Substance use in sexual context among Spanish resident men who have sex with men

Authors

  • Juan-Miguel Guerras Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid
  • Juan Hoyos CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid Departamento de Salud Pública y Materno-Infantil, Universidad Complutense de Madrid, Madrid
  • Cristina Agustí CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid Centre Estudis Epidemiologics sobre les Infeccions de Transmissio Sexual i Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya (ASPCAT), Badalona
  • Jordi Casabona CIBER Epidemiologia y Salud Pública (CIBERESP). Departament de Salut Centre Estudis Epidemiologics sobre les Infeccions de Transmissio Sexual i Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya (ASPCAT), Badalona
  • Luis Sordo CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid Departamento de Salud Pública y Materno-Infantil, Universidad Complutense de Madrid, Madrid
  • José Pulido CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid Departamento de Salud Pública y Materno-Infantil, Universidad Complutense de Madrid, Madrid
  • Luis de la Fuente Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid
  • María-José Belza CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid
  • Grupo de Trabajo Euro HIV EDAT

DOI:

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

Keywords:

Men who have sex with men, chemsex, drug use, HIV, STI.

Abstract

We analysed patterns of sexualized drug use (SDU) and pinpointed the one with the highest risk for the acquisition/transmission of HIV/Sexually Transmitted Infections (STIs) in a sample of men who have sex with men (MSM) residing in Spain. Additionally, we also identified the most affected subpopulations by highest risk SDU pattern. In 2016, we promoted an online survey in gay dating apps. We estimated the prevalence of several HIV/STI risk indicators for each identified SDU pattern. We built two different Poisson regression models identifying factors associated to the pattern associated with the highest risk. All analyses were carried out by HIV status. Of 2,883 MSM, 21.9% self-reported SDU in the last 12 months. All patterns of SDU were more frequent in HIV+ MSM. Of the four SDU patterns identified (chemsex, recreational drugs, sexual performance enhancing drugs, and cannabinoids), the most frequent was chemsex (21.9% in HIV+ vs 6.6% in HIV-). It also comprised the highest risk profile for HIV/STI. Among HIV-, chemsex was associated with living in a city of > 1,000,000 inhabitants, living sexuality in an open way and having been paid for sex, having had unprotected anal intercourse (UAI) in the last 12 months and having ever received an STI diagnosis. Among HIV+, it was associated with being 30-49 years old, having paid for sex, having had UAI and having been diagnosed with an STI in the last 12 months. Given its high prevalence, especially among HIV positive individuals, and its association with subpopulations with high-risk behaviour, chemsex could be playing a relevant role in the acquisition/transmission of HIV and other STIs.

Author Biographies

Juan Hoyos, CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid Departamento de Salud Pública y Materno-Infantil, Universidad Complutense de Madrid, Madrid

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

Cristina Agustí, CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid Centre Estudis Epidemiologics sobre les Infeccions de Transmissio Sexual i Sida de Catalunya (CEEISCAT), 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, CIBER Epidemiologia y Salud Pública (CIBERESP). Departament de Salut Centre Estudis Epidemiologics sobre les Infeccions de Transmissio Sexual i Sida de Catalunya (CEEISCAT), 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, CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid Departamento de Salud Pública y Materno-Infantil, Universidad Complutense de Madrid, Madrid

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

José Pulido, CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid Departamento de Salud Pública y Materno-Infantil, Universidad Complutense de Madrid, 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

CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid.

María-José Belza, CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid 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. 

References

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.

Published

2022-02-16

Issue

Section

Originals