Sexual Health Sexual Health Society
Publishing on sexual health from the widest perspective

Sexual Health

Sexual Health

Sexual Health publishes contributions on sexual health from the widest perspectives including HIV/AIDS, STIs, issues of sexuality, and reproductive health. Read more about the journalMore

Editors: Christopher Fairley and Roy Chan

Current Issue

Sexual Health

Volume 15 Number 2 2018

Sharing Solutions for a Reasoned and Evidence-based Response: Chemsex/Party and Play among Gay and Bisexual Men

The use of drugs in sexual settings among gay, bisexual or other men who have sex with men (MSM) is colloquially known as ‘chemsex’ or ‘party and play’. It has been documented in numerous countries around the world and is associated with a range of mental, physical and sexual health harms. This Special Issue of Sexual Health provides valuable data about the patterns and impacts of chemsex/party and play, as well as examining the healthcare and policy responses needed to reduce harm.

Combining sex and drugs shares many features with other voluntary high risk activities that involve specialist skills and intense sensations. This paper suggests some chemsex is a type of ‘edgework’, an exploration of personal limits when living under conditions of alienation. The consumptive nature of chemsex locates it as a quintessential activity in a sex and drugs ‘shopping culture’.

Existing health and drug programming exists within blinkered silos, inappropriate for delivering multifaceted interventions which chemsex urgently needs. This narrative review aims to draw international health and drug policies into existing chemsex dialogue,and encourage health programming to widen its focus. It calls upon countries to honour their international commitments to health and vulnerable populations; advocates for data disaggregation; and endorses recent progressive changes within international drug policies.

SH17122Gay men's chemsex survival stories

Vivienne Smith and Fiona Tasker
pp. 116-122

This study considered factors affecting chemsex (the combined use of drugs and sexual experiences) engagement and remission by gay men. Participants’ identified multiple incidents and feelings as contributing to chemsex engagement, and engagement was connected with participants’ gay identity development. Chemsex journeys were perceived to spiral from exciting and exploratory into high-risk activity, but the association of chemsex with a gay identity gain explained participants’ ambivalence to remaining chemsex free.

SH17146Intensive sex partying with gamma-hydroxybutyrate: factors associated with using gamma-hydroxybutyrate for chemsex among Australian gay and bisexual men – results from the Flux Study

Mohamed A. Hammoud, Adam Bourne, Lisa Maher, Fengyi Jin, Bridget Haire, Toby Lea, Louisa Degenhardt, Jeffrey Grierson and Garrett Prestage
pp. 123-134

Gamma-hydroxybutyrate among gay and bisexual men has increased in recent years, and is accompanied by growing concerns about overdose and HIV risk behaviour. We examined factors associated with GHB use, its relationship to sexual risk behaviour, and the contexts, consequences, and motivations for its use. Use of gamma-hydroxybutyrate to enhance sexual experiences often occurred in the context of sexual risk behaviour and frequent use was associated with overdose.

SH17151Sex, drugs and social connectedness: wellbeing among HIV-positive gay and bisexual men who use party-and-play drugs

Jennifer Power, Gosia Mikołajczak, Adam Bourne, Graham Brown, William Leonard, Anthony Lyons, Gary W. Dowsett and Jayne Lucke
pp. 135-143

This study considers whether use of ‘party drugs’, such as crystal methamphetamine, in a social or sex-based setting facilitates a sense of social connectedness for some men. A survey of Australian gay and bisexual men (GBM) living with HIV found that those who used party-and-play drugs reported greater connection with some social networks, which was associated with resilience and less concern about HIV-related stigma. While party drug use poses risks health risks, the social contexts in which these drugs by GBM) may provide wellbeing benefits linked to social connectedness.

‘Chemsex’ – using specific illicit drugs to enhance sex among men who have sex with men (MSM) – has recently received sustained attention. This survey found that while only 1 in 20 MSM report chemsex, those who do report high levels of HIV and sexual risk taking. Early identification of those most vulnerable to chemsex-related harm and the development of a specialised responsive patient pathway would help address their particularly acute needs.

SH17142Chemsex among men who have sex with men in Germany: motives, consequences and the response of the support system

Niels Graf, Anna Dichtl, Daniel Deimel, Dirk Sander and Heino Stöver
pp. 151-156

This study aimed to identify patterns of drug use in sexual settings (i. e. chemsex) among men who have sex with men in Germany. Contrary to some media portrayals, chemsex is a minority behaviour and does not necessarily constitute a dangerous practice. Yet, some men report a range of harmful consequences, such as sexually transmissible infections. Suitable offers of support are, hence, necessary, but yet not available in most German cities.

SH17148Re-Wired: treatment and peer support for men who have sex with men who use methamphetamine

Kent Burgess, Garth Parkhill, Jeremy Wiggins, Simon Ruth and Mark Stoovè
pp. 157-159

Methamphatime use amongst gay men and other men who have sex with men can be associated with significant harms, including increased risk of HIV and STI transmission. This paper outlines an innovative treatment and peer support program having success in reducing drug use and improving wellbeing, for men in this vulnerable population who use methamphetamine. This program has potential to be expanded into other similar settings.

