Consumo sexualizado de drogas entre hombres que tienen sexo con hombres residentes en España

Autores/as

  • Juan-Miguel Guerras Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid.
  • Juan Hoyos Universidad Complutense de Madrid.
  • Cristina Agustí Agència de Salut Pública de Catalunya (ASPCAT), Badalona.
  • Jordi Casabona Agència de Salut Pública de Catalunya (ASPCAT), Badalona.
  • Luis Sordo Universidad Complutense de Madrid.
  • José Pulido Universidad Complutense de Madrid.
  • Luis de la Fuente Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid.
  • María-José Belza Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid.
  • Grupo de Trabajo Euro HIV EDAT

DOI:

https://doi.org/10.20882/adicciones.1371

Palabras clave:

Hombres que tienen sexo con hombres, chemsex, consumo de drogas, VIH, ITS.

Resumen

Analizar los patrones de consumo sexualizado de drogas (CSD) e identificar cual es el de mayor riesgo para la adquisición/transmisión del VIH y de otras infecciones de transmisión sexual (ITS) en una muestra de hombres que tienen sexo con hombres (HSH) residentes en España. Adicionalmente, también se identifican las subpoblaciones más afectadas por el patrón de CSD de mayor riesgo. En 2016, se realizó una encuesta online en app de contacto gay. Se identificaron los patrones de CSD y se estimaron las prevalencias de varios indicadores de riesgo para el VIH/ITS para cada uno.  Se construyeron dos modelos multivariantes de Poisson identificando factores asociados al patrón de mayor riesgo. Todos los análisis se realizaron en función del estado serológico frente al VIH. De 2883 HSH, el 21,9% refirió CSD en los últimos 12 meses. Todos los patrones de CSD fueron más frecuentes en los VIH+. De los cuatro patrones identificados (chemsex, drogas recreacionales, drogas para mejorar el rendimiento sexual y cannabinoides) el más prevalente y de mayor riesgo, fue el chemsex (21,9% en VIH+ vs. 6,6% en VIH-). En los VIH- el chemsex se asoció con: ciudad de residencia > 1 000 000 habitantes, vivir la sexualidad abiertamente, haber cobrado por tener sexo, haber mantenido relaciones anales desprotegidas (RAD) en el último año y haber sido diagnosticado de una ITS. En los VIH+ se asoció con: tener 30-49 años, haber pagado por tener relaciones sexuales, haber tenido RAD y haber sido diagnosticado de ITS en el último año. Dada su elevada prevalencia especialmente en VIH+ y a que se observa fundamentalmente en poblaciones con perfiles de alto riesgo, el chemsex podría estar jugando un papel relevante en la adquisición y/o transmisión del VIH y otras ITS.

Biografía del autor/a

Juan Hoyos, Universidad Complutense de Madrid.

Departamento de Salud Pública y Materno-Infantil. CIBER Epidemiologia y Salud Pública (CIBERESP).

Cristina Agustí, Agència de Salut Pública de Catalunya (ASPCAT), Badalona.

Centre Estudis Epidemiologics sobre les Infeccions de Transmissio Sexual i Sida de Catalunya (CEEISCAT).CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid. 

Jordi Casabona, Agència de Salut Pública de Catalunya (ASPCAT), Badalona.

Centre Estudis Epidemiologics sobre les Infeccions de Transmissio Sexual i Sida de Catalunya (CEEISCAT).CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid. 

Luis Sordo, Universidad Complutense de Madrid.

Departamento de Salud Pública y Materno-Infantil. CIBER Epidemiologia y Salud Pública (CIBERESP).

José Pulido, Universidad Complutense de Madrid.

Departamento de Salud Pública y Materno-Infantil. CIBER Epidemiologia y Salud Pública (CIBERESP).

Luis de la Fuente, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid.

CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid.

María-José Belza, Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid.

CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid. 

Grupo de Trabajo Euro HIV EDAT

Sonia Fernández, Laura Fernández, Tomás Maté, Michael Meulbroek, Ferran Pujol, Fèlix Pérez, Sarah Benayoun, Laura Rios, Virginie Laporte, Klaus Legau, Tanja Kustec, Miha Lobnik, Christian Gladel, Michael Wurm, Ralf Dierichs, Oliver Schubert, Galina Mussat, Liliana Velica, Eric Florence, Tom Platteau, Daniel Simões, Nikos Debes, Ulrich Marcus, Sebastián Meyer, Mercè Meroño, Hrvoje Fucek, Henrique Barros, Anna Marzec-Bogustawska, Thea Indahl Mæhlum, Sandro Mattioli, Ferenc Bagyinszky, Maria Luisa Cosmaro, Loreta Stoniene, Joan Caylà, Nicky Voudouri, Jasmine Murphy, Anthony Nardone, Igor Sobolev, Inga Upmace, Aleksandar Skundric, Jorge Álvarez Rodríguez, Anna Rafel y Mario Poljak. 

