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Effectiveness of Harm Reduction Interventions in Chemsex: A Systematic Review

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Official websites use. Share sensitive information only on official, secure websites. Correspondence: elena. The phenomenon of chemsex has emerged as an essential public health issue in recent years. This systematic review aimed to investigate currently available harm reduction strategies and to evaluate the efficacy of the corresponding interventions. Methods: A systematic review of the scientific literature related to harm and risk reduction strategies and the effectiveness of chemsex interventions. The inclusion criteria were as follows: I original studies published in peer-reviewed journals, II studies exploring harm reduction interventions for chemsex, and III studies reflecting the efficacy of harm reduction interventions for chemsex. Two reviewers independently selected articles by title, abstract, and full paper review and extracted data. Two authors described the selected studies and assessed their methodological quality. Results: The systematic review comprised six scientific papers that met the selection criteria and were obtained from five countries. Although a limited number of studies were included, it was observed that they presented a medium—high methodological quality. Programs evaluated interventions to reduce harm from chemsex, such as a web-based intervention that improved self-efficacy to refuse risky behaviors and accept HIV testing. The studies suggested that peer-led programs can be effective, especially with facilitators who have experienced chemsex dependence. Conclusion: Harm reduction strategies in chemsex are effective and should be promoted by health professionals. Interventions should be accessible, personalized, and non-judgmental to provide appropriate care and support, ensuring a comprehensive and effective public health response. Keywords: systematic review, chemsex, harm reduction, risk behavior, health promotion. According to the National Institute on Drug Abuse NIDA , addiction is characterized by compulsive drug-seeking behavior and use despite harmful consequences \[ 1 \]. This definition aligns with the DSM-5 classification of substance-related disorders, which categorizes them into distinct classes: alcohol, caffeine, cannabis, hallucinogens such as phencyclidine, LSD, and similar substances , inhalants, opioids, sedatives, hypnotics or anxiolytics, stimulants including amphetamine-type substances and cocaine , tobacco, and other unspecified substances \[ 2 \]. While specific groups of psychoactive substances are well-recognized as potential triggers for substance-related or addictive disorders, it is essential to acknowledge that such disorders can also emerge from the use of other substances or the consumption of unknown substances \[ 3 \]. In recent years, a notable increase in substance use has been observed among men who have sex with men MSM within sexual contexts such as sessions, parties, and other social gatherings \[ 4 , 5 , 6 , 7 \]. This phenomenon, commonly referred to as chemsex, a term coined and popularized by David Stuart in the United Kingdom \[ 6 \], is characterized by the intentional use of drugs to prolong sexual encounters among homosexual, bisexual, and other men who have sex with men MSM , with an emphasis on extended duration as a defining feature \[ 5 , 8 \]. In the case of intravenous substance use, it is known as slam or slamming \[ 9 , 10 \]. There is considerable variability in the terminology used to describe the phenomenon of substance use within specific cultural contexts, reflecting the global nature of the issue. As the duration of chemsex sessions increases, so does the exposure to risks and harms associated with substance use, as well as the risk of infections and sexually transmitted diseases \[ 12 \]. Mixtures of substances can potentiate and prolong their effects, negatively impacting emotion processing and behavior \[ 13 , 14 \]. This phenomenon significantly influences the initiation and progression of substance use. It has a profound impact on the mental health of individuals, posing significant public health, sexual, occupational, and social challenges \[ 14 , 15 , 16 \]. The chemsex phenomenon is closely associated with risky sexual behaviors and an increased incidence of sexually transmitted infections \[ 4 , 17 , 18 , 19 , 20 , 21 , 22 \]. Practices such as unprotected anal sex barebacking , fisting, and group sex are common. They are linked to a higher risk of contracting infections such as gonorrhea, chlamydia, syphilis, hepatitis C, and HIV, among others \[ 20 , 23 , 24 , 25 \]. Additionally, studies have shown that chemsex is associated with the emergence of mental health issues such as anxiety, depression, psychosis risk, suicidal ideation, social isolation, stigmatization, and loss of