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This is an open access article distributed under the Creative Commons Attribution 4. Drug-related harms, including harms from sexualised drug use SDU , are disproportionately experienced by sexual and gender minority people, relative to their majority counterparts. Therefore, participants are at increased risk of immunocompromise. Existing evidence suggests that drug use increases following natural disasters. A PRISMA-adherent systematic review was conducted to synthesise reports of changes in the prevalence, frequency, or characteristics of drug use and factors associated with these changes following the onset of the COVID pandemic. A comprehensive search across nine databases, supplemented with backward-forward citation searching and contact with key opinion leaders, was conducted. Two reviewers carried out title-abstract screening, full-text screening, and data extraction. Following a final, single database search, nine studies were included in the narrative synthesis. More than half the sample were studies investigating HIV pre-exposure prophylaxis use. Twenty percent of participants in most studies reported chemsex participation. In four, participants reported a net increase or maintenance of chemsex participation during the pandemic and five reported a net decrease. Increased chemsex participation was associated with loneliness, cravings, and working during the pandemic. Sexualised drug use SDU is defined as the use of drugs before and or during sexual activity to prolong or enhance the experience. Men who have sex with men MSM are believed to experience a unique set of social e. SDU practice has been associated with an increased risk of acquiring sexually transmitted infections STIs , 15 poorer engagement in HIV-related care, 16 soft-tissue and other injecting consequences, 17 mental ill health including psychosis , 18 sexual violence victimisation, 19 among other issues. In March , the World Health Organization declared a pandemic as cases of the novel, highly infectious strain of coronavirus disease COVID continued to rise across the globe. However, evidence from historical natural disasters e. Explore factors associated with an increase or decrease in the prevalence or frequency of SDU among MSM since the beginning of the pandemic. This study comprised a primary and secondary search. Thirteen global key opinion leaders KOLs were contacted to request additional published or unpublished work. All potentially relevant records from Google Scholar, handsearching journals and KOLs were read in full. A secondary search was conducted to update the review. Samples with aggregated data for MSM and transgender women were included. Owing to anticipated variation in the definition of chemsex, studies could report on changes in the use of any drug, by any route, in any sexualised context. Primary quantitative, qualitative and mixed-methods studies were eligible with no restriction by study design. Data identified from search one were uploaded to Rayyan, a systematic review software. Where clarification or additional data were required, study authors were contacted. Results from search two were reviewed twice DC against the same inclusion criteria. A data extraction table was piloted before two independent reviewers DC, EE extracted the pre-specified data from included studies identified by search one. The first author extracted data from records identified by search two and these data were reviewed prior to submission. Record selection is in Fig. Most studies were small with two-thirds reporting data from fewer than participants Table 1. Five studies were cross-sectional, three were prospective and one qualitative. Average age was largely between 30 and 50 years. Lastly, the primary aim of almost half of the included studies was to monitor changes in HIV pre-exposure prophylaxis PrEP use and related behaviour during the pandemic. Four records reported a net maintenance or increase in SDU participation Table 2. Across three waves of follow-up, corresponding to three episodes of pandemic-related restrictions, between Five studies reported a net decrease in SDU following the onset of the pandemic. Of these, two-thirds decreased while A further 6. In another article reporting lockdown-associated changes in patterns of casual sex in Israel, fewer men participated in SDU Each measure of SDU decreased in frequency in , relative to This study also found chemsex to be a strong motivator for sex outside the household reported by In another, where each wave of follow-up took place after a period of pandemic-related restrictions, chemsex was associated with unchanged or increased PrEP use in waves one adjusted odds ratio aOR 2. One study reported the number of chemsex events attended, suggesting sex with non-cohabitant partners. Few correlates were identified. However, two identified that PrEP use was associated with