CHEMSEX - not that different in Australia

A report back on Magdalena Rosinka and Tristian Barber's session CHEMSEX: East and West.

On the first morning of EACS 19, as part of the EACS pre-educational course, I attended a fascinating presentation on Chemsex: East and West, which also discussed HIV prevalence and PrEP. The session was in two parts and Magdalena Rosinka presented on Eastern Europe, and Tristan Barber on Western Europe.

The prevalence of chemsex and the drugs used varied some-what between the two areas, but were consistently higher in large urban centers, which is not that different from Australia. The main difference compared to Australia is that we don’t have the high prevalence of mephedrone, as they do in Europe, which is probably a blessing.

The reasons reported for using chems for sex, were also similar to what have been reported by the Flux Study, from The Kirby Institute - “more intense”, “longer sex”, “more passionate sex”, “intimacy issues”, “sense of freedom”, “better sex”, and “fancy” (?).

As we know, studies all around the world  show chemsex is associated with increased sexual risk behaviours which results in increased transmission of STIs, including HIV.

We also know one of the most effective measures of reducing new HIV infections is PrEP (along with effective ARV treatment for PLHIV).

What was particularly alarming is that while PrEP is accessible in many countries across Eastern Europe, access is generally restricted to those most at risk, ie MSM, and in many countries in Eastern Europe, homosexuality is illegal. This means that while PrEP may be available, unless you identify as MSM, access to PrEP is not easily obtained through the health system. Stigma and homophobia are denying one of the most at risk populations access to PrEP - MSM who engage in chemsex. Even if you do identify as MSM, cost is also an issue in Eastern Europe, not only for the medications, but all the follow-up testing that we think of as standard-of-care.

The stigma associated with homosexuality feeds into the official reported data from Eastern European countries, where the number of new HIV diagnoses in MSM is extremely low. Normally, we would cheer that news, but in fact, because of the stigma attached to being homosexual, people are not disclosing that they are MSM. According to official stats published in 2019, approx 20% of new diagnoses in the Russian Federation are PWID, over 70% are in the heterosexual population, and MSM represents only 3% of new infections. So when asked, MSM are concealing their homosexual relationships.

When we look at Western Europe, it’s a bit of a mixed bag. While the agency and resources may be there, access too can be problematic. In England, PrEP is mainly available through the PrEP Impact Trial, and in Wales, Scotland and Northern Ireland it is available through programs at Sexual Health Clinics, although getting access is a bit hit or miss. In fact, it was reported that there have been 6 new HIV diagnoses in Manchester in MSM while waiting to get on to one of these programs. That’s 6 too many in anyone’s thinking.

Getting back to Chemsex, some findings from an Irish study reported that 1 in 4 men attending GMHS (Gay Men’s Health Service) have engaged in chemsex, and of those, 1 in 4 feel it is having a negative impact of their lives. Alarmingly 1 in 4 (or their partners) have lost consciousness.

Leading on from the last point about “loss of consciousness”, there was a brief post presentation discussion about consent, and how some people may construe that the attendance at one of these events, implies consent.

This can obviously have significant impact on the victims who were not capable of consenting, but also on perpetrators who only come to the realisation later (once the drugs have worn off), what they have done.

Of course there were no magic strategies to reduce the prevalence of chemsex, but good sound advice on what we as HCPs can do to reduce some of the harms associated with chemsex. There was also the reminder that we should ask our clients about this, as a significant number of them who currently engage in chemsex may want help or advice, and want this within the sexual health setting or online.

Author bio: Hamish is a HIV/Sexual Health Clinical Pharmacist at The Albion Centre, Sydney. He has a love for drug interactions between ARVs and other medications, whether they be prescribed, OTC or CAMs. He is an advocate for PrEP and U=U.