impulse control \[ 13 , 26 \]. Moreover, a lack of awareness about the risks and consequences of substance use can lead to intoxication, drug interactions, mental health problems, accidents, and overdose \[ 5 , 8 , 24 , 27 \]. Furthermore, the social impact of chemsex should not be overlooked, as it often leads to feelings of shame, guilt, and negative thoughts related to excessive drug use and partying, as well as loss of impulse control and altered behavior \[ 9 , 10 , 28 \]. In the literature, motivations for engaging in chemsex include seeking increased pleasure, disinhibition, managing negative emotions, and even addressing internalized homophobia \[ 29 \]. Understanding the characteristics of individuals who engage in chemsex is essential, as is identifying any barriers they may face in accessing support services to ensure timely and comprehensive assistance \[ 30 \]. Similar to other public health challenges, such as injecting drug use, approaches to addressing chemsex include punitive and prohibitive public policies as well as harm reduction strategies. The harm reduction approach encompasses policies, programs, and practices aimed at reducing the adverse health, social, and economic consequences of drug use. Examples of harm reduction initiatives include syringe exchange programs and supervised drug injection rooms \[ 30 \]. Harm reduction strategies complement prevention efforts \[ 31 , 32 \]. There were no date restrictions, and articles were searched in English and Spanish. The last search date was May The inclusion criteria for the literature were as follows: 1 Original studies published in peer-reviewed journals. The exclusion criteria for the literature included the following: 1 Studies that do not follow harm reduction recommendations or protocols. The articles were selected based on whether they fully or partially answered the research question, fulfilled the inclusion criteria, and had sufficient methodological quality. Titles and abstracts of retrieved papers were independently reviewed by two authors P. The two reviewers separately assessed the full text of these potentially eligible studies P. Discrepancies between reviews were resolved by discussion, with the participation of a third reviewer P. Two authors independently checked the quality of the studies included in the review. Two independent authors P. The following variables were collected: author, aim, design, country, year of study publication, sample size, type of community intervention, harm reduction strategies, and intervention effectiveness. In addition, we explored which type of interventions led to a more significant reduction in the risk of chemsex practice. The initial search yielded results. After reviewing the article abstracts and removing duplicate articles, remained. Following a full review and final selection process, six articles were finally included in the review see Figure 1. The inter-rater reliability ICC between reviewers was 0. The detailed analysis of the included studies, the characteristics types of intervention, description of intervention, and tools used , and their effectiveness are shown in Table 1. At the same time, the results participants, primary outcomes, and quality of the articles are detailed in Table 2. The total sample of studies was individuals, ranging from 29 \[ 36 \] to \[ 37 \]. The mean age ranged from 25 \[ 37 \] to 37 \[ 38 \]. Of the six definitive articles, one was a cohort study \[ 37 \], two were a randomized clinical trial \[ 36 , 39 \], one was a cross-sectional \[ 40 \], one was a cross-sectional follow-up study \[ 38 \], and one was a pilot study \[ 41 \]. The intervention consisted of interactive components and knowledge-based information about chemsex in two parts. The first was interactive. Participants completed two questionnaires to assess their understanding of chemsex. Each questionnaire consisted of 10 multiple-choice questions. The second part consisted of educating participants about chemsex, its risks, and legal consequences. Side effects of substances associated with chemsex and information on self-protection against HIV and STIs, as well as local resources for emotional support and testing, were also addressed. CSES: item instrument with three domains: 1 consistent condom use, 2 correct condom use, and 3 condom use communication. A total score from 14 to 70, a higher score indicates a higher level of condom use efficacy. Cronbach alpha 0. SESS: instrument. A 7-item instrument. Total score from 7 to 35, a higher score indicates a higher level of self-efficacy. DASES: 16 items assessing abstinence self-efficacy across high-risk situations. Total score from 16 to , a higher score indicates a higher level of self-efficacy. All study outcomes were self-assessed at baseline and 3-month follow-up interviews through an online structured questionnaire. Baseline characteristics and study outcomes between IG and CG were compared