Hepatitis C Virus Reinfection Among Men Who Have Sex With Men With HIV in New York City.

BACKGROUND: Hepatitis C virus (HCV) reinfection rates are substantially higher than primary infection rates among men who have sex with men (MSM) with human immunodeficiency virus (HIV) in European cohorts. The behaviors mediating this high rate of transmission among MSM are poorly characterized. METHODS: We performed a prospective cohort study in New York City (NYC) of MSM with HIV who cleared HCV to determine the incidence of and risk factors for HCV reinfection. We assessed the risk behaviors for primary HCV in NYC: receipt of semen in the rectum, and sexualized methamphetamine use, along with route of use. Multivariable analysis was performed with Andersen-Gill extension of the Cox proportional hazards model. RESULTS: From 2000 through 2018, among 304 MSM with HIV who cleared HCV, 42 reinfections occurred over 898 person-years, for an incidence rate of 4.7 per 100 person-years. Assessing 1245 postclearance visits, only receipt of semen into the rectum was associated with reinfection (hazard ratio, 9.7 [95% confidence interval: 3.3-28.3], P < .001); methamphetamine use was not. CONCLUSIONS: The high HCV reinfection rate over almost 2 decades demonstrates that sexual transmission of HCV is not inefficient or unusual and that direct-acting antiviral treatment is not sufficient for HCV elimination among MSM in NYC. The contrasts between both the rates of and risk factors for primary and HCV reinfection suggest that HCV prevalence is highly heterogenous among sexual networks and that sexualized methamphetamine use, rather than mediating transmission, is instead a surrogate marker for the highest HCV prevalence networks. As neither condoms nor treatment have been successful strategies for HCV prevention in NYC, novel interventions are needed to stem this sexually transmitted HCV epidemic.

Sexualized drug use and chemsex: A bibliometric and content analysis of published literature.

Sexualized drug use (SDU) describes drug-facilitated sexual enhancement, and chemsex is an SDU subculture involving the use of specific drugs by men who have sex with men (MSM). This study aimed to identify research trends, foci, and themes within the SDU and chemsex-specific literature. The Web of Science Core Collection was searched with a list of SDU synonyms. All SDU-related articles were analyzed using the R package, bibliometrix. Full text review identified chemsex-specific records, and text was extracted verbatim for content analysis in Leximancer. The search returned 1,866 unique records. A total of 521 addressed SDU, and 301 papers specifically addressed chemsex. The small but growing SDU literature primarily addressed consensual encounters between MSM, and drug-facilitated assault experienced by women, in Western settings. Little attention was given to transgender communities or consensual SDU in cisgender heterosexual individuals. The literature primarily viewed SDU through a public health lens, specifically focusing on the risk conferred to sexual health.The SDU and chemsex-specific literature are potentially limited in scope and may inadequately capture the geographical, demographic, and cultural diversity of these phenomena. Future research should address the myriad social and health implications of SDU and chemsex participation across all relevant communities and settings.

Chemsex as lines of flight? Critical Deleuzean perspectives on chemical intimacies.

BACKGROUND: Public health scholars informed by a dominant biomedical paradigm have in their 'rush to risk' emphasised the problematic aspects of chemsex. Meanwhile, critical chemsex scholars have attemped to destigmatise such sexual-chemical practices and foreground how they can be transformative. Taking these two perspectives as points of departure, we make a case for understanding chemsex vis-à-vis Deleuzean lines of flight. METHODS: Semi-structured in-depth interviews were conducted with 33 purposively sampled sexual minority men seeking therapy for chemsex dependency in Singapore. Interview topics included participants' experiences and histories of chemsex, substance use, and their ongoing recovery. Interviews were audio-recorded, transcribed and then analysed according to key themes. RESULTS: We illustrate how chemically inflected sexual encounters can offer deterritorialising flights of fantasy and freedom from a heteronormative social structure that pathologises gay sex. At the same time, we argue that these flight lines are not static, neither do they extend indefinitely in space-time. Rather, we show how flights of freedom can evolve into lines of fright (or non-flight) when chemsex practitioners are met with critical thresholds that reveal the less-than-desirable aspects of being intoxicated. Consequently, they may eventually consider the reterritorialisation of their lives (i.e. abstinence and recovery) as a more constructive option. Regardless of their decisions to ride on chemically-induced flight lines or to take a step back from such deterritorialising pathways, they have troubled stereotypical perspectives of drug users as passive automatons. CONCLUSIONS: This paper enriches the chemsex scholarship by presenting a Deleuzean conceptualisation of chemical-sexual intimacies without romantacising and/or overstating the 'escape'/'freedom' that chemsex can facilitate. Future research in this arena could explore the complicated intimate relationships that users may have with their drug(s) of choice, and their varied lines of (non-)flight over a longitudinal study.

