journal article Open Access Dec 12, 2024

Comparing the impact of sexualised drug use with and without chemsex on sexual behaviours among men who have sex with men in China: a national multi-site cross-sectional study

Abstract
Background
Sexualised drug use (SDU) is common in men who have sex with men (MSM). Chemsex, a form of psychoactive SDU, is a strong risk factor for sexually transmitted infections (STIs). We investigated the associations of SDU and chemsex with the sexual behaviours in Chinese MSM.


Methods
From 23 March 2022 to 22 April 2022, we recruited participants (male, >18 years old) via WeChat across five Chinese cities to an online cross-sectional survey on sexual behaviour preferences, pre-exposure prophylaxis, SDU, and chemsex. One-way ANOVA and chi-squared tests were used to compare sexual behaviour patterns across the groups.


Results
We included the responses from 796 eligible participants, who were aged 18–70 years, and mostly single. Three groups of participants were identified, the largest was the ‘non-SDU group’ (71.7%), followed by the ‘SDU without chemsex’ group (19.7%), and the ‘chemsex’ group (8.5%). Poppers (8.4%) were the most used drugs in the ‘chemsex’ group. The ‘chemsex’ group also had the highest number of sexual partners, and reported the highest frequency of self-masturbation (38.2%). The ‘chemsex’ group also exhibited the highest Shannon diversity index value of 2.32 (P = 0.03), indicating a greater diversity of sexual acts. For sequential sex act pairs, the ‘chemsex’ group was more likely to self-masturbate than perform receptive oral sex, perform receptive oral sex than self-masturbate, being masturbated or perform receptive oral sex than being rimmed by another man.


Conclusion
Our findings identify the urgent need for targeted HIV/STI interventions for MSM who practice chemsex.
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References
40
[1]
Íncera-Fernández "Understanding sexualized drug use: substances, reasons, consequences, and self-perceptions among men who have sex with other men in Spain." Int J Environ Res Public Health (2023) 10.3390/ijerph20032751
[2]
Lipari RN, Hedden SL, Hughes A. Substance Use and Mental Health Estimates from the 2013 National Survey on Drug Use and Health: Overview of Findings. 2014 Sep 4. In: The CBHSQ Report. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2013. 27656739
[3]
Norman SB, Harrop E, Wilkins KC, Pedersen ER, Myers US, Chabot A, Rodgers C. Development of sexual relationships and substance use. The Oxford Handbook of Adolescent Substance Abuse, Oxford Library of Psychology (2019; online edn, Oxford Academic, 10 Dec. 2015). Available at https://doi.org/10.1093/oxfordhb/9780199735662.013.020 [accessed 3 Dec 2024] 10.1093/oxfordhb/9780199735662.013.020
[4]
Weibell "The effect of substance use on 10-year outcome in first-episode psychosis." Schizophr Bull (2017) 10.1093/schbul/sbw179
[5]
[6]
Hegazi "Chemsex and the city: sexualised substance use in gay bisexual and other men who have sex with men attending sexual health clinics." Int J STD AIDS (2017) 10.1177/0956462416651229
[7]
Edmundson "Sexualised drug use in the United Kingdom (UK): a review of the literature." Int J Drug Policy (2018) 10.1016/j.drugpo.2018.02.002
[8]
European Chemsex Forum report Paris. Chemsex Forum Organisation Committee. 2019. Available at https://idpc.net/publications/2020/04/european-chemsex-forum-report
[9]
Irfan "An uncharted territory of sexualized drug use: exploring the dynamics of chemsex among young and adolescent MSM including self-identified gay men in urban Dhaka, Bangladesh." Front Psychol (2023) 10.3389/fpsyg.2023.1124971
[10]
Maxwell "Chemsex behaviours among men who have sex with men: a systematic review of the literature." Int J Drug Policy (2019) 10.1016/j.drugpo.2018.11.014
[11]
Wang "Chemsex and chemsex associated substance use among men who have sex with men in Asia: a systematic review and meta-analysis." Drug Alcohol Depend (2023) 10.1016/j.drugalcdep.2022.109741
[12]
Berg "Links between chemsex and reduced mental health among Norwegian MSM and other men: results from a cross-sectional clinic survey." BMC Public Health (2020) 10.1186/s12889-020-09916-7
[13]
Wang "Uptake and willingness to use PrEP among Chinese gay, bisexual and other men who have sex with men with experience of sexualized drug use in the past year." BMC Infect Dis (2020) 10.1186/s12879-020-05024-4
[14]
Tam "Acceptance of opt-out HIV testing in out-patient clinics in Hong Kong." Hong Kong Med J (2022) 10.12809/hkmj209222
[15]
del Pozo-Herce "Descriptive study on substance uses and risk of sexually transmitted infections in the practice of Chemsex in Spain." Front Public Health (2024) 10.3389/fpubh.2024.1391390
[16]
Olete "ChemsexPH: the association between chemsex, HIV status and adherence to antiretroviral therapy among men who have sex with men in the Philippines." J Int AIDS Soc (2024) 10.1002/jia2.26323
[17]
Glynn "Chemsex, risk behaviours and sexually transmitted infections among men who have sex with men in Dublin, Ireland." Int J Drug Policy (2018) 10.1016/j.drugpo.2017.10.008
[18]
Tomkins "Sexualised drug taking among men who have sex with men: a systematic review." Perspect Public Health (2019) 10.1177/1757913918778872
[19]
Malandain "Chemsex: review of the current literature and treatment guidelines." Curr Addict Rep (2023) 10.1007/s40429-023-00488-1
[20]
Yu "Neither legal nor illegal: poppers as ‘acceptable’ chemsex drugs among men who have sex with men in the Philippines." Int J Drug Policy (2023) 10.1016/j.drugpo.2023.104004
[21]
Coronado-Muñoz "Sexualized drug use and chemsex among men who have sex with men in Europe: a systematic review and meta-analysis." J Clin Med (2024) 10.3390/jcm13061812
[22]
Ma "Safer ‘chemsex’: GPs’ role in harm reduction for emerging forms of recreational drug use." Br J Gen Pract (2016) 10.3399/bjgp16x683029
[23]
Calsyn "Sex under the influence of drugs or alcohol: common for men in substance abuse treatment and associated with high-risk sexual behavior." Am J Addict (2010) 10.1111/j.1521-0391.2009.00022.x
[24]
[25]
Xu "A machine-learning-based risk-prediction tool for HIV and sexually transmitted infections acquisition over the next 12 months." J Clin Med (2022) 10.3390/jcm11071818
[26]
Konopiński "Shannon diversity index: a call to replace the original Shannon’s formula with unbiased estimator in the population genetics studies." PeerJ (2020) 10.7717/peerj.9391
[27]
[28]
[29]
The Bayesian information criterion: background, derivation, and applications

