Low levels of chemsex among men who have sex with men, but high levels of risk among men who engage in chemsex: analysis of a cross-sectional online survey across four countries
Jamie Frankis A D , Paul Flowers A , Lisa McDaid B and Adam Bourne CA School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, G4 0BA, UK.
B MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, G12 8QQ, UK.
C Australian Research Centre in Sex, Health & Society, La Trobe University, Melbourne, Vic. 3086, Australia.
D Corresponding author. Email: J.Frankis@gcu.ac.uk
Sexual Health 15(2) 144-150 https://doi.org/10.1071/SH17159
Submitted: 22 August 2017 Accepted: 8 December 2017 Published: 29 March 2018
Abstract
Background: This paper establishes the prevalence of chemsex drug use among men who have sex with men (MSM), the extent to which these drugs are used in a sexual context, as well as their associated behaviours and circumstances of use. Methods: Data from a cross-sectional, online survey of 2328 MSM recruited via gay sociosexual media in Scotland, Wales, Northern Ireland and the Republic of Ireland were analysed. Results: While almost half (48.8%) of participants had ever taken illicit drugs, lifetime chemsex drug use was less common (18.0%) and far fewer reported chemsex drug use in the last year (8.2%) or last 4 weeks (3.0%). Just over one-quarter (27.1%) of men who used chemsex drugs in the last year reported no sexualised drug use, but almost three-quarters (72.9%) did. Only 6.1% of the whole sample reported sexualised chemsex drug use in the last year. The odds of reporting chemsex in the last year were significantly higher for men aged 36–45 years (AOR = 1.96), single men (AOR = 1.83), men who were HIV positive (AOR = 4.01), men who report high-risk sex (AOR = 4.46), being fisted (AOR = 7.77) or had sex in exchange for goods other than money (AOR = 4.7) in the last year and men who reported an HIV test in the last 3 months (AOR = 1.53). Discussion: Only a small proportion of MSM in Scotland, Wales, Northern Ireland and the Republic of Ireland reported chemsex, and, for the first time, it is demonstrated that not all chemsex drug use was sexualised. Nevertheless, MSM who engage in chemsex (MWEC) reported substantial sexual risk inequalities. These novel findings highlight several opportunities for intervention, particularly around the multiple vulnerabilities of MWEC, opportunities for early identification of those most vulnerable to chemsex-related harm and the potential to develop a specialised responsive patient pathway.
Additional keywords: MSM, recreational drug use, sexual risk taking, sexualised drug use.
References
[1] Stuart D. Sexualised drug use by MSM: background, current status and response. HIV Nursing 2013; 13 6–10.[2] Kirby T, Thornber-Dunwell M. High-risk drug practices tighten grip on London gay scene. Lancet 2013; 381 101–2.
| High-risk drug practices tighten grip on London gay scene.Crossref | GoogleScholarGoogle Scholar |
[3] Bourne A, Reid D, Hickson F, Torres-Rueda S, Steinberg P, Weatherburn P. “Chemsex” and harm reduction need among gay men in South London. Int J Drug Policy 2015; 26 1171–6.
| “Chemsex” and harm reduction need among gay men in South London.Crossref | GoogleScholarGoogle Scholar |
[4] Hockenhull J, Murphy KG, Paterson S. An observed rise in gamma-hydroxybutyrate-associated deaths in London: evidence to suggest a possible link with concomitant rise in chemsex. Forensic Sci Int 2017; 270 93–7.
| An observed rise in gamma-hydroxybutyrate-associated deaths in London: evidence to suggest a possible link with concomitant rise in chemsex.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC28XhvF2mtLrN&md5=2faf6999895a34cbda5b8795659cc2d6CAS |
[5] Sewell J, Miltz A, Lampe FC, Cambiano V, Speakman A, Phillips AN, Stuart D, Gilson R, Asboe D, Nwokolo N, Clarke A, Collins S, Hart G, Elford J, Rodger AJ, Attitudes to and Understanding of Risk of Acquisition of HIV (AURAH) Study Group Poly drug use, chemsex drug use, and associations with sexual risk behaviour in HIV-negative men who have sex with men attending sexual health clinics. Int J Drug Policy 2017; 43 33–43.