Chemsex Among Men Who Have Sex With Men: A Systematic Scoping Review of Research Methods.

Chemsex refers to the use of psychoactive substances with sex. We carried out a systematic scoping review of methodological characteristics of chemsex research among men who have sex with men (MSM), published between 2010 and 2020. For inclusion, chemsex had to be the main focus, and studies had to specify GHB/GBL, stimulant (amphetamine, crystal meth, ecstasy/MDMA, cathinones, cocaine) and/or ketamine use with sex as a variable. From 7055 titles/abstracts, 108 studies were included, mostly cross-sectional, and from Western countries. About one-third of studies recruited exclusively from clinical settings. A majority of these recruited from sexually transmitted infection (STI) clinics. The included quantitative studies analyzed possible associations between chemsex and STI health (40%), mental health (15%), drug health (12%), sexological health (10%), and post-diagnostic HIV health (7%). Most studies included GHB/GBL and crystal meth in their operationalization of chemsex. Definitions and operationalizations of chemsex vary greatly in the literature, and researchers of chemsex among MSM should consider ways in which this variation impacts the validity of their results. More studies are needed among MSM in non-high income and non-Western countries, and examination of possible links between chemsex and post-diagnostic HIV health, sexological health, and mental health.

Patterns of Sexualized Drug Use among Gay, Bisexual, and Other Men Who Have Sex with Men Living with HIV: Insights from a Comprehensive Study-The U-SEX-2 GESIDA 9416 Study.

BACKGROUND: Sexualized drug use (SDU) has become a public health concern in recent years. This study aimed to estimate the prevalence of SDU in gay, bisexual, and other men who have sex with men living with HIV (HIV + GBMSM) in Madrid during 2019/2020 and compare it with data from 2016/2017 in order to detect changes in patterns. METHODS: We analyzed the frequency of SDU in a sample of HIV + GBMSM attending HIV clinics, who participated in an anonymous online survey regarding sexual behavior and recreational drug use. The association between SDU, sexual risk behaviors, and STIs was evaluated. RESULTS: This study included 424 HIV + GBMSM, with a mean age of 40 (10.43) years. Overall, 94% (396) reported being sexually active. Additionally, 33% (140) had been diagnosed with an STI within the previous year. Moreover, 54% (229) had used drugs in the last year, 25% (107) engaged in SDU, and 16% (17) reported engagement in slamsex. After adjusting for confounding factors, SDU was associated with STIs, fisting, unprotected anal intercourse, and having >24 sexual partners in the last year. According to the DUDIT test scores, 80% (81) probably had problematic drug use (≥6 points), and 8% (8) probable drug dependence (≥25 points). When comparing the U-SEX-1 (2016/2017) data with the U-SEX-2 (2019/2020) data, no significant differences were found in the proportion of participants practicing SDU or slamming. CONCLUSIONS: The prevalence of SDU among HIV + GBMSM has remained high in recent years and without significant changes. The risk of problematic drug use among those who practice SDU is high. We observed a clear association between SDU, high-risk sexual behaviors, and STIs.

Understandings, attitudes, practices and responses to GHB overdose among GHB consumers.

