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REVIEW
Contents Vol 15(2)

Thinking upstream: the roles of international health and drug policies in public health responses to chemsex

Oliver Stevens A C and Jamie I. Forrest B
+ Author Affiliations
- Author Affiliations

A 45C Northdown St, London, N1 9BL, United Kingdom.

B School of Population and Public Health, University of British Columbia, Vancouver, Canada.

C Corresponding author. Email: bolistevens@gmail.com

Sexual Health 15(2) 108-115 https://doi.org/10.1071/SH17153
Submitted: 21 August 2017  Accepted: 20 December 2017   Published: 19 March 2018

Abstract

Chemsex is a growing public health concern in urban centres, and few interventions exist to mitigate the significant sexual, drug-related, and social harms potentially experienced by people who participate in chemsex. In much of the world, these immediate harms are further compounded by the criminalisation and stigmatisation of both homosexuality and drug use, preventing participants fully engaging with treatment services or provision of health care. Gay, bisexual and other men who have sex with men participating in chemsex fall between the traditional definitions of key populations and consequently are poorly provided for by existing drug and sexual health frameworks. Aetiologically complex issues such as chemsex require multifaceted interventions that may fall outside conventional frameworks. Existing interventions have been designed and implemented at the local level. The use of international policy to mitigate these structural barriers, however, has largely been ignored. International policy is broad in nature and its implementation is, in principle, binding for member states. We believe that despite its low international prevalence, international policy can be of use in improving the lives of people who participate in chemsex. Through stimulating a much-needed debate on the interplay between sex and drugs within global health and harm reduction frameworks, this paper aims to address the paucity of substantial discussion surrounding the applicability of international language to chemsex. We analyse international policy aimed at addressing HIV, illicit drugs, harm reduction, and development, and make recommendations for both national advocacy, and advocates working to alter the positions of member states internationally.

Additional keywords: Commission on Narcotic Drugs (CND), gay men, injecting drug use, Joint United Nations Program on HIV/AIDS (UNAIDS), men who have sex with men, sexual behaviour, stimulant, Sustainable Development Goals (SDGs), UNGASS.


References

[1]  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 |

[2]  Hurley M, Prestage G. Intensive sex partying amongst gay men in Sydney. Cult Health Sex 2009; 11 597–610.
| Intensive sex partying amongst gay men in Sydney.Crossref | GoogleScholarGoogle Scholar |

[3]  Vosburgh HW, Mansergh G, Sullivan PS, Purcell DW. A review of the literature on event-level substance use and sexual risk behavior among men who have sex with men. AIDS Behav 2012; 16 1394–410.
| A review of the literature on event-level substance use and sexual risk behavior among men who have sex with men.Crossref | GoogleScholarGoogle Scholar |

[4]  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 |

[5]  Pollard A, Nadarzynski T, Llewellyn C. Syndemics of stigma, minority-stress, maladaptive coping, risk environments and littoral spaces among men who have sex with men using chemsex. Cult Health Sex 2017; 1–17.
| Syndemics of stigma, minority-stress, maladaptive coping, risk environments and littoral spaces among men who have sex with men using chemsex.Crossref | GoogleScholarGoogle Scholar |

[6]  Meyer IH. Minority stress and mental health in gay men. J Health Soc Behav 1995; 36 38–56.
| Minority stress and mental health in gay men.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2M3ls1KjsQ%3D%3D&md5=349772ea7ceea628e173518cdb263d93CAS |

[7]  Pufall E, Kall M, Shahmanesh M, Nardone A, Gilson R, Delpech V. Chemsex and high-risk sexual behaviours in HIV-positive men who have sex with men. Conference on retroviruses and opportunistic infections; February 22–25; Boston, MA. 2016. p. abstract 913.

[8]  Beyrer C, Baral SD, van Griensven F, Goodreau SM, Chariyalertsak S, Wirtz AL, Brookmeyer R. Global epidemiology of HIV infection in men who have sex with men. Lancet 2012; 380 367–77.
| Global epidemiology of HIV infection in men who have sex with men.Crossref | GoogleScholarGoogle Scholar |

[9]  Fridae, “Asia Internet MSM Sex Survey,” 2010. Available at http://www.fridae.asia/download/aimss_stats_A4.pdf

[10]  European Centre for Disease Control (ECDC). EMIS 2010: The European Men-Who-Have- Sex-With-Men Internet Survey. Stockholm: ECDC; 2013.

