Printer Friendly

Drug use with sex tied to condom-free sex, HCV, and STIs in gay men with HIV.

Using drugs during sex boosted the odds of condom-free anal sex with a detectable viral load, * hepatitis C virus (HCV) infection, and bacterial sexually transmitted infections (STIs) in gay or bisexual men with HIV in England and Wales.1 Three in 10 men surveyed used drugs when having sex and 1 in 10 injected drugs when having sex.

In countries like the United Kingdom (which includes England and Wales) and the United States, gay or bisexual men account for a large proportion of new HIV infections. Rates of other STIs, including HCV infection, have been rising in gay and bisexual men in Western Europe and the United States. Sex without condoms allows viruses like HIV and HCV and bacteria like gonorrhea and syphilis to pass from an infected partner to an uninfected partner during sex.

Studies show that many gay or bisexual men use drugs before or during sex (called chemsex) or inject drugs at the time of sex (called slamsex). But the impact of chemsex and slamsex on risk of condom-free anal sex, HCV infection, and bacterial STIs remains poorly understood. (2) Researchers in England conducted this study to address those questions.

How the study worked. The study involved sexually active HIV-positive gay or bisexual men who completed a computer-assisted survey about sex habits, party drug use, and other factors. Researchers matched men who completed the survey to a national database so they could gather medical and personal data (like age and race) on everyone who completed the survey.

The investigators used a statistical technique to ensure that data collected represents the entire UK population of gay or bisexual men in care for HIV infection.

The researchers were particularly interested in how many men had anal sex (1) without a condom, (2) without a condom and with an HIV-negative partner or partner of unknown HIV status, and (3) without a condom while having a detectable HIV viral load. (A person with a detectable viral load can pass HIV to a sex partner.) Survey participants reported whether they ever had a positive HCV test and whether they got 1 of 3 bacterial STIs (chlamydia, gonorrhea, or syphilis) in the past year.

The research team used a standard statistical method to determine the impact of chemsex or slamsex on condom-free anal sex, HCV infection, and newly detected bacterial STIs. This method figures the impact of chemsex or slamsex on these outcomes regardless of any other factors that may affect chances of these outcomes. In this way the researchers could have more confidence that chemsex or slamsex alone affected chances of condom-free anal sex, HCV infection, or newly detected STIs.

What the study found. The analysis involved 392 HIV-positive gay or bisexual men who said they had sex with another man in the past year. Of those 392 men, 29.5% said they had chemsex in the past 3 months and 10% said they had slamsex. Among all men who responded to the survey, 54% reported using drugs in the past year and 42.5% reported using drugs in the past 4 weeks. Chemsex proved more common in men (1) who had depression or anxiety at some point in their lives, (2) who smoked cigarettes, and (3) who used drugs when not having sex.

Almost three quarters of study participants (72%) had condom-free sex, 35% had condom-free anal sex with an HIV-negative partner or a partner with unknown HIV status, and 10% had condom-free sex when they had a detectable viral load. More than 40% of men got infected with a bacterial STI in the past year.

Statistical analysis that considers several factors at the same time linked chemsex alone or slamsex alone to higher odds of having condom-free anal sex. Specifically, men who had chemsex had more than 5 times higher odds of reporting condom-free anal sex, while men who had slamsex had more than 6 times higher odds of reporting condom-free anal sex (Figure 1). Men who had chemsex had more than doubled odds of condom-free anal sex with an HIV-negative partner; and men who had chemsex had almost 4 times higher odds of condom-free sex with a detectable viral load (Figure 1).

A similar analysis linked chemsex or slamsex, by themselves, to higher odds or any recent STI, more than 1 recent STI, recent chlamydia, and recent gonorrhea (Figure 2). Slamsex, by itself, was linked to higher odds of recent syphilis. Having chemsex boosted odds of HCV at any time more than 6-fold, and having slamsex boosted odds of HCV at any time more than 9-fold.