BACKGROUND: Gamma-hydroxybutyrate (GHB) is used at disproportionately high rates within sexuality and gender diverse communities and carries a high risk of overdose. GHB overdose can result in death. Internationally, recent increases in GHB overdoses have been observed. Coronial reviews of GHB-related death highlight the pivotal roles that bystanders to GHB overdose play in preventing fatality. No research has examined, in detail, how bystanders respond to GHB overdose. This qualitative study was conducted among people who use GHB and explored how they responded upon witnessing a GHB overdose experienced by someone else. METHODS: Interviews were conducted with 31 sexuality and gender diverse Australian residents reporting three or more occasions of GHB use in the previous 12 months. Participants were asked questions about witnessed GHB overdose, their actions and decision-making processes throughout overdose. Data were analysed thematically. RESULTS: Participants described witnessing GHB overdose, commonly in private settings involving sexualized GHB use. Variable definitions of GHB overdose were reported, ranging from GHB-induced symptoms of distress to comatose intoxication. Drastic actions to keep someone alert and responsive post-GHB ingestion were reported; these included the administration of stimulant substances and citrus. Decisions to call or not call for emergency medical services (EMS) were influenced by many circumstantial variables. In most instances, an EMS call was resisted and response practices deviated from established first aid protocols. CONCLUSIONS: GHB overdose prevention and response training programs targeting people who use GHB are urgently required. These education interventions ought to address inaccuracies that inform street remedies for GHB overdose, teach people how to safely check breathing and response, promote basic first aid principles and address barriers to contacting EMS.

Chemsex and Harm Reduction Practices Among Men Who Have Sex with Men in Malaysia: Findings from a Qualitative Study.

Chemsex is a form of sexualized drug use commonly practiced among MSM with psychoactive substances, such as methamphetamine. While this phenomenon has gained global attention in the past two decades, there is a dearth of empirical data to inform culturally competent interventions. The current work investigates the socio-contextual factors related to chemsex and harm reduction practices among Malaysian MSM. Between February and August 2022, we conducted six online focus group sessions with Malaysian MSM who had engaged in chemsex during the previous 6 months (N = 22). We queried participants about perceived benefits and harms, harm reduction practices, and informational needs. Most participants' first chemsex experience occurred in a casual sexual encounter, often facilitated by mobile technology. Participants reported engaging in harm reduction practices before (e.g. medication reminders), during (e.g. peer support), and after (e.g. rest) chemsex. These findings have implications for future efforts to develop and implement tailored interventions to address the specific and acute needs of Malaysian MSM engaging in chemsex.

An mHealth-Delivered Sexual Harm Reduction Tool (PartyPack) for Men Who Have Sex With Men in Malaysia: Usability Study.

BACKGROUND: Chemsex-the use of psychoactive drugs to enhance the sexual experience-is an increasing phenomenon globally. Despite the increasing burden and associated harms of chemsex, evidence-based interventions (ie, behavioral and pharmacological) for chemsex users are nonexistent. OBJECTIVE: In this study, we assessed the usability and acceptability of a mobile health (mHealth)-delivered safer chemsex package ("PartyPack") as a sexual harm reduction strategy among men who have sex with men in Malaysia-a setting where chemsex is becoming increasingly prevalent. METHODS: This study is part of a larger smartphone app-based intervention (ie, JomPrEP; University of Connecticut) designed to improve access to HIV prevention services among Malaysian men who have sex with men. A total of 50 participants were recruited from the Greater Kuala Lumpur region of Malaysia to use the JomPrEP app, which included a feature allowing participants to order PartyPack, for 30 days (March-April 2022). The usability and acceptability of the PartyPack were assessed using self-report, app analytics, and exit interviews (n=20). RESULTS: Overall, 8% (4/50) of participants reported having engaged in chemsex in the past 6 months; however, engagement in condomless sex (34/50, 68%) and group sex (9/50, 18%) was much higher. A total of 43 (86%) participants ordered PartyPack, of which 27 (63%) made multiple orders during the 30 days. Most participants (41/43, 95%) reported being satisfied with the PartyPack order feature in the app, with 91% (39/43) indicating the order and tracking process was easy. Thematic data exploration further revealed important information for understanding (eg, items included in the package, use of mHealth platform to order package, and discreetness of the PartyPack box and order and delivery) and refining the logistical preferences (eg, using branded items and allowing customization during order). CONCLUSIONS: Our findings provide strong evidence of the usability and acceptability of a mHealth-delivered safer chemsex package as a potential sexual harm reduction tool among this underserved population. Replication in a study with a larger sample size to test the efficacy of the PartyPack is warranted.

Sexualized drug use and STD and HIV incidence among men who have sex with men in Amsterdam, the Netherlands.

