Gay men who use crystal methamphetamine during sex are five times as likely to report a negative impact on their mental health, 15 times as likely to be hospitalised and twice as likely to have a sexually transmitted infection as users of other drugs in sexual settings, according to data from a London clinic presented to the joint British HIV Association (BHIVA) and British Association for Sexual Health and HIV (BASHH) conference in Edinburgh last week.
Dr Mark Pakianathan said that all gay, bisexual and other men who have sex with men attending the sexual health clinic at St George’s Hospital are asked about mental health, drug and alcohol use and chemsex. Between January 2014 and September 2017, one in five gay men attending the service disclosed engaging in chemsex. The clinic’s definition of chemsex is the use of any of the following drugs to facilitate or enhance sex: crystal meth, GHB/GBL, mephedrone, ketamine, MDMA, cocaine or amphetamine. Most of those reporting chemsex used the first three drugs and often used multiple substances at the same time.
Men engaging in chemsex were asked about harms and adverse outcomes associated with their drug use. The proportion reporting harms were compared between men who used crystal meth during chemsex and men who used other drugs (mostly GHB/GBL and mephedrone) during chemsex.
- Any negative consequence: 84% of crystal meth users and 47% of other chemsex respondents
- An impact on mental health: 66% and 29%
- Time off work: 49% and 16%
- Overdose: 34% and 7%
- Relationship consequences: 41% and 22%
- Hospital admission: 35% and 4%
- Involvement with the criminal justice system: 13% and 8%
- Financial consequences: 37% and 5%.
The 214 men who used crystal meth during chemsex were seven times more likely to report one of these harms than men who used other drugs (adjusted odds ratio 7.0, 95% confidence interval 3.7-13.4). Crystal meth users had a statistically significant raised risk of experiencing each of the harms – for example, 15 times as likely to be hospitalised, 13 times as likely to have financial consequences and seven times as likely to overdose.
They were also nine times as likely to inject drugs, six times as likely to fist and four times as likely to share sex toys – each of these behaviours have been associated with hepatitis C transmission. Users of crystal meth were three times as likely to buy or sell sex, and twice as likely to acquire a sexually transmitted infection as other men engaging in chemsex.
St George’s clinicians also reported that a validated screening tool for identifying people with drug-related problems appear to work well in chemsex users. DUDIT (Drug Use Disorders Identification Test) is similar to AUDIT (Alcohol Use Disorders Identification Test), being a series of eleven questions asking about frequency of use, perception of self-control and negative consequences. A DUDIT score of six or more indicates possible problematic drug use.
Of 116 gay men who completed a DUDIT questionnaire, 12 reported one of the previously mentioned harms to a clinician. Of these 12, eleven scored six or more on DUDIT, suggesting that the screening tool is sensitive, i.e. it correctly identifies men with chemsex problems. However, it was not specific – another 14 men without chemsex problems also scored above six.
This suggests that it could be a useful tool for sexual health clinics to identify men who may be having difficulties with chemsex, but that further assessment of men scoring highly on it is essential.
Online chemsex support
Online counselling and groupwork are promising approaches for men involved in chemsex, with potential to reach men living in parts of the country where specialised services are not available, according to a poster presented at the conference.
One-to-one counselling sessions and groupwork were offered, using online video conferencing software. Clients could access the service using their phone, tablet or computer from any location, removing geographical barriers. The service was hosted on Terrence Higgins Trust’s chemsex support website www.fridaymonday.org.uk with counsellors and therapists provided by Antidote at London Friend.
Half of those who signed up for groupwork and a third of those who signed up for counselling were from outside London. Three-quarters of those starting groupwork completed it and 96% of those starting counselling did so.
The majority of clients have reported positive outcomes in terms of control over their drug use, control over their sex life and quality of life. A groupwork client said, “I initially had some doubts about how the online session would work, thinking it may be a little too impersonal for real discussion and connections. This was not the case at all however, and I actually found that doing the sessions in the privacy and safety of my own home made it feel really comfortable and I felt totally at ease.”
Pakianathan M et al. Chemsex with crystal methamphetamine, associated risk-taking and patient reported adverse consequences. Fourth Joint Conference of the British HIV Association (BHIVA) with the British Association for Sexual Health and HIV (BASHH), Edinburgh, April 2018, abstract P75.
McDonald ER et al. Drug Use Disorders Identification Test (DUDIT): a new tool to identify problematic chemsex in sexual health clinics? Fourth Joint Conference of the British HIV Association (BHIVA) with the British Association for Sexual Health and HIV (BASHH), Edinburgh, April 2018, abstract P83.
Edwardes D et al. Online services: reaching MSM around the country who are struggling with issues around sex, drugs and alcohol. A Public Health England HIV Innovation Project March 2016–November 2017. Fourth Joint Conference of the British HIV Association (BHIVA) with the British Association for Sexual Health and HIV (BASHH), Edinburgh, April 2018, abstract P257.