Chemsex and chemsex associated substance use among men who have sex with men in Asia: A systematic review and meta-analysis

Drug Alcohol Depend. 2023 Feb 1:243:109741. doi: 10.1016/j.drugalcdep.2022.109741. Epub 2022 Dec 20.

Abstract

Background: The prevalence of chemsex has been reported by multiple systematic reviews among men who have sex with men (MSM) focussing predominantly on the Global North. An Asian perspective with meta-analytical evidence is missing. This meta-analysis summarised the prevalence of substance use associated with chemsex, and chemsex activity among MSM and MSM sub-populations in Asia, as well as the likelihood for chemsex among MSM living with or without HIV.

Methods: We utilized PubMed, Web of Science and medRxiv to search for literature describing chemsex and its associated substance use among MSM and MSM sub-populations in Asia from January 1, 2010 to November 1, 2021 to conduct three meta-analyses with both frequentist and Bayesian approaches.

Results: We identified 219 studies and included 23 in the meta-analysis. Based on the frequentist models, methamphetamine was the default substance associated with chemsex among MSM in Asia (prevalence = 0.16, 95 %CI:0.09-0.22), followed by GHB/GBL (prevalence = 0.15, 95 %CI:0.03-0.27) and ketamine (prevalence = 0.08, 95 %CI:0.04-0.12), but hardly any cocaine (prevalence = 0.01, 95 %CI:0.00-0.03). Compared to a general MSM population (prevalence = 0.19, 95 %CI:0.15-0.23), MSM engaging in transactional sex showed a higher prevalence of chemsex (MSM sex work clients [prevalence = 0.28, 95 %CI:0.11-0.45]; MSM sex worker [prevalence = 0.28, 95 %CI:0.17-0.26]). MSM living with HIV also showed higher odds of chemsex activity (OR = 3.35, 95 %CI:1.57-7.10), compared to MSM living without HIV. Both meta-analytic models converged, indicating robust evidence.

Conclusions: Our meta-analyses showed that chemsex is not uncommon among MSM, and MSM engaging in transactional sex in Asia. We confirmed that MSM living with HIV have a higher likelihood of engaging in chemsex, too. Chemsex prevention and management strategies in Asia should be adjusted accordingly.

Keywords: Chemsex; HIV; MSM; Meta-analysis; Substance use; Transactional sex.

Publication types

  • Meta-Analysis
  • Systematic Review
  • Review
  • Research Support, Non-U.S. Gov't
  • Research Support, N.I.H., Extramural

MeSH terms

  • Asia / epidemiology
  • Bayes Theorem
  • Cross-Sectional Studies
  • HIV Infections* / complications
  • HIV Infections* / epidemiology
  • Homosexuality, Male
  • Humans
  • Illicit Drugs*
  • Male
  • Sexual Behavior
  • Sexual and Gender Minorities*
  • Substance-Related Disorders* / complications
  • Substance-Related Disorders* / epidemiology
  • Unsafe Sex

Substances

  • Illicit Drugs