BACKGROUND: We assessed the association between sexualized drug use (SDU), and incident sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV) infections among men who have sex with men (MSM). METHODS: We used data from the MS2 cohort study, conducted at the STI Outpatient Clinic of the Public Health Service of Amsterdam, the Netherlands, in 2014-2019. Eligible participants were adult HIV-negative MSM with ≥2 STDs in the preceding year and MSM living with HIV and ≥1 STD. Participation encompassed 3-monthly visits including STD screening and questionnaires on drug use. Primary outcomes were incident HIV, anal chlamydia/gonorrhoea, and syphilis. We studied the association between SDU of individual drugs and incident HIV and STDs, using Poisson regression. Analyses were adjusted for age and HIV-status. RESULTS: 131 HIV-negative MSM and 173 MSM living with HIV were included for analysis. SDU with GHB/GBL (aIRR = 7.2, 95% CI = 1.4-35.5) in the 3 months before testing was associated with incident HIV. SDU with GHB/GBL (aIRR = 1.2, 95% CI = 1.0-1.4), ketamine (aIRR = 1.3, 95% CI = 1.0-1.6) or methamphetamine (aIRR = 1.3, 95% CI = 1.0-1.6) was associated with incident anal chlamydia/gonorrhoea. We found no association between SDU with specific drug types and syphilis incidence. CONCLUSIONS: SDU with GHB/GBL, ketamine and methamphetamine among MSM was associated with incident HIV and anal chlamydia/gonorrhoea. HIV-negative MSM engaging in SDU should be advised to use HIV pre-exposure prophylaxis, and all MSM engaging in SDU should be advised to have STD screening regularly. We suggest counselling on STDs among MSM engaging in SDU.

Utilization of mental health services in relation to the intention to reduce chemsex behavior among clients from an integrated sexual health services center in Taiwan.

INTRODUCTION: The intention of chemsex-practicing gay and bisexual men and other men who have sex with men (GBMSM) to reduce their drug use is an important factor for the utilization of harm reduction services. This study aimed to examine data from an integrated sexual health services center to understand the relationship between the intention to reduce chemsex behavior and chemsex-related utilization of mental health services among GBMSM who engage in chemsex. METHOD: We used data collected from Healing, Empowerment, Recovery of Chemsex (HERO), an integrated health center in Taiwan, between November 2017 and December 2021. As the baseline, clients were asked to rate the current and ideal proportions of their sexual activities that involved the use of MDMA, ketamine, methamphetamine, GHB/GBL, or mephedrone. Having the intention to reduce chemsex was defined as having a lower proportion of ideal engagement compared to actual engagement. The data on the use of the services provided at HERO were linked to the survey responses and compared to information gathered during regular follow-up visits. Univariable and multivariable logistic regression analyses and a Poisson regression analysis were performed on the data. RESULTS: A total of 152 GBMSM reported engaging in chemsex, of whom 105 (69.1%) expressed the intention to reduce their chemsex behavior. Service utilization ranged from 23.0% for participating in meetings of a chemsex recovery group, 17.1% for visiting a mental health clinic, and 10.5% for using both of these services. The intention to reduce chemsex behavior significantly associated with visiting a mental health clinic (aOR = 4.68, p < 0.05), but its association with attending meetings of a chemsex recovery group was only marginally significant (aOR = 2.96, p < 0.1). Other factors that remained significantly associated with service use were a high frequency of substance use and living with HIV. CONCLUSION: Comprehensive harm reduction strategies, which touch on mental health, drug use management and recovery, are needed for those who want to reduce their chemsex behavior. Public health practitioners should endeavor to raise awareness of resources that are available for people who engage in chemsex and to minimize the barriers blocking their access to the appropriate services.

Lethal Lust: Suicidal Behavior and Chemsex-A Narrative Review of the Literature.

