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This phenomenon poses a public health problem, increasing the risk of sexually transmitted infections STIs and mental disorders. Objective: The primary aim of this study was to delve into the correlation between substance use and sexual health, specifically examining the association between different substances used and the risk of sexually transmitted infections STIs in the context of Chemsex in Spain. Methods: An observational, descriptive, cross-sectional study was conducted among Spanish participants between January and April Non-probabilistic purposive sampling was used by the investigators. The researchers administered a questionnaire to men who have sex with men who use substances, especially in the sexual sphere, in all the autonomous communities of Spain. Results: The The use of various drugs during chemsex, such as amyl nitrite, GHB, ecstasy, and others, correlates with higher rates of STIs, highlighting the need for interventions to reduce risk and harm. The drugs most associated with slamsex include ketamine, mephedrone, and methamphetamine, underscoring the importance of addressing the risk behaviors associated with this activity. Conclusion: This study shows that chemsex appears to be associated with a high prevalence among men who have sex with men. Who use multiple substances in a sexual context, and are particularly exposed to sexually transmitted infections STIs , indicating a particular need for STI prevention and care in this group. In recent years, there has been an increase in the intentional use of drugs for sex, which can last for hours or even days, among men who have sex with men MSM 1 — 6. The recreational uses of substances vary in place or environment. This shows that it is a global problem present at the international level. The Chemsex phenomenon has been linked to risky sexual behaviors, as well as an increase in sexually transmitted infections 1 , 10 — If the consumption of these psychoactive substances is intravenous 19 , 32 in this context, it is called slamming or slamsex 1 , 6 , 14 , 25 , 28 , For this reason, chemsex is considered a health concern due to the increase in HIV primary infection, hepatitis C reinfections 14 , and, in general, a higher probability of acquiring sexually transmitted diseases STDs 1 , 14 , As a consequence, PLHIV are at increased risk for mental health problems 6 , 25 , 32 , 34 , specifically anxiety and depression 23 , In the same vein, Chemsex practices have been associated with increased risk of psychosis 6 , 14 and delusional thoughts due to chronic methamphetamine use 29 , 40 , suicidal ideation 6 , 41 anxiety, depression 14 , 34 , overdose 15 , behavioral disturbances 6 , substance addiction 26 and reduced adherence to PrEP treatment 6. The reasons why MSM engage in chemsex can be diverse, including increasing libido 27 , intensifying sexual pleasure 18 , facilitating sexual euphoria and disinhibition 39 , better management of negative emotions such as lack of self-confidence during sex 14, Furthermore, the rapid changes in substance consumption, including the expansion of new psychoactive substances NPS reported in Europe 42 , underscore the need to explore the profile of substance consumption in sexual contexts among MSM. Understanding these profiles could provide insights into the possible connection between chemsex and MSM participation in these practices, particularly in light of the association between chemsex and sexually transmitted infections STIs , as well as the emergence of antibiotic-resistant infections. An observational and descriptive cross-sectional study was conducted between January and April The study was conducted across all autonomous communities of Spain. The investigators employed non-probabilistic purposive sampling. Exclusion criteria included: 1 refusal to provide informed consent and 2 participants who incorrectly filled out or left the questionnaire incomplete. Participants were asked to provide a series of sociodemographic characteristics as part of the survey data related to the study phenomenon. These characteristics included age, gender identity, sexual behavior, marital status, autonomous community, employment status, socioeconomic level, monthly income, level of education, and relationship status. The use of more than one of these substances in connection with the practice of Chemsex was considered poly-drug use. Participants were also asked about administration routes oral or injecting. The questionnaire featured a comprehensive list of substances, including tobacco, alcohol, cannabis, and cocaine. These substances were explicitly included due to their frequent association with the practice of chemsex, as supported by existing literature. Moreover, other substances commonly linked to chemsex were also included in the questionnaire, ensuring a thorough examination of substance use patterns in this context The online questionnaire received 1, responses. Participants were recruited through disseminating the questionnaire on social networks, LGTBI-related websites, social media channels, sexual health clinics, geolocation applications, and LGTBI groups. Participants were not offered any incentives for taking part in the study. All data were collected voluntarily, anonymously, and confidentially. They were explicitly informed that completing the questionnaire was voluntary and their participation was anonymous and