Background: 'Chemsex' is the use of drugs before or during planned sexual events to facilitate, enhance, prolong and sustain the experience. Drugs associated with chemsex are methamphetamine, GHB/GBL, mephedrone, cocaine and ketamine. This review syntheses published research on the antecedents, behaviours and consequences associated with chemsex behaviours among men who have sex with men (MSM). Methods: Papers from high income countries which were published between January 2000 and September 2018 reporting the use of chemsex drugs before or during sex were identified through Medline, Web of Science, CINAHL and Central. Results were synthesised using a narrative approach and conceptualised using a behavioural analysis framework. Results: The search identified 2492 publications, of which 38 were included in the final synthesis. There were wide variations in chemsex prevalence estimates due to the heterogeneous sampling in the studies. Chemsex participants have expectations that the drugs will positively affect their sexual encounters and HIV positive MSM are more likely to engage in the behaviour than HIV negative MSM. There were wide ranging prevalence estimates on injecting drugs for sexual purposes and the sharing of injecting equipment with some evidence of unsafe injecting practices. Participants were more likely to engage in condomless anal intercourse than men who do not engage in chemsex. This may increase the risk of transmission for HIV and other sexually transmitted infections. Conclusion: A minority of MSM appear to engage in chemsex behaviours but they are at risk of this negatively impacting on their health and well-being. Further research is required to examine high risk chemsex behaviours, impact of chemsex on psychosocial well-being and if chemsex influences uptake of PrEP, PEP and sexual health screening.

The appropriate use of pre-exposure prophylaxis (PrEP) by men who have sex with men (MSM) can be highly effective at reducing HIV transmission. Our review examined prevalence estimates, sexual behaviors, and medication adherence among MSM PrEP users in high-income countries. Papers published between January 2008 and December 2018 were identified through Medline, Web of Science, CINAHL, and Central. The search identified 643 publications, of which 52 were included in the final synthesis. We found that PrEP initiation was not consistently associated with significant changes in sexual behavior, but some users may have risk compensated. A minority of MSM used PrEP and they had high levels of adherence. PrEP-related stigma, side effects, and psychosocial factors lead to nonadherence. A daily routine, pill boxes, alarms/texts, and education can promote adherence. Further research is required to examine PrEP impact on sexual behavior and factors that influence adherence in high-risk MSM sub-populations.

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Men who have sex with men (MSM) who experience problematic chemsex are at high risk of acquiring HIV due to combined drug use and sexual behaviours. Pre-exposure prophylaxis (PrEP) could substantially reduce the risk of HIV transmission in this group of men. The aim of this study was to examine the biopsychosocial characteristics associated with PrEP use among HIV-negative MSM who have experienced problematic chemsex. This was a cross-sectional analysis of secondary data collected during client assessments at a specialist alcohol and drug service based within the United Kingdom. We compared the socio-demographics, substance use, sexual behaviours and mental health of MSM who reported ever using PrEP to those who reported never using PrEP. Statistical analysis was conducted using the Mann–Whitney U-test for continuous variables and Fisher’s exact test for categorical variables. Between August 2016 and July 2018, 165 HIV-negative MSM who engaged in chemsex had an assessment completed. Thirty-four per cent (n = 50/145) had ever used PrEP. The median age was 36 years (IQR: 30–42), 92% identified as gay (n = 152/165) and 79% were of white ethnicity (n = 130/164). The use of crystal methamphetamine was associated with higher levels of men ever using PrEP (40% versus 21%) (p= 0.047). Men who had ever used PrEP had a higher median number of sexual partners in the previous three months (20 versus 10) (p= 0.004) and had lower level of condom use in their sex lives (median reported 5% versus 50%) (p= 0.010) in comparison to men who had never used PrEP. It is encouraging that men having higher-risk sex had been accessing PrEP. However, further research is required to explore PrEP uptake, retention and adherence in this high-risk group.

SUMMARY Disability rates among low‐birthweight infants, particularly those related to congenital abnormality and cerebral palsy, are high. Both prenatal and perinatal factors are likely to be involved in the aetiology of most types of disability. IQ tends to be lower among low‐birthweight infants, but does not appear to be closely related to birthweight alone. The confounding effect of social class should be considered when assessing aetiology and outcome. The long‐term outcome for the increasing number of low‐birthweight infants who survive and receive intensive neonatal care requires to be continually assessed; however, studies should not be confined to the very‐ and extremely‐low‐birthweight infant requiring prolonged intensive care, but should include abortions, stillbirths and neonatal deaths. As disability in survivors can relate to preterm birth but not perinatal complications, all low‐birthweight infants require to be studied if selective bias is to be solved. RÉSUMÉ Étude du devenir sur 10 ans des accidents de grossesse Les taux d'incapacités chez les nourrissons de faible poids de naissance, particulièrement pour celles qui sont liées à une malformation congénitale ou une IMC, sont élevés. Des facteurs à la fois prénataux et périnataux sont probablement impliqués dans l'étiologie de la plupart des incapacityés. Le QI tend àêtre plus bas chez les nourrissons de faible poids de naissance, mais cela ne semble pas lie uniquement au poids de naissance. Les effets surajoutes de classe sociale doivent être pris en compte lorsque l'étiologie et le devenir sont analysés. Le devenir à long terme d'un nombre croissant de nourrissons de faible poids de naissance qui survivent et bénéficient de soins intensifs péri‐nataux doivent être continuellement évalués; cependant les études ne devraient pas se restreindre aux nourrissons de très faible et extrêmement faible poids de naissance ayant exigé des soins intensifs prolongés mais devraient inclure les avortement, les morts‐nés et les décès péri‐nataux. Comme l'incapacité chez les survivants peut être reliée à la naissance prématurée et non aux complications périnatales, tous les nourrissons de faible poids de naissance doivent être pris en compte si on vent éviter un biais par sélection de cas. ZUSAMMENFASSUNG Eine 10‐Jahres Studie uber rezidivierende Schwangerschaftsprobleme Die Behinderungsraten bei Kindern mit niedrigen Geburtsgewicht, besonders solche, die auf congenitalen Anomalien und Cerebralparese beruhen, sind hoch. Sowohl pränatale, als auch perinatale Faktoren spielen wahrscheinlich für die Aetiologie der meisten Behinderungsarten eine Rolle. Der IQ ist bei hypotrophen Kindern eher niedriger, scheint aber nicht nur mit dem Geburtsgewicht zusammenzuhängen. Der Einfluß der sozialen Schicht sollte bei der Beurteilung von Aetiologie und Outcome berücksichtigt werden. Der Langzeit Outcome für die zunehmende Zahl der hypotrophen Kinder, die überleben und intensivmedizinisch versorgt werden, erfordert eine kontinuierliche Überwachung; jedoch sollten die Untersuchu...