Chemsex is described as the use of certain drugs-commonly methamphetamine, gamma-butyrolactone (GBL)/gammahydroxybutyrate (GHB), and mephedrone-before or during planned sexual activity primarily among men who have sex with men (MSM). Evidence shows that MSM who engage in chemsex are at increased risk of physical harm, such as sexually transmittable infections (STIs), and are more likely to experience mental health symptoms. To further assess this, we reviewed the recent literature to evaluate whether the psychological impact of chemsex behavior includes suicidal ideation and suicidal attempts. Pubmed/MEDLINE was searched for articles reporting suicidal ideation and behavior among chemsex users with the terms "chemsex", "sexualized drug use", "suicide", and "mental health". Twelve articles (three case reports and nine cross-sectional studies) were included in the final narrative review. Overall, we retrieved mixed results regarding the relationship between chemsex practice and suicidality outcomes. Considering the inhomogeneous nature of the studies, the findings indicate that suicidality could be an issue of concern among MSM in general but among chemsex users in particular. Possible risk factors for suicidality among chemsex participants may include adversities experienced due to one's sexual orientation and an increased risk for HIV and other STI infections and the resulting negative impact on mental well-being. These aspects warrant further investigations.

Understanding Sexualized Drug Use: Substances, Reasons, Consequences, and Self-Perceptions among Men Who Have Sex with Other Men in Spain.

Sexualized drug use (SDU) has been identified as a health risk factor among gay, bisexual, and other men who have sex with men (GBMSM). This study aimed to analyze the associations between SDU frequency and a broad set of substances, motives, consequences, and self-perceptions. Sampling was conducted through an online survey. The final sample consisted of 185 GBMSM aged between 18 and 78 years old (mean age = 38.38, SD = 11.52) who engaged in SDU. We analyzed the frequency of SDU in terms of practicing it "once," "moderately" ("once a month or less" or "a few times a month"), or "frequently" (from "once a week" to "daily") during the previous 18 months. A questionnaire was administered through which sociodemographic variables, substances, reasons, consequences, and self-perceptions of SDU practice were analyzed. Participants who did so frequently were significantly more likely to use mephedrone, methamphetamine, and GHB/GBL than those who performed SDU less often (large effect sizes). In addition, habitual SDU was associated with motivations to achieve pleasurable emotions and sensations and manage negative feelings. Health implications, such as blackout moments, were also significantly related to frequent SDUs. Finally, those who practiced frequent SDU perceived it as a severe problem and wanted to control it. These data indicate the importance of raising awareness of chemsex as a public health problem among GBMSM. Specific identification, education, and prevention programs need to be strengthened to reduce the incidence of the most undesirable implications of SDU among GBMSM.

Prevalence of sexualized drug use and risk of HIV among sexually active MSM in East and South Asian countries: systematic review and meta-analysis.

INTRODUCTION: Sexualized drug use (SDU), the use of psychoactive drugs in the context of sexual intercourse, has been identified as a risk factor for HIV among men who have sex with men (MSM) in Asia. Given the distinct social and cultural context of same-sex relationships and drug-using practice in Asia, we aimed to describe the prevalence of SDU in East and South Asian countries and its associations with condomless anal sex (CAI) and HIV status. Synthesizing SDU research in this region, including SDU definitions, prevalence and outcomes, provides insights to inform future research and improved programme planning, resourcing and advocacy. METHODS: We systematically searched OVID Medline, OVID EMBASE, OVID Global Health, CINAHL, PsycINFO and SCOPUS publication databases for scientific articles published from 1990 to 2022 measuring SDU among MSM in East and South Asian countries. A narrative synthesis was utilized to describe key study attributes and findings, and meta-analyses using random pooled effect models were used to estimate SDU prevalence and its associations with CAI and HIV status. Subgroup meta-analyses, sensitivity analysis and assessment of publication bias examined potential sources of heterogeneity for the pooled SDU prevalence estimates. RESULTS AND DISCUSSION: Of the 1788 publications screened, 49 publications met the selection criteria and 18 were suitable for meta-analyses. Findings highlight SDU definitions distinct from other regions but inconsistencies in the definition of SDU between studies that have been highlighted in research elsewhere. The pooled prevalence of recent SDU (past 12 months) was 13% (95% CI = 10-16%; I2 = 97.6) but higher when studies utilized self-administered surveys (15%; 95% CI = 12-19%; p<0.05). SDU was associated with greater odds of CAI (pooled odds ratio [OR] = 3.21; 95% CI = 1.82-5.66) and living with diagnosed HIV (OR = 4.73; 95% CI = 2.27-8.21). CONCLUSIONS: SDU is common among MSM in East and South Asian countries, but varying SDU definitions limit between-study comparisons. Responses to SDU-related harms should consider local contexts, including specific drug types used and their relative risks.

