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Introduction <p>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&#xa0;years following a specific approach at the HIV Unit of Hospital Clinic in Barcelona, Spain.</p> Methods <p>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.</p> Results <p>Chemsex incidence decreased significantly (IRR 0.88, 95%&#xa0;CI 0.83–0.92, <i>p</i> &lt; 0.001). People engaging in intravenous drug use (slamming) decreased in year&#xa0;2 (IRR 0.71, 95%&#xa0;CI 0.52–0.98, <i>p</i> = 0.037) but rose non-significantly in year&#xa0;3 (IRR 0.86, 95%&#xa0;CI 0.60–1.25, <i>p</i> = 0.434). High-risk sexual behaviours persisted, specifically unprotected anal sex (IRR 1.02, 95%&#xa0;CI 0.96–1.08, <i>p</i> = 0.481) and unprotected fisting (IRR 1.20, 95%&#xa0;CI 1.05–1.39, <i>p</i> = 0.010). Syphilis cases declined (IRR 0.40, 95%&#xa0;CI 0.26–0.60, <i>p</i> &lt; 0.001). At baseline, 29% had HCV antibodies, with five new acute HCV cases. Concerns about chemsex decreased (IRR 0.52, 95%&#xa0;CI 0.43–0.63, <i>p</i> &lt; 0.001), whereas the demand for sexuality-related assistance increased (IRR 1.53, 95%&#xa0;CI 1.20–1.94, <i>p</i> = 0.004).</p> <p>Loss to follow-up (21%) was greater among younger individuals, people engaging in intravenous drug use (slamming) (IRR 2.43 95%&#xa0;CI 1.33–4.42, <i>p</i> = 0.004), detectable HIV viral load (IRR 3.01, 95%&#xa0;CI 1.57–5.76, <i>p</i> = 0.001), and greater need for help (IRR 1.35, 95%&#xa0;CI 1.03–1.78, <i>p</i> = 0.03). Migrants and sex workers had higher rates of syphilis, lower education levels, and increased prevalence of STIs.</p> Conclusion <p>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.</p>

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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

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年8月5日

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  • Lorena De La Mora,
  • Montserrat Laguno,
  • Berta Torres,
  • Ivan Chivite,
  • Alberto Foncillas,
  • Alexy Inciarte,
  • Júlia Calvo,
  • Ana González-Cordón,
  • Juan Ambrosioni,
  • Leire Berrocal,
  • Elisa De Lazzari,
  • Esteban Martínez,
  • José Luís Blanco,
  • Rubén Mora,
  • Estela Solbes,
  • Ana Rodriguez,
  • Pilar Callau,
  • Laia Miquel,
  • Jordi Blanch,
  • Duncan Short,
  • Josep Mallolas,
  • Maria Martínez-Rebollar

摘要

Introduction

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.

Methods

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.

Results

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.

Conclusion

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.