SH17134Links SU-Sex: development of a screening tool for health-risk sexual behaviours related to substance use among men who have sex with men

Mathieu Goyette, Jorge Flores-Aranda, Karine Bertrand, Frédérick Pronovost, Valérie Aubut, Roberto Ortiz and Marianne Saint-Jacques
pp. 160-166

ChemSex is a public health issue that is forcing stakeholders to improve care by addressing both sexual health and addiction in the gay, bisexual and trans men community. This article describes the development and foreseen use of the Links-SU Sex, a screening tool designed to assess sexual behaviours related to substance use among this population. The Link-SU Sex represents a crucial step in identifying at risk populations and in supporting clinical decision-making.

This case discusses a gay male participating in sexualised drug use. It raises several important issues which may not have been disclosed if the patient was not specifically asked about drug use during or before sex. It strengthens the case for routine screening for sexualised drug use in men who have sex with men so that better informed and higher quality health care can be provided.

This case review examines some of the steps that have helped formulate a policy response to chemsex in England. It highlights that although the evidence on chemsex and related harms for users is growing, there are still opportunities to improve drug treatment and other support for those negatively impacted by chemsex. It contributes to the literature on developing effective responses to problematic chemsex.

SH17139Towards a continuum of care concerning chemsex issues

Ingrid Bakker and Leon Knoops
pp. 173-175

In response to the apparent rise in chemsex in the Netherlands, Mainline foundation has been offering harm-reduction intervention for MSM and promoting the development of a continuum of care by building networks, training professionals and investing in advocacy. This case study describes the various interventions of Mainline foundation, that make up their continuum of care approach concerning chemsex issues.

SH17158Anova Health Institute's harm reduction initiatives for people who use drugs

Johannes M. Hugo, Kevin B. Rebe, Evan Tsouroulis, Anthony Manion, Glenn de Swart, Helen Struthers and James A. McIntyre
pp. 176-178

Chemsex, the use of recreational drugs in the context of sex, is a potentially harmful behaviour that is of increasing concern among men who have sex with men. We describe two harm reduction programs aimed at mitigating these harms and discuss innovations and challenges that arose. Harm reduction programs are an effective response to the phenomenon of Chemsex.

SH17145A community-led, harm-reduction approach to chemsex: case study from Australia’s largest gay city

Zahra Stardust, Johann Kolstee, Stefan Joksic, James Gray and Siobhan Hannan
pp. 179-181

With illicit drug use among lesbian, gay and bisexual people higher than in the general Australian population, community organisations can support people to party and play safely. In Sydney, harm-reduction, pleasure-positive and peer-based responses have led to increased service uptake, strong community engagement and robust research relationships. Such targeted health promotion has been enabled by Australia’s strong partnership response to HIV.

Online Early

The peer-reviewed and edited version of record published online before inclusion in an issue

Published online 16 March 2018

SH17163A ‘scoping review' of qualitative literature about engagement with HIV care in Indonesia

Elan Lazuardi, Stephen Bell and Christy E. Newman

There is a common misconception that qualitative research generates less trustworthy evidence for guiding the design and implementation of national HIV programs. A scoping review - conducted to undertake a comprehensive review of published qualitative evidence about engagement with HIV care in Indonesia - highlighted a range of factors influencing both successful engagement with HIV care and the broader HIV response in Indonesia. Future qualitative research which describes the experiences of clients and the role of clinics and providers in delivering care will give an important contribution in enhancing the understanding of engagement with HIV care in the Indonesian context.

Published online 06 March 2018

SH17064Comparing Australian gay and bisexual men with undiagnosed and recently diagnosed HIV infection to those in the National HIV Registry

Ian Down, Garrett Prestage, Graham Brown, Jeanne Ellard, Rebecca Guy, Margaret Hellard, David Wilson, John de Wit, Mark Stoové and Martin Holt

Studies of recent seroconverters provide key insights for HIV-prevention. We sought to identify how representative of all recently diagnosed gay and bisexual men in Australia were those included in three study samples. Although undiagnosed men were somewhat younger, the study samples were broadly similar to all gay and bisexual men recently diagnosed with HIV, suggesting that these research approaches were reasonably effective."

Published online 06 March 2018

SH17097Leveraging a relationship-based sexual health framework for sexual risk prevention in adolescent men in the United States

Devon J. Hensel, Casey L. Bales, Julia F. Taylor and J. Dennis Fortenberry

Relationships are an important venue for sexual risk prevention. The current study links a collection of positive sexual attributes in relationships, such as communication and sexual satisfaction, to lower sexual risk behaviours, such as condom use and intimate partner violence, in adolescent men. These findings suggest that helping young men build positive relationships may also help them avoid sexual risk.