Wired Sex Assemblages Among Men Who Have Sex with Men: Sexualized Drug Use, Hookup Apps, and HIV Service Provision.

Sexualized drug use is a form of sexual practice that resists risk-based discourses (otherwise referred to as "radical sex practices") and is reportedly common among gay, bisexual and other men who have sex with men (GBMSM). With the growth of online technologies, the use of hookup apps has also increased. We refer to men's use of drugs, apps, and sex form as "wired sex" that forms what post-structuralist theorists Deleuze and Guattari described as an assemblage. Perspectives of the health and social service providers who work directly with GBMSM has not been explored. This research project involved a critical discourse analysis of 13 semi-structured interviews with service providers in Canada to understand their perspectives and interactions with wired sex assemblages. We identified several themes reflecting the social and political effects of wired sex assemblages and discuss the implications of these effects on services provision with GBMSM.

Getting Inside the Mind of Gay and Bisexual Men Who Have Sex with Men with Sexualized Drug Use - A Systematic Review.

Objectives: Sexualized Drug Use (SDU) consists of using any drug purposely before or during sex with the intent of modifying sex experiences. SDU is especially practiced among Gay and Bisexual Men who have Sex with Men (GBMSM). This study aims to review the relevant literature to identify and summarize the reasons reported by GBMSM to engage in SDU. Methods: A systematic review of the literature using PubMed/Medline, Scopus, Google Scholar, and PsycINFO, comprising qualitative and quantitative papers published between 2010 and 2022, was conducted with a narrative synthesis of the findings. PRISMA guidelines were followed. Results: Our search identified 1400 publications, of which 23 were included. Reasons to engage in SDU were aggregated as follows: (1) Enhancing sexual sensations and performance, (2) Achieving hedonic mental and emotional states, (3) Tackling negative thoughts and feelings, and (4) Social motivations. Different sample methods and ways of asking for motivations may limit the internal validity of these conclusions. Conclusion: Both individual and social factors are involved in the decision to engage in SDU. SDU practices should not be medicalized, however therapeutic support if needed should provide multidisciplinary, pleasure-centered, harm-reducing care interventions, specifically designed for these minorities of GBMSM.

Sexualized drug use among men who have sex with men in Madrid and Barcelona: The gateway to new drug use?

This original study compares the prevalences of drug use for any purpose and for sexualized drug use (SDU) among MSM. It also describes relevant characteristics of first SDU, analyzes to what extent SDU has been the first experience (the gateway) with different drugs by age and explores the correlates of SDU. Study participants included 2,919 HIV-negative MSM attending four HIV/STI diagnosis services in Madrid and Barcelona. They answered an online, self-administered questionnaire. Poisson regression models with robust variance were used. About 81.4% had ever used any drug, and 71.9% had done so in the last-12-months, while 56% had ever engaged in SDU, and 50% had done so in the last-12-months. Participants under 25 years old had the lowest prevalences of SDU, and the 25-39 age group the highest, except for Viagra, which was higher among those over age 40. The most frequently used drugs for first SDU were poppers (53.6%), cannabis (19.6%) and Viagra (12.2%). These drugs were also the most ever consumed for SDU. Among sexualized users, methamphetamine (78.3%) and Mephedrone (75.4%) were used always/most of the times for sex in the last-12-months. Around 72.2% of Mephedrone sexualized users and 69.6% of Methamphetamine vs 23.1% of ecstasy users' first consumption of these drugs involved use for sex. These drugs were provided to them free where they have sex for 66.8, 79.1, and 31.9%, respectively. On that occasion, 8.1% of Mephedrone, 6.8% of Methamphetamine and 18.4% of ecstasy users had sex only with steady partner; with 50.2, 56.2, and 26.2% respectively using a condom with any partner. SDU in the first use was associated with similar variables for recreational and chemsex drugs. The highest prevalence ratios were for having ever been penetrated by >20 men and having ever injected drugs. It can be concluded that the prevalence of SDU was more than half of the prevalence for any purpose. Thus SDU was the gateway to use for many drugs in an important proportion of users, who frequently consumed drugs that were free and had condomless anal sex with occasional and multiple partners. These circumstances were much more common for chemsex than for recreational drugs.

