Experiences of harm and mental ill-health among gay, bisexual and other men-who-have-sex-with-men who use methamphetamine or GHB/GBL in different combinations: findings from the COMeT study in Taiwan.

Polydrug use in the context of chemsex is commonplace among gay, bisexual, and other men-who-have-sex-with-men (GBMSM). This study aimed to examine the differences in experiences of physical, social, and psychological harms, as well as mental ill-health among GBMSM who use different combinations of methamphetamine and gamma-hydroxybutyric acid/gamma-butyrolactone (GHB/GBL) during chemsex. Adult GBMSM participants who had experience of chemsex in the past 12 months participated in a cross-sectional online survey in Taiwan and self-reported their sociodemographic background, sexual behaviours, mental health, and experiences of harm following a chemsex session. We used univariable and multivariable logistic regression to assess the different experiences of harm and mental ill-health among GBMSM who engaged in chemsex without using methamphetamine, used methamphetamine but not GHB/GBL, and who used both drugs. Out of 510 participants who completed all items included in the analysis, 24.1% engaged in chemsex without using methamphetamine, 36.9% used methamphetamine but not GHB/GBL, and 39.0% used both drugs. Eighty five percent of men who used both methamphetamine and GHB/GBL reported at least one kind of social harm after a chemsex session, such as missing dates or appointments, or appearing "high" at work, followed by used methamphetamine but not GHB/GBL (69.7%) and those without using methamphetamine (37.4%). After controlling for polydrug and frequency of drug use in the multivariable logistic regression, those who used methamphetamine but not GHB/GBL and those who used both drugs were more likely to report experiencing physical and psychological harms compared to those who did not use methamphetamine (p < 0.003). GBMSM who used both methamphetamine and GHB/GBL in a chemsex context were more likely to report experience of harms than those who only used a single chemsex drug or engaged in chemsex without methamphetamine or GHB/GBL. Harm reduction should focus on both preventing HIV and STI transmission and on minimising psychosocial harm to GBMSM, with varying impacts depending on drug use.

Hsu JH ，Huang P ，Li CW ，Bourne A ，Strong C ，Ku SW ... -  《Harm Reduction Journal》

"Chemsex" and harm reduction need among gay men in South London.

Chemsex is a colloquial term used by gay men in some parts of the UK to describe the use of psychoactive substances (typically mephedrone, GHB/GBL or crystal methamphetamine) during sex. Use of these drugs by gay men in London appears to have risen sharply from relatively low levels and, as yet, there is little data to inform appropriate harm reduction services. This study sought to understand the personal and social context of chemsex and the nature of harm reduction need. In-depth interviews were conducted with 30 self-identifying gay men (age range 21-53) who lived in three South London boroughs, and who had used either crystal methamphetamine, mephedrone or GHB/GBL either immediately before or during sex with another man during the previous 12 months. Data were subjected to a thematic analysis. While around half of participants had utilised a range of drugs over many years, others had only recently been introduced to drugs, often by sexual partners who wished to enhance the sexual session. As relatively new drugs on the gay scene, understanding of appropriate dosing was lacking and a majority described overdoses, particularly in relation to GHB/GBL. Negotiation of sex, especially in group sex environments, was complicated by the effects of the drugs and a small number of men reported concerns relating to sexual consent. While a significant proportion of men had experienced a range of physical and mental health harms, few had accessed professional support for fear of judgement or concern about chemsex expertise. Findings from this study indicate a substantial degree of harm in the usage of relatively new psychoactive substances in highly sexual circumstances. Generic drug services, typically designed to address the needs of opiate users, may not be sufficiently resourced to address the specific and acute needs of gay men engaging in chemsex.

Bourne A ，Reid D ，Hickson F ，Torres-Rueda S ，Steinberg P ，Weatherburn P ... -  《-》

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.

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. 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. 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. 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.

Hung YR ，Chuang TT ，Chen TW ，Chung AC ，Wu MT ，Hsu ST ，Ko NY ，Strong C ... -  《-》

Illicit drug use in sexual settings ('chemsex') and HIV/STI transmission risk behaviour among gay men in South London: findings from a qualitative study.

'Chemsex' is a colloquial term used in the UK that describes sex under the influence of psychoactive substances (typically crystal methamphetamine, mephedrone and gamma-hydroxybutyric acid (GHB)/gamma-butyrolactone (GBL)). Recently, concern has been raised as to the impact of such behaviour on HIV/sexually transmitted infection (STI) transmission risk behaviour, which this qualitative study aimed to explore via semistructured interviews with gay men living in three South London boroughs. Interviews were conducted with 30 community-recruited gay men (age range 21-53) who lived in the boroughs of Lambeth, Southwark and Lewisham, and who had used crystal methamphetamine, mephedrone or GHB/GBL either immediately before or during sex with another man during the previous 12 months. Data were subjected to a thematic analysis. Chemsex typically featured more partners and a longer duration than other forms of sex, and the relationship between drug use and HIV/STI transmission risk behaviour was varied. While some men believed that engaging in chemsex had unwittingly led them to take risks, others maintained strict personal rules about having safer sex. Among many participants with diagnosed HIV, there was little evidence that the use of drugs had significantly influenced their engagement in condomless anal intercourse (primarily with other men believed to be HIV positive), but their use had facilitated sex with more men and for longer. Analysis revealed that, within this sample, chemsex is never less risky than sex without drugs, and is sometimes more so. Targeted clinic-based and community-based harm reduction and sexual health interventions are required to address the prevention needs of gay men combining psychoactive substances with sex.

Bourne A ，Reid D ，Hickson F ，Torres-Rueda S ，Weatherburn P ... -  《-》

Cross-sectional analysis of chemsex drug use and gonorrhoea diagnosis among men who have sex with men in the UK.

Kohli M ，Hickson F ，Free C ，Reid D ，Weatherburn P ... -  《-》