Do pre-exposure prophylaxis (PrEP) users engaging in chemsex experience their participation as problematic and how can they best be supported? Findings from an online survey in Belgium
T. Vanbaelen
A B * , A. Rotsaert B , E. Van Landeghem B , C. Nöstlinger B , B. Vuylsteke B , T. Platteau A , C. Herrijgers A and T. Reyniers B
A Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, Antwerp 2000, Belgium.
B Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, Antwerp 2000, Belgium.
Abstract
Chemsex involves the use of psychoactive drugs in a sexual context and is a growing phenomenon among men who have sex with men (MSM) and pre-exposure prophylaxis (PrEP) users. Investigating how its negative consequences can be avoided is important. The objective of this study was to explore the perceived impact of chemsex, the willingness to reduce chemsex activities and associated risks and preferred interventions to do so among PrEP users.
We analysed data from an online survey among PrEP users in Belgium. Chemsex was assessed in two questionnaires distributed between September 2020 and January 2022.
A total of 326 participants completed the baseline questionnaire, and 186 the follow-up questionnaire. About one in three participants (36.5%, 119/326) reported engaging in chemsex, and half of those (49.6%, 59/119) were willing to reduce chemsex-related risks. The most preferred strategies for reducing risks were online support via an app (37.3%, 22/59) and face-to-face counselling with a health care professional (30.5%, 18/59). Among those reporting recent chemsex in the follow-up questionnaire, about one in five (21.9%, 14/64) wanted to reduce or stop chemsex activities. About 23.4% (15/64) also reported experiencing negative consequences of chemsex on their health, social or professional life.
Our findings show that one in four PrEP users engaging in chemsex experienced negative consequences of these activities and about one in five was willing to reduce or stop chemsex activities. We recommend embedding comprehensive chemsex support in the PrEP package of care and developing novel tools and interventions in order to reach maximum impact.
Keywords: chemsex, harm reduction, HIV, mental health, MSM, pre-exposure prophylaxis, substance use, support.
References
1 Compton WM, Jones CM. Substance use among men who have sex with men. N Engl J Med 2021; 385(4): 352-6 PMID:.
| Crossref | Google Scholar | PubMed |
2 Tomkins A, George R, Kliner M. Sexualised drug taking among men who have sex with men: a systematic review. Perspect Public Health 2019; 139(1): 23-33 PMID:.
| Crossref | Google Scholar | PubMed |
3 Maxwell S, Shahmanesh M, Gafos M. Chemsex behaviours among men who have sex with men: A systematic review of the literature. Int J Drug Policy 2019; 63: 74-89 PMID:.
| Crossref | Google Scholar | PubMed |
5 Evers YJ, Hoebe CJPA, Dukers-Muijrers NHTM, Kampman CJG, Kuizenga-Wessel S, Shilue D, et al. Sexual, addiction and mental health care needs among men who have sex with men practicing chemsex – a cross-sectional study in the Netherlands. Prev Med Rep 2020; 18: 101074.
| Crossref | Google Scholar |
6 Strong C, Huang P, Li C-W, Ku SW-W, Wu H-J, Bourne A. HIV, chemsex, and the need for harm-reduction interventions to support gay, bisexual, and other men who have sex with men. Lancet HIV 2022; 9: e717-25 PMID:.
| Crossref | Google Scholar | PubMed |
7 De La Mora L, Ugarte A, Martínez-Rebollar M, de Lazzari E, García-Hernández D, Font G, et al. Chemsex practices in PrEP: beyond addiction and risk toward a healthy sex life—baseline experiences from a hospital-based PrEP program in Barcelona, Spain. AIDS Behav 2022; 26: 4055-62 PMID:.
| Crossref | Google Scholar | PubMed |
8 Rotsaert A, Reyniers T, Jacobs BKM, Vanbaelen T, Burm C, Kenyon C, et al. PrEP user profiles, dynamics of PrEP use and follow-up: a cohort analysis at a Belgian HIV centre (2017-2020). J Int AIDS Soc 2022; 25(7): e25953.
| Crossref | Google Scholar |
9 McCall H, Adams N, Mason D, Willis J. What is chemsex and why does it matter? BMJ 2015; 351: h5790.
| Crossref | Google Scholar |
10 Hibbert MP, Germain JS, Brett CE, Van Hout M-C, Hope VD, Porcellato LA. Service provision and barriers to care for men who have sex with men engaging in chemsex and sexualised drug use in England. Int J Drug Policy 2021; 92: 103090.
| Crossref | Google Scholar |
11 Glynn RW, Byrne N, O’Dea S, Shanley A, Codd M, Keenan E, et al. Chemsex, risk behaviours and sexually transmitted infections among men who have sex with men in Dublin, Ireland. Int J Drug Policy 2018; 52: 9-15 PMID:.