Sexual behavior and drug use impact in gay, bisexual, and other men who have sex with men

Background: The emergence of chemsex has raised several concerns about gay, bisexual, and other men who have sex with men's (GBMSM) health. In this study we aim to analyze illicit drugs and chemsex use, sexual behavior and sexually transmitted infections (STI) in GBMSM who attended to a sexual health clinic and to explore any potential association between drug use and STI.MethodsWe conducted an observational study between January and June 2019 among GBMSM population attending to a STI clinic in Barcelona, Spain. An anonymous self-administered questionnaire was given consecutively to all participants older than 18 years who accepted to participate.ResultsA total of 514 GBMSM (median age of 34 years-old) were included. The median number of sexual partners in the last year was 20. Seventy-one percent did not use condoms consistently for receptive anal intercourse. Drug abuse prevalence in the preceding year was 64.2%, and 26.5% of the individuals practiced chemsex. Gamma-hydroxibutyrate/gammabutyrolactone, poppers and methamphetamine were the most common drugs in chemsex. Chemsex was associated to group sex (OR 9.8 [95 CI: 4–24]), HIV infection (OR 2.5 [95 CI: 1.1–5.8]), taking pre-exposure prophylaxis (OR 3.2 [95 CI: 1.5–7.1]), developing gonorrhea (OR 3.7 [95 CI: 1.5–8.8]) or syphilis (OR 6.7 [95 CI: 2.4–18.7]).ConclusionsThe prevalence of drug use and chemsex was high among GBMSM in Barcelona. Chemsex was associated with group sex, taking PrEP, and contracting syphilis, gonorrhea, and HIV. (AU)

Antecedentes: El chemsex genera preocupaciones sobre la salud de gays, bisexuales y otros hombres que tienen sexo con hombres (GBHSH). En este estudio analizamos el uso de sustancias recreativas, chemsex, comportamiento sexual e infecciones de transmisión sexual (ITS) en GBHSH y exploramos cualquier asociación potencial entre el uso de drogas e ITS.MétodosEstudio observacional entre enero y junio de 2019 entre GBHSH atendidos en una clínica de ITS de Barcelona, España. Se entregó un cuestionario autoadministrado anónimo de forma consecutiva a todos los adultos que aceptaron participar.ResultadosSe incluyeron 514 GBHSH (edad mediana 34 años). La mediana del número de parejas sexuales en el último año fue de 20. El 71% no usó preservativo de manera consistente para el coito anal receptivo. La prevalencia de uso de drogas el año previo fue del 64,2% y el 26,5% de las personas practicó chemsex. Gamma-hidroxibutirato/gammabutirolactona, poppers y metanfetamina fueron las drogas más comunes en chemsex. El chemsex estuvo asociado a practicar sexo en grupo (OR 9,8 [IC 95%: 4-24]), infección por VIH (OR 2,5 [IC 95% 1,1-5,8]), profilaxis preexposición de VIH (PrEP) (OR 3,2 [IC 95% 1,5-7,1]), gonorrea (OR 3,7 [IC 95%: 1,5-8,8]) y sífilis (OR 6,7 [IC 95%: 2,4 - 18,7]).ConclusionesLa prevalencia de consumo de drogas y chemsex fue alta entre GBHSH en Barcelona. El chemsex se asoció con sexo en grupo, toma de PrEP e infección por sífilis, gonorrea y VIH. (AU)

Risky Sexual Practices, Sexually Transmitted Infections, Motivations, and Mental Health among Heterosexual Women and Men Who Practice Sexualized Drug Use in Spain.

