Sex between men that occurs under the influence of Mephedrone, GHB/GBL or Crystal Meth
GB MSM Drug Use Use of any stimulant drug: 4.1% heterosexual vs 21.6% Gay/Bi Use of any drug: 11.1% heterosexual vs 33% Gay/Bi Crime Survey of England and Wales 2011-2014
Incidence of ChemSex 0.7% had used crystal meth in previous 4 weeks (London 2.9%) 2.9% had used mephedrone in previous 4 weeks (London 10.2%) 1.6% had used GHB/GBL in previous 4 weeks (London 5.5%) European GBMSM Internet Survey (EMIS)
Wandsworth & Kingston Recreational Drug Use 30% Chemsex 63% IVDU 15% HIV +ve more likely to participate in chemsex [OR 6.68; 95% CI 3.91-11.42; p<0.001] 5% shared needles 35% shared snorting devices Drugs used in chemsex (67% polydrug use) Mephedrone 69% GBL/GHB 56% Crystal Meth 46% Other 12% (n=111) > once/month 34% 1-3 times in 3 month 48% Less often 18% <12 hrs 59% >24hrs 16 % A Hegazi 3-2-16 A Hegazi 3-2-16
Chemsex Support Clinic 874 GBMSM attending chemsex support clinic 70% - no sober sex in past 6 months Chemsex episodes Typically 12-48 hours 88% with multiple partners (56% ≥ 4 partners) Those who were HIV Positive 64% of those not on ART (n=42) reported zero condom use 30% of those on ART reported poor adherence 9% of those who were HIV negative tested +ve for HIV at the same clinic within 1 year Chemsex escalated after HIV diagnosis Relationship breakdown Migration to London A Hegazi 3-2-16 Stuart D, Weymann J. Chemsex and Care Planning: One year in practice. HIV Nursing. 2015;15:24-8.
Positive Voices Study (Pufall et al 2016) HIV + GBMSM & ChemSex 29% of HIV+ gay male patients reported engaging in chemsex 37% of HIV+ gay male Londoners reported chemsex 19% of HIV+ gay men on ART reported injecting Positive Voices Study (Pufall et al 2016)
HIV + GBMSM & Risk Chemsex associated with a six fold increase of condomless anal sex Chemsex associated with a sevenfold increase in the risk of sex with a risk of HIV transmission Chemsex was associated with having an average of 30 sexual partners in the last year compared with 9 partners who do not have chemsex STIs were 4 times higher in men reporting chemsex Positive Voices Study (Pufall et al 2016)
ChemSex – Why? Curiosity / adventure / enhance intensity Drug use normalised HIV / sexuality stigma Problems with intimacy Lack of confidence and an unhappiness with sex life To manage mood - higher levels of anxiety and depression Adam Bourne. Chemsex Study http://www.sigmaresearch.org.uk/files/report2014b.pdf
Consequences
ChemSex: a clinic issue People present much earlier than they would to a drug service Preference for GUM-based interventions High number of sexual partners per ChemSex episode Consistently poor condom use when using Chems High number of STIs/multiple HCV re-infections High frequency of PEP presentations Seroconversion symptoms that might be disguised as a ‘drug high’ or drug ‘comedown’ Opportunity to deliver motivational and preventative interventions Consistently poor ARV adherence if HIV-positive
Questions What do you know about the drugs you are using? Are you happy with your level of drug use? What do you know about the drugs you are using? What do you enjoy about Chemsex? What do you know about the risks? What percentage of your sex life/free time involves Chemsex? When was the last time you had sober sex? Do you ever feel your drug use is negatively impacting your sex life or wellbeing? Do you sometimes regret the choices you make when high? How confident are you about disclosing your HIV status? What is your non-sexual social life like? Is using Chems giving you what you want from life? How would you rate the intensity of your experience and your sense of satisfaction and enjoyment for both Chemsex and sober sex?