[11]  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 |

[12]  Daskalopoulou M, Rodger AJ, Phillips AN, Sherr L, Elford J, McDonnell J, Edwards S, Perry N, Wilkins E, Collins S, Johnson AM, Burman WJ, Speakman A, Lampe FC. Condomless sex in HIV-diagnosed men who have sex with men in the UK: prevalence, correlates, and implications for HIV transmission. Sex Transm Infect 2017; 93 590–598.
| Condomless sex in HIV-diagnosed men who have sex with men in the UK: prevalence, correlates, and implications for HIV transmission.Crossref | GoogleScholarGoogle Scholar |

[13]  Grubb IR, Beckham SW, Kazatchkine M, Thomas RM, Albers ER, Cabral M, Lange J, Vella S, Kurian M, Beyrer C. Maximizing the benefits of antiretroviral therapy for key affected populations. J Int AIDS Soc 2014; 17 19320–19328.
| Maximizing the benefits of antiretroviral therapy for key affected populations.Crossref | GoogleScholarGoogle Scholar |

[14]  Joint United Nations Program on HIV/AIDS. 90-90-90 An ambitious treatment target to help end the AIDS epidemic. Geneva: UN; 2014.

[15]  World Health Organization. The use of antiretrovial drugs for treating and preventing HIV infection. Geneva: WHO; 2016.

[16]  Joint United Nations Program on HIV/AIDS. Ending AIDS: progress towards the 90–90–90 Targets. Geneva: UN; 2017.

[17]  UK Drug Policy Commission, “Drugs and Diversity: Lesbian, gay, bisexual and transgender (LGBT) communities,” 2010.

[18]  Gupta S, Granich R. National HIV care continua for key populations: 2010 to 2016. J. Int. Assoc. Provid. AIDS Care 2017; 16 125–132.

[19]  World Health Organization. HIV prevention, diagnoses, treatment and care for key populations. Geneva: WHO; 2014.

[20]  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 |

[21]  Cook C, Bridge J, Mclean S, Phelan M, Barrett D, Fennell R, Golichenko O, Khuat O, Kriauzaite N, Madden A, Morrison E, Seiler N, Wright J, Wolfe D. The funding crisis for harm reduction: donor retreat, government neglect and the way forward. London: International Harm Reduction Association; 2014.

[22]  Cook C, Lines R, Wilson DP. A no-brainer for ending AIDS: the case for a harm reduction decade. J Int AIDS Soc 2016; 19 21129
| A no-brainer for ending AIDS: the case for a harm reduction decade.Crossref | GoogleScholarGoogle Scholar |

[23]  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 |

[24]  Stall R, Friedman M, Catania JA. Interacting epidemics and gay men’s health: a theory of syndemic production among urban gay men. In Wolitski RJ, Stall R, Valdiserri RO, editors. Unequal Opportunity: Health Disparities Affecting Gay and Bisexual Men in the United States. Oxford: Oxford University Press; 2009. pp. 251–74.

[25]  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 |

[26]  Hockenhull J, Murphy KG, Paterson S. An observed rise in γ-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 γ-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 |

[27]  Batisse A, Fortias M, Sec I, Gregoire M, Djezzar S. 1627 – A French case series of twenty synthetic cathinones abuse. Eur Psychiatry 2013; 28 1
| 1627 – A French case series of twenty synthetic cathinones abuse.Crossref | GoogleScholarGoogle Scholar |

[28]  Bourne A, Reid D, Hickson F, Torres S, Weatherburn RP. The Chemsex Study: drug use in sexual settings among gay and bisexual men in Lambeth, Southwark & Lewisham. London: Sigma Research, London School of Hygiene & Tropical Medicine; 2014.

[29]  World Health Assembly. Public health dimension of the world drug problem including in the context of the special session of the United Nations General Assembly on the world drug problem, held in April 2016. Geneva: WHO; 2016.

[30]  World Health Organization. Framework on integrated, people-centred health services. Geneva: WHO; 2016.

[31]  World Health Assembly. Public health dimension of the world drug problem. Geneva: World Health Organization; 2017.

[32]  The Global Forum on MSM & HIV. Agenda 2030 for LGBTI health and well-being. New York: The Global Forum on MSM & HIV & OutRight Action International; 2017.

[33]  United Nations. UN Entity submissions for UNGASS Preparations. Vienna: UN; 2016. Available online at: http://www.unodc.org/ungass2016/en/contribution_UN_Entities.html [verified 18 August 2017].

