Long-Term Health Outcomes of People with HIV Engaged in Chemsex: A Prospective Cohort Study on Drug Use, Sexual Behaviour, Sexually-Transmitted Infections and Vulnerability

Résumé fourni par la source

Chemsex, the intentional use of drugs to enhance sexual experiences among gay, bisexual, and other men who have sex with men (gbMSM), is linked to high-risk sexual behaviours and increased sexually transmitted infections (STIs). Data on its long-term evolution after implementing specific strategies in HIV settings are limited. We evaluated the incidence of drug use, sexual behaviour, STIs, and vulnerabilities over 3 years following a specific approach at the HIV Unit of Hospital Clinic in Barcelona, Spain. We included 209 gbMSM living with HIV who engaged in chemsex in a prospective cohort (2018–2022). Quarterly visits assessed sexual behaviours, drug use, and STIs screening. Data were collected via self-administered questionnaires, medical records, and microbiological tests. Statistical analyses included descriptive statistics and Poisson regression models. Chemsex incidence decreased significantly (IRR 0.88, 95% CI 0.83–0.92, p < 0.001). People engaging in intravenous drug use (slamming) decreased in year 2 (IRR 0.71, 95% CI 0.52–0.98, p = 0.037) but rose non-significantly in year 3 (IRR 0.86, 95% CI 0.60–1.25, p = 0.434). High-risk sexual behaviours persisted, specifically unprotected anal sex (IRR 1.02, 95% CI 0.96–1.08, p = 0.481) and unprotected fisting (IRR 1.20, 95% CI 1.05–1.39, p = 0.010). Syphilis cases declined (IRR 0.40, 95% CI 0.26–0.60, p < 0.001). At baseline, 29% had HCV antibodies, with five new acute HCV cases. Concerns about chemsex decreased (IRR 0.52, 95% CI 0.43–0.63, p < 0.001), whereas the demand for sexuality-related assistance increased (IRR 1.53, 95% CI 1.20–1.94, p = 0.004). Loss to follow-up (21%) was greater among younger individuals, people engaging in intravenous drug use (slamming) (IRR 2.43 95% CI 1.33–4.42, p = 0.004), detectable HIV viral load (IRR 3.01, 95% CI 1.57–5.76, p = 0.001), and greater need for help (IRR 1.35, 95% CI 1.03–1.78, p = 0.03). Migrants and sex workers had higher rates of syphilis, lower education levels, and increased prevalence of STIs. Chemsex incidence and syphilis rates declined, but persistent high-risk behaviours, subgroup vulnerabilities, and increasing demand for sexuality-related assistance require targeted interventions and comprehensive support. This study investigated chemsex, which refers to the use of drugs to enhance sexual experiences among gay, bisexual, and other men who have sex with men (gbMSM) over 3 years at the HIV Unit of Hospital Clinic in Barcelona, Spain. The goal was to determine how drug use, sexual behaviour, sexually transmitted infections (STIs), and other vulnerabilities changed after the implementation of a specific care approach. The study followed 209 gbMSM living with HIV engaged in chemsex. Every 3 months, the participants completed questionnaires on substance use, sexual behaviours, and concerns, and medical tests were conducted. The results revealed that the number of people engaging in chemsex decreased over time. Most drug use decreased, except for mephedrone, a stimulant drug. Slamming, or injecting drugs in this context, also decreased in the second year but rose slightly in the third year without reaching significant levels. The number of syphilis cases decreased and only a few new cases of hepatitis C were found despite the continuation of risky sexual behaviours. Concerns about engaging in chemsex diminished, although people who still needed help asked for support related to their sexuality. Migrants and sex workers had higher rates of syphilis, lower education levels, and more STIs. Younger people and people who use intravenous drugs were more likely to be lost to follow-up. In conclusion, while the rates of chemsex and syphilis declined, risky sexual behaviours and vulnerabilities remained. More support and targeted health programs are needed to help those facing specific vulnerabilities.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.