Institute for Global Health, University College London, London, UK
Institute for Global Health, University College London, London, UK.
Sex Transm Infect. 2020 May;96(3):197-203. doi: 10.1136/sextrans-2019-054139. Epub 2019 Nov 19.
London has one of the highest identified prevalence of chemsex (sexualised recreational drug use) among men who have sex with men (MSM) in Europe. We examine MSM's patterns of chemsex and its association with HIV/STI risk behaviours, STI diagnoses and sexual healthcare-seeking behaviours, including if HIV testing behaviour met UK national guidelines (three monthly if engaging in chemsex).
Cross-sectional survey data from 2013 (n=905) and 2016 (n=739) were collected using anonymous, self-administered questionnaires from MSM recruited in commercial gay venues in London, UK. Descriptive and multivariable analyses, stratified by self-reported HIV status, were conducted. Adjusted prevalence ratios (aPR) with 95% CIs were calculated.
Comparing the 2013 and 2016 surveys, chemsex prevalence in the past year remained stable, in both HIV-negative/unknown-status MSM (20.9% in 2013 vs 18.7% in 2016, p=0.301) and HIV-positive MSM (41.6% in 2013 vs 41.7% in 2016, p=0.992). Combined 2013-2016 data showed that compared with other MSM, those reporting chemsex were more likely to report HIV/STI risk behaviours, including condomless anal intercourse with serodifferent HIV-status partners (HIV-negative/unknown-status men: aPR 2.36, 95% CI 1.68 to 3.30; HIV-positive men: aPR 4.19, 95% CI 1.85 to 9.50), and STI diagnoses in the past year (HIV-negative/unknown-status men: aPR 2.10, 95% CI 1.64 to 2.69; HIV-positive men: aPR 2.56, 95% CI 1.57 to 4.20). 68.6% of HIV-negative/unknown-status men reporting chemsex attended sexual health clinics and 47.6% had tested for HIV more than once in the past year.
Chemsex in London MSM remained stable but high, particularly among HIV-positive men. Irrespective of HIV status, chemsex was associated with engagement in HIV/STI risk behaviours. Frequency of HIV testing in the past year among HIV-negative/unknown-status men was below national recommendations. Promoting combination prevention strategies, including three monthly HIV/STI testing, access to pre-exposure prophylaxis/antiretroviral treatment and behavioural interventions among MSM reporting chemsex, remains vital to address sexual health inequalities in MSM.
伦敦是欧洲男男性行为者（MSM）中化学性行为（性化娱乐性药物使用）发生率最高的城市之一。我们研究了 MSM 化学性行为的模式及其与 HIV/性传播感染（STI）风险行为、STI 诊断和性保健服务寻求行为的关联，包括 HIV 检测行为是否符合英国国家指南（如果进行化学性行为，每三个月检测一次）。
使用匿名自填问卷，于 2013 年（n=905）和 2016 年（n=739）从英国伦敦商业同性恋场所招募的 MSM 中收集了横断面调查数据。对按自我报告的 HIV 状态分层的描述性和多变量分析进行了分析。计算了调整后的患病率比（aPR）及其 95%置信区间（CI）。
比较 2013 年和 2016 年的调查结果，过去一年的化学性行为患病率在 HIV 阴性/未知状态的 MSM 中保持稳定（2013 年为 20.9%，2016 年为 18.7%，p=0.301），在 HIV 阳性 MSM 中也保持稳定（2013 年为 41.6%，2016 年为 41.7%，p=0.992）。2013-2016 年的数据显示，与其他 MSM 相比，报告化学性行为的人更有可能报告 HIV/STI 风险行为，包括与性伴侣发生无保护的肛交（HIV 阴性/未知状态男性：aPR 2.36，95%CI 1.68 至 3.30；HIV 阳性男性：aPR 4.19，95%CI 1.85 至 9.50），以及过去一年的 STI 诊断（HIV 阴性/未知状态男性：aPR 2.10，95%CI 1.64 至 2.69；HIV 阳性男性：aPR 2.56，95%CI 1.57 至 4.20）。报告化学性行为的 HIV 阴性/未知状态男性中有 68.6%曾到性保健诊所就诊，47.6%在过去一年中不止一次接受过 HIV 检测。
伦敦 MSM 中的化学性行为仍然稳定，但仍很高，尤其是在 HIV 阳性男性中。无论 HIV 状态如何，化学性行为都与 HIV/STI 风险行为有关。在过去一年中，HIV 阴性/未知状态男性中 HIV 检测的频率低于国家建议。在报告化学性行为的 MSM 中，推广包括每三个月进行一次 HIV/STI 检测、获得暴露前预防/抗逆转录病毒治疗和行为干预在内的综合预防策略，对于解决 MSM 中的性健康不平等问题仍然至关重要。