using Fisher exact tests or independent samples t-test. Generalized linear mixed-effects models with logit links were used to analyze the binary outcomes. Follow-up questionnaires were collected during subsequent visits. Participants were asked to report whether they had used any substances in the previous year by selecting items from a list of 14 options. The GAD-7 assessment scale was used to evaluate the degree of anxiety, and the PHQ-9 assessment scale was used to evaluate depression. Descriptive statistics were computed to demonstrate the frequency and distribution of the occurrence of the various participant characteristics. Chi-squared tests were used to compare participants in terms of the intention to reduce chemsex behavior. Logistic and Poisson regressions were used to test for relationships between the use of healthcare services and all other variables. Variables with a p -value of less than 0. A pilot evaluation of a novel peer-led harm reduction intervention for chemsex. Demographic characteristics, retention, completion, and abstinence were collected between January and August in MSM using Beyond Motivation to remain abstinent and mental well-being at baseline and the end of Beyond were compared using a point Likert scale. Demographics of the MSM referred to Beyond were collected data on entry into the program, completion, and remaining abstinent at their final review between January and August With a point Likert scale, participants were routinely asked to provide a score of how motivated they felt to enter the program; at the end, they were asked to repeat the score, focusing on their motivation to remain abstinent. Descriptive statistics were used to summarize the sociodemographic characteristics and study outcomes. The PK course is a unique 4-hour training course that provides participants with tools to identify, prevent, and treat common medical syndromes associated with substance overuse. The course was offered to MSM and transgender individuals, who were asked to enroll in the training free of charge between January and March Anonymous online questionnaire about demographic characteristics, drug use habits before and after the course, personal experience with eight common chemsex and party substances marijuana, GHB, MDMA, ketamine, cocaine, and methamphetamine , alcohol use, incidence of drug-impaired sex, use of PrEP, and whether they had ever needed emergency treatment for excessive drug use. Finally, they were asked to describe a common intervention they had performed as a PK after the course open-ended question. The evaluation of the program consisted of several steps. Secondly, it was assessed how many PKs had assisted people in emergency medical situations at LGBT social events, comparing them with those who had not. Finally, open-ended questions were analyzed using content analysis to provide descriptive statistics of the common interventions of PKs and their need for additional training. Participants were informed about downloading the JomPrEP app with instructions on how to use the app to request and track PartyPack for 30 days between March and April and complete a post-survey at the end of the study period. They were provided with a single-use registration code needed to access the app. Recruitment was conducted through flyers posted in local organizations and social media platforms. Means for continuous variables and frequencies for categorical variables were calculated to describe the participants. The usability and acceptability of the PartyPack were based on descriptive statistics from the app analytics and acceptability measure. All exit interviews were audio-recorded, transcribed, and analyzed for qualitative data. The comments and issues were grouped and categorized according to common themes relative to specific app functions by two coders. The main activities included mindfulness, breathing, relaxation techniques, mindfulness of the senses and the body, and understanding the self. This online MBCI contains cognitive, behavioral, and mindfulness factors. Each session included substance use and sexual behavior, working with the inner critic and high-risk situations, sex without drugs and sexual identity and psychosexual well-being, substance use, and self-compassion. Both study groups completed self-report questionnaires throughout the program at weeks 0 baseline , 8, and Group 1 did not access the materials until week 1 follow-up. Group 2 did not access the materials until week 8 when the program began. The assessments lasted approximately 20 minutes. Online group mindfulness sessions lasted 2 to 3 hours every two weeks. Three tools were used to assess levels of cognitive mindfulness, sexual self-efficacy, well-being, and chemsex use. Higher scores indicate higher levels of mindfulness range 4— Scores ranged between 19 low chemsex engagement and 76 very high chemsex engagement. A focus group was also held during week 12 to