Evidence suggests that among men who have sex with men (MSM) and who use drugs, there is a preference for ‘sex drugs’, including alkyl nitrites (‘poppers’), crystal methamphetamine (‘crystal meth’), club drugs (including ketamine and ecstasy) and new psychoactive substances.1 Drug use for or during sex (‘chemsex’) among MSM has caused concern because of the direct effects of the drugs themselves in addition to an increased risk of transmission of sexually transmitted infections (STIs).

Recent Irish research aimed to assess the prevalence of chemsex, associated behaviours and STIs among attendees at Ireland’s only MSM-specific sexual health clinic in Dublin, over a six-week period in 2016.2 In this study, published in the International Journal of Drugs Policy, a questionnaire was used to collect demographic data, information on sexuality and sexual practice, self-reported history of treatment for STIs, and chemsex use. Key variables independently associated with treatment for STIs over the previous 12 months were identified using multivariable logistic regression. Ninety-four per cent of attendees who were asked to take part in the study completed the questionnaire.

Among the findings, the study authors highlighted the following:

• One in four (27%) reported engaging in chemsex within the previous 12 months.
• One-half had taken two drugs on their last chemsex occasion.
• One in five (23%) reported that they or their partners had lost consciousness as a result of chemsex.
• One in four (25%) reported that chemsex was impacting negatively on their lives and almost one-third (31%) reported that they would like help or advice about chemsex.

It was also found that those engaging in chemsex were more likely to have had more sexual partners (p<0.001), more partners for anal intercourse (p<0.001) and to have had anal intercourse without a condom (p=0.041). They were also more likely to report having been treated for gonorrhoea over the previous 12 months (adjusted OR: 2.03, 95% CI 1.19–3.46, p=0.009). Overall, 6% of participants reported that they had ever been diagnosed with HIV, though no significant difference was seen in the proportion of respondents who reported having been diagnosed with HIV according to whether they reported that they had (8%) or had not (5%) engaged in chemsex (p=0.097).

The authors concluded that the results from this survey of MSM clinic attendees in Dublin agree with international evidence suggesting a chemsex culture among a subset of MSM. They hope that these findings will be used to develop an effective response that addresses addiction and sexual ill-health among MSM who experience harm, and seek help as a consequence of engagement in chemsex.

1    McCarty-Caplan D, Jantz I and Swartz J (2014) MSM and drug use: a latent class analysis of drug use and related sexual risk behaviors. AIDS and Behavior, 18(7): 1339‒51.

2    Glynn RW, Byrne N, O’Dea S, Shanley A, Codd M, Keenan E, et al. (2018) Chemsex, risk behaviours and sexually transmitted infections among men who have sex with men in Dublin, Ireland. International Journal of Drug Policy, 52: 9-15. https://www.drugsandalcohol.ie/28327/