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Chemsex practice in men who have sex with men: reduction or relapse during lockdown? Results of the CheRRLock study
COVID Lockdown Boosts Chemsex Use, Cuts Sex Partners in Paris MSM
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18th European AIDS Conference, EACS 2021, October 27-30, 2021, London
Mark Mascolini
COVID-related social restrictions led to an overall increase in sex drug use (chemsex) among men who have sex with men (MSM) attending a Paris sexual health clinic [1]. Yet numbers of sex partners fell during the COVID lockdown.
Researchers working with the CheRRLock study group noted that chemsex (using illicit drugs to enhance sex) and slamming (injecting chemsex drugs) have become popular among MSM. Besides causing addiction, these practices can lead to acute or chronic psychiatric or cognitive disorders, infectious diseases, overdoses, and death.
Chemsex prevalence ranged from 4% to 41% among MSM in one UK review [2], while in France a study of MSM in 5 large cities charted a chemsex prevalence of 21% and a slamming rate of 1.6% [3]. At Le 190, a lesbian, gay, bisexual, transexual (LGBT) health clinic in Paris, chemsex prevalence stands at about 24% and slamming prevalence at about 7%. Some recent research found that MSM tended to maintain sexual activity but change sex behaviors during COVID lockdowns.
Because little research has addressed the impact of lockdowns on chemsex, the CheRRLock group studied MSM attending Le 190 clinic before and during COVID social restrictions. The analysis included all consecutive MSM seeking care at Le 190 from November 19 to December 18, 2020 who practiced chemsex at least 3 times in their life and at least once in the 3 months before the lockdown. Participants agreed to complete repeated face-to-face questionnaires on lifestyle, sex practices, mental health, and COVID concerns before and during the second French lockdown.
Researchers recruited 93 MSM with a median age of 38 years (interquartile range 33 to 48). Two thirds of the men had HIV infection, 56% engaged in group sex, 33% practiced fist fucking, 42% never had sex without drugs, 33% used drugs at other times, and 19% practiced slamming. One third reported having a stable relationship, and 71% had at least 1 sexually transmitted infection in the last year.
Two thirds of the men lived in Paris, 58% lived alone, 79% worked, 57% had an income of at least 1900 Euros (about $2200) per month, and 48% had a stock of chemsex drugs at home. One in 5 men (19%) said they feared COVID, 64% felt isolated, and 77% felt craving for chemsex. Median PHQ-4 score stood at 3, indicating mild anxiety or depression.
The largest proportion of men, 42%, increased chemsex use during the lockdown, while 22% had stable chemsex use. Another 22% decreased chemsex use, and 14% stopped chemsex. Comparing the 6 weeks before the lockdown with 6 weeks during the lockdown, a significantly larger proportion of participants reported using chemsex more than 5 days during the lockdown (31% to 49%, P = 0.016) but a significantly lower proportion had more than 5 sex partners during the lockdown (70% to 49%, P = 0.004). The lockdown did not significantly change rates of having more than 10 sex partners, group sex, fist fucking, illicit drug use outside of sex, slamming, or no sex without chemsex (42% before lockdown, 46% during lockdown).
Cathinones (3-MMC, "khat," similar to amphetamines) proved the most popular chemsex drugs (91% before lockdown, 80% during lockdown, not a significant change). Use of the second most popular drug, GHB/GBL (gamma hydroxybutyrate/gamma butyrolactone, "liquid ecstasy") increased slightly but significantly from before the lockdown to during the lockdown (52% to 58%, P = 0.038).
Multivariable logistic regression identified four independent predictors of maintaining or increasing chemsex use versus decreasing use during the lockdown: Fear of COVID lowered chances of maintaining or increasing use by 75% (adjusted odds ratio [aOR] 0.25, 95% confidence interval [CI] 0.07 to 0.90, P = 0.03). Three factors raised chances of maintaining or increasing chemsex use during the lockdown: feeling lonely (aOR 3.53, 95% CI 1.16 to 10.74, P = 0.03), craving chemsex (aOR 4.51, 95% CI 1.38 to 14.72, P = 0.01), and working during the lockdown (aOR 3.82, 95% CI 1.05 to 13.96, P = 0.04).
CheRRLock collaborators counseled clinical colleagues to try to identify the most vulnerable and isolated people who use chemsex and monitoring them closely.
References
1. L'Vavanc T, Gosset D, Plathey M, et al. Chemsex practice in men who have sex with men: reduction or relapse during lockdown? Results of the CheRRLock study, 18th European AIDS Conference, EACS 2021, October 27-30, 2021, London. Abstract OS4/2.
2. Edmundson C, Heinsbroek E, Glass R, et al. Sexualised drug use in the United Kingdom (UK): A review of the literature. Int J Drug Policy. 2018;55:131-148. doi: 10.1016/j.drugpo.2018.02.002.
3. Trouiller P, Velter A, Saboni L, et al. Injecting drug use during sex (known as "slamming") among men who have sex with men: Results from a time-location sampling survey conducted in five cities, France. Int J Drug Policy. 2020;79:102703. doi: 10.1016/j.drugpo.2020.102703.
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