confidential. They were also assured that they could withdraw from the study at any point if they wished to do so. Participants were queried about their marital status and if they were in a committed relationship, as well as whether they were currently using pre-exposure prophylaxis PrEP. Descriptive analyses were conducted to examine the sociodemographic characteristics of the sample. Frequencies of Chemsex behaviors and other risky sexual practices were computed. Furthermore, differences between homosexual and heterosexual men concerning substance use during Chemsex were investigated. The chi-square statistic was used for STI diagnosis and use of pre-exposure prophylaxis. The dataset underwent systematic cleaning, which included addressing missing values and identifying outliers. Demographic characteristics such as age, gender, etc. Differences between these subgroups were analyzed using the same statistical tests employed for Chemsex use. Logistic regression was then utilized to explore factors associated with Chemsex use, with independent variables including demographic characteristics, substance use patterns, and injection drug use status. Among the participants, The majority Approximately half of the sample Twenty-one percent of the sample was on PrEP treatment. Regarding participants on PrEP treatment, 35 As for participants who were not on PrEP treatment, 33 7. Table 3 shows the distribution of the participants according to the primary drug of use. For example, Table 3. Table 4 illustrates a statistically significant association between injecting substance use slamsex and the diagnosis of sexually transmitted infections STIs. Table 4. Prevalence of injecting substance use among men with sexually transmitted infections STIs. Our research aimed to explore the profile of men who have sex with men in a sexual context since it could explain the relationship between chemsex, sexual behavior, and the increase in the diagnosis of STIs. These factors are in line with other studies that have scientifically established that the homosexual population is potentially up to twice as prone to experiencing psychotic symptoms compared to the heterosexual population 45 , Chemsex has been identified as a coping mechanism for the stressors that men who have sex with men MSM encounter regularly 45 , The research presents an alarming picture of the prevalence of sexually transmitted infections STIs among men who have sex with men MSM involved in chemsex and slamsex. According to the study data, This is striking, as one might expect those on PrEP to be less exposed to STIs due to their greater awareness of sexual health and regular intake of preventive medication. For all of the above, harm reduction strategies and community-based chemsex approaches that combine support services with health promotion and education activities should be pursued 51 — Running and implementation in the different Autonomous Communities CCAA of the PrEP programs, with the aim of collecting information on the number of participants, their characteristics, their clinical evolution and the effectiveness of PrEP. Thus, up to and including , the estimated number of users who were taking PrEP is 18, people On the other hand, substance use appears to be associated with an increased risk of STIs in general. MSM who engage in chemsex have been reported to be at increased risk of transmitting STIs and at increased risk of engaging in risky sexual behaviors, and acquiring HIV When considering substance use in the context of chemsex and slamsex, the results show a significant association between the use of certain substances and the prevalence of STIs. Data that are also consistent with other studies in which drugs used in the chemsex context were related to STIs and sexual risk behaviors 30 , 56 — Moreover, the findings of a previous study demonstrated a 2. This result aligns with the outcomes of the current study. These data reinforce the need for continued sexual health education and safer practices, even among those on PrEP. The high prevalence of STIs among participants on PrEP suggests that access to preventive medication is not sufficient to eliminate STI risk and that other factors, such as sexual risk behavior, may be at play. In regards to slamsex, it is notable that a significant percentage of participants in our study reported consuming injected substances Among individuals who engaged in slamsex, a higher frequency of STI diagnoses was observed, consistent with findings from other studies. For instance, research has shown that Other studies focused on drug use and STI risk have shown an increased risk of STI acquisition by people who use drugs 39 , which may be related to the search for new sensations and experiences as well as disinhibition. The potent stimulant effect of mephedrone has been associated with a heightened risk of engaging in high-risk sexual behaviors, which in turn increases the risk of HIV infection and other sexually transmitted infections STIs Additionally, mephedrone use has been linked to severe psychiatric symptoms, intoxications, and dependence on injecting drugs This includes a range of adverse effects such as binge drinking, anxiety, binge eating, withdrawal symptoms, and psychotic symptomatology resulting from injecting mephedrone use 6 , 29 , The significant prevalence of substance use within the context of chemsex, coupled with its correlation with risky sexual behaviors, underscores the importance