Sexualized drug use (SDU) has been poorly studied among heterosexuals. The purpose of the present study was to analyze the prevalence of and gender differences in types of substances, risky sexual practices, sexually transmitted infections (STIs), motivations, and psychological adjustment among heterosexual women and men who engage in SDU. The study sample consisted of 1181 heterosexuals (795 women) between 18 and 78 years old (mean age = 24.4, SD = 7.4). Approximately 12% of the participants had engaged in SDU. No differences were found in the prevalence of SDU between men and women. Alcohol, cannabis, and 3,4-methylenedioxy-methamphetamine (MDMA) were the substances most frequently used for sexual purposes. Men were significantly more likely to use MDMA, ecstasy, cocaine, and erectile dysfunction (ED) drugs, and they tended to have more sexual partners than women. Likewise, SDU was related to have more sexual partners, penetrative sex without a condom, practice a fetish, be diagnosed with syphilis, chlamydia, and others STIs, and present more depression symptoms (but not with more anxiety). In conclusion, SDU was associated with poorer physical and mental health. It is, therefore, necessary to design programs aimed at reducing the incidence of the consequences of SDU on the physical and mental health of both men and women. Moreover, programs that seek to understand why these individuals engage in SDU should be undertaken.

Sexual behavior and drug use impact in gay, bisexual, and other men who have sex with men.

BACKGROUND: The emergence of chemsex has raised several concerns about gay, bisexual, and other men who have sex with men's (GBMSM) health. In this study we aim to analyze illicit drugs and chemsex use, sexual behavior and sexually transmitted infections (STI) in GBMSM who attended to a sexual health clinic and to explore any potential association between drug use and STI. METHODS: We conducted an observational study between January and June 2019 among GBMSM population attending to a STI clinic in Barcelona, Spain. An anonymous self-administered questionnaire was given consecutively to all participants older than 18 years who accepted to participate. RESULTS: A total of 514 GBMSM (median age of 34 years-old) were included. The median number of sexual partners in the last year was 20. Seventy-one percent did not use condoms consistently for receptive anal intercourse. Drug abuse prevalence in the preceding year was 64.2%, and 26.5% of the individuals practiced chemsex. Gamma-hydroxibutyrate/gammabutyrolactone, poppers and methamphetamine were the most common drugs in chemsex. Chemsex was associated to group sex (OR 9.8 [95 CI: 4-24]), HIV infection (OR 2.5 [95 CI: 1.1-5.8]), taking pre-exposure prophylaxis (OR 3.2 [95 CI: 1.5-7.1]), developing gonorrhea (OR 3.7 [95 CI: 1.5-8.8]) or syphilis (OR 6.7 [95 CI: 2.4-18.7]). CONCLUSIONS: The prevalence of drug use and chemsex was high among GBMSM in Barcelona. Chemsex was associated with group sex, taking PrEP, and contracting syphilis, gonorrhea, and HIV.

The 'Viennese epidemic' of acute HCV in the era of direct-acting antivirals.

The recently reported epidemic of acute hepatitis C virus (HCV) infections -observed predominantly among men who have sex with men (MSM)-may now decline due to wide availability of direct-acting antivirals (DAAs). This study aimed to investigate the current trends of acute hepatitis C in Vienna. Patients presenting with acute hepatitis C between 01/2007 and12/2020 at the Vienna General Hospital were retrospectively enrolled and followed after virologic clearance/eradication. The introduction of unrestricted DAA access after 09/17 defined the 'DAA era', as compared to the 'pre-DAA era' prior to 09/17. We identified 134 acute hepatitis C cases in 119 patients with a mean age of 39 ± 9 years at inclusion. The majority of patients were male (92%), HIV-positive (88%) and MSM (85%). In the DAA era, a history of prior chronic HCV infection at inclusion was found in 24% (11/46) compared to 7% (5/73) in the pre-DAA era (p = .012). The annual rate of acute hepatitis C cases increased in the DAA era (17.11 per year) compared to the pre-DAA era (7.76 per year). The DAA era included an AHC-genotype-2 cluster and more HIV-negative acute hepatitis C cases (0% (0/73) vs. 30% (14/46), p < .001). Patients were followed after spontaneous clearance or sustained virologic treatment response (SVR) for a total of 251.88 patient-years (median 1.39 years per patient). In the DAA era, we recorded 15 acute hepatitis C-reinfections - corresponding to an incidence rate of 5.96 (95% CI: 3.57-9.66) reinfections per 100-patient-years. We continue to observe a high incidence of acute hepatitis C in Vienna in the DAA era-primarily among HIV-positive MSM, but increasingly also in HIV-negative MSM.