[34]  Pūras D. Open letter by the Special Rapporteur on the right of everyone to the highest attainable standard of mental and physical health in the context of UNGASS preparation. Vienna: UN; 2015.

[35]  United Nations Program on HIV/AIDS. Joint United Nations statement on ending discrimination in health care settings. Geneva: UN; 2017.

[36]  Knight J. Adult substance misuse statistics from the National Drug Treatment Monitoring System (NDTMS): 1 April 2015 to 1 March 2016. London: Public Health England; 2016.

[37]  European Monitoring Centre for Drugs and Drug Addiction. Drug treatment profiles; 2017. Available online at: http://www.emcdda.europa.eu/responses/treatment-overviews [verified 11 October 2017].

[38]  National Institute on Drug Abuse. TEDS National Admissions 2000 – 2010; 2017. Available online at: https://www.samhsa.gov/data/sites/default/files/2010_Treatment_Episode_Data_Set_National/2010_Treatment_Episode_Data_Set_National.html#Chp2 [verified 11 October 2017].

[39]  European Monitoring Centre for Drugs and Drug Addiction. Best practice portal: harm reduction interventions for stimulant injectors; 2017. Available online at: http://www.emcdda.europa.eu/best-practice/harm-reduction/stimulant-injectors [verified 18 August 2017].

[40]  World Health Organization. Technical Briefs on amphetamine-type stimulants (ATS). WPRO; 2015. Available online at: http://www.wpro.who.int/hiv/documents/atstechnicalbriefs/en/ [verified 18 August 2017].

[41]  European Monitoring Centre for Drugs and Drug Addiction. Health and social responses to drug problems. Lisbon: EMCDDA; 2017.

[42]  Gesellschaft für Internationale Zusammenarbeit and the International Drug Policy Consortium. New approaches on harm reduction with a look at UNGASS 2016 Conference Room Paper. 59th Session of the Commission on Narcotic Drugs; 2016.

[43]  Chomchai C, Chomchai S. Global patterns of methamphetamine use. Curr Opin Psychiatry 2015; 28 269–74.
| Global patterns of methamphetamine use.Crossref | GoogleScholarGoogle Scholar |

[44]  Galloway GP, Buscemi R, Coyle JR, Flower K, Siegrist JD, Fiske LA, Baggott MJ, Li L, Polcin D, Chen CYA, Mendelson J. A randomized, placebo-controlled trial of sustained-release dextroamphetamine for treatment of methamphetamine addiction. Clin Pharmacol Ther 2011; 89 276–82.
| A randomized, placebo-controlled trial of sustained-release dextroamphetamine for treatment of methamphetamine addiction.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3MXpsVyluw%3D%3D&md5=8c99998c51fc7060962ea9224fc69426CAS |

[45]  Courtney KE, Ray LA. Methamphetamine: an update on epidemiology, pharmacology, clinical phenomenology, and treatment literature. Drug Alcohol Depend 2014; 143 11–21.
| Methamphetamine: an update on epidemiology, pharmacology, clinical phenomenology, and treatment literature.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC2cXhsVynt7nF&md5=af0122ba1164c6348315925ebf3dba16CAS |

[46]  Brensilver M, Heinzerling KG, Shoptaw S. Drug Alcohol Rev 2013; 32 449–460.

[47]  Beddoes D, Sheikh S, Khanna M, Francis R. The impact of drugs on different minority groups: a review of the UK literature. London: The UK Drug Policy Commission (UKDPC); 2010.

[48]  Stuart D. Sexualised drug use by MSM: background, current status and response. HIV Nurs. 2013; 13 6–10.

[49]  Treloar C, Holt M. Afterword. Int J Drug Policy 2017; 49 171–2.
| Afterword.Crossref | GoogleScholarGoogle Scholar |

[50]  Pakianathan MR, Lee MJ, Kelly B, Hegazi A. How to assess gay, bisexual and other men who have sex with men for chemsex. Sex Transm Infect 2016; 92 568–70.
| How to assess gay, bisexual and other men who have sex with men for chemsex.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC28bit1amsw%3D%3D&md5=e78b9cfc517b261a4300614a2f56375cCAS |

[51]  Commission on Narcotic Drugs. Resolution 55/7: Promoting measures to prevent drug overdose, in particular opioid overdose. 9th Plenary Meeting, Vienna; 2012.