hear opinions, general experiences, and program suggestions. The focus groups lasted approximately one hour, with about five participants per group. The two groups were compared between-subjects design on the efficacy of MBCI on chemical sex use, well-being, and self-efficacy at weeks 0, 8, and 12 within-subjects design. T -test comparisons were made between Groups 1 and 2 at Weeks 0, 8, and 12 and between Group 1 at Week 8 and Group 2 at Week 0. A repeated measures ANOVA was conducted to analyze the effect of time on chemsex, mindfulness and cognition, sexual self-efficacy, and well-being. Marital status: Employment: Monthly income: Intention to have chemsex in the last three months: IG: 28 Participation in chemsex: in the last three months: IG: 27 HIV testing in the last three months: IG: 40 Marital status: 79 Substance use: 55 A total of 25 Living with HIV: 39 Intended to reduce chemsex behavior: Most prevalent drugs: methamphetamine Health service utilization ranged from In total, 14 of 19 Sexual orientation: 47 Marital status: 30 A total of 34 participants A total of 50 participants They reduced their use of drugs, mainly cocaine and alcohol, and increased their use of PrEP. Before the course, 21 A total of 33 There were no significant demographic differences between those who helped and those who did not. However, those who did exhibit greater confidence levels as PKs gained more knowledge in the course and felt a greater sense of community responsibility and self-confidence than those who did not. Chemsex initiated between 18 and 30 years of age 24, Participants also reported being more compassionate with themselves and more aware of their needs, emotions, and feelings. In addition, lower levels of chemsex and higher levels of cognitive mindfulness, sexual self-efficacy, and well-being were observed after the intervention and at the week follow-up. Regarding the least helpful aspects of the intervention, Regarding the experience using the MBCI, Regarding MBCI support for drug use, of the 25 responses, Regarding how this intervention supported sexual well-being, of the 15 respondents, In terms of how MBCI supported overall well-being, of the 52 responses, In addition, Among the cohort studies, one examined the relationship between the intention to reduce chemsex behavior and chemsex-related mental health service utilization among MSM who engage in chemsex \[ 37 \]. The clinical trial evaluated the efficacy of a web-based intervention to reduce the sexual harms of chemsex among MSM \[ 39 \]. From the pilot study, the feasibility, retention, and effect of Beyond on chemsex abstinence, abstinence motivation, and mental well-being were examined \[ 41 \]. The results of the reviewed studies can be classified into approach, interventions, and access difficulties. Regarding approach, Hung et al. On the other hand, regarding interventions and their effectiveness, it was observed that a web-based intervention focused on harm reduction demonstrated significant improvement in MSM self-efficacy to refuse risky sexual behavior and chemsex, as well as in their acceptance of HIV testing \[ 39 \]. Mental health clinic attendance was significantly associated with increased intention to reduce chemsex behavior \[ 37 \] as well as decreased risky sexual behaviors \[ 38 \] and an increased sense of community responsibility with a knowledge of first aid care \[ 38 \]. Finally, the pilot study by Thain et al. In terms of consequences, Hung et al. They indicated that many people who engage in chemsex may not want to change their behavior or use available care services. On the other hand, Thain et al. This systematic review aimed to investigate currently available harm reduction strategies and to evaluate the effectiveness of the corresponding interventions. Despite including a limited number of studies, most were of medium to high methodological quality. This analysis was conducted to clarify the influence of these strategies on harm reduction, thus addressing the research question posed. In recent years, the chemsex phenomenon has emerged as a critical public health challenge. The first mentions in the scientific literature date back to , with several studies dedicated to defining and understanding the concept of chemsex and its relationship with drug use, contact applications, sexually transmitted disease outbreaks, and HIV transmission \[ 18 , 42 , 43 , 44 , 45 \]. Recent research underscores the urgency of obtaining reliable and relevant data for a better understanding of chemsex, mainly due to its increasing prevalence, possibly linked to the rise of mobile dating apps \[ 19 , 46 \]. Our findings emphasize the importance of investigating the motivations and contexts surrounding chemsex to develop effective risk-reduction measures \[ 7 , 47 \]. In our country, studies and government initiatives have been conducted to understand the prevalence and motivations underlying chemsex