Transcript Skeletons in our Closet – Sexual Health Advisers and Chemsex

Sex between men that occurs
under the influence of
Mephedrone, GHB/GBL or
Crystal Meth
GB MSM Drug Use
• Use of any stimulant drug: 4.1% heterosexual
vs 21.6% Gay/Bi
• Use of any drug: 11.1% heterosexual vs 33%
Gay/Bi
Crime Survey of England and Wales 2011-2014
Incidence of ChemSex
• 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%)
European GBMSM Internet Survey (EMIS)
Wandsworth & Kingston
Recreational Drug Use
30%
(n=662)
HIV +ve more likely to participate in
chemsex
[OR 6.68; 95% CI 3.91-11.42;
p<0.001]
Chemsex
63%
IVDU
15%
(n=185)
Drugs used in chemsex (67%
polydrug use)
 Mephedrone
69%
 GBL/GHB
56%
 Crystal Meth
46%
 Other
12%
(n=169)



(n=111)
A Hegazi 3-2-16
5% shared needles
35% shared snorting devices
> once/month
34%
1-3 times in 3 month
48%

Less often

18%
<12 hrs 59%
>24hrs 16 %
A Hegazi 3-2-16
Chemsex Support Clinic
•
•
•
874 GBMSM attending chemsex support clinic
70% - no sober sex in past 6 months
Chemsex episodes
–
–
•
Those who were HIV Positive
–
–
•
•
Typically 12-48 hours
88% with multiple partners (56% ≥ 4 partners)
64% of those not on ART (n=42) reported zero condom use
30% of those on ART reported poor adherence
9% of those who were HIV negative tested +ve for HIV at the same clinic within 1
year
Chemsex escalated after
–
–
–
HIV diagnosis
Relationship breakdown
Migration to London
A Hegazi 3-2-16
Stuart D, Weymann J. Chemsex and Care Planning: One year in practice. HIV Nursing. 2015;15:24-8.
HIV + GBMSM & ChemSex
• 29% of HIV+ gay male patients reported engaging
in chemsex
• 37% of HIV+ gay male Londoners reported
chemsex
• 19% of HIV+ gay men on ART reported injecting
Positive Voices Study (Pufall et al 2016)
HIV + GBMSM & Risk
• Chemsex associated with a six fold increase of
condomless anal sex
• Chemsex associated with a sevenfold increase in the
risk of sex with a risk of HIV transmission
• Chemsex was associated with having an average of 30
sexual partners in the last year compared with 9
partners who do not have chemsex
• STIs were 4 times higher in men reporting chemsex
Positive Voices Study (Pufall et al 2016)
ChemSex – Why?
•
•
•
•
•
Curiosity / adventure / enhance intensity
Drug use normalised
HIV / sexuality stigma
Problems with intimacy
Lack of confidence and an unhappiness with
sex life
• To manage mood - higher levels of anxiety and
depression
Adam Bourne. Chemsex Study http://www.sigmaresearch.org.uk/files/report2014b.pdf
Consequences
ChemSex: a clinic issue
• People present much earlier than they would to a drug
service
• Preference for GUM-based interventions
• High number of sexual partners per ChemSex episode
• Consistently poor condom use when using Chems
• High number of STIs/multiple HCV re-infections
• High frequency of PEP presentations
• Seroconversion symptoms that might be disguised as a
‘drug high’ or drug ‘comedown’
• Opportunity to deliver motivational and preventative
interventions
• Consistently poor ARV adherence if HIV-positive
Questions
1.
Are you happy with your level of drug use?
2.
What do you know about the drugs you are using?
3.
What do you enjoy about Chemsex?
4.
What do you know about the risks?
5.
What percentage of your sex life/free time involves Chemsex?
6.
When was the last time you had sober sex?
7.
Do you ever feel your drug use is negatively impacting your sex life or
wellbeing?
8.
Do you sometimes regret the choices you make when high?
9.
How confident are you about disclosing your HIV status?
10. What is your non-sexual social life like?
11. Is using Chems giving you what you want from life?
12. How would you rate the intensity of your experience and your sense of
satisfaction and enjoyment for both Chemsex and sober sex?