Fusetti Chiara, Caruso Enrico, Giacomelli Andrea, Calzavara Daniele, Cossu Maria Vittoria, Frattini Nicoletta, Caruso Francesco, Vinti Pietro, Atzori Chiara, Petri Francesco, Antinori Spinello, Gori Andrea, Cernuschi Massimo, Moschese Davide
Department of Infectious Diseases, ASST FBF Sacco, Luigi Sacco University Hospital, Milan, Italy.
Milano Checkpoint ETS, Milan, Italy.
AIDS Behav. 2025 Jun 9. doi: 10.1007/s10461-025-04778-9.
Chemsex, the use of psychostimulant substances during sexual activity particularly among men who have sex with men (MSM), is a growing public health concern. This study aimed to assess drug use, engagement in chemsex, and related knowledge among pre-exposure prophylaxis (PrEP) users and people with HIV (PWH) attending two sexually transmitted infection (STI) services in Milan, Italy. An anonymous online survey was conducted between January and March 2024 at a hospital-based clinic and a community-based center. The questionnaire explored demographics, HIV/PrEP status, drug use, chemsex, its disclosure to healthcare providers, and perceptions of drug use trends. Among 420 respondents, of whom 365 (84%) PrEP-users and 55 (13%) PWH, 167 (40%) reported current drug use and 68 (16%) engaging in chemsex. Polydrug use was also common (96/167, 57%). Commonly used substances included cocaine (50/167, 30%), mephedrone (45/167, 27%), 3,4-methylenedioxymethamphetamine (36/167, 22%), gamma-hydroxybutyrate/gamma-butyrolactone (33/167, 20%) and ketamine (29/167, 17%). The use of methylenedioxypyrovalerone (25/167, 15%) and crystal methamphetamine (10/167, 6%) was also consistent. Of the drug users, 62 (37%) did not disclose their substance use to healthcare providers, frequently citing lack of inquiry by clinicians or the perception that disclosure was not relevant. A total of 223/420 (53%) respondents knew people who used substances, and of these, 90.6% (202) perceived an increase in substance use within their community. In conclusion, the study revealed high rates of drug use and chemsex in Milan underscoring the need for increased healthcare provider awareness, and stigma-free environments to support risk reduction for chemsex users.
化学性行为，即在性活动期间使用精神刺激药物，尤其是在男男性行为者（MSM）中，这一现象日益引起公共卫生关注。本研究旨在评估在意大利米兰两家性传播感染（STI）服务机构就诊的暴露前预防（PrEP）使用者和艾滋病毒感染者（PWH）的药物使用情况、化学性行为参与情况及相关知识。2024年1月至3月，在一家医院诊所和一个社区中心开展了一项匿名在线调查。问卷内容涉及人口统计学信息、艾滋病毒/PrEP状态、药物使用情况、化学性行为、向医疗服务提供者的披露情况以及对药物使用趋势的看法。在420名受访者中，365人（84%）为PrEP使用者，55人（13%）为PWH，167人（40%）报告目前有药物使用情况，68人（16%）参与化学性行为。多药使用也很常见（96/167，57%）。常用物质包括可卡因（50/167，30%）、甲麻黄碱（45/167，27%）、3,4-亚甲基二氧甲基苯丙胺（36/167，22%）、γ-羟基丁酸/γ-丁内酯（33/167，20%）和氯胺酮（29/167，17%）。亚甲基二氧吡咯戊酮（25/167，15%）和冰毒（10/167，6%）的使用情况也较为一致。在药物使用者中，62人（37%）未向医疗服务提供者披露其药物使用情况，常见理由是临床医生未询问或认为披露无关紧要。共有223/420（53%）的受访者认识使用物质的人，其中90.6%（202人）认为其社区内物质使用有所增加。总之，该研究揭示了米兰药物使用和化学性行为的高发生率，凸显了提高医疗服务提供者意识以及营造无耻辱感环境以支持化学性行为使用者降低风险的必要性。
