HIV and other STI, like syphilis, HCV[63] and HPV (high-risk types like HPV 16)[64].…”