Is on-Demand HIV Pre-exposure Prophylaxis a Suitable Tool for Men Who Have Sex With Men Who Practice Chemsex? Results From a Substudy of the ANRS-IPERGAY Trial

Roux, Perrine; Fressard, Lisa; Suzan‐Monti, Marie; Chas, Julie; Sagaon-Teyssier, Luis; Capitant, Catherine; Meyer, Laurence; Tremblay, Cécile; Castro, Daniela Rojas; Pialoux, Gilles; Molina, Jean‐Michel; Spire, Bruno

doi:10.1097/qai.0000000000001781

Cited by 41 publications

(36 citation statements)

References 41 publications

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“…In PROUD, 44% (231/525) of participants reported using any of the three drugs most commonly associated with chemsex in the three months prior to enrolment [ 12 ]. In the IPERGAY study in France, 29% (95/331) of participants reported chemsex and interestingly chemsex users were twice as likely to use PrEP the last time they had sex than non-users [ 25 ]. Evidence from both trials, and from a recent evaluation of PrEP use among chemsex users in Australia, suggests that MSM engaging in chemsex are incorporating PrEP into their sexual practice [ 26 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

The Context of Sexual Risk Behaviour Among Men Who Have Sex with Men Seeking PrEP, and the Impact of PrEP on Sexual Behaviour

Gafos

Horne

Nutland³

et al. 2018

AIDS Behav

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There are still important gaps in our understanding of how people will incorporate PrEP into their existing HIV prevention strategies. In this paper, we explore how PrEP use impacted existing sexual risk behaviours and risk reduction strategies using qualitative data from the PROUD study. From February 2014 to January 2016, we conducted 41 in-depth interviews with gay, bisexual and other men who have sex with men (GBMSM) enrolled in the PROUD PrEP study at sexual health clinics in England. The interviews were conducted in English and were audio-recorded. The recordings were transcribed, coded and analysed using framework analysis. In the interviews, we explored participants’ sexual behaviour before joining the study and among those using or who had used PrEP, changes to sexual behaviour after starting PrEP. Participants described the risk behaviour and management strategies before using PrEP, which included irregular condom use, sero-sorting, and strategic positioning. Participants described their sexual risk taking before initiating PrEP in the context of the sexualised use of drugs, geographical spaces linked with higher risk sexual norms, and digitised sexual networking, as well as problematic psychological factors that exacerbated risk taking. The findings highlight that in the main, individuals who were already having frequent condomless sex, added PrEP to the existing range of risk management strategies, influencing the boundaries of the ‘rules’ for some but not all. While approximately half the participants reduced other risk reduction strategies after starting PrEP, the other half did not alter their behaviours. PrEP provided an additional HIV prevention option to a cohort of GBMSM at high risk of HIV due to inconsistent use of other prevention options. In summary, PrEP provides a critical and necessary additional HIV prevention option that individuals can add to existing strategies in order to enhance protection, at least from HIV. As a daily pill, PrEP offers protection in the context of the sex cultures associated with sexualised drug use, digitised sexual applications and shifting social norms around sexual fulfilment and risk taking. PrEP can offer short or longer-term options for individuals as their sexual desires change over their life course offering protection from HIV during periods of heightened risk. PrEP should not be perceived or positioned in opposition to the existing HIV prevention toolkit, but rather as additive and as a tool that can and is having a substantial impact on HIV.

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Section: Discussionmentioning

confidence: 99%

The Context of Sexual Risk Behaviour Among Men Who Have Sex with Men Seeking PrEP, and the Impact of PrEP on Sexual Behaviour

Gafos

Horne

Nutland³

et al. 2018

AIDS Behav

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“…Conversely, the same research also suggested that on average “club drug” users were no more likely to miss PrEP doses than non “club drugs” users (Grov, Rendina, John, & Parsons, 2018), and in another study among American GBM, methamphetamine use was shown not to be associated with decreased PrEP adherence (Hoenigl et al., 2019, Hoenigl et al, 2019). Interestingly, in an IPERGAY trial substudy, GBM reporting chemsex were more likely to report correct PrEP use during their most recent sexual encounter, which authors have explained by their additional finding that participants reporting chemsex also reported having a higher risk perception (Roux et al., 2018).…”

Section: Introductionmentioning

confidence: 99%

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

O’Halloran

Rice

White

et al. 2019

International Journal of Drug Policy

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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.

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“…8 In addition, a study based in France on episodic PrEP use highlighted that 30% of the sample had been under the influence of psychoactive substances during sex. 9 This study also reported that the correct use of PrEP was associated with periods when sample members were under the influence of psychoactive drugs during sex. 9 PrEP's effectiveness is dependent on medication adherence, but this study could not examine this area as these data were not collated.…”

Section: Discussionmentioning

confidence: 72%

“… 9 This study also reported that the correct use of PrEP was associated with periods when sample members were under the influence of psychoactive drugs during sex. 9 …”

Section: Discussionmentioning

confidence: 72%

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

Maxwell

Gafos

Moncrieff³

et al. 2020

Int J STD AIDS

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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.

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Is on-Demand HIV Pre-exposure Prophylaxis a Suitable Tool for Men Who Have Sex With Men Who Practice Chemsex? Results From a Substudy of the ANRS-IPERGAY Trial

Cited by 41 publications

References 41 publications

The Context of Sexual Risk Behaviour Among Men Who Have Sex with Men Seeking PrEP, and the Impact of PrEP on Sexual Behaviour

The Context of Sexual Risk Behaviour Among Men Who Have Sex with Men Seeking PrEP, and the Impact of PrEP on Sexual Behaviour

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

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

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