chemsex participation. Given the prevalence of PrEP use among the whole sample, it is possible that these studies provide an inflated estimate of chemsex participation during the pandemic. The wider literature confirms that chemsex practice did not cease during the pandemic with studies reporting prevalence but not change suggesting significant participation in Portugal Participants in these studies were also more likely to report an increase 9. However, the heterogeneity in sample composition e. Overall, there was little research reporting changes in SDU during the pandemic. SDU was a secondary outcome in all but one study which investigated participants with a history of chemsex participation. Further qualitative work is required to understand motivations for SDU participation and abstinence during the COVID pandemic and to identify targets for intervention. The association between PrEP use and SDU represents a potential concern and further work is required to understand if this association is bidirectional. Additional work is required to understand the nature of pandemic-associated changes in SDU in terms of drugs used, routes of administration and harms experienced so that existing interventions can be adapted, as required. Pandemic-related changes may suggest a need for trauma-informed interventions moving forward. Assertive outreach is required to ensure people who have disengaged in testing or ART care due to SDU participation are re-engaged. This may have contributed to increased COVID transmission and severity among these potentially vulnerable people. Supplementary material is available online. The data that support this study will be shared upon reasonable request to the corresponding author. Long-term conditions among sexual minority adults in England: evidence from a cross-sectional analysis of responses to the English GP Patient Survey. Crossref Google Scholar. A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people. BMC Psychiatry ; 8: Prevalence and correlates of substance use among transgender adults: a systematic review. Addict Beha ; International differences in alcohol use according to sexual orientation. Subst Abus ; 32 4 : Differences in substance use between sexual orientations in a multi-country sample: findings from the Global Drug Survey J Public Health ; 39 3 : Substance use of lesbian, gay, bisexual and heterosexual college students. Am J Health Behav ; 38 6 : Alcohol and club drug use among same-sex attracted young people: associations with frequenting the lesbian and gay scene and other bars and nightclubs. Subst Use Misuse ; 48 1—2 : Sexual orientation and adolescent substance use: a meta-analysis and methodological review. Addiction ; 4 : Sexualised drug use in the United Kingdom UK : a review of the literature. Int J Drug Policy ; J Sex Med ; 16 5 : Chemsex: origins of the word, a history of the phenomenon and a respect to the culture. Drugs Alcohol Today ; 19 1 : The lack of focus on trans women in a themed issue of the International Journal of Drug Policy on sexualised drug use. A narrative systematic review of sexualised drug use and sexual health outcomes among LGBT people. Int J Drug Policy ; 26 12 : Cross-sectional analysis of chemsex drug use and gonorrhoea diagnosis among men who have sex with men in the UK. Sex Health ; 16 5 : HIV Med ; 22 8 : Slam practice: a review of the literature. Crossref Google Scholar PubMed. Chemsex and psychosis: a systematic review. Behavioral Sciences ; 12 12 : Sexual violence and chemsex among substance-using sexual and gender minorities in Texas. Subst Use Misuse ; 56 14 : Acta Biomed ; 91 1 : Postdisaster course of alcohol use disorders in systematically studied survivors of 10 disasters. Arch Gen Psychiatry ; 68 2 : Alcohol problems as a risk factor for postdisaster depressed mood among U. Psychol Addict Behav ; 27 1 : Front Psychiatry ; Longitudinal associations with alcohol consumption during the first COVID lockdown: associations with mood, drinking motives, context of drinking, and mental health. Drug Alcohol Depend ; Understanding the impact of the COVID pandemic on the mental health of transgender and gender nonbinary individuals engaged in a longitudinal cohort study. J Homosex ; 68 4 : Disproportionate impact of the COVID pandemic on perceived social support, mental health and somatic symptoms in sexual and gender minority populations. Depression and anxiety changes among sexual and gender minority people coinciding with onset of COVID pandemic. J Gen Intern Med ; 35 9 : Changes in alcohol use since the onset of COVID are associated with psychological distress among sexual and gender minority university students in the U. Traumatology ; 27 1 : AIDS Behav ; 25 2 : Lancet Diabetes Endocrinol ; 8 7 : Sexual and gender minorities facing the coronavirus pandemic: a systematic review of the distinctive psychosocial and health-related impact. J Homosex ; Minority stress and