Citas

Abdulrahim, D., Whiteley, C., Moncrieff, M. y Bowden-Jones, O. (2016). Club Drug Use Among Lesbian, Gay, Bisexual and Trans (LGBT) People. Novel Psychoactive Treatment UK Network (NEPTUNE). Recuperado de http://neptune-clinical-guidance.co.uk/wp-content/uploads/2016/02/neptune-club-drug-use-among-lgbt-people.pdf .

Bracchi, M., Stuart, D., Castles, R., Khoo, S., Back, D. y Boffito, M. (2015). Increasing use of ‘party drugs’ in people living with HIV on antiretrovirals: A concern for patient safety. AIDS, 29, 1585-1592. doi:10.1097/QAD.0000000000000786.

Caputi, T. L., Smith, L. R., Strathdee, S. A. y Ayers, J. W. (2018). Substance use among lesbian, gay, bisexual, and questioning adolescents in the United States, 2015. American Journal of Public Health, 108, 1031-1034. doi:10.2105/AJPH.2018.304446.

Carey, J. W., Mejia, R., Bingham, T., Ciesielski, C., Gelaude, D., Herbst, J. H.,... Stall, R. (2009). Drug use, high-risk sex behaviors, and increased risk for recent HIV infection among men who have sex with men in Chicago and Los Angeles. AIDS and Behavior, 13, 1084-1096. doi:10.1007/s10461-008-9403-3.

Corkery, J. M., Loi, B., Claridge, H., Goodair, C. y Schifano, F. (2018). Deaths in the lesbian, gay, bisexual and transgender United Kingdom communities associated with GHB and precursors. Current Drug Metabolism, 19, 1086-1099. doi:10.2174/1389200218666171108163817.

Daskalopoulou, M., Rodger, A., Phillips, A. N., Sherr, L., Speakman, A., Collins, S.,... Lampe, F. C. (2014). 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, 1, e22-e31. doi:10.1016/S2352-3018(14)70001-3.

Degenhardt, L., Ferrari, A. J., Calabria, B., Hall, W. D., Norman, R. E., McGrath, J.,... Vos, T. (2013). The global epidemiology and contribution of cannabis use and dependence to the global burden of disease: Results from the GBD 2010 study. PLoS One, 8, e76635. doi:10.1371/journal.pone.0076635.

Dolengevich-Segal, H., Rodriguez-Salgado, B., Bellesteros-Lopez, J. y Molina-Prado, R. (2017). Chemsex. An emergent phenomenon. Adicciones, 29, 207-209. doi:10.20882/adicciones.894.

Druckler, S., van Rooijen, M. S. y de Vries, H. J. C. (2018). 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. Sexually Transmitted Diseases, 45, 325-331. doi:10.1097/OLQ.0000000000000753.

Dutta, A., Uno, H., Holman, A., Lorenz, D. R., Wolinsky, S. M. y Gabuzda, D. (2017). Long-term nitrite inhalant exposure and cancer risk in MSM. AIDS, 31, 1169-1180. doi:10.1097/QAD.0000000000001451.

Edmundson, C., Heinsbroek, E., Glass, R., Hope, V., Mohammed, H., White, M. y Desai, M. (2018). Sexualised drug use in the United Kingdom (UK): A review of the literature. International Journal of Drug Policy, 55, 131-148. doi:10.1016/j.drugpo.2018.02.002.

EMIS Network. (2013). EMIS 2010: The European men-who-have-sex-with-men internet survey. Findings from 38 countries. Recuperado de https://www.ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/EMIS-2010-european-men-who-have-sex-with-men-survey.pdf.

Frankis, J. y Clutterbuck, D. (2017). What does the latest research evidence mean for practitioners who work with gay and bisexual men engaging in chemsex? Sexually Transmitted Infections, 93, 153-154. doi:10.1136/sextrans-2016-052783.

Glynn, R. W., Byrne, N., O’Dea, S., Shanley, A., Codd, M., Keenan, E.,... Clarke, S. (2018). Chemsex, risk behaviours and sexually transmitted infections among men who have sex with men in Dublin, Ireland. International Journal of Drug Policy, 52, 9-15. doi:10.1016/j.drugpo.2017.10.008.

