Sexualised substance use and mental health in men, who have sex with men – results of the 'German Chemsex Survey'
Background: Sexualized substance use (“chemsex”) is a rising phenomenon among men, who have sex with men (MSM). Under the influence of recreational drugs like GHB/GBL, mephedrone, methamphetamines ketamine or cocaine, users tend to enhance, intensify and prolong sexual experiences. Adverse mental health outcomes are reported in samples of MSM with continuous substance use in sexual settings. Sexualized substance use is correlated with sexual behavior setting at risk for the acquisition and transmission of sexually transmitted infections. The study aims to describe the interplay of sexualized substance use, sexual behavior, mental health (e.g. depression, anxiety, posttraumatic stress) and psychosocial aspects (e.g. homonegativity, discrimination, loneliness, lack of social support) in a German sample of MSM with sexualized substance use. In addition, users’ needs regarding support services, peer support and harm reduction strategies were identified.
Methods: Data of the online based, non-representative “German Chemsex Survey” were collected between September and December 2018. Inclusion criteria were > 18 years of age and self-identified as man who has sex with men. The survey was promoted via social media, LGBT-networks and HIV-specialized outpatient care services.
Results: N= 1049 (mean age: 40y, min 18, max 88) MSM were included, education and socioeconomic status were above-average. Sexualized substance use (incl. alcohol) was reported by 83 %, substances: alcohol 85 %, amylnitrites 48 %, cannabis 27 %, MDMA 17 %, amphetamines 16 %, GHB/GBL 15 %, ketamine 11 %, cocaine 10 %, methamphetamines 8 % and mephedrone 6 %. 11 % reported any intravenous drug use, and among those, 74 % used methamphetamine, 35 % mephedrone and 30 % ketamine. Substance use often occurred in private settings e.g. at home (52 %), or at private sex parties (44 %). 66 % used geo-social dating apps to meet sexpartners. 9 % reported that they want to reduce or quit sexualized substance use and are interested in professional support. 41 % reported non-consensual actions during sexual encounters and 15 % reported physical violence in sexual situations. In one third of those cases, substances were involved. Current prevalence for depression was 13 %, for symptoms of posttraumatic stress disorder 12 % and 3 % for symptoms of generalized anxiety disorder. Lifetime prevalence for at least one suicide attempt was 6 %.
Conclusion: Sexualized drug use was common in this sample of German MSM, especially for stimulant drugs. MSM with sexualized substance use seem to be a vulnerable group for mental health problems like depression, suicide attempts and posttraumatic stress. Sexualized substance use often occurs in private settings, which is a challenge for MSM-community based prevention. Frequently used geo-social dating apps might be an alternative way to spread prevention and harm reduction messages.