[52]  Mexican Delegation. Opening address from the Mexican delegation at UNGASS. Vienna; 2016.

[53]  UN General Assembly. UNGASS Outcome Document. New York: United Nations; 2016.

[54]  Hallam C. Striving for system-wide coherence: an analysis of the official contributions of United Nations entities for the UNGASS on drugs. London: IDPC; 2016.

[55]  Ochoa JF, Nougier M. How to capitalise on progress made in the UNGASS Outcome Document. London: International drug policy consortium; 2017.

[56]  International Drug Policy Consortium. What comes next? Post-UNGASS options for 2019/2020. London: International drug policy consortium; 2016.

[57]  UN General Assembly. Political Declaration on HIV and AIDS: on the fast-track to accelerate the fight against HIV and to end the AIDS epidemic by 2030. New York: United Nations; 2016.

[58]  UN General Assembly. Resolution 65/277. Political Declaration on HIV and AIDS. New York: United Nations; 2011.

[59]  WHO, UNODC, and UNAIDS. WHO, UNODC, UNAIDS technical guide for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users. Geneva: WHO; 2012.

[60]  United Nations Program on HIV/AIDS. Get on the fast-track. Geneva: UNAIDS; 2016.

[61]  United Nations. Sustainable Development Goals, Sustainable Development Goals – 17 Goals To Transform Our World. Geneva: United Nations; 2015. Available online at: http://www.un.org/sustainabledevelopment/sustainable-development-goals/ [verified 18 August 2017].

[62]  Mills E. ‘Leave no one behind’: gender, sexuality and the sustainable development goals. London: Institute of Development Studies; 2015.

[63]  European Commission. Civil Society Forum on Drugs (CSF). Brussels: European Commission Migration and Home Affairs; 2017. Available online at: https://ec.europa.eu/home-affairs/what-we-do/networks/civil-society-forum-drugs_en [verified 18 August 2017].

[64]  Joint United Nations Program on HIV/AIDS. UNAIDS guidance for partnerships with civil society, including people living with HIV and key populations. Geneva: UNAIDS; 2011. p. 44.

[65]  UN General Assembly. Transforming our world: the 2030 Agenda for Sustainable Development. New York: United Nations; 2015.

[66]  Government of Thailand. Voluntary National Review 2017. Bangkok: Government of Thailand; 2017.

[67]  Csete J, Kaplan K, Hayashi K, Fairbairn N, Suwannawong P, Zhang R, Wood E, Kerr T. Compulsory drug detention center experiences among a community-based sample of injection drug users in Bangkok, Thailand. BMC Int Health Hum Rights 2011; 11 12
| Compulsory drug detention center experiences among a community-based sample of injection drug users in Bangkok, Thailand.Crossref | GoogleScholarGoogle Scholar |

[68]  Fairbairn N, Hayashi K, Ti L, Kaplan K, Suwannawong P, Wood E, Kerr T. Compulsory drug detention and injection drug use cessation and relapse in Bangkok, Thailand. Drug Alcohol Rev 2015; 34 74–81.
| Compulsory drug detention and injection drug use cessation and relapse in Bangkok, Thailand.Crossref | GoogleScholarGoogle Scholar |

[69]  Kamarulzaman A, McBrayer JL. Compulsory drug detention centers in East and Southeast Asia. Int J Drug Policy 2015; 26 S33–7.
| Compulsory drug detention centers in East and Southeast Asia.Crossref | GoogleScholarGoogle Scholar |

[70]  Federal republic of Nigeria. Implementation of the SDGs A National Voluntary Review. Lagos: Federal republic of Nigeria; 2017.

[71]  United Nations. The Sustainable Development Goals Report. New York: United Nations, 2016. pp. 1–56.

[72]  UN Statistical Division. A note to the reader – SDG Indicators. New York: United Nations; 2017. Available online at: https://unstats.un.org/sdgs/report/2017/note-to-reader/ [verified 18 August 2017].

[73]  Government of Venezuela. Voluntary national review at the 2016 High-Level Political Forum on the Sustainable Development Goals: Venezuela. 2016.

[74]  Government of the Philippines. Philippines voluntary national review at the 2016 High-Level Political Forum on the Sustainable Development Goals (SDGs). 2016.

[75]  European Monitoring Centre for Drugs and Drug Addiction. High-risk drug use and new psychoactive substances. Luxembourg: Publications Office of the European Union; 2017.