Gómez-Gil, E., Simulionyte, E., Balcells-Oliveró, M., Valdés, M., Salamero, M., Guillamón, A. y Esteva, I. (2019). Patterns of alcohol, tobacco, and illicit drug use among transsexuals. Adicciones, 31, 189-195. doi:10.20882/adicciones.945.

Gonzalez-Baeza, A., Dolengevich-Segal, H., Perez-Valero, I., Cabello, A., Tellez, M. J., Sanz, J.,... Ryan, P. (2018). 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. AIDS Patient Care and STDs, 32, 112-118. doi:10.1089/apc.2017.0263.

Hammoud, M. A., Bourne, A., Maher, L., Jin, F., Haire, B., Lea, T.,... Prestage, G. (2018). Intensive sex partying with gamma-hydroxybutyrate: Factors associated with using gamma-hydroxybutyrate for chemsex among Australian gay and bisexual men - results from the Flux Study. Sexual Health, 15, 123-134. doi:10.1071/SH17146.

Hegazi, A., Lee, M. J., Whittaker, W., Green, S., Simms, R., Cutts, R.,... Pakianathan, M. R. (2017). Chemsex and the city: Sexualised substance use in gay bisexual and other men who have sex with men attending sexual health clinics. International Journal of STD & AIDS, 28, 362-366. doi:10.1177/0956462416651229.

Hibbert, M. P., Brett, C. E., Porcellato, L. A. y Hope, V. D. (2019). Psychosocial and sexual characteristics associated with sexualised drug use and chemsex among men who have sex with men (MSM) in the UK. Sexually Transmitted Infections, 95, 342-350. doi:10.1136/sextrans-2018-053933.

Hirshfield, S., Schrimshaw, E. W., Stall, R. D., Margolis, A. D., Downing, M. J. y Chiasson, M. A. (2015). Drug use, sexual risk, and syndemic production among men who have sex with men who engage in group sexual encounters. American Journal of Public Health, 105, 1849-1858. doi:10.2105/AJPH.2014.302346.

Hockenhull, J., Murphy, K. G. y Paterson, S. (2017). An observed rise in gamma-hydroxybutyrate-associated deaths in London: Evidence to suggest a possible link with concomitant rise in chemsex. Forensic Science International, 270, 93-97. doi:10.1016/j.forsciint.2016.11.039.

Hoyos, J., Belza, M. J., Fernández, S., Perez, S., de la Fuente, L., Arranz, B.,... Cosic, M. (2017). Euro HIV EDAT Project. KAB/P study on the implementation of innovative HIV testing strategies: Main results of a study conducted among MSM and stakeholders. Recuperado de https://eurohivedat.eu/arxius/ehe_docsmenu_docsmenu_doc_154-Final_Report_KABP_study_on_the_implementation_of_innovative_HIV_testing_strategies.pdf.

Kirby, T. y Thornbern-Dunwell, M. (2013). High-risk drug practices tighten grip on London gay scene. Use of crystal methamphetamine is on the rise in London’s gay scene, putting men who have sex with men at higher risk of infections. The Lancet, 381, 101-102. doi:10.1016/S0140-6736(13)60032-X.

Knight, R. (2018). Investments in implementation science are needed to address the harms associated with the sexualized use of substances among gay, bisexual and other men who have sex with men. Journal of the International AIDS Society, 21, e25141. doi:10.1002/jia2.25141.

Lawn, W., Aldridge, A., Xia, R. y Winstock, A. R. (2019). Substance-linked sex in heterosexual, homosexual, and bisexual men and women: An online, cross-sectional “Global Drug Survey” report. The Journal of Sexual Medicine, 16, 721-732. doi:10.1016/j.jsxm.2019.02.018.

McCall, H., Adams, N., Mason, D. y Willis, J. (2015). What is chemsex and why does it matter? BMJ, 351, h5790. doi:10.1136/bmj.h5790.

Melendez-Torres, G. J., Bourne, A., Reid, D., Hickson, F., Bonell, C. y Weatherburn, P. (2018). Typology of drug use in United Kingdom men who have sex with men and associations with socio-sexual characteristics. International Journal of Drug Policy, 55, 159-164. doi:10.1016/j.drugpo.2018.01.007.