Published online 15 February 2018

SH16218Using marijuana, drinking alcohol or a combination of both: the association of marijuana, alcohol and sexual risk behaviour among adolescents

Erik D. Storholm, Brett A. Ewing, Stephanie Brooks Holliday, Bradley D. Stein, Lisa S. Meredith, William G. Shadel and Elizabeth J. D'Amico

There is currently little understanding of whether marijuana use alone or combining marijuana with alcohol use contributes to sexual risk behaviour among adolescents. This study aimed to assess the association between use of marijuana, alcohol, and sexual risk behaviour among adolescents and found that combined alcohol and marijuana use or alcohol use alone was associated with greater sexual risk behaviour. Providers should screen and educate adolescents about these risks.

Published online 15 February 2018

SH17137HIV susceptibility among clients of female sex workers in Indonesia: a qualitative inquiry

Lillian Mwanri, Nelsensius Klau Fauk, Christina Yeni Kustanti, Atik Ambarwati and Maria Silvia Merry

The Clients of female sex workers (FSWs) in Belu and Malaka districts of Indonesia are a group at higher risk for HIV transmission due to their frequent engagement in sex with multiple female sex workers (FSWs). This study aimed to identify risk factors for acquiring HIV infections among them and found several behavioural and socioeconomic factors that increased their susceptibility to these infections.  These findings provide information about HIV susceptibility factors among FSWs’ clients, which can be used to develop programs and policies to help the study participants.

Published online 23 January 2018

SH17118The development of an online risk calculator for the prediction of future syphilis among a high-risk cohort of men who have sex with men and transgender women in Lima, Peru

Lao-Tzu Allan-Blitz, Kelika A. Konda, Silver K. Vargas, Xiaoyan Wang, Eddy R. Segura, Boris M. Fazio, Gino M. Calvo, Carlos F. Caceres and Jeffrey D. Klausner

The incidence of syphilis has been on the rise since the early 2000s. We aimed to identify factors which might predict future syphilis among high-risk populations and developed an online risk calculator for future infection. The ability to predict future syphilis may inform screening recommendations and other prevention strategies.

Published online 11 January 2018

SH17017Sexual content in video games: an analysis of the Entertainment Software Rating Board classification from 1994 to 2013

Dèsirée Vidaña-Pérez, Ariela Braverman-Bronstein, Ana Basto-Abreu, Inti Barrientos-Gutierrez, Rainer Hilscher and Tonatiuh Barrientos-Gutierrez

Video games are a source of exposure to sexual content for children and adolescents. We aimed to analyse the trends of sexual content in video games from 1994 to 2013. Our results suggest that sexual content in video games has increased for ratings ‘Teen’ and ‘Mature’. Top selling video games had more sexual content compared to non-top selling games.

We studied community prevalence and testing patterns for sexually transmitted infections in northern New Zealand. After Chlamydia trachomatis, Mycoplasma genitalium was the most common infection detected, though it is not routinely sought. There was a mismatch between testing rates and prevalence of infection in high risk patient groups. We conclude that testing strategies should be altered to better reflect need.

Published online 21 December 2017

SH17074Age differences in attitudes toward safer sex practices in heterosexual men using an Australian Internet dating service

Yan Cheng, Kevin McGeechan, Deborah Bateson, Todd Ritter, Edith Weisberg and Mary Stewart

STIs are increasing in older people globally. This cross-sectional study investigated STI knowledge, safe sex attitudes and behaviours of heterosexual men using an internet dating service. Results suggested that older men had lower STI knowledge scores, lower use of condoms and greater beliefs that condoms reduced interest in sex. Health promotion interventions to increase STI awareness, condom use and STI testing in older men are warranted.

Published online 07 December 2017

SH17111Concordance between monetary and sexual delay discounting in men who have sex with men

Jeb Jones, Jodie L. Guest, Patrick S. Sullivan, Michael R. Kramer, Samuel M. Jenness and Jessica M. Sales

Delay discounting is a measure of impulsivity, often measured in the context of financial choices, that is associated with multiple health outcomes and might be associated with sexual risk-taking. The current study assessed the concordance between monetary and sexual discount rates. No association was observed between monetary and sexual discount rates suggesting that these are distinct processes.

Published online 12 October 2017

SH17108Sexual (dys)functioning is related to drive for thinness, not drive for muscularity

Anandi Alperin and Fiona K. Barlow

Body image problems can impact one’s performance and enjoyment in the bedroom for both genders. This paper examines which body image factors predict these problems, and found that wanting to be thinner was the main cause of dysfunction. This highlights how the promotion of thinness can have far-reaching consequences, affecting not only how we feel about ourselves, but also our interactions and relationships with others.

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Professor David Cooper AO, a founding Joint Editor of Sexual Health, sadly passed away on 19 March after a short illness. He was Australia’s leading HIV scientist and an internationally renowned leader whose work saved many lives. His very strong support for the journal, despite being one of the most eminent HIV scientists in the world, was incredibly impressive. Sexual Health will forever be immensely grateful for his unfailing support and his presence will be sorely missed.