lesbian women. Lexington: Lexington Books; Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull ; 5 : A conceptual framework for clinical work with transgender and gender nonconforming clients: an adaptation of the minority stress model. Prof Psychol Res Pr ; 43 5 : Gender minority stress: a critical review. J Homosex ; 67 10 : Health disparities between genderqueer, transgender, and cisgender individuals: an extension of minority stress theory. J Couns Psychol ; 66 4 : How the loss of gay spaces has impacted alcohol use among sexual minorities during the COVID pandemic. Google Scholar. Expert Rev Vaccines ; 19 12 : AIDS Behav ; 24 11 : Syst Rev ; 10 1 : PRISMA explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ ; n BMJ ; g Citationchaser: a tool for transparent and efficient forward and backward citation chasing in systematic searching. Res Synth Methods ; 13 4 : Rayyan—a web and mobile app for systematic reviews. Syst Rev ; 5 1 : J Acquir Immune Defic Syndr ; Is there a reduction in chemsex practice in men who have sex with men during Covid lockdown? Results of the CheRRLock study. J Acquir Immune Defic Syndr ; 92 5 : The impact of COVIDrelated restrictions in on sexual healthcare use, pre-exposure prophylaxis use, and sexually transmitted infection incidence among men who have sex with men in Amsterdam, the Netherlands. HIV Med ; 24 2 : J Acquir Immune Defic Syndr ; 86 3 : Sex Transm Infect ; COVID and the changes in the sexual behavior of men who have sex with men: Results of an online survey. J Sex Med ; 17 10 : Front Public Health ; Chemsex cultures: subcultural reproduction and queer survival. Sexualities ; Enfermagem ; e Cad Saude Publica ; 36 12 : e Perceived difficulty of getting help to reduce or abstain from substances among sexual and gender minority men who have sex with men SGMSM and use methamphetamine during the early period of the COVID pandemic. Subst Abuse Treat Prev Policy ; 16 1 : J Sex Res ; 58 8 : AIDS Behav ; 24 7 : J Adolesc Health ; 69 5 : Sexual minority disparities in health and well-being as a consequence of the COVID pandemic differ by sexual identity. LGBT Health ; 8 4 : Mental health severity is associated with increases in alcohol consumption in young adult students during the COVID Pandemic. Alcohol Treat Q ; 39 3 : Am J Prev Med ; 61 3 : Doxycycline prophylaxis for bacterial sexually transmitted infections. Clin Infect Dis ; 70 6 : Sex Health ; 20 2 : P Chemsex and antiretroviral therapy non-adherence in HIV-positive men who have sex with men: a systematic review. Sex Transm Infect ; 93 Suppl 1 : A Publishing on sexual health from the widest perspective. Shopping Cart: empty. Search our journals. Previous Next Contents Vol 20 5. Access Article. Abstract Drug-related harms, including harms from sexualised drug use SDU , are disproportionately experienced by sexual and gender minority people, relative to their majority counterparts. Search strategy This study comprised a primary and secondary search. Study selection Data identified from search one were uploaded to Rayyan, a systematic review software. Data extraction A data extraction table was piloted before two independent reviewers DC, EE extracted the pre-specified data from included studies identified by search one. Search results and sample characteristics Record selection is in Fig. Table 1. Characteristics of included studies. A Geospatial networking application. Key findings from included studies. Loneliness OR 3. Compared with usual i. Tan et al. SAU was most common In , 0. In , 72— SDU declined during pandemic compared with pre-pandemic Decreased SDU prevalence or frequency including no participation Five studies reported a net decrease in SDU following the onset of the pandemic. Findings in context The wider literature confirms that chemsex practice did not cease during the pandemic with studies reporting prevalence but not change suggesting significant participation in Portugal Implications for research, policy, and practice Overall, there was little research reporting changes in SDU during the pandemic. Abstract PDF 1. View Altmetrics. Chow et al. Convenience clinical. Med: 38 IQR: 32— Any drug use during sex chemsex. Med: 45 IQR: 38— Prospective cohort. Hyndman et al. United Kingdom. Sexualised recreational drug use chemsex. Med: 40 IQR: 33— Med: 38 IQR: 33— Shilo and Mor Qualitative IDI. Uhrmacher et al. To understand the relationship between the pandemic onset and PrEP uptake and sexual behaviour. Psychoactive substances consumed during sex. Prospective observational. Convenience from cohort. Med: 47 IQR: 38— Zhang et al. Purposive and respondent-driven. Increased or unchanged SDU prevalence or frequency. Decreased SDU prevalence or frequency including no participation. Across four quarters of ,

Coronavirus (COVID-19) and sexualised drug use among men who have sex with men: a systematic review

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