Transcript Chemsex use among MSM attending a sexual health clinic in Dublin

Chemsex use among MSM attending a
sexual health clinic in Dublin
Dr. Ronan Glynn
SPR Public Health Medicine
Dr. Steevens’ Hospital
SSSTDI Autumn Meeting
2016
Background – Increasing burden STIs in MSM
HIV
↑ 300%
Gonorrhoea
↑60%
Syphilis
↑53%
Similar
internationally
Recreational drug use among MSM
MSM Internet Survey (MISI), 2015
36% within previous 12 months
Chemsex
Direct Drug-Related Harms
• Dependency
• Psychoses
• Overdose
• Death
“The of
use
recreational
drugs for or during sex”
Transmission
STIsof
and
HIV
meth,
G, Ketamine,
Mephedrone,
Cocaine,in
Ecstasy)
Use of G in (Crystal
chemsex
implicated
in small
outbreakNPS,
of Shigella
UK
Those engaging in chemsex more likely
 To have been diagnosed with an STI
 To participate in high risk sexual behaviours
Gilbart el, 2013; Hegazi et al., 2016
Aims & Objectives
Aim
To assess the prevalence of chemsex among attendees at Ireland’s only dedicated
sexual health clinic for MSM
Objectives
• Investigate the association between chemsex &
• direct drug-related harms
• sexual risk behaviours
• self-reported history of STIs and HIV
• Inform health and social care professionals about changing patterns in drug use and
risk behaviour within the MSM community
• Advise on the need for the provision of drug support and addiction services within
sexual health services for MSM
Methods
Convenience Sampling
All attendees at GMHS over 6 weeks, June-July 2016
invited to participate
Paper Based Questionnaire
Information leaflet
English & Portuguese
Anonymous Data Collection
28 Questions
• demographic history
• sexuality
• sexual practice
• STI history
• alcohol consumption
• chemsex use
Ethics Approval
St. James/AMNCH REC
Response Rate
568
questionnaires
distributed
510 Returned
Response Rate
89.7%
486 included in
analysis
24 excluded
Inadequate info re chemsex
Heterosexual & no history of
sexual contact with a man
Failure to tick consent box
Results
Demographics
• Median age 29 years (range 18-77)
• 60% aged between 25 and 39 years
• 65% had a university degree or higher education
• 58% born in Ireland
Sexuality
• 90% identified as gay/homosexual
• 68% were single
Chemsex
27% had engaged in “chemsex” – had used ≥ 1 of crystal meth, G, ketamine,
mephedrone, NPS, cocaine, ecstasy or other stimulants for/during sex
More common in 25-39 yr olds (31%) vs. those in the 18-24 and 40+ age groups
(20%)
No other significant differences by socio-demographic variables
56% had met
their partners
for chemsex
through phone
apps or online
34% - Gay café/bar
Types of drugs used for chemsex
G was the most commonly used drug for chemsex
70
60
57
50
% of those 40
engaging in
chemsex 30
20
10
0
Drug used
Direct Drug-Related Harms
Polydrug use
Half of respondents had used ≥2 drugs the last time they
had chemsex
Injecting drug use
9% of those engaging in chemsex had ever injected
drugs for chemsex
Loss of consciousness
23% of respondents/their partners had ever lost
consciousness as a result of chemsex
Sexual risk behaviours associated with chemsex
Multiple Sexual Partners
1 in 3 had >10 sexual partners within previous 12
months
Chemsex: 2.4 times more likely to have had >10 sexual
partners within the previous 12 months (p<0.001)
Multiple Partners for Anal Sex
1 in 5 had anal sex with >10 partners within previous
12 months
Chemsex: 2 times more likely to have had >10 sexual
partners within the previous 12 months (p<0.001)
Unprotected Anal Sex
1 in 3 did not use a condom at last anal sex
Chemsex: 1.4 times more likely to have engaged in UAI at last anal intercourse
(p=0.041)
Chemsex, STIs and HIV – Ever diagnosed
*
71%
*
56%
*
*
Have you EVER been diagnosed with …
Chemsex, STIs and HIV – Treated within past 12 months
48%
33%
*
*
*
*
Have you EVER been diagnosed with …
Chemsex, STIs and HIV
Predictor variables
Ever
Diagnosed
Treated last 12
months
Age group


Level of Education


Country of Birth


Frequency of binge alcohol consumption


No. sexual contacts last 12 months


No. anal sexual contacts last 12 months


Use of a condom at last anal sex


Engagement in chemsex last 12 months


Engagement in chemsex significant for:
Chlamydia
OR 1.96
(1.21-3.17)
Gonorrhoea
OR 1.93
(1.22-3.07)
OR 2.03
(1.19-3.46)
Study Limitations
1. Survey of GMHS only – not representative of MSM in general
2. Results based on self-reported data
3. Association versus causation
4. Relatively broad definition of chemsex
MISI = crystal meth, G, ketamine and/or mephedrone – 7%
This study – 18%
5. Need for - in-depth qualitative work
- case control study
Summary of Findings
1 in 4 men
• attending GMHS have engaged in chemsex
• who engage in chemsex (or their partners) has lost consciousness
• who engage in chemsex say it is impacting negatively on their lives
There appears to be an association between chemsex &
• Sexual risk taking behaviours
• Multiple partners
• UAI
• Gonorrhoea and chlamydia
Those engaging in chemsex are not a “hidden population”
• Reachable through sexual health services
• Need for sexual health and addiction services to work together
Response to date
National Drug Treatment Centre now accepting referrals for G detox
Awareness-raising with bars and nightclubs
Brief intervention training provided to healthcare professionals
Awareness campaign & development of posters and G-card
Additional outreach workers employed to deliver peer support & interventions
Multidisciplinary working between addiction & sexual health services
Submission to new National Drugs Strategy re chemsex
Acknowledgements
• Dr. Niamh Byrne, Department of Public Health, HSE East
• Ms. Siobhan O’Dea, Manager, GMHS
• Dr. Mary Ward, Department of Public Health, HSE East
• Dr. Derval Igoe, Health Protection Surveillance Centre
• Dr. Susan Clarke, St. James’ Hospital, Dublin and GMHS
• Dr. Eamon Keenan, National Clinical Lead, Addiction Services, HSE
• Mr. Adam Shanley, Director, Gay Switchboard Ireland
• Dr. Ford Hickson, London School of Tropical Medicine and Hygiene
• Professor Mary Codd, School of Public Health, Physiotherapy & Sports Science, UCD
• Mr. Mick Quinlan, Manager (Retired), GMHS
• All of the staff at the GMHS who facilitated the day-to-day conduct of the study.