The association between use of chemsex drugs and HIV clinic attendance among gay and bisexual men living with HIV in London.

Ar Howarth,C Sabin,S Michie,Ch Mercer,Fm Burns,Vc Delpech,S Morris,A Evans,V Apea,M Sachikonye

doi:10.1111/hiv.13103

Ar Howarth, C Sabin + Show 8 more

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https://doi.org/10.1111/hiv.13103

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Abstract

To investigate the association between chemsex drug use and HIV clinic attendance among gay and bisexual men in London. A cross-sectional survey of adults (>18years) diagnosed with HIV for >4months, attending seven London HIV clinics (May 2014 to August 2015). Participants self-completed an anonymous questionnaire linked to clinical data. Sub-optimal clinic attenders had missed one or more HIV clinic appointments in the past year, or had a history of non-attendance for >1year. Over half (56%) of the 570 men who identified as gay or bisexual reported taking recreational drugs in the past 5years and 71.5% of these men had used chemsex drugs in the past year. Among men reporting chemsex drug use (past year), 32.1% had injected any drugs in the past year. Sub-optimal clinic attenders were more likely than regular attenders to report chemsex drug use (past year; 46.9% vs. 33.2%, P=0.001), injecting any drugs (past year; 17.1% vs. 8.9%, P=0.011) and recreational drug use (past 5years; 65.5% vs. 48.8%, P<0.001). One in five sub-optimal attenders had missed an HIV clinic appointment because of taking recreational drugs (17.4% vs. 1.8%, P<0.001). In multivariable logistic regression, chemsex drug use was significantly associated with sub-optimal clinic attendance (adjusted odds ratio = 1.71, 95% confidence interval: 1.10-2.65, P=0.02). Our findings highlight the importance of systematic assessment of drug use and development of tools to aid routine assessment. We suggest that chemsex drug use should be addressed when developing interventions to improve engagement in HIV care among gay and bisexual men.

Highlights

In the UK, life expectancy for people living with HIV who are successfully treated with antiretroviral therapy (ART) is similar to that of the general population [1]
Given the previously reported prevalence of chemsex among HIV-positive men who have sex with men (MSM), in this paper, we focused on the subsample of gay and bisexual men from REACH to examine the association between use of chemsex drugs and HIV clinic attendance
We examined the association between background characteristics and variables measuring physical, mental and social wellbeing which may be confounded with use of chemsex drugs

Summary

Introduction

In the UK, life expectancy for people living with HIV who are successfully treated with antiretroviral therapy (ART) is similar to that of the general population [1]. The past few years have seen growing concern about the potential health impacts of ‘chemsex’ or use of drugs with disinhibiting effects during sex – crystal methamphetamine (crystal meth), gamma-butyrolactone (GBL) and mephedrone. Recreational drug use is more prevalent among men who have sex with men (MSM) than the general population [3,4], and sexualized drug use is more prevalent among MSM who are HIV-positive [5,6,7,8]. One in five MSM in London (21%) reported taking part in chemsex in the past year [9], compared with nearly one-third (30%) of sexually active HIV-positive gay men in the UK and ~ 40% of HIV-positive gay men in London [10,11]

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