The new MTV generation: Using Methamphetamine, Truvada, and Viagra to enhance sex and stay safe
Authors: Mo A. Hammoud, Stefanie Vaccher, Jeff Jin, Lisa Maher, Jeff Jin, Adam Bourne, Bridget Haire, Garrett Prestage.
Journal: International Journal for Drug Policy, In press, (2018).
Gay and bisexual men (GBM) often use illicit drugs to enhance sexual pleasure, commonly referred to as ‘chemsex’ or ‘party n play’. In particular, the use of methamphetamine and Viagra, and other erectile dysfunction medications, both together and separately are strongly predictive of subsequent HIV infection. Truvada, as pre-exposure prophylaxis (PrEP), virtually eliminates HIV transmission during condomless anal intercourse (CLAI). HIV-negative GBM in intensive sex partying networks may be adding PrEP to their drug regimen to actively reduce the possibility of HIV transmission during chemsex.
We describe the prevalence and context of concurrent use of methamphetamine, Truvada (or its generic formulations), and Viagra or other erectile dysfunction medication (collectively, MTV).
The Following Lives Undergoing Change study is an online prospective observational study of licit and illicit drug use among Australian GBM. Between January and July 2017, 1831 GBM provided details about their use of MTV. Binary logistic multiple regression analysis were used to estimate adjusted odds ratios (aOR) and associated 95% confidence intervals (95%CI).
Concurrent MTV use was reported by 6.0% of participants; 3.1% used methamphetamine and Viagra or other erectile dysfunction medication (‘MV only’) and 11.2% used Truvada as PrEP (‘T only’). In multivariate analysis, compared to use of ‘MV only’, MTV was independently associated with CLAI with casual partners (aOR=6.78;95%CI=1.42–32.34) and ‘fuckbuddies’ (aOR=3.47;95%CI=1.41–8.56) in the previous six months. Compared to use of ‘T only’, MTV was independently associated with being older (aOR=3.95;95%CI=1.55–10.03) and engaging in group sex (aOR=3.31;95%CI=1.82–6.00). Greater social engagement with other gay men (aOR=1.44;95%CI=1.18–1.76) and having more sexual partners (aOR=2.30;95%CI=1.10–4.82) were independently associated with use of MTV compared to use of ‘MV only’ or ‘T only’.
GBM in intensive sex partying networks are increasingly adding PrEP alongside other drugs they use to enhance sexual experiences. Interventions that promote the use of PrEP during chemsex could mitigate HIV risk.
Age-related prevalence and twelve-month incidence of illicit drug use in a cohort of Australian gay and bisexual men: Results from the Flux Study
Authors: Jeff Jin, Mo A. Hammoud, Lisa Maher, Louisa Degenhardt, Adam Bourne, Stefanie Vaccher, Jeffrey Grierson, Brent Mackie, Colin Batrouney, Bridget Haire, Nicky Bath, Garrett Prestage.
Journal: Drug and Alcohol Dependence, In press, (2018).
We report prevalence and incidence of drug use initiation in Australian gay and bisexual men (GBM) participating in an online cohort study.
Between September 2014 and June 2015, 1,710 GBM were enrolled in the Following Lives Undergoing Change Study and followed-up six monthly. Participants were asked about measures of lifetime use at baseline and recent use (last six months) at all visits. Drug use initiation was defined as men who reported having never used a specific drug prior to baseline and reported recent use at follow-up.
Participants’ median age was 31 years (range: 16–81). Prevalence of lifetime use was significantly associated with older age for all individual drugs (p trend<0.001), and 84.1% reported lifetime use of any drugs. Just above half (51.9%) reported recent use at baseline, with the majority reporting occasional use (once or twice in the previous six-months). Among men who reported no history of drug use at baseline, drug initiation was highest for amyl nitrite, with an incidence of 10.5 per 100 person-years (95% CI 7.9–13.9), followed by cannabis (7.3 per 100 person-years, 95% CI 5.0–10.6) and ecstasy (5.0 per 100 person-years, 95% CI 3.6–7.0). Younger age was significantly associated with higher incidence of initiation of amyl nitrite, ecstasy, cocaine, ketamine, GHB, and LSD (p trend <0.05 for all).