| Poly drug use, chemsex drug use, and associations with sexual risk behaviour in HIV-negative men who have sex with men attending sexual health clinics.Crossref | GoogleScholarGoogle Scholar |
[6] Ottaway Z, Finnerty F, Amlani A, Pinto-Sander N, Szanyi J, Richardson D. Men who have sex with men diagnosed with a sexually transmitted infection are significantly more likely to engage in sexualised drug use. Int J STD AIDS 2017; 28 91–3.
| Men who have sex with men diagnosed with a sexually transmitted infection are significantly more likely to engage in sexualised drug use.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC2sXhsVOgt73E&md5=eca8c8dc680edd3ed8559a567a6114acCAS |
[7] Bourne A, Reid D, Hickson F, Torres-Rueda S, Weatherburn P. Illicit drug use in sexual settings (“chemsex”) and HIV/STI transmission risk behaviour among gay men in South London: findings from a qualitative study. Sex Transm Infect 2015; 91 564–8.
| Illicit drug use in sexual settings (“chemsex”) and HIV/STI transmission risk behaviour among gay men in South London: findings from a qualitative study.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC28%2FitlWgtA%3D%3D&md5=e3b0e09b147c5d8fbad362b4be4a0facCAS |
[8] Bolding G, Hart G, Sherr L, Elford J. Use of crystal methamphetamine among gay men in London. Addiction 2006; 101 1622–30.
| Use of crystal methamphetamine among gay men in London.Crossref | GoogleScholarGoogle Scholar |
[9] Melendez-Torres GJ, Hickson F, Reid D, Weatherburn P, Bonell C. Findings from within-subjects comparisons of drug use and sexual risk behaviour in men who have sex with men in England. Int J STD AIDS 2017; 28 250–8.
| Findings from within-subjects comparisons of drug use and sexual risk behaviour in men who have sex with men in England.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC28fjs1Cltg%3D%3D&md5=fb5e2f9e1670f46fa35f1551f8e61facCAS |
[10] Prestage G, Fogarty AS, Rawstorne P, Grierson J, Zablotska I, Grulich A, Kippax SC. Use of illicit drugs among gay men living with HIV in Sydney. AIDS 2007; 21 S49–55.
| Use of illicit drugs among gay men living with HIV in Sydney.Crossref | GoogleScholarGoogle Scholar |
[11] Melendez-Torres GJ, Bourne A. Illicit drug use and its association with sexual risk behaviour among MSM: more questions than answers? Curr Opin Infect Dis 2016; 29 58–63.
| Illicit drug use and its association with sexual risk behaviour among MSM: more questions than answers?Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC28rktVKitw%3D%3D&md5=5627e45883aee19f26d1cca1528a0712CAS |
[12] Hickson F, Reid D, Hammond G, Weatherburn P. State of play: findings from the England Gay Men’s Sex Survey 2014. London: Sigma Research @ LSHTM: 2016.
[13] Schmidt AJ, Bourne A, Weatherburn P, Reid D, Marcus U, Hickson F. Illicit drug use among gay and bisexual men in 44 cities: findings from the European MSM Internet Survey (EMIS). Int J Drug Policy 2016; 38 4–12.
| Illicit drug use among gay and bisexual men in 44 cities: findings from the European MSM Internet Survey (EMIS).Crossref | GoogleScholarGoogle Scholar |
[14] Garin N, Zurita B, Velasco C, Feliu A, Gutierrez M, Masip M, Mangues A. Prevalence and clinical impact of recreational drug consumption in people living with HIV on treatment: a cross-sectional study. BMJ Open 2017; 7 e014105
| Prevalence and clinical impact of recreational drug consumption in people living with HIV on treatment: a cross-sectional study.Crossref | GoogleScholarGoogle Scholar |
[15] Strudwick P. Inside the dark dangerous world of chemsex [Internet]. Buzzfeed. 2016. Available online at: https://www.buzzfeed.com/patrickstrudwick/inside-the-dark-dangerous-world-of-chemsex?utm_term=.qsDKq7vVP#.ht77dvonW [verified 23 January 2018].