use \[ 48 \]. In addition, it has been observed that initial recreational drug use can be a precursor to problematic use \[ 26 \]. The evaluation of community health intervention in a sexual minority population can provide invaluable guidance to health policymakers. A lack of social and family support, along with the stress associated with minority status, may contribute to recreational drug use among men who have sex with men MSM and increase the risk of acquiring HIV \[ 49 , 50 \]. This assessment can facilitate the design of additional community-focused interventions and the efficient allocation of resources, also allowing for the greater inclusion of community members in policies aimed at risk and harm reduction \[ 38 \]. Factors such as unemployment, smoking, condomless sex, recent sexually transmitted infections STIs , the use of post-exposure prophylaxis PEP , and pre-exposure prophylaxis PrEP have been associated with chemsex initiation \[ 49 \]. Therefore, it is crucial to recognize and support these vulnerable individuals by ensuring equitable access to preventive measures such as PrEP pre-exposure prophylaxis for all individuals at risk for HIV \[ 49 \]. However, there are still regions where the health system does not provide access to PrEP \[ 51 \]. Collaboration between health services focused on gay, bisexual, other MSM GBMSM , and drug prevention and recovery services could enhance awareness and access to care \[ 37 \]. Importantly, chemsex studies should include a comprehensive assessment of individuals, including aspects such as personal situation and social support, to improve risk awareness and facilitate risk reduction measures \[ 49 \]. Clinical and community-based services focused on the sexual health of MSM are critical for providing education and harm reduction for those who engage in chemsex \[ 52 \]. The effective integration of these services can result in improved prevention and treatment, promoting the health and well-being of these communities. In our country, comprehensive care of the chemsex phenomenon has been advocated, involving various actors and care contexts to improve risk reduction according to substances, consumption routes, and sexual practices \[ 8 \]. Our results underscore the need for a more thorough understanding of chemsex, highlighting the importance of engaging specialized services such as addiction units, sexually transmitted disease clinics, and mental health services. These health facilities can effectively share information and implement chemsex-focused risk prevention campaigns \[ 53 \]. It is critical to individualize care and improve services by measuring and defining behaviors, along with a standardized assessment of outcomes \[ 54 \]. However, people who engage in chemsex face known barriers in different healthcare settings related to GBMSM care, resulting in the underutilization of health services and worse health outcomes \[ 55 , 56 \]. In terms of harm reduction, despite educational strategies and more information being available, chemsex users are perceived differently from other people with dependencies, such as heroin or crack cocaine users, who tend to use addiction care centers where the primary care system has more experience in their management \[ 57 \]. The MSM perspective is crucial to ensure interventions are tailored to individual contexts, needs, and particularities. However, barriers to consultation in specialized centers persist, mainly due to a fear of being recognized. Therefore, it is crucial to promote existing services, focusing on the areas where chemsex sessions are most frequently organized, and to tailor specific support services for this population \[ 58 , 59 \]. In many regions, sexual health, homosexuality, and chemsex are considered embarrassing topics, which can make it challenging to access support services due to stigma, fear of judgment, or concern about the chemsex experience \[ 39 , 46 , 58 \]. In addition, in some countries, there are legal and criminal penalties for substance use, which increases the difficulty of turning to specific care structures and requesting medical and psychological coverage \[ 37 , 60 \]. Notably, many men who engage in chemsex may not want to change their behavior or utilize specialized care services, opting instead for harm reduction strategies rather than seeking abstinence \[ 39 , 44 \]. Therefore, there is a need for healthcare professionals to generate an awareness of the consequences of sexualized drug use and the availability of harm reduction resources \[ 37 \]. Perhaps a mindfulness intervention could help raise awareness of drug use by recognizing the triggers. Indeed, Banbury et al. Therapies that foster a non-judgmental attitude of acceptance toward beliefs, thoughts, and feelings are crucial for managing shame \[ 36 \]. The lack of referral options for sexual health professionals seeking to direct clients to facilities with the