What the findings mean for you. This study of HIV positive gay and bisexual men in England and Wales linked taking drugs before or during sex to higher odds of risky sex and sexually transmitted infections (STIs), including HCV infection. Men who used drugs for sex (called chemsex or slamsex) were more likely to have 3 health-threatening kinds of sex (Figure 1): (1) condom-free anal sex, (2) condom-free anal sex with an HIV-negative partner or partner of unknown HIV status, and (3) condom-free anal sex with a detectable viral load-meaning they had a chance of passing HIV to a sex partner.

Having anal sex without a condom is risky not only because condoms largely protect partners from passing along HIV during sex. Condoms also block transmission of bacterial STIs like gonorrhea and syphilis, and viruses like HCV and human papillomavirus (HPV), which can cause anal cancer, cervical cancer, and other cancers. Condoms can also protect an already-infected person from picking up new bacteria or viruses.

People like to use party drugs during sex because the drugs seem to increase and prolong sexual excitement and enjoyment. But these drugs can have other effects that change the sexual experience in possibly risky ways: They can dull your negotiating skills so you agree to things you might not do without drugs. They can dim your judgment so you end up taking risks you might not without drugs. And they can increase your sexual aggression so you push yourself and your partner to places you might not otherwise go.

Two results of all these behavior changes, this study shows, are higher odds of anal sex without condoms and higher odds of sexually transmitted infections.

All of the STIs considered in this study can be successfully treated. But STIs often have no signs or signals, so they can go undetected and untreated for a long time. Untreated STIs can damage your health and raise chances that you will pass viruses or bacteria to sex partners or pick up new STIs from your partner. Chemsex itself can cause serious side effects and even death.

This study used a statistical technique to select a study group that reflects the whole group of gay or bisexual men in care for HIV in the United Kingdom. These men are similar in many habits and health factors to gay or bisexual men in the United States and other countries with gay HIV epidemics. In the study population, one third of the men took drugs before or during sex. They also had other behaviors and conditions that threaten their health, including depression, anxiety, smoking, and drug use not related to sex. These are all conditions that you should discuss with your HIV provider or with other health professionals you see.

REFERENCES

(1.) Pufall EL, Kall M, Shahmanesh M, et al. Sexualized drug use ('chemsex') and high-risk sexual behaviours in HIV- positive men who have sex with men. HIV Medicine. 2018:19:261-270.

(2.) McCall H, Adams N, Mason D, Willis J. What is chemsex and why does it matter? BMJ. 2015;351:h5790.

* Words in boldface are explained in the Technical Word List at the end of this issue.
Figure 1. A study of HIV-positive gay or bisexual men linked
drug use during sex (Chemsex) and injecting drugs during
sex (Slamsex) to higher odds of 3 kinds of risky anal sex:
condom-free (CF) anal sex, condom-free anal sex with an
HIV-negative partner, and condom-free sex with a detectable
viral load (VL+).

Impact of drugs with sex on condom-free sex

Slamsex

CF anal sex        6.11
CF anal sex        5.73

Chemsex

HIV-neg anal sex   2.34
VL+ anal sex       3.86

Note: Table made from bar graph.

Figure 2. Regardless of other risk factors, using drugs during
sex (Chemsex) or injecting drugs during sex (Slamsex)
independently boosted odds of any sexually transmitted
infection (STI), more than one (multiple) STIs, chlamydia
infection, and gonorrhea.

Impact of drugs with sex on recent STIs

          Any STI  Multiple STIs  Chlamydia  Gonorrhea

Slamsex    6.11      4.00          3.09        3.40
Chemsex    2.65      2.01          1.98        3.11

Note: Table made from bar graph.
COPYRIGHT 2018 The Center for AIDS: Hope & Remembrance Project
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2018 Gale, Cengage Learning. All rights reserved.

Article Details
Printer friendly Cite/link Email Feedback
Title Annotation:ARTICLE 11; hepatitis C virus; and sexually transmitted infection
Publication:HIV Treatment: ALERTS!
Date:Dec 1, 2018
Words:1447
Previous Article:Almost 1 in 5 people with HIV drinks alcohol despite health problems.
Next Article:Hepatitis C cure does not slow kidney decline in people with Hep C and HIV.
Topics:

Terms of use | Privacy policy | Copyright © 2020 Farlex, Inc. | Feedback | For webmasters