Ottaway, Z., Finnerty, F., Amlani, A., Pinto-Sander, N., Szanyi, J. y Richardson, D. (2017). Men who have sex with men diagnosed with a sexually transmitted infection are significantly more likely to engage in sexualised drug use. International Journal of STD & AIDS, 28, 91-93. doi:10.1177/0956462416666753.

Pakianathan, M.R., Whittaker, W., Lee, M. J., Avery, J., Green, S. y Hegazi, A. (2018). Chemsex and new HIV diagnosis in gay, bisexual and othermen who have sex with men attending sexual health clinics. HIV Medicine, 19, 485-490. doi:10.1111/hiv.12629.

Pakianathan, M. R., Lee, M. J., Kelly, B. y Hegazi, A. (2016). How to assess gay, bisexual and other men who have sex with men for chemsex. Sexually Transmitted Infections, 92, 568-570. doi:10.1136/sextrans-2015-052405.

Prestage, G., Hammoud, M., Jin, F., Degenhardt, L., Bourne, A. y Maher, L. (2018). Mental health, drug use and sexual risk behavior among gay and bisexual men. International Journal of Drug Policy, 55, 169-179. doi:10.1016/j.drugpo.2018.01.020.

Pufall, E. L., Kall, M., Shahmanesh, M., Nardone, A., Gilson, R., Delpech, V. y Ward, H. (2018). Sexualized drug use (‘chemsex’) and high-risk sexual behaviours in HIV-positive men who have sex with men. HIV Medicine, 19, 261-270. doi:10.1111/hiv.12574.

Rana, S., Macdonald, N., French, P., Jarman, J., Patel, S., Portman, M.,... Crook, P. (2019). Enhanced surveillance of syphilis cases among men who have sex with men in London, October 2016-January 2017. International Journal of STD & AIDS, 30, 422-429. doi:10.1177/0956462418814998.

Redondo-Dominguez, D., Picazo, L., Docavo-Barrenechea-Moxo, M. L. y Gonzalez Del Castillo, J. (2018). Chemsex: are we prepared? Adicciones, 30, 158-159. doi:10.20882/adicciones.1062.

Rosinska, M., Gios, L., Nostlinger, C., Vanden Berghe, W., Marcus, U., Schink, S.,... Mirandola, M. (2018). Prevalence of drug use during sex amongst MSM in Europe: Results from a multi-site bio-behavioural survey. International Journal of Drug Policy, 55, 231-241. doi:10.1016/j.drugpo.2018.01.002.

Schmidt, A. J., Bourne, A., Weatherburn, P., Reid, D., Marcus, U. y Hickson, F. (2016). Illicit drug use among gay and bisexual men in 44 cities: Findings from the European MSM Internet Survey (EMIS). International Journal of Drug Policy, 38, 4-12. doi:10.1016/j.drugpo.2016.09.007.

Sewell, J., Cambiano, V., Speakman, A., Lampe, F. C., Phillips, A., Stuart, D.,... Rodger, A. J. (2019). Changes in chemsex and sexual behaviour over time, among a cohort of MSM in London and Brighton: Findings from the AURAH2 study. International Journal of Drug Policy, 68, 54-61. doi:10.1016/j.drugpo.2019.03.021.

Sewell, J., Miltz, A., Lampe, F. C., Cambiano, V., Speakman, A., Phillips, A. N.,... Rodger, A. J. (2017). 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. International Journal of Drug Policy, 43, 33-43. doi: 10.1016/j.drugpo.2017.01.001.

Swartz, J. A. y McCarty-Caplan, D. (2018). A study of the longitudinal patterns of stimulant and amyl nitrite use and sexual behavior pre- and post-HIV seroconversion among MSM. AIDS and Behavior, 22, 1395-1409. doi:10.1007/s10461017-2008-y.

Tomkins, A., George, R. y Kliner, M. (2018). Sexualised drug taking among men who have sex with men: A systematic review. Perspectives in Public Health, 139, 23-33. doi:10.1177/1757913918778872.

Weatherburn, P., Hickson, F., Reid, D., Torres-Rueda, S. y Bourne, A. (2017). Motivations and values associated with combining sex and illicit drugs (‘chemsex’) among gay men in South London: Findings from a qualitative study. Sexually Transmitted Infections, 93, 203-206. doi:10.1136/sextrans-2016-052695.

Winstock, A. (2015). New health promotion for chemsex and gamma-hydroxybutyrate (GHB). [carta al Editor]. BMJ, 351, h6281. doi:10.1136/bmj.h6281.

Publicado

2022-02-16

Número

Sección

Originales