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Background‘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.MethodsInterviews 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.ResultsChemsex 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.ConclusionsAnalysis 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.

ObjectivesThere is considerable public health concern about the combining of sex and illicit drugs (chemsex) among gay men. With a view to inform supportive therapeutic and clinical interventions, we sought to examine the motivations for engaging in chemsex among gay men living in South London.MethodsCommunity advertising recruited 30 gay men for qualitative semi-structured interview. Aged between 21 and 53 years, all lived in South London in the boroughs of Lambeth, Southwark and Lewisham and all had combined crystal methamphetamine, mephedrone and/or γ-hydroxybutyric acid/γ-butyrolactone with sex in the past 12 months. Transcripts were subjected to a thematic analysis.ResultsWe broadly distinguished two groups of reasons for combining sex and drugs, within which we described eight distinct motivations. The first major group of motivations for combining drugs with sex was that drugs provide the means by which men can have the sex they desire by increasing libido, confidence, disinhibition and stamina. The second major group of motivations for chemsex was that drugs enhance the qualities of the sex that men value. Drugs made other men seem more attractive, increased physical sensations, intensified perceptions of intimacy and facilitated a sense of sexual adventure.ConclusionAnalysis revealed that sexualised drug use provides both motivation and capability to engage in the kinds of sex that some gay men value: sex that explores and celebrates adventurism. Those services providing (talking) interventions to men engaging in chemsex should consider these benefits of sexualised drug use alongside the harms arising.

Results of a community HIV testing pilot (fasTest) targeting men who have sex with men (MSM) in Brighton are reported and service users are compared with those testing in genitourinary medicine (GUM) clinics. FasTest offers rapid HIV testing in a weekly evening drop-in session staffed by GUM professionals in a community organisation. It was prospectively evaluated from November 2004 to March 2006 using a self-completed paper questionnaire assessing demographics, previous use of GUM, HIV testing history and sexual behaviour. Follow-up through GUM/HIV services was monitored. A simplified questionnaire was completed by MSM accessing the GUM clinic over the same time period. Men were included in the analysis if they identified as gay or bisexual or had recent sex with a man, tested for HIV and received a result. In both the fastest and GUM groups, men reported high rates of unprotected anal sex in the last 3 months. fasTest clients were significantly younger and less likely to test positive for HIV. This difference was independent of age and HIV testing history. There was no difference in rates of recent infection between the two. We conclude that community HIV testing is feasible and reaches the target group of high risk MSM.

Objectives:The INSIGHT case-control study confirmed that HIV serodiscordant unprotected anal intercourse (SdUAI) remains the primary risk factor for HIV infection in gay men in England. This paper uses qualitative follow-up data to examine the contexts of SdUAI and other risk factors among the case-control study participants.Methods:In-depth interviews were conducted with 26 recent HIV seroconverters and 22 non-converters. Purposive selection was used to provide diversity in demographics and sexual behaviour and to facilitate exploration of risk factors identified in the case-control study.Results:Condoms were perceived as barriers to intimacy, trust and spontaneity. The potential consequences of the loss of these were traded off against the consequences of HIV infection. Previous negative HIV tests and the adoption of risk reduction strategies diminished the perceived threat of HIV infection, supporting beliefs that HIV was something that happened to others. Depression and low self-esteem, often combined with use of alcohol or other drugs, led to further risk taking and loss of control over risk reduction strategies.Conclusions:A range of psychosocial reasons led some men to engage in UAI with serodiscordant or unknown partners, despite high levels of risk awareness. Men in their mid-life, those in serodiscordant relationships and men that had experienced bereavement or other significant, negative, life events revealed factors related to these circumstances that contributed to increases in risky UAI. A diverse portfolio of interventions is required to build confidence and control over safer sex practices that are responsive to gay men’s wider emotional needs.

