Gay and bisexual men living with HIV who engaged in chemsex, or drug use during sex, were three times more likely to say they were “very unhappy” with their sex lives than those who didn’t. Plus, they were were more likely to report missing doses of their HIV medications, and they rarely but consistently reported harms like not fully consenting to sex and drug overdose, according to an analysis published in HIV Medicine.

Chemsex is a term generally used to describe sex between men that includes the use of drugs like crystal methamphetamine and sometimes cocaine and ketamine; the use of injection drugs is known as slamsex.  Sex in the context of drug use often includes multiple partners. There have been reports of rising rates of chemsex in Europe.

In this cross-sectional analysis conducted between April 2018 and May 2019, Gary Whitlock, MD, a consulting physician at London’s sexual health clinic 56 Dean Street, and colleagues asked 500 people attending HIV clinics each in the United Kingdom, Spain, Italy and Greece to answer a 36-item questionnaire about HIV care, sexual behavior, recreational drug use and chemsex.

In total, 1,589 people living with HIV answered the questionnaire; the United Kingdom had the most  respondents (512), and Italy had the fewest (159). The median age was 38, 1% identified as transgender and the rest identified as gay or bisexual cisgender men. Almost all participants (96%) were taking HIV treatment; 84% reported an undetectable viral load. Three out of four participants said they hadn’t missed any antiretroviral doses in the past two weeks, while 17% reported missing one or two doses. Twenty-one participants said they had missed seven or more doses in the past two weeks.

Nearly one in three, 29%, reported having a bacterial sexually transmitted infection (STI) in the past year, and one in 10 had ever had hepatitis C.

When asked whether they were happy with their sex lives, the majority said they were either very happy (24%) or quite happy (40%). Only 6% said they were quite unhappy with their sex lives, and 3% were very unhappy.

And those sex lives appeared to be active ones: One in four participants reported having one partner in the past year, 17% reported two or three partners, 13% reported four or five partners, 12% reported six to 10 partners, 6% reported 16 to 20 partners and 14% reported 21 or more partners. In addition, 13% reported fisting or being fisted by a partner in the last year.

As for drug use, 45% said they’d used drugs recreationally; more than half of these said they used marijuana most frequently, followed by cocaine (43%). Participants also used common chemsex drugs, like GHB/GBL (35%), crystal meth (34%), ecstasy (28%) and ketamine (17%).  GHB/GBL was the most favored drug for chemsex, followed by cocaine, mephedrone and ketamine.

So maybe it shouldn’t be a surprise that one in four participants reported chemsex during the last 12 months, and one in 15 (6.5%) reported slamsex, or sex after injecting their drug of choice. Methamphetamine was the most common drug used for this kind of sex.

Chemsex and slamsex were most common in the United Kingdom, where 44% of participants reported chemsex. For instance, U.K. residents were eight times more likely to have chemsex than residents of Italy and twice as likely to do so as residents of Greece. 

The few people of trans experience in the study were just as likely to engage in chemsex as their cisgender peers.

Chemsex was more than twice as likely among people who’d had an STI in the last year, 11 times more likely among people with 11 or more partners in a year and nearly 5 times as likely among people who’d engaged in fisting in the last year. People who engaged in chemsex were also 70% more likely ever to have been diagnosed with hep C.

When asked whether chemsex caused unwanted side effects, 41% of participants agreed. These included 7% of participants who went to an emergency department, 6% who were injured injecting drugs, 7% who had a drug overdose and 6% who reported having sex without full consent.

One in four people who engaged in chemsex said it had negatively impacted their work and social lives, and 28% reported that it hurt their intimate relationships. A full 15% sought professional help for their chemsex use. People who had chemsex were also three times more likely to report being very unhappy with their sex lives and 2.5 times more likely to miss doses of their HIV medication.

“The harms experienced in the context of chemsex were remarkably similar across all four countries, despite different patterns of drugs used, suggesting that, irrespective of reported prevalence of chemsex use, needs and impacts are similar,” wrote Whitlock and colleagues. “This study indicates the particular importance of sexual health and psychological needs of HIV-positive [men who have sex with men] engaging in chemsex, paying particular attention to those engaging in injecting drug use practices.”

Click here to read the full study.

Click here to read more about drug use among people with HIV and  great sex for people with HIV.