Chemsex is not a barrier to self-reported daily PrEP adherence among PROUD study participants

Abstract

BackgroundPre-exposure prophylaxis (PrEP) is a novel HIV prevention method whereby HIV-negative individuals take the drugs tenofovir and emtricitabine to prevent HIV acquisition. Optimal adherence is critical for PrEP efficacy. Chemsex describes sexual activity under the influence of psychoactive drugs, in the UK typically; crystal methamphetamine, gamma-hydroxybutyrate(GHB) and/or mephedrone. Chemsex drug use has been associated with increased HIV transmission risk among gay, bisexual and other men who have sex with men (GBM) and poor ART adherence among people living with HIV. This study assessed whether self-reported chemsex events affected self-reported daily PrEP adherence among PROUD study participants.MethodsThe PROUD study was an open-label, randomised controlled trial, conducted in thirteen English sexual health clinics, assessing effectiveness of TruvadaⓇ-PrEP among 544 HIV-negative GBM. The study reported an 86% risk-reduction of HIV from daily PrEP. Participants were asked about chemsex engagement at follow-up visits. Monthly self-reports of missed PrEP tablets were aggregated to assess adherence between visits. Univariable and multivariable regression analyses were performed to test for associations between chemsex and reporting less than seven out of seven intended doses(<7/7ID) in the 7 days before and/or after last condomless anal intercourse(CAI).Results1479 follow-up visit forms and 2260 monthly adherence forms from 388 participants were included in the analyses, with 38.5% visit forms reporting chemsex since last visit and 29.9% follow-up periods reporting <7/7ID. No statistically significant associations were observed between reporting <7/7ID and chemsex (aOR=1.29 [95% CI 0.90–1.87], p = 0.168). Statistically significant associations were seen between reporting <7/7ID and participants perceiving that they would miss PrEP doses during the trial, Asian ethnicity, and reporting unemployment at baseline.ConclusionsThese analyses suggest PrEP remains a feasible and effective HIV prevention method for GBM engaging in chemsex, a practise which is prevalent in this group and has been associated with increased HIV transmission risk.

Missed opportunities to prevent HIV infections among pre‐exposure prophylaxis users: a population‐based mixed methods study, San Francisco, United States

“…Additional resources for treatment of substance use disorder are needed within PrEP clinics and primary care settings, such as counselling, social workers, providers who can prescribe buprenorphine for opioid use disorder, harm reduction education, referral to syringe exchange programmes, and naloxone distribution. Although novel interventions for stimulant use disorder are needed, it should be noted that with sufficient support, stimulant users can achieve high PrEP adherence [27‐29]. One participant specifically requested that mental health services be co‐located within primary care clinics that offer PrEP [30].…”

Prática de chemsex entre homens que fazem sexo com homens (HSH) durante período de isolamento social por COVID-19: pesquisa online multicêntrica

“…A recent survey found that Brazilian and Portuguese MSM experience difficulty in remaining socially isolated, since 53% reported engaging in casual sex during social distancing, despite the growing risk of acquiring SARS-CoV-2, the cause of COVID-19. They also reported increased consumption of alcohol and other drugs 3,4 , sometimes associated with sex, thus chemsex 5,6 , or sexual practice under the influence of drugs and chemical substances. Widely reported among MSM 7 before the pandemic, this practice has the purpose of prolonging and enhancing pleasure from the sex act.…”

Pre-exposure prophylaxis use among men who have sex with men who have experienced problematic chemsex

“… 7 One analysis of data from a UK PrEP effectiveness trial reported that there was no association between self-reported adherence and chemsex. 11 However, purposive research is required to explore the biopsychosocial factors which influence PrEP medication adherence among MSM chemsex participants.…”