[16] Wilson C. What is chemsex and why is the UK government worried about it? [Internet] New Scientist. London: New Scientist; 2017. Available online at: https://www.newscientist.com/article/2140756-what-is-chemsex-and-why-is-the-uk-government-worried-about-it/ [verified 23 January 2018].
[17] Scrivener J, McGowan A, Stuart D. Recreational drug use amongst GUM attendees—Implications for service delivery. BASHH Spring Meeting, 15–17 May 2013; Bristol, UK 2013. Poster Presentation Abstr. P109 International Journal of STD & AIDS 2013; 24 (suppl. 1): 37–38.
[18] Daskalopoulou M, Rodger A, Phillips AN. Recreational drug use, polydrug use, and sexual behaviour in HIV-diagnosed men who have sex with men in the UK: results from the cross-sectional ASTRA study. Lancet HIV 2014; 1 e22–31.
| Recreational drug use, polydrug use, and sexual behaviour in HIV-diagnosed men who have sex with men in the UK: results from the cross-sectional ASTRA study.Crossref | GoogleScholarGoogle Scholar |
[19] Hegazi A, Lee MJ, Whittaker W, Green S, Simms R, Cutts R, Nagington M, Nathan B, Pakianathan MR. Chemsex and the city: sexualised substance use in gay bisexual and other men who have sex with men attending sexual health clinics. Int J STD AIDS 2017; 28 362–6.
| Chemsex and the city: sexualised substance use in gay bisexual and other men who have sex with men attending sexual health clinics.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC28bpt1yntw%3D%3D&md5=07ed5b11243d7184b344c3d86c169424CAS |
[20] McDaid LM, Aghaizu A, Frankis J, Riddell J, Nardone A, Mercey D, Johnson AM, Hart GJ, Flowers P. Frequency of HIV testing among gay and bisexual men in the UK: implications for HIV prevention. HIV Med 2016; 17 683–93.
| Frequency of HIV testing among gay and bisexual men in the UK: implications for HIV prevention.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC28fhsVCjsg%3D%3D&md5=30497f964000e11bd533ae0130f913c5CAS |
[21] Frankis J, Young I, Flowers P, McDaid L. Who will use pre-exposure prophylaxis (PrEP) and why?: understanding PrEP awareness and acceptability amongst men who have sex with men in the UK – a mixed methods study. PLoS One 2016; 11 e0151385
| Who will use pre-exposure prophylaxis (PrEP) and why?: understanding PrEP awareness and acceptability amongst men who have sex with men in the UK – a mixed methods study.Crossref | GoogleScholarGoogle Scholar |
[22] Bourne A, Weatherburn P. Substance use among men who have sex with men: patterns, motivations, impacts and intervention development need. Sex Transm Infect 2017; 93 342–6.
| Substance use among men who have sex with men: patterns, motivations, impacts and intervention development need.Crossref | GoogleScholarGoogle Scholar |
[23] Prah P, Hickson F, Bonell C, McDaid LM, Johnson AM, Wayal S, Clifton S, Sonnenberg P, Nardone A, Erens B, Copas AJ, Riddell J, Weatherburn P, Mercer CH. Men who have sex with men in Great Britain: comparing methods and estimates from probability and convenience sample surveys. Sex Transm Infect 2016; 92 455–63.
| Men who have sex with men in Great Britain: comparing methods and estimates from probability and convenience sample surveys.Crossref | GoogleScholarGoogle Scholar |
[24] Weatherburn P, Hickson F, Reid D, Torres-Rueda S, Bourne A. Motivations and values associated with combining sex and illicit drugs (‘chemsex’) among gay men in South London: findings from a qualitative study. Sex Transm Infect 2017; 93 203–6.
| Motivations and values associated with combining sex and illicit drugs (‘chemsex’) among gay men in South London: findings from a qualitative study.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC2szgtlyrtA%3D%3D&md5=0fb5dca6d581719792c5a488f34536edCAS |
[25] Singer M, Bulled N, Ostrach B, Mendenhall E. Syndemics and the biosocial conception of health. Lancet 2017; 389 941–50.
| Syndemics and the biosocial conception of health.Crossref | GoogleScholarGoogle Scholar |