of targeting men who have sex with men MSM as a critical population for prevention strategies. These findings support the need for comprehensive interventions that address both substance use and sexual health to reduce STI risk in vulnerable populations, especially in populations where chemsex is prevalent, as appears to be the case in Spain and who are on PrEP treatment. A retrospective case review conducted in a London service found that half of MSM who reported engaging in chemsex perceived subsequent adverse physical and mental health consequences, highlighting the need for comprehensive support and intervention strategies 32 , Furthermore, there exists an association between engaging in chemsex and the heightened risk of experiencing emotional instability, including symptoms of anxiety and depression. These findings align with numerous previous studies conducted among MSM, which have consistently reported a link between drug use for sexual purposes and an increased likelihood of experiencing depressive outcomes Indeed, some studies have identified anxiety as a predictor in the relationship between psychosis and chemsex Conversely, other research has found no significant differences in anxiety levels, although it did reveal that chemsex users exhibited higher scores on the GAD-7 scale This may suggest that the use of substances to extend time in a sexual context may provoke depressive symptoms with ideas of guilt and ruin of the people who practice it, or also, it may be depressive symptoms such as social isolation and loneliness that lead to substance use in a sexual context to disinhibit themselves and be a way to socialize with other people. Our findings also suggest that risk factors such as substance use, poly consumption, engaging in slamsex, and injecting methamphetamine use are associated with an elevated likelihood of experiencing a psychotic break. This association with the risk of psychosis aligns with the results of previously published studies 29 , Associations have been noted between chemsex and an increased risk of suicide. Additionally, there is evidence of an association between chemsex, impulsivity, and distorted body perception. This suggests that MSM and individuals involved in chemsex may have a higher lifetime risk of suicide attempts compared to the general population One of the strengths of our study is that the survey was anonymous, so participants may be especially willing to disclose their chemsex experiences. Other strengths of our study are validated measurement methods, multivariate analysis, and explicit questions about chemsex. Our findings have certain limitations. Using a cross-sectional study design means that the relationships between variables cannot be interpreted as cause-and-effect. Additionally, the use of non-probability purposive sampling to obtain the sample restricts the generalizability of our results to the broader MSM population. However, the sizable sample size suggests that the results hold validity. It underlines the urgent need for preventive strategies and care programs tailored to this population. Chemsex poses unique public health challenges, requiring a comprehensive approach that addresses substance use and sexual health. Individuals involved exhibit high-risk behaviors, along with symptoms of psychopathology and substance dependence. Therefore, identification, education and prevention programs are crucial to mitigate negative consequences. Improving awareness of PrEP as HIV prevention can be effective, as can screening programs for health problems related to drug use, and interventions to increase awareness of risks and provide access to health resources. The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation. The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study. PK: Writing — original draft. We would like to thank all the participants who have contributed to part of the contributed to part of it. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. Rev Multidiscip Sida. Google Scholar. What is chemsex and why does it matter? Madrid: MSD. Application of the Delphi method for content validity analysis of a questionnaire to determine the risk factors of the Chemsex. Soriano, R. Servicio Canario de Salud The Chemsex study: Drug use in sexual settings among gay and bisexual men in Lambeth , Southwark and Lewisham. Mephedrone and chemsex. A descriptive analisis of a sample of patients in Madrid. Sex Transm Infect. Crossref Full Text Google Scholar. Pufall E. Sexualized drug use 'chemsex' and high-risk sexual behaviours in HIV-positive men who have sex with men. HIV Med. Vulnerability to HIV among older men who have sex with men users of dating apps in Brazil. Braz J Infect Dis. Chemical sex chemsex in a population of French university students. Dialogues Clin Neurosci. Uso de metanfetamina en el contexto chemsex y sus consecuencias en la salud mental: un estudio descriptivo. Chemsex y uso de sustancias durante las relaciones sexuales: resultados de una encuesta realizada en Argentina. Actual SIDA infectol. Ministerio de Sanidad. Ministerio de Sanidad Cited January 12 , pp. Encuesta online europea para hombres que tienen relaciones sexuales con hombres. Health characteristics associated with chemsex among men who have sex with men: results from a cross-sectional clinic survey in Norway. PLoS One. Chemsex among men who have sex with men living outside major cities and associations with sexually