Abstract
Recreational drug use in men who have sex with men (MSM) is of concern because it might be linked to the transmission of HIV and other sexually transmitted infections. Evidence about drug use in HIV-diagnosed MSM in the UK is limited by representativeness of the study populations. We describe patterns of drug use and associations with sexual behaviours in HIV-diagnosed MSM in the UK. We used data from the cross-sectional ASTRA study, which recruited participants aged 18 years or older with HIV from eight HIV outpatient clinics in the UK between Feb 1, 2011, and Dec 31, 2012. We examined data for MSM, assessing the prevalence of recreational drug use and polydrug use in the previous 3 months and associations with sociodemographic and HIV-related factors. We examined the association of polydrug use with measures of condomless sex in the previous 3 months and with other sexual behaviours. Our analysis included data for 2248 MSM: 2136 (95%) were gay, 1973 (89%) were white, 1904 (85%) were on antiretroviral treatment (ART), and 1682 (76%) had a viral load of 50 copies per mL or lower. 1138 (51%) used recreational drugs in the previous 3 months; 608 (27%) used nitrites, 477 (21%) used cannabis, 460 (21%) used erectile dysfunction drugs, 453 (20%) used cocaine, 280 (13%) used ketamine, 258 (12%) used 3,4-methylenedioxy-N-methylamphetamine (MDMA), 221 (10%) used gamma-hydroxybutyrate or gamma-butyrolactone, 175 (8%) used methamphetamine, and 162 (7%) used mephedrone. In the 1138 individuals who used drugs, 529 (47%) used three or more drugs and 241 (21%) used five or more. Prevalence of injection drug use was 3% (n = 68). Drug use was independently associated with younger age (p < 0·0001), not being religious (p = 0·001), having an HIV-positive stable partner (p = 0·0008), HIV-serostatus disclosure (p = 0·009), smoking (p < 0·0001), evidence of harmful alcohol drinking (p = 0·0001), and ART non-adherence (p < 0·0001). Increasing polydrug use was associated with increasing prevalence of condomless sex (prevalence range from no drug use to use of five or more drugs was 24% to 78%), condomless sex with HIV-seroconcordant partners (17% to 69%), condomless sex with HIV-serodiscordant partners (10% to 25%), and higher-HIV-risk condomless sex after taking viral load into account (4% to 16%; p ≤ 0·005 for all). Associations were similar after adjustment for sociodemographic and HIV-related factors. Methamphetamine was more strongly associated with higher-HIV-risk condomless sex than were other commonly used drugs. Polydrug use is prevalent in HIV-diagnosed MSM and is strongly associated with condomless sex. Specialist support services for MSM with HIV who use recreational drugs might be beneficial in the reduction of harm and prevention of ongoing transmission of HIV and other sexually transmitted infections. National Institute for Health Research.
Highlights
Drugs that are usually taken in nightclubs and in unlicensed dance parties are collectively known as club drugs and encompass controlled and non-controlled substances including 3,4-methylenedioxy-N-methylamphetamine (MDMA, or ecstasy), methamphetamine, gamma-hydroxybutyrate (GHB), gamma-butyrolactone (GBL), mephedrone, and ketamine.[6,7]
We describe the prevalence of recreational drug use and polydrug use, their association to socio-demographic, lifestyle, and HIV-related factors, and their relation with condomless sex and other sexual behaviours in HIVdiagnosed men who have sex with men (MSM) in the UK from the ASTRA (Antiretrovirals, Sexual Transmission Risk and Attitudes) study
We further examined the adjusted association of specific drugs and club drugs with higher-HIV-risk condomless sex with a serodiscordant partner with multivariable modified Poisson models
Summary
Recreational drug use is an important public health concern in men who have sex with men (MSM) in the UK.[1,2] Findings from studies done in Europe and the USA show that drug use is more prevalent in MSM compared with the general population.[3,4,5] Drugs that are usually taken in nightclubs and in unlicensed dance parties are collectively known as club drugs and encompass controlled and non-controlled substances including 3,4-methylenedioxy-N-methylamphetamine (MDMA, or ecstasy), methamphetamine (crystal meth), gamma-hydroxybutyrate (GHB), gamma-butyrolactone (GBL), mephedrone, and ketamine.[6,7] findings from many studies in the past 15 years have shown the high prevalence of drug use in MSM,[4,5,6] club drug use might have increased in this group possibly becoming normalised within sexual contexts.[1,8] One London club drug clinic (a free health service for adult clubbers and lesbian, gay, bisexual, and transgender people), for which data have been collected since 2005, reports increasing use of methamphetamine, mephedrone, and GHB, solely in facilitating sex (known as chemsex) in MSM attendingLancet HIV 2014; 1: e22–31Published Online September 8, 2014 http://dx.doi.org/10.1016/ S2352-3018(14)70001-3This online publication has been corrected. Recreational drug use is an important public health concern in men who have sex with men (MSM) in the UK.[1,2] Findings from studies done in Europe and the USA show that drug use is more prevalent in MSM compared with the general population.[3,4,5] Drugs that are usually taken in nightclubs and in unlicensed dance parties are collectively known as club drugs and encompass controlled and non-controlled substances including 3,4-methylenedioxy-N-methylamphetamine (MDMA, or ecstasy), methamphetamine (crystal meth), gamma-hydroxybutyrate (GHB), gamma-butyrolactone (GBL), mephedrone, and ketamine.[6,7] findings from many studies in the past 15 years have shown the high prevalence of drug use in MSM,[4,5,6] club drug use might have increased in this group possibly becoming normalised within sexual contexts.[1,8] One London club drug clinic (a free health service for adult clubbers and lesbian, gay, bisexual, and transgender people), for which data have been collected since 2005, reports increasing use of methamphetamine, mephedrone, and GHB, solely in facilitating sex (known as chemsex) in MSM attending. Published Online September 8, 2014 http://dx.doi.org/10.1016/ S2352-3018(14)70001-3. The corrected version first appeared at thelancet.com/infection on September 29, 2014
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