Prevalence of lifetime illicit drug use is lower in younger GBM than in their older counterparts. However, incidence of drug use initiation is high among younger men, providing an opportunity for early intervention.
Prevalence and correlates of recent injecting drug use among Gay and Bisexual Men in
Australia: Results from the FLUX study.
Authors: Hao Bui, Iryna Zablotska-Manos, Mo A. Hammoud, Jeff Jin, Toby Lea, Adam Bourne, Jenny Iversen, Nicky Bath, Jeffrey Grierson, Louisa Degenhardt, Garrett Prestage, Lisa Maher
Journal: International Journal for Drug Policy, In press, (2018).
While illicit drug use is prevalent among gay and bisexual men (GBM) in Australia, little is known about the relationship between injecting drug use and sexual risk in this group.
The Following Lives Undergoing Change (FLUX) study is a national, online prospective observational cohort investigating drug use among Australian GBM. Men living in Australia who were aged 16.5 years or older, identified as gay or bisexual or had sex with at least one man in the last year were eligible to enrol. We used univariate and multivariate log-binomial regression methods to examine associations between socio-demographic and behavioural characteristics and recent (last six months) injecting.
Of 1,995 eligible respondents, 206 (10.3%) reported ever injecting drugs and 93 (4.7%) had injected recently. Crystal methamphetamine was the drug most commonly recently injected (91.4%), followed by methamphetamine powder (9.7%). Only 16 (17.2%) men who recently injected drugs reported injecting weekly or more frequently but one in ten (N=8, 8.6%) reported recent receptive syringe sharing. Recent injecting was associated with lifetime use of more drug classes (adjusted prevalence ratio (APR) = 1.31, 95% Confidence Interval (CI) 1.21-1.41), longer time since initiating party drug use (APR = 1.02, 95% CI 1.01-1.04), greater numbers of sex partners (2-10 sex partners: APR = 3.44, 95% CI 1.45-8.20; >10 sex partners: APR = 3.21, 95% CI 1.30-7.92), group sex (APR = 1.42, 95% CI 1.05-1.91) and condomless anal intercourse with casual partners (APR = 1.81, 95% CI 1.34-2.43) in the last six months.
Observed associations between injecting and sexual risk reflect a strong relationship between these practices among GBM. The intersectionality between injecting drug use and sex partying indicates a need to integrate harm reduction interventions for GBM who inject
methamphetamine into sexual health services and targeted sexual health interventions into Needle and Syringe Programs.
Mental health, drug use and sexual risk behavior among gay and bisexual men.
Authors: Garrett Prestage, Mo A. Hammoud, Jeff Jin, Louisa Degenhardt, Lisa Maher, Adam Bourne, Lisa Maher.
Journal: International Journal for Drug Policy, In press, (2018).
Compared to the general population, among gay and bisexual men (GBM) prevalence rates of anxiety and depression, and of drug use, are high.
This paper explores the relationship between mental health, sexual risk behavior, and drug use among Australian GBM. We identify factors associated with indicators of poor mental health.
Methods: Between September 2014 and July 2017, 3,017 GBM responded to measures of anxiety and depression in an online cohort study of drug use.
Mean age was 35.3 years (SD 12.8). 17.9% screened positive for current moderate-severe anxiety and 28.3% for moderate-severe depression. The majority (52.2%) reported use of illicit drugs in the previous six months, including 11.2% who had used methamphetamine. One third had high (20.4%) or severe (10.6%) risk levels of alcohol consumption, and 18.3% who were current daily smokers. Most illicit drug use in general was not associated with either anxiety or depression, but men who used cannabis were more likely to show evidence of depression (p=0.005). Among recent methamphetamine users, 28.0% were assessed as dependent: dependent users were more likely to show evidence of both depression and anxiety than were non-dependent users. High or severe risk drinking was associated with depression and daily tobacco use was associated with both anxiety and depression. Depression and anxiety was associated with: less personal support, viewing oneself as ‘feminine’, and being less socially engaged with gay men. Sexual risk behavior was not associated with either depression or anxiety.