Andrew A. Neath, Joseph E. Cavanaugh

WIREs Computational Statistics 2012 10.1002/wics.199
[30]
Lee "What is the proper way to apply the multiple comparison test?" Korean J Anesthesiol (2018) 10.4097/kja.d.18.00242
[31]
Ivey "Chemsex drug use among a national sample of sexually active men who have sex with men – American Men’s Internet Survey, 2017–2020." Subst Use Misuse (2023) 10.1080/10826084.2023.2184207
[32]
Song "Sexual risk behaviours and their correlates among gay and non-gay identified men who have sex with men and women in Chengdu and Guangzhou, China." Int J STD AIDS (2013) 10.1177/0956462413482425
[33]
Esteban "The “Chemsex” phenomenon and its relationship with psychological variables in men who have sex with men." Arch Sex Behav (2024) 10.1007/s10508-024-02920-7
[34]
Perry "The role of impulsive behavior in drug abuse." Psychopharmacology (2008) 10.1007/s00213-008-1173-0
[35]
Lyons "Age at first anal sex and HIV/STI vulnerability among gay men in Australia." Sex Transm Infect (2012) 10.1136/sextrans-2011-050253
[36]
Florêncio "Chemsex cultures: subcultural reproduction and queer survival." Sexualities (2023) 10.1177/1363460720986922
[37]
Nguyen "Erectile dysfunction in young men – a review of the prevalence and risk factors." Sex Med Rev (2017) 10.1016/j.sxmr.2017.05.004
[38]
Deimel "Drug use and health behaviour among German men who have sex with men: results of a qualitative, multi-centre study." Harm Reduct J (2016) 10.1186/s12954-016-0125-y
[39]
Íncera-Fernández "mental health symptoms associated with sexualized drug use (Chemsex) among Men who have sex with men: a systematic review." Int J Environ Res Public Health (2021) 10.3390/ijerph182413299
[40]
Kwan "Bridging awareness and acceptance of pre-exposure prophylaxis among men who have sex with men and the need for targeting chemsex and HIV testing: cross-sectional survey." JMIR Public Health Surveill (2019) 10.2196/13083
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References
Details
Published
Dec 12, 2024
Vol/Issue
21(6)
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Authors
Funding
National Key R&D Program of China Award: 2022YFC2505100, 2022YFC2505103
Central Clinical School International Tuition Scholarship Award: APP5228547
Xi’an Jiaotong University Young Scholar Support Grant Award: YX6J004
National Health and Medical Research Council (NHMRC) Emerging Leadership Fellowship Award: 1193955
Epidemiology modelling and risk assessment Award: 20200344
Outstanding Young Scholars Support Program Award: 3111500001
Cite This Article
Jiajun Sun, Bingyang She, Phyu M. Latt, et al. (2024). Comparing the impact of sexualised drug use with and without chemsex on sexual behaviours among men who have sex with men in China: a national multi-site cross-sectional study. Sexual Health, 21(6). https://doi.org/10.1071/sh24173