transmitted infections: a cross-sectional study in the Netherlands. Stuart, D, and Weyman, J. ChemSex and care-planning: one year in practice. HIV Nurs. J Clin Med. Chemsex behaviours among men who have sex with men: a systematic review of the literature. Int J Drug Policy. Chemsex and new HIV diagnosis in gay, bisexual and other men who have sex with men attending sexual health clinics. Low levels of chemsex among men who have sex with men, but high levels of risk among men who engage in chemsex: analysis of a cross-sectional online survey across four countries. Sex Health. Prevalence of drug use during sex among swingers and perceived benefits and risks - a cross-sectional internet survey in the Netherlands. Coll, J, and Fumaz, C. Recreational drugs and sex in men who have sex with men: chemsex, risks, health problems related, emotional factors and intervention strategies. Rev Enf Emerg. Understanding sexualized drug use: substances, reasons, consequences, and self-perceptions among men who Have sex with other men in Spain. Cross-sectional analysis of chemsex drug use and gonorrhoea diagnosis among men who have sex with men in the UK. Substance-linked sex in heterosexual, homosexual, and bisexual men and women: an online, cross-sectional «global drug survey» report. J Sex Med Mai. Chemsex and the city: sexualised substance use in gay bisexual and other men who have sex with men attending sexual health clinics. Chemsex and mental health of men who Have SexWith men in Germany. Front Psych. Sexualised drug taking among men who have sex with men: a systematic review. Perspects Public Health. Psychosocial and sexual characteristics associated with sexualised drug use and chemsex among men who have sex with men MSM in the UK. Chemsex among men who Have sex with men: a sexualized drug use survey among clients of the sexually transmitted infection outpatient clinic and users of a gay dating app in Amsterdam, the Netherlands. Sex Transm Dis. Risky Sexual Practices, sexually transmitted infections, motivations, and mental health among heterosexual women and men who practice sexualized drug use in Spain. Methamphetamine use among gay and bisexual men in Australia: trends in recent and regular use from the gay Community periodic surveys. Severe psychosis, drug dependence, and hepatitis C related to slamming Mephedrone. Case Rep Psychiatry. European drug report trends and developments. European monitoring centre for drugs and drug addiction. Sexualized drug use and specialist service experience among MSM attending urban and rural sexual health clinics in England and Scotland. Chemsex and psychosis: a systematic review. Behav Sci. Psychol Med. Psychological and interpersonal factors associated with sexualized drug use among men who Have sex with men: a mixed-methods systematic review. Arch Sex Behav. Review of sexualized drug use associated with sexually transmitted and blood-borne infections in gay, bisexual and other men who have sex with men. Drug Alcohol Depend. Identification and characterization of latent classes based on drug use among men who have sex with men at risk of sexually transmitted infections in Amsterdam, the Netherlands. A community-led, harm-reduction approach to chemsex: case study from Australia's largest gay city. Re-wired: treatment and peer support for men who have sex with men who use methamphetamine. Crystal methamphetamine use in sexual settings among German men who Have sex with men. Informe de resultados noviembre mayo Ministerio de Sanidad, Julio Major physical and psychological harms of methamphetamine use. Drug Alcohol Rev. Methamphetamine use among gay men across the UK. Amphetamine-type stimulants and HIV infection among men who have sex with men: implications on HIV research and prevention from a systematic review and metaanalysis. The role of drugs during group sex among gay men in Australia. Nested event-level case-control study of drug use and sexual outcomes in multipartner encounters reported by men who have sex with men. AIDS Behav. Substance use and sexual risk behavior in HIV-positive men who have sex with men: an episode level analysis. Abdulrahim, D, and Bowden-Jones, O. Guidance on the Management of Acute and Chronic Harms of Club drugs and novel psychoactive substances. Public Health Chasing the rainbow: pleasure, sex-based sociality and consumerism in navigating and exiting the Irish Chemsex scene. Cult Health Sex. Demand for and availability of specialist chemsex services in the UK: a cross-sectional survey of sexual health clinics. Associations between intimate partner violence and health among men who have sex with men: a systematic review and meta-analysis. PLoS Med. Keywords: substance use, HIV infections, sexual behavior, STIs, pre-exposure prophylaxis, sexually transmitted infection. Public Health. The use, distribution or reproduction in other forums is permitted, provided the original author s and the copyright owner s are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher. Top bar navigation. About us About us. Sections Sections. About journal About journal. Article types Author guidelines Editor guidelines Publishing fees Submission checklist Contact editorial office. Public Health , 10 May Substance Use Disorders and Behavioral Addictions. Descriptive study on substance uses and risk of sexually transmitted infections in the practice of Chemsex in Spain. Table 1. Table 2.

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