Prevalence of anxiety and depression was high, as was prevalence of licit and illicit drug use. Substance use was associated with anxiety and depression only when the use was considered problematic or dependent. Social isolation and marginalization are strong drivers of poor mental health, even within this population for whom anxiety and depression are common.
Authors: Mo A. Hammoud, Adam Bourne, Lisa Maher, Jeff Jin, Bridget Haire, Toby Lea, Louisa Degenhardt, Jeffrey Grierson, Garrett Prestage.
Journal: Sexual Health, In press, (2017).
Gamma-hydroxybutyrate (GHB) use among gay and bisexual men (GBM) has increased in recent years. It is commonly cited as a sexual-enhancement drug. There is, however, little evidence for factors associated with GHB use or the consequences of its use among GBM.
Factors associated with GHB use, its relationship to sexual risk behaviour, and the contexts, consequences, and motivations for its use were examined. Methods: The Following Lives Undergoing Change (Flux) Study is an online prospective observational study of Australian GBM. At baseline, a total of 3190 GBM provided details about their use of GHB. Data on frequency, methods, pleasures and consequences of their drug use, alongside key demographic variables were collected.
Mean age was 35.0 years. One in five men (19.5%) had a history of GHB use and 5.4% reported use within the past 6 months, with 2.7% having used it monthly or more frequently. Overdose had been experienced by 14.7%, this was more common among men who used GHB at least monthly. Being HIV-positive, having more gay friends, greater social engagement with gay men who use drugs, a greater number of sexual partners, group sex, and condomless anal intercourse with casual partners were independently associated with GHB use in the past 6 months. Greater social engagement with gay men who use drugs and group sex were independently associated with at least monthly use. More frequent GHB use was independently associated with experiencing overdose among GHB users.
Most men used GHB infrequently and it was often used explicitly to enhance sexual experiences, often in the context of intensive sex partying. Men who used GHB frequently, were at greater risk of overdose and other negative health outcomes. GHB use should be considered alongside other drugs that have been implicated in sexual risk behaviour and HIV transmission. Harm-reduction interventions need to consider the particular impact of frequent GHB use.
Authors: Garrett Prestage, Mo A. Hammoud, Toby Lea, Jeff Jin, Lisa Maher.
Journal: International Journal of Drug Policy, 49, 73-79 (2017).
Gay and bisexual men (GBM) use illicit drugs at higher rates than most other population groups and their use has been associated with sexual risk behavior. The measure of sexual sensation-seeking has been a useful tool for understanding sexual risk behavior in this population, but there is no equivalent measure for sensation-seeking in relation to drug-using behaviors.
This paper explores baseline associations with illicit drug use in an online prospective observational study of licit and illicit drug use among GBM. We describe the development of a measure of drug-use sensation-seeking, and its association with illicit drug use.
Australian GBM were invited to enroll online through social networking and gay community sites. Between September 2014 and July 2015, a total of 2251 GBM completed the questionnaire and 1900 men provided useable baseline data on items designed to measure drug use sensation-seeking.
Mean age was 32.8 years (SD 12.7). Half (50.7%) had used illicit drugs within the previous six months. Among these 963 recent users, 27.3% had used illicit drugs weekly or more often. Responses to items to measure drug use sensation-seeking formed a reliable scale (α = 0.944). Within the total sample, any illicit drug use within the previous six months was associated with a higher score on the measure of drug use sensation-seeking (aOR = 1.18; 95%CI = 1.16–1.20). When we restricted our analyses to men who reported recent illicit drug use, it was also associated with using those drugs at least weekly in the previous six months (aOR = 1.09; 95%CI = 1.07–1.11).
We developed a reliable measure of drug use sensation-seeking for this sample of GBM. Our measure predicted any use of illicit drugs within the total sample, and when restricted to men who reported illicit drug use, it also predicted more frequent use of those drugs.