capacity to provide more in-depth treatment remains a prominent area of improvement for continuity of care \[ 46 \]. In addition, the lack of harm-reduction guidance from professionals requires synergies between the community and healthcare stakeholders to develop accessible and acceptable harm-reduction strategies \[ 51 \]. Individuals engaged in chemsex experience moments of both opportunities to change their behavioral health and vulnerability to adverse effects on their well-being. Offering follow-up consultations to address individual needs and provide personalized interventions is crucial. These interventions should be easily accessible according to individual needs, avoiding excessive exposure that may lead to resistance to change or stigmatization \[ 58 \]. Regarding the characteristics of the interventions, associations have been found between age, PEP use, and taking PrEP with a lower probability of quitting chemsex. On the other hand, being younger than 40 years, being unemployed, having sex without a condom, and having recently had STIs and substance use increase the likelihood of initiating chemsex \[ 39 \]. The urgent need to strengthen screening and care for sexually transmitted infections STIs in the MSM population is emphasized \[ 39 \]. Integrating harm reduction initiatives into health services, psychotherapy, sexology, and addiction counseling services targeting GBMSM is essential. Motivational interviewing and therapeutic education, supported by psychosocial and multidisciplinary options, are critical starting points for addressing chemsex practices, especially in resources- and support facilities-limited settings \[ 58 \]. Another effective harm reduction strategy is providing chemsex packages through consultations in healthcare settings or mobile health platforms \[ 40 \]. This initiative aims to support MSM in reducing the harmful effects of chemsex and promoting safe sexual practices. Recognizing the difficulty of quitting drug use abruptly and educating users about safe practices during use can be highly beneficial. The discreet home delivery of these packages ensures marginalized individuals feel safe and less exposed to legal or social repercussions. This discretion also helps alleviate the fear of stigma and discrimination associated with homosexual behavior and chemsex. The applications included in these packages offer confidential and less stigmatizing access to health resources, thereby overcoming barriers to traditional clinical care. Training courses such as the one by Zucker et al. The knowledge, self-empowerment, and confidence gained in the course were associated with increased emergency intervention in gay venues. These results highlight the positive impact of harm reduction initiatives that focus on education and understanding safe recreational drug use rather than outright prohibition or coercive measures. This initiative can be defined as both a harm reduction intervention and a prevention program for a population at high risk of drug overdose \[ 38 \]. Specific sexual health and harm reduction interventions are required across the health system to address the prevention needs of gay men who combine psychoactive substances with sex. In conclusion, harm reduction strategies for chemsex are effective, and health professionals must promote their implementation. Interventions must be accessible, personalized, and free of bias to ensure that men who engage in chemsex receive appropriate care and support. Additionally, it is essential to combat the stigma associated with chemsex and promote the public awareness of this phenomenon to ensure a comprehensive and effective public health response \[ 21 , 61 , 62 \]. The chemsex phenomenon has important implications for clinical practice, as well as for treatment and intervention strategies aimed at reducing the associated harms. In this context, it is crucial to approach this issue from a comprehensive perspective that considers both clinical and psychosocial aspects. Some of the implications and strategies related to chemsex pose significant challenges in contemporary clinical practice. The health implications associated with chemsex are diverse. A state of euphoria and disinhibition increases the risk of unprotected sexual practices, which can increase the likelihood of HIV and other STI transmission. In addition, chemsex can negatively affect the adherence to antiretroviral therapy ART and PrEP, as the drugs used can alter judgment about reality and awareness, which can lead to missed doses of treatment. Therefore, non-adherence to ART and PrEP can decrease the efficacy of these treatments, exposing individuals to greater health risks \[ 63 \]. In clinical practice, healthcare professionals must be trained to recognize and appropriately address chemsex regarding diagnosis and treatment. In addition, it is critical to adopt an approach free of prejudice and stigmatization, creating