Sexualized drug use (‘chemsex’) and high‐risk sexual behaviours in <scp>HIV</scp>‐positive men who have sex with men

<jats:sec><jats:title>Objectives</jats:title><jats:p>The incidence of sexually transmitted infections (<jats:styled-content style="fixed-case">STI</jats:styled-content>s) and <jats:styled-content style="fixed-case">HIV</jats:styled-content> infection remains high in gay, bisexual, and other men who have sex with men (<jats:styled-content style="fixed-case">MSM</jats:styled-content>) in the <jats:styled-content style="fixed-case">UK</jats:styled-content>, and sexualized drug use (“chemsex”) and injecting drug use (“slamsex”) may play a part in this. We aimed to characterize <jats:styled-content style="fixed-case">HIV</jats:styled-content>‐positive <jats:styled-content style="fixed-case">MSM</jats:styled-content> engaging in chemsex/slamsex and to assess the associations with self‐reported <jats:styled-content style="fixed-case">STI</jats:styled-content> diagnoses and sexual behaviours.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Data from a 2014 survey of people attending <jats:styled-content style="fixed-case">HIV</jats:styled-content> clinics in England and Wales were linked to clinical data from national <jats:styled-content style="fixed-case">HIV</jats:styled-content> surveillance records and weighted to be nationally representative. Multivariable logistic regression assessed the associations of chemsex and slamsex with self‐reported unprotected anal intercourse (<jats:styled-content style="fixed-case">UAI</jats:styled-content>), serodiscordant <jats:styled-content style="fixed-case">UAI</jats:styled-content> (sd<jats:styled-content style="fixed-case">UAI</jats:styled-content>) (i.e. <jats:styled-content style="fixed-case">UAI</jats:styled-content> with an <jats:styled-content style="fixed-case">HIV</jats:styled-content>‐negative or unknown <jats:styled-content style="fixed-case">HIV</jats:styled-content> status partner), sd<jats:styled-content style="fixed-case">UAI</jats:styled-content> with a detectable viral load (>50 <jats:styled-content style="fixed-case">HIV</jats:styled-content>‐1 <jats:styled-content style="fixed-case">RNA</jats:styled-content> copies/<jats:styled-content style="fixed-case">mL</jats:styled-content>), hepatitis C, and bacterial <jats:styled-content style="fixed-case">STI</jats:styled-content>s.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>In the previous year, 29.5% of 392 sexually active participants engaged in chemsex, and 10.1% in slamsex. Chemsex was significantly associated with increased odds of <jats:styled-content style="fixed-case">UAI</jats:styled-content> [adjusted odds ratio (<jats:styled-content style="fixed-case">AOR</jats:styled-content>) 5.73; <jats:italic>P </jats:italic><<jats:italic> </jats:italic>0.001], sd<jats:styled-content style="fixed-case">UAI</jats:styled-content> (<jats:styled-content style="fixed-case">AOR</jats:styled-content> 2.34; <jats:italic>P </jats:italic><<jats:italic> </jats:italic>0.05), sd<jats:styled-content style="fixed-case">UAI</jats:styled-content> with a detectable viral load (<jats:styled-content style="fixed-case">AOR</jats:styled-content> 3.86; <jats:italic>P </jats:italic><<jats:italic> </jats:italic>0.01), hepatitis C (<jats:styled-content style="fixed-case">AOR</jats:styled-content> 6.58; <jats:italic>P </jats:italic><<jats:italic> </jats:italic>0.01), and bacterial <jats:styled-content style="fixed-case">STI</jats:styled-content> diagnosis (<jats:styled-content style="fixed-case">AOR</jats:styled-content> 2.65; <jats:italic>P </jats:italic><<jats:italic> </jats:italic>0.01). Slamsex was associated with increased odds of <jats:styled-content style="fixed-case">UAI</jats:styled-content> (<jats:styled-content style="fixed-case">AOR</jats:styled-content> 6.11; <jats:italic>P </jats:italic><<jats:italic> </jats:italic>0.05), hepatitis C (<jats:styled-content style="fixed-case">AOR</jats:styled-content> 9.39; <jats:italic>P </jats:italic><<jats:italic> </jats:italic>0.001), and bacterial <jats:styled-content style="fixed-case">STI</jats:styled-content> diagnosis (<jats:styled-content style="fixed-case">AOR</jats:styled-content> 6.11; <jats:italic>P </jats:italic><<jats:italic> </jats:italic>0.001).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Three in ten sexually active <jats:styled-content style="fixed-case">HIV</jats:styled-content>‐positive <jats:styled-content style="fixed-case">MSM</jats:styled-content> engaged in chemsex in the past year, which was positively associated with self‐reported depression/anxiety, smoking, nonsexual drug use, risky sexual behaviours, <jats:styled-content style="fixed-case">STI</jats:styled-content>s, and hepatitis C. Chemsex may therefore play a role in the ongoing <jats:styled-content style="fixed-case">HIV</jats:styled-content> and <jats:styled-content style="fixed-case">STI</jats:styled-content> epidemics in the <jats:styled-content style="fixed-case">UK</jats:styled-content>.</jats:p></jats:sec>