Transcript Chem Sex for GP

A clinical perspective of
Chemsex
Dr Jake Bayley
Consultant Sexual Health and HIV
Barts Health NHS Trust
Slides courtesy of Dr Adam Bourne, LSHTM
Use of drug in last
year, British Crime
Survey 2007/8
All respondents
Cannabis
Men
Straight % (n/N) Gay/Bisexual %
(n/N)
Adjusted Odds
Ratio* (95%CI)
7.1
(1593/22309)
9.4
(946/10011)
18.8
(46/245)
1.73
1.22-2.43
Cocaine
2.2
(495/22374)
3.1
(311/10045)
7.4
(18/244)
1.92
1.15-3.18
Amyl nitrite
1.4
(307/22421)
1.4
(142/10069)
24.4
(60/246)
23.04
16.00-33.18
Ecstasy
1.3
(299/22393)
1.8
(182/10053)
6.5
(16/245)
2.88
1.67-4.96
Amphetamine
1.1
(244/22352)
1.3
(132/10039)
3.7
(9/246)
2.28
1.14-4.58
Tranquilisers
0.5
(111/22438)
0.4
(45/10076)
2.8
(7/247)
4.33
1.90-9.87
Magic mushrooms
0.4
(81/22420)
0.5
(50/10065)
2.8
(7/247)
5.14
2.27-11.66
Ketamine
0.3
(65/22437)
0.3
(31/10079)
3.7
(9/246)
10.01
4.60-21.77
LSD
0.2
(52/22414)
0.3
(31/10063)
1.6
(4/247)
4.03
1.39-11.69
Crack
0.1
(28/22428)
0.2
(19/10072)
0.8
(2/247)
2.68
0.61-11.84
Heroin
0.1
(26/22438)
0.2
(17/10077)
0.8
(2/247)
2.90
0.65-12.91
Annual prevalence
of drug use by
sexuality in British
Crime Survey
2007/8
Unpublished data from the British
Crime Survey 2007/8. Data
personal communication from
Jacqueline Hoare (Home Office
Statistics Unit); analysis by Ford
Hickson (Sigma Research)
Current trends in drug use
Name of drug
Street names
Delivery
Mephedrone
Meow Meow, MCAT, plant
food
Snorted as a powder, injected or
administered rectally
GHB/GBL
G, Gina, liquid ecstasy
Swallowed in small liquid doses
Crystal meth
Crystal, Ice, Tina, T
Snorted as powder, smoked in
glass pipe, or administered rectally
Ketamine
K, special K, Green
Swallowed as tablet, snorted
Chemsex: “Sex between men that occurs under the influence of [these]
drugs taken immediately preceding and/or during the sexual session”
Chemsex 'prevalence' (UK)
• European MSM Internet Survey (EMIS)
– 15,423 MSM living in England
– 0.7% had used crystal meth in previous 4 weeks (London 2.9%)
– 2.9% had used mephedrone in previous 4 weeks (London
10.2%)
– 1.6% had used GHB/GBL in previous 4 weeks (London 5.5%)
• Chemsex drug use highest among HIV positive gay men
– 8.6% of HIV positive men used crystal meth Vs <1% negative or
untested men
– 13.5% of HIV positive men used GHB/GBL Vs <3% of negative or
untested men
Chemsex & sexual health
1. Maintenance of safer sex behaviour
2. Pre-determined unprotected anal intercourse
3. Unintended sexual risk under the influence of
drugs
– Drug use associated with increased odds of UAI
during group sex
– Three-fold increase in odds of UAI associated with
use of crystal meth
Chemsex & broader well-being
• Impact on mental health
– Anxiety attacks
– Acute paranoia
– Sexual dependency
• Impact on physical health
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Overdose
Disturbed sleeping problems
Injection site injuries
Sexual consent concerns
Bourne et al, 2015a; 2015b; Fourer et al, 2014; Knoops et al, 2015)
Conclusions – What we know
• The drugs most popular among MSM appears to
have shifted
• Injection drug use has emerged as a source of
concern for MSM
• Use of drugs in general is higher among MSM with
diagnosed HIV
• Newly popular drugs lend themselves to use in
sexual settings
• Chemsex is associated with a higher risk of HIV/STI
transmission behaviour
• MSM using drugs are exposed to (and experience)
a range of physical and mental health harms
“CHEMSEX”
Tadgh Crozier & Louis
Driver
Senior Engagement
Workers
WHO ARE WE?
• Lifeline Project – Registered charity providing
national Drug & Alcohol Treatment.
• AFTER PARTY SERVICE – Started 2014
• London based outreach service
• Supported and funded by the Elton John Aids
Foundation
• One-to-one support, Harm reduction, Group
work and Training.
• Focus on sexual health, HIV Prevention and
provision Self Test HIV Kits.