a safe and trusting environment in which people feel comfortable talking openly about their experiences. Regarding treatment, it is essential to consider multidisciplinary approaches that integrate pharmacotherapy, psychotherapy, and harm reduction interventions. Pharmacotherapy can help treat both substance addiction and underlying mental health problems. For example, opioid replacement therapy may be beneficial for those with opioid dependence, while antidepressants may help treat depression associated with chemsex. Psychotherapy, such as cognitive behavioral therapy and acceptance and commitment therapy, can help people develop skills to cope with drug use triggers and improve their emotional health and interpersonal relationships. In addition to treatment, harm reduction intervention strategies play a crucial role in preventing the harms associated with chemsex. These strategies may include providing accurate information about the health risks associated with drug use, distributing harm reduction kits containing materials for safer use such as sterile syringes and condoms , and promoting safer sex practices, such as the use of condoms and lubricants. For all of the above, chemsex poses significant challenges in clinical practice. By adopting a comprehensive people centered approach, healthcare professionals can significantly reduce the harms associated with chemsex and improve the quality of life of those affected by this practice. Several limitations of the present systematic review should be highlighted. First, the search for articles was conducted in English and Spanish, which could have excluded relevant studies published in other languages. Second, methodological heterogeneity among the studies made it difficult to compare the results of the studies included in this review. Third, each study had its criteria for measuring harm reduction strategies and chemsex interventions, as well as study design and inclusion criteria, so the studies may not have accounted for the possibility of confounding variables. Our review shows that the results contribute to the evidence that there is an association between the practice of chemsex and the lack of harm reduction strategies and interventions. Risk factors such as age, comorbidity with other pathologies, mental problems, and unemployment have a negative impact on health, as they increase vulnerability to the practice of chemsex and, therefore, to the development of mental disorders that affect the quality of life of individuals. These findings may have clinical implications, so developing chemsex intervention strategies may mitigate harm by reducing STIs and mental problems and improving physical, sexual, and mental health. It would be interesting to continue researching these variables to expand the knowledge of health professionals and strengthen the evaluation and effectiveness of chemsex programs and strategies to prevent its possible consequences. Future research should include a more extensive study sample, as well as the causes, consequences, frequency of use, and subjective and emotional experiences of chemsex users. Conceptualization, P. All authors have read and agreed to the published version of the manuscript. An ethics statement is not applicable because this study was based exclusively on published literature. This section collects any data citations, data availability statements, or supplementary materials included in this article. As a library, NLM provides access to scientific literature. Healthcare Basel. Find articles by Pablo Del Pozo-Herce. Find articles by Paula Sanchez-Palomares. Find articles by Paula Cristina Garcia-Boaventura. Find articles by Elena Chover-Sierra. Find articles by Vicente Gea-Caballero. Find articles by Carles Saus-Ortega. Find articles by Piotr Karniej. Juan Carlos Sierra : Academic Editor. Open in a new tab. Primary outcomes were assessed with the Chinese version of three instruments. Linear mixed effects models assessed the differential change in continuous outcomes. The independent variables included time, group, and interaction between group and time. Hung et al. Thain et al. The Kruskal—Wallis test was used to compare pre- and post-program Likert scores. Zucker et al. Gautam et al. Banbury et al. Group 2 received MBCI at week 8. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. Choi et al. To evaluate the effectiveness of web-based intervention in reducing the sexual harms of chemsex among MSM. To understand the relationship between the utilization of mental health services among GBMSM who engage in chemsex and the intention to reduce chemsex behavior and use health services. To evaluate the feasibility, retention, and effect of Beyond on abstinence from chemsex, motivation for abstinence, and mental well-being. Randomized controlled trial. Cohort study. Cross-sectional follow-up study. Cross-sectional study.

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