Authors: Mo A. Hammoud, Jeff Jin, Toby Lea, Lisa Maher, Jeffrey Grierson, Garrett Prestage.
Journal: The Journal of Sexual Medicine, 14, 774-784 (2017).
Gay and bisexual men (GBM) use oral erectile dysfunction medications (EDMs) often with little evidence of medical indication necessitating their use.
To investigate the prevalence, contexts, and motivations for oral EDM use and its relation to sexual risk behavior.
A total of 2,250 Australian GBM completed an online survey of licit and illicit drug use and their associated behaviors. Multivariate logistic regression analysis identified factors associated with use of EDMs in the previous 6 months and, for those who had used EDMs, factors associated with use on a weekly basis.
Any EDM use and at least weekly use in the previous 6 months.
The median age of the sample was 33.0 years (range = 16-81). Two thirds (67.7%) reported no lifetime history of EDM use. Approximately 1 in 10 participants (11.1%) had last used an EDM more than 6 months previously. In the previous 6 months, 11.5% reported using EDMs less than monthly, 5.3% reported using EDMs approximately monthly, and 4.5% reported using EDMs at least weekly. Of men who had used EDMs in the previous 6 months, common reasons cited for its use were to maintain an erection for longer (73.3%), to make it easier to "get hard" (67.3%), and difficulty in attaining or maintain an erection (53.5%). Use of EDMs in the previous 6 months was associated with illicit drug use and higher rates of sexual risk behavior. Weekly users were more likely to have severe anxiety than less frequent users.
The use of EDMs in the context of intensive sex partying, with the associated potential for increased risk of HIV transmission and illicit drug use, indicates a need to consider the use of EDMs among GBM in HIV prevention and minimizing harm.
Strengths and limitations:
This large-scale study of drug use among GBMs includes comprehensive detailed data on their history of use and rationales for use. Our online methodology potentially decreases social desirability bias in reporting illegal or stigmatized behaviors. This volunteer online convenience sample might not be representative of all GBMs in Australia.
GBMs who used an oral EDM in the previous 6 months often used it for recreational purposes, but many of those who used it on a weekly basis also might have used it for therapeutic reasons. GBMs often use EDMs to enhance their sexual experiences often in the context of intensive sex partying (which can include risky sexual behavior).
Authors: Mo A. Hammoud, Jeff Jin, Louisa Degenhardt, Toby Lea, Lisa Maher, Jeffrey Grierson, Brent Mackie, Marcus Pastorelli, Colin Batrouney, Nicky Bath, Jack Bradley, Garrett Prestage.
Journal: International Journal of Drug Policy, 41, 41-50 (2017).
Drug use among gay and bisexual men (GBM) is higher than most populations. The use of crystal methamphetamine, erectile dysfunction medication (EDM), and amyl nitrite have been associated with sexual risk behaviour and HIV infection among gay and bisexual men (GBM).
This paper describes an online prospective observational study of licit and illicit drug use among GBM and explores baseline prevalence of drug use in this sample. Capturing these data poses challenges as participants are required to disclose potentially illegal behaviours in a geographically dispersed country. To address this issue, an entirely online and study specific methodology was chosen.
Men living in Australia, aged 16.5 years of age or older, who identified as homosexual or bisexual or had sex with at least one man in the preceding 12 months were eligible to enrol.
Between September 2014 and July 2015, a total of 2250 participants completed the baseline questionnaire, of whom, 1710 (76.0%) consented to six-monthly follow-up. The majority (65.7%) were recruited through Facebook targeted advertising. At baseline, over half (50.5%) the men reported the use of any illicit drug in the previous six months, and 28.0% had used party drugs. In the six months prior to enrolment, 12.0% had used crystal methamphetamine, 21.8% had used EDM, and 32.1% had used amyl nitrite. Among the 1710 men enrolled into the cohort, 790 men had used none of these drugs.
Ease of entry and minimal research burden on participants helped ensure successful recruitment into this online cohort study. Study outcomes will include the initiation and cessation of drug use, associated risk behaviours, and health consequences, over time. Results will provide insights into the role gay community plays in patterns of drug use among GBM.