Chemsex: An Umbrella Review

Background 
Chemsex describes the use of specific drugs by men who have sex with men (MSM) to prolong, disinhibit and intensify sex, typically with multiple partners identified using geo-social networking applications, (i.e., “hook-up apps”), such as Grindr. While the level of harm experienced by chemsex participants is variable, the practice has been shown to present a significant risk to mental and physical health and of sexual violence. This umbrella review sought to identify all systematic reviews and synthesise the current state of knowledge about chemsex practice, its antecedents, and sequelae.
Methods
Five bibliographic databases (Embase, Epistemonikos, MEDLINE, PsycINFO, Web of Science Core Collection) were searched for relevant systematic reviews published before 16th May 2023. Title-abstract screening, full text review, and data extraction were performed independently by two authors. AMSTAR-2 was used to critically appraise included reviews. Extracted data included review characteristics, chemsex operationalisation, prevalence and correlates of chemsex participation, drugs used and routes of administration, characteristics of chemsex participants, and chemsex sequalae.
Results 
The search returned 5,626 unique records, with 20 reviews included in the synthesis. Most reviews used a narrative synthesis (n=17). Two reported meta-analyses. Chemsex was inconsistently operationalised. Reviews reported a wide range of estimates of chemsex prevalence (2-93.7%). Across all the reviewed studies the most commonly used drugs were GHB/GBL, mephedrone, and methamphetamine. Use of ketamine and “poppers” was also common. BBV seropositivity, use of HIV prophylaxis and STI acquisition were associated with chemsex practice. Experiencing trauma was prominent in those participating in chemsex, as was managing external and internalised homophobia and a desire for community belonging. Chemsex, particularly slamsex, was associated with mental illness, negative impacts on personal relationships and occupational harms. Most included reviews were of low to critically low quality.
Conclusions 
Existing reviews were broad in scope though found to be of low quality and rarely reported formal quantitative or qualitative meta-syntheses. Owing, perhaps, to limited primary research, common mental illness and non-BBV/STI physical health harms were rarely reported, which informs priorities for future primary research.