Increased Risk of HIV With Chemsex Participation

By Will Boggs MD

June 05, 2018

NEW YORK (Reuters Health) - Chemsex participation is associated with increased odds of developing HIV in gay, bisexual and other men who have sex with men (GBMSM), researchers from the U.K. report.

Chemsex refers to the use of crystallized methamphetamine, mephedrone, cocaine, and other drugs to facilitate sex.

"Physicians should take note that STI (sexually transmitted infection), HIV, and other health presentations in gay and bisexual and other men who have sex with men can be a consequence of chemsex," Dr. Aseel Hegazi from St. George's University Hospital Foundation Trust, in London, told Reuters Health by email. "Skilled, culturally competent communication skills are essential to enabling honest disclosure so that the most appropriate support can be provided."

Chemsex is believed to increase the risk of HIV infection, but definitive data are lacking.

Dr. Hegazi's team investigated the association between chemsex and new HIV and STI diagnoses in their retrospective study of 1,840 GBMSM attending sexual health clinics.

Among 1,708 men with data on drug use, 27.1% reported current recreational drug use, including 18.1% who disclosed injecting drug use and 16.5% who disclosed chemsex participation.

HIV-positive men had 2.55-fold higher odds of participating in chemsex than did HIV-negative men, the researchers report in HIV Medicine, online May 22.

The rate of new HIV diagnosis was significantly higher in chemsex participants (8.6%) than in nonparticipants (1.8%), as was the incidence of acute hepatitis C (2.8% vs. 0.2%, respectively).

Compared with nonparticipants, chemsex participants had 5.06-fold higher odds of a new HIV diagnosis (P<0.001), 9.16-fold higher odds of hepatitis C (P=0.002) and 3.51-fold higher odds of any STI (P<0.001).

Chemsex participants had significantly higher odds of sexual behaviors associated with HIV and hepatitis C acquisition, including transactional sex, injection-drug use, sharing sex toys, fisting, group sex and having a known serodiscordant HIV- or hepatitis C virus-positive partner. They also had higher odds of having five or more sexual partners in the past three months and higher odds for having accessed postexposure prophylaxis (PEP).

The researchers caution that their findings may not be representative of GBMSM in the community or in other geographical areas, because most GBMSM do not attend sexual health clinics and because London differs from other areas in terms of its sexual networks and patterns of drug use.

"There needs to be more targeted public information about chemsex and its risks so that people can make better informed choices and receive harm minimization information," Dr. Hegazi said. "There is a need to ensure pre-exposure prophylaxis (PrEP) for HIV is readily available to HIV-negative men participating in chemsex. Finally, there is an urgent need to develop and evaluate interventions for those with a chemsex problem."

She added, "Harms associated with problematic chemsex extend beyond sexual health and may include overdose, drug-related deaths, mental health consequences, social and forensic consequences. There is an urgent need for further research into understanding vulnerabilities that result in chemsex becoming problematic and the full range of consequences that result."

Janey Sewell, a research nurse and PhD student at the University College London Center for Population Research in Sexual Health and HIV, who has participated in numerous studies of HIV-related behaviors, told Reuters Health by email, "This study clearly highlights the importance of asking MSM about drug use, and specifically chemsex drug use, at sexual health appointments and in a wider healthcare setting, particularly those attending sexual health clinics in London, who would benefit from PrEP or PEP, as well as other targeted HIV and STI prevention interventions."

"Incorporating nonjudgmental, understandable dialogue around drug use and specifically chemsex into a sexual history proforma is highly recommended for physicians and health care professionals so that pathways to HIV interventions such as PEP and PrEP can be recommended if necessary," said Sewell, who was not involved in the new study.

"Introducing such dialogue at every sexual health appointment could also help to identify MSM whose chemsex is becoming problematic and who would benefit from further support and HIV prevention interventions," she added.

Dr. Perry N. Halkitis, who directs the Center for Health, Identity, Behavior and Prevention Studies at Rutgers School of Public Health in Piscataway Township, New Jersey, told Reuters Health by email, "These findings suggest what I have been long advocating - healthcare for sexual minority that is all-inclusive and nonjudgmental. Providers must be more than culturally competent. They must create a safe and supportive space from judgment and heteronormative paradigms to treat their patients. In such contexts, sexual-minority men will be more open."

"For too long gay men's health has been synonymous with HIV," said Dr. Halkitis, who also was not involved in the study. "We must move beyond this narrow view recognizing, as is noted in one of our recent articles, that HIV is only part of and not the totality of gay men’s lives. Moreover, care must honor and respect gay identity, as care must be informed by a biopsychosocial and not simply biomedical approach."

Dr. Elske Hoornenborg from Amsterdam PrEP Project, Public Health Service of Amsterdam, the Netherlands, who recently reported changes in sexual risk behavior after six months of PrEP, said, "It is important to stress that chemsex users differ at many behavioral points from non-chemsex users, and these other factors are more likely to be causally related to HIV and STI acquisition."

She recommends that physicians "consider providing PrEP to those who report chemsex (and may also report other behavior related to HIV and STI acquisition) in areas with similar chemsex prevalence and associated increased risk for HIV and STI."

"Integrate chemsex counseling and referral into HIV/STI consultations - it needs attention to achieve sustainable results in the broader field of health and wellbeing of GBMSM," Dr. Hoornenborg, who also was not part of the study, told Reuters Health by email.


HIV Medicine 2018.