Chemsex behaviours among men who have sex with men: A systematic review of the literature

Abstract

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.

Methamphetamine Use and Sexual Risk Behaviors among Men Who Have Sex With Men in a Mexico‐US Border City

“…18 These parties are becoming very popular in gay culture because it facilitates the interaction with other MSM and often lowers inhibition for esoteric sex (eg, fisting) that can increase the risk for HIV and other STIs. 18 In a cross-sectional study among 388 MSM in San Francisco in 2001, 15% used meth before or during their most recent unprotected insertive anal sex encounter. 16 Men who use meth during sexual activities have more sexual partners with whom they engage in unprotected anal sex as the receptive partner as well as higher frequency of unprotected oral sex.…”

“…MSM who report having four or more male sex partners are 1.58 (95% CI: 1.06, 2.36) times more likely to contract HIV in comparison with MSM who reported fewer partners . A recent systematic review found that chem sex parties (also known as party and play or PnP) are popular events where meth and other drugs are used and abused . These parties are becoming very popular in gay culture because it facilitates the interaction with other MSM and often lowers inhibition for esoteric sex (eg, fisting) that can increase the risk for HIV and other STIs .…”

Uptake and willingness to use PrEP among Chinese gay, bisexual and other men who have sex with men with experience of sexualized drug use in the past year

“…The rates were slightly lower in Asia, ranged from 28% in mainland China, 18% in Thailand, 14% in Vietnam, to 7% in Malaysia (14). Worldwide, the prevalence of chemsex ranged from 3% to 35% among GBMSM (7,13,15). A recent study reported that 12% of GBMSM in Hong Kong had SDU in the past six months (excluding the use of amyl nitrite alone) (16).…”

“…In line with numerous published studies, psychoactive substances were defined as the following: 1) ketamine, 2) methamphetamine, 3) cocaine, 4) cannabis, 5) ecstasy, 6) Dormicum/Halcion/Erimin 5/non-prescription hypnotic drugs, 7) heroin, 8) cough suppressant (not for curing cough), 9) amyl nitrite (popper), 10) GHB/GBL (γ-hydroxybutyrate), 11) 5-methoxy-N, Ndiisopropyltryptamine (Foxy), and 12) mephedrone (5)(6)(7). Sexualized drug use (SDU) refers to the use of any of the abovementioned psychoactive substances before/during sexual intercourse (8).…”

“…Chemsex is considered as a subset of SDU, which is commonly defined as the use of some specific psychoactive substances (methamphetamine, mephedrone, γ-hydroxybutyrate (GHB/GBL), ketamine and cocaine) before/during sexual intercourse (5)(6)(7). These psychoactive substances were mainly used to facilitate, initiate, prolong, sustain and intensify sexual encounter (8,9).…”