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Sexual Health

Recent research papers from the peer-reviewed journal Sexual Health


Sharing solutions for a reasoned and evidence-based response: chemsex/party and play among gay and bisexual men


Adam Bourne, Jason Ong, Mark Pakianathan - Volume 15(2)

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.

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


Zahra Stardust, Johann Kolstee, Stefan Joksic, James Gray, Siobhan Hannan - Volume 15(2)

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.

Low levels of chemsex among men who have sex with men, but high levels of risk among men who engage in chemsex: analysis of a cross-sectional online survey across four countries


Jamie Frankis, Paul Flowers, Lisa McDaid, Adam Bourne - Volume 15(2)

‘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.

Chemsex 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, Heino Stöver - Volume 15(2)

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.

Anova 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, James A. McIntyre - Volume 15(2)

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.

Thinking upstream: the roles of international health and drug policies in public health responses to chemsex


Oliver Stevens, Jamie I. Forrest - Volume 15(2)

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.

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


Elan Lazuardi, Stephen Bell, 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.

Links 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, Marianne Saint-Jacques - Volume 15(2)

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.

Sex, 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, Jayne Lucke - Volume 15(2)

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.

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


Kent Burgess, Garth Parkhill, Jeremy Wiggins, Simon Ruth, Mark Stoovè - Volume 15(2)

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.

Comparing 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, 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."

Leveraging 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, 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.

Using 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, 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.

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


Lillian Mwanri, Nelsensius Klau Fauk, Christina Yeni Kustanti, Atik Ambarwati, 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.

Chemsex case study: is it time to recommend routine screening of sexualised drug use in men who have sex with men?


Mark O'Reilly - Volume 15(2)

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.

Towards a continuum of care concerning chemsex issues


Ingrid Bakker, Leon Knoops - Volume 15(2)

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.

The 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, 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.

Sexual 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, 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.

Chemsex as edgework: towards a sociological understanding


Ford Hickson - Volume 15(2)

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’.

Towards a supportive policy and commissioning environment for chemsex in England


Monty Moncrieff - Volume 15(2)

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.

Sexual transmission of Zika virus: a literature review


Miranda Sherley, Chong-Wei Ong

Gay men's chemsex survival stories


Vivienne Smith, Fiona Tasker - Volume 15(2)

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.

Intensive 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, Garrett Prestage - Volume 15(2)

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.

Diagnosis of Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis and Mycoplasma genitalium: an observational study of testing patterns, prevalence and co-infection rates in northern New Zealand


Arlo Upton, Liselle Bissessor, Peter Lowe, Xiaoying Wang, Gary McAuliffe

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.

Age 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, 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.