What is the issue?
There is a substantial prevalence of drug use, particularly stimulant use, among the clientele of sexual health services and sexual health problems are common among persons treated for drug problems. Links between sexual health and drug problems can arise in a number of ways:

Drug use can intoxicate and disinhibit and lead to unintended sexual activities — consensual or not — that result in negative consequences, such as regret, mental distress, sexually transmitted infections or unwanted pregnancy.
Some people with drug problems may engage in sex work to fund drug use, increasing their risks of sexually transmitted infections and assault.

Drugs may be used before or during sex to enhance sexual performance and pleasure (‘chemsex’) increasing risks of sexually transmitted infections, and the development of drug dependence. Reports of this pattern of behaviour among some groups of men who have sex with men have raised concerns in some countries.
Drugs may be used to cope with the emotional distress arising from a sexual health problem, such as an HIV diagnosis.

What is happening in Europe?
In Europe, treatment services for drug and sexual health problems are usually funded separately, have different eligibility criteria and are rarely co-located. This makes it challenging to provide ‘joined up’ care for people with both types of problems. Each type of service focuses on providing only one type of care, missing an opportunity to address both sets of problems.

Implications for the future
Research has not yet identified a good model for services, although new ones are emerging. In the absence of an evidence base, there is a need to start collecting better data on the extent of the problem in sexual health and drug treatment services in order to:

• identify people with problems related to drug use, including dependence, and sexual health;
• understand their risk behaviours and treatment needs;
• understand where linking or integrating sexual health and drug treatment services may be beneficial, for example, in services for men who have sex with men that have been developed in some countries.

The two types of services also need to share expertise and develop treatment pathways by:

• training sexual health staff to assess drug use and offer brief interventions where indicated;
• training drug treatment staff to assess sexual health and offer brief interventions for sexual problems related to drug use; and
• encouraging services to work together more closely, for example, through joint training events or staff exchanges.

See the 2017 background paper, Joining up sexual health and drug services to better meet clients’ needs.