What is CHEMSEX
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Having sex whilst using drugs
Gay, bisexual, MSM
Specific intention to meet, use and have sex
Three main drugs: mephedrone, GHB/GBL,
crystal methamphetamine
Why is it a concern?
• Marked change in drugs used
• Changing context and methods of use
• Increasing presentations to services – Sexual
health and counselling
• Backdrop of rising HIV diagnoses & infections
• Clients not identifying as ‘that type’ of drug
user (STIGMA)
How have things have
changed?
• Different drugs being used with different routes
of administration
• Different harms – injecting, dependence (G),
mental health (psychosis)
• Interventions need to include substance use,
sexual behaviour & HIV prevention
• Interventions delivered in different settings GUM clinics (motivational, preventative)
The drugs: Mephedrone
MIAOW, MEPH, MEOW MEOW, M-CAT, DRONE
The drugs: GHB/GBL
G, GINA, GEEBS, GBL, GBH,
The drugs: Crystal Meth
METHAMPHETAMINE, TINA, CHRISTINE, METH, ICE,
GLASS, CRANK,
‘Apps’ & ‘On-line’
What we’re seeing
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Sexualised drug using, multiple partners
Meeting & trading of drugs through apps
Private sex parties, sex on premises venues
High level of current sexual risk
‘Slamming’ - Injecting (Crystal meth &
Mephedrone)
We have seen an increase in HIV infection
as a result of Chemsex
Poor adherence to HIV meds whilst using
Lack of knowledge and understanding in
relation to BBV’s
Widespread poor self-esteem issues
What we’re hearing
• Concerns around consent whilst using –
exploitation, rent, rape – Unconscious
• Slamming (injecting) on the increase as
criterion for sex party admission
• Dealers offering needles to slamming users
• Filming and webcams at parties
Interventions
• Same principles: brief interventions, MI, CBT,
SFT & relapse prevention
• But with cultural adaptations: e.g. relapse
prevention through management of online
sexual-social profiles
• Tackle sexual health and drug use together
• Delivered in LGBT-specific, or LGBTcompetent locations
• Anecdotally 90% say ‘important’ or ‘very
important’ to have LGBT specific services
• Breaking free – online
• Skype/telephone
Work in Clinics and Sauna’s
•People present much earlier than they would to a
drug service
•Treatment of STIs
•PeP or PReP
•Perfect opportunity to deliver motivational &
preventative interventions
•Chemsex Study: preference for clinic based
interventions
•Caution! Approach works well for gay/bi men,
may need to think differently for lesbian/bi
women & trans people who experience different
sexual health barriers
Key Messages
• Increase own confidence & competence of
community/MSM/LGBT issues and newer drugs
• Be conscious of environment, language, attitude
etc.
• Non-judgmental harm reduction advice
• Know where & when to refer
• Be aware of potential G dependence – must see
a specialist service for detox advice
• Safer injecting – needle exchange
• HIV, Hep, HPV and other STI advice
• Monitor sexual orientation & gender identity
ANY QUESTIONS
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RESOURCES
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London Friend: http://londonfriend.org.uk/ Antidote: http://londonfriend.org.uk/antidote
Out Of Your Mind report: http://londonfriend.org.uk/outofyourmind/
Antidote/Orange Nation G-Aware campaign: http://londonfriend.org.uk/get-support/g-aware/ London Friend CEO
Blog : http://londonfriend.org.uk/montys-thoughts/
Chemsex Study: www.sigmaresearch.org.uk/chemsex
NTA Club Drug Report: http://www.nta.nhs.uk/uploads/clubdrugsreport2012[0].pdf
UK Drug Policy Commission Report: http://www.ukdpc.org.uk/publication/the-impact-drugs-different-minoritygroups-lgbt- groups/
UK Drug Policy Commission Policy Briefing: http://www.ukdpc.org.uk/publication/drugs-diversity-lgbt-groupspolicy- briefing/
Lesbian & Gay Foundation Part of the Picture: http://www.lgbt.foundation/potp
Lancet article of crystal meth rise in London (Jan 2013):
http://www.thelancet.com/journals/lancet/article/PIIS0140- 6736(13)60032-X/fulltext
CNWL Club Drug Clinic: http://clubdrugclinic.cnwl.nhs.uk/
LDAN News Nov/Dec 2012 (Club Drugs & Antidote articles): http://www.ldan.org.uk/PDFs/LDANNewsDec12.pdf
Engendered Penalties: http://www.pfc.org.uk/pdf/EngenderedPenalties.pdf
Sexual Orientation Monitoring Guide: http://www.lgbt.foundation/som Stonewall Healthy Lives mini-site:
http://www.healthylives.stonewall.org.uk/
Public Health Outcomes Framework LGBT Companion: http://www.lgbt.foundation/phof
CONTACT DETAILS:
• [email protected] Tel: 07584 126
904
• [email protected] Tel: 07595 415 139
• WWW.AFTERPARTY.ORG.UK