BackgroundAnalyses of drug use in men who have sex with men (MSM) have exclusively focused on examining individual drugs in isolation, and have not examined how different drug use patterns in combination are associated with socio-sexual variables. Understanding these patterns is important in targeting HIV prevention and harm reduction interventions and in developing a fuller picture of drug use patterns in context. We use latent class analysis to develop a typology of recent drug use in MSM, and to explore how the distribution of MSM across latent classes differs by HIV testing history and sexual risk.MethodsWe used data from the 2014 Gay Men’s Sex Survey, an online community-based survey of MSM in the UK conducted in summer 2014. MSM aged 16 and above and resident in the UK were recruited via a variety of online dating sites and community email bulletins. We constructed a latent class model with manifest indicators corresponding to last year use of: poppers, erectile dysfunction medications, tranquilisers, cannabis, ecstasy, speed, mephedrone, GHB, ketamine, crystal meth and cocaine. We tested associations between HIV testing history and number/type of non-steady sexual partners, and membership in each drug use class.ResultsWe judged a five-class model to be optimal, with scaled relative entropy of 79.3%. The classes described were ‘minimal users’ (64.2% of respondents), ‘low-threshold users’ (14.0%) who mostly used poppers and erectile dysfunction medications, ‘old-skool users’ (cocaine/ecstasy/poppers) (14.0%), ‘new psychoactive substance (NPS) users’ (3.1%) with high rates of mephedrone, GHB and crystal meth, and ‘polydrug users’ (4.7%) with high probabilities of use across all drugs. MSM with multiple non-steady partners in the last year were about twenty times as likely to belong to the class of NPS users and more than seven times as likely to belong to the class of diverse users as compared to MSM with no non-steady partners; similarly, MSM who reported being HIV positive were more than six times as likely to belong to the class of diverse users as MSM whose last test was negative.DiscussionWhile much attention has been paid to chemsex among MSM, this analysis indicates that men using drugs associated with chemsex are in the minority, and encourages reflection on how harm reduction and HIV prevention services are addressing the needs of men whose drug use clusters differently. This latent class model, like all analyses of its kind, is tentative and should be revisited as drug use changes over time.

BackgroundCrystal methamphetamine (‘meth’) use by men who have sex with men (MSM) is an ongoing public health issue in the UK. Concern has increased with the emergence of ‘chemsex’ in the last five years (combining of drugs with sex). Understanding the characteristics of MSM using meth is important to develop targeted harm reduction and HIV prevention interventions. However, the last study to examine the demographic and socio-sexual risk factors for meth use in national samples used data from 2007.MethodsWe used data from the 2014 Gay Men’s Sex Survey, an online community-based survey of MSM in the UK conducted in summer 2014. MSM aged 16 and above and resident in the UK were recruited via a variety of online dating sites and community email bulletins. We used logistic regression to relate socio-sexual and demographic risk factors to last-year use of meth. Each variable was entered into a univariate model before a multivariate model was estimated with all risk factors.ResultsOf the 16,565 MSM contributing to the analysis sample, 4.5% (n = 747) reported last-year meth use. In univariate models, compared with those aged 20–29 years, men aged 30–39 years of age (OR 2.24, 95% CI [1.84, 2.72]) or 40–49 years of age (2.21, [1.80, 2.72]) were more likely to use meth. Compared to MSM who lived in London, MSM in the Midlands and East of England (0.17, [0.13, 0.21]) and in the North of England (0.17, [0.13, 0.22]) were less likely to have used meth. MSM whose last HIV test was positive were more likely (7.37, [6.28, 8.65]) than MSM whose last test was negative to have used meth. Odds of meth use increased with the number of non-steady sexual partners with whom unprotected anal intercourse occurred; MSM with two or more such partners were more likely to have used meth (13.83, [10.30, 18.58]) compared to those with no non-steady partners in the last year.DiscussionThe use of meth may have risen faster in London than elsewhere, contrasting findings from previous surveys. Future research should continue to investigate patterns of use, including distinguishing between occasional or episodic use and drug use that may be problematic. This cross-sectional, community-based sample may reflect higher risk than the general population of MSM, though it is difficult to establish a sampling frame for this population and longitudinal studies may better highlight temporal relationships between drug use, sexual risk and possible harms.

Existing reviews suggest some sexually transmitted infections (STIs) are risk factors in heterosexual HIV transmission. This may not be so in homosexual HIV transmission, about which reviews make no specific conclusions. This paper reviews published studies which report on the relative risk of STIs in HIV seroconversion in homosexually-active men in order to examine this matter. Papers obtained via various searches were judged adequate if they were prospective cohort or cohort-nested case-control studies; used HIV seroconversion as the outcome; assessed STI exposure objectively; and controlled for potential confounding from age and sexual behaviour. Sixteen papers were obtained, of these 3 were judged adequate. Adequate papers reported little association. Inadequate papers were more likely to report association. Evidence from adequate studies does not suggest STIs are risk factors in homosexual HIV transmission. Some caution is needed in interpreting the results because of the paucity of adequate studies.