| Crossref | Google Scholar | PubMed |
12 Kenyon C, Wouters K, Platteau T, Buyze J, Florence E. Increases in condomless chemsex associated with HIV acquisition in MSM but not heterosexuals attending a HIV testing center in Antwerp, Belgium. AIDS Res Ther 2018; 15(1): 14.
| Crossref | Google Scholar |
13 Drückler S, van Rooijen MS, de Vries HJC. Chemsex among men who have sex with men: a sexualized drug use survey among clients of the sexually transmitted infection outpatient clinic and users of a gay dating app in Amsterdam, the Netherlands. Sex Transm Dis 2018; 45(5): 325-31 PMID:.
| Crossref | Google Scholar | PubMed |
14 Íncera-Fernández D, Gámez-Guadix M, Moreno-Guillén S. Mental health symptoms associated with sexualized drug use (Chemsex) among men who have sex with men: a systematic review. Int J Environ Res Public Health 2021; 18(24): 13299.
| Crossref | Google Scholar |
15 Bohn A, Sander D, Köhler T, Hees N, Oswald F, Scherbaum N, et al. Chemsex and mental health of men who have sex with men in Germany. Front Psychiatry 2020; 11: 542301.
| Crossref | Google Scholar |
16 Nöstlinger C, Reyniers T, Smekens T, Apers H, Laga M, Wouters K, et al. Drug use, depression and sexual risk behaviour: a syndemic among early pre-exposure prophylaxis (PrEP) adopters in Belgium? AIDS Care 2020; 32(sup2): 57-64 PMID:.
| Crossref | Google Scholar | PubMed |
17 Rotsaert A, Reyniers T, Vanhamel J, Van Landeghem E, Vanbaelen T, Van Mieghem H, et al. Putting 2-1-1 into practice: PrEP users’ knowledge of effectively starting and stopping oral PrEP use. AIDS Behav 2023; 27: 1793-9 PMID:.
| Crossref | Google Scholar | PubMed |
18 Dennermalm N, Scarlett J, Thomsen S, Persson KI, Alvesson HM. Sex, drugs and techno – a qualitative study on finding the balance between risk, safety and pleasure among men who have sex with men engaging in recreational and sexualised drug use. BMC Public Health 2021; 21(1): 863.
| Crossref | Google Scholar |
19 Steinhubl SR, Muse ED, Topol EJ. The emerging field of mobile health. Sci Transl Med 2015; HHS Public Access. 7(283): 283rv3.
| Crossref | Google Scholar |
20 Fiordelli M, Diviani N, Schulz PJ. Mapping mHealth research: a decade of evolution. J Med Int Res 2013; 15(5): e95.
| Crossref | Google Scholar |
21 World Health Organization. Consolidated guidelines on HIV, viral hepatitis and STI prevention, diagnosis, treatment and care for key populations: web annex C: systematic review findings and GRADE tables. 2022; Geneva World Health Organization.
| Google Scholar |
22 Platteau T, Herrijgers C, de Wit J. Digital chemsex support and care: the potential of just-in-time adaptive interventions. Int J Drug Policy 2020; 85: 102927.
| Crossref | Google Scholar |
23 Herrijgers C, Platteau T, Vandebosch H, Poels K, Florence E. Using intervention mapping to develop an mHealth intervention to support men who have sex with men engaging in chemsex (Budd): development and usability study. JMIR Res Protoc 2022; 11(12): e39678 PMID:.
| Crossref | Google Scholar | PubMed |
24 Demant D, Carroll JA, Saliba B, Bourne A. Information-seeking behaviours in Australian sexual minority men engaged in chemsex. Addict Behav Rep 2021; 16: 100399.
| Google Scholar |
25 Stardust Z, Kolstee J, Joksic S, Gray J, Hannan S, Stardust Z, et al. A community-led, harm-reduction approach to chemsex: case study from Australia’s largest gay city. Sex Health 2018; 15(2): 179-81 PMID:.
| Crossref | Google Scholar | PubMed |
26 Herrijgers C, Poels K, Vandebosch H, Platteau T, van Lankveld J, Florence E. Harm reduction practices and needs in a belgian chemsex context: findings from a qualitative study. Int J Environ Res Public Health 2020; 17(23): 9081.
| Crossref | Google Scholar |
27 Bakker I, Knoops L. Towards a continuum of care concerning chemsex issues. Sex Health 2018; 15(2): 173-5 PMID:.
| Crossref | Google Scholar | PubMed |
28 Reyniers T, Rotsaert A, Thunissen E, Buffel V, Masquillier C, Van Landeghem E, et al. Reduced sexual contacts with non-steady partners and less PrEP use among MSM in Belgium during the first weeks of the COVID-19 lockdown: results of an online survey. Sex Transm Infect 2021; 97: 414-9 PMID:.
| Crossref | Google Scholar | PubMed |
