Chemsex and the city: an investigation into recreational drug use, poly drug use, chemsex and sexual behaviours among HIV negative men who have sex with men

Recreational drug use and the emerging phenomenon of chemsex (the use of mephedrone, crystal methamphetamine and γ -hydroxybutyrate/γ -butryolactone (GHB/GBL) to enable, enhance and prolong sexual interactions), are of significant concern in men who have sex with men (MSM), particularly in the context of HIV and STI transmission. Prevalence data from the UK and Europe are lacking and no studies have examined changes in chemsex over time within a cohort of MSM. In this thesis I use data from two studies that recruited HIV negative MSM from sexual health clinics in England; the cross-sectional AURAH study (Attitudes to and Understanding Risk of Acquisition of HIV), 2013-2014, (n=1484), and the prospective cohort study, AURAH2 study (Attitudes to and Understanding Risk of Acquisition of HIV over Time) (n=1167), which collected online questionnaire data from 2015 to 2018. I investigate the prevalence of recreational drug use including chemsex, and associations with sexual behaviours, and examine whether prevalence of chemsex and sexual behaviour changed over time. Over half (54.7% AURAH, 60.4% AURAH2) of HIV negative MSM attending sexual health clinics self-reported recreational drug use, and whilst the proportion engaged in chemsex was less (21.8% AURAH, 32.3% AURAH2), it is significant in terms of vulnerability to HIV and STI infections. Prevalence of chemsex significantly declined during online follow-up of AURAH2 participants (n=622) from 31.8% (198/622) at first online questionnaire, to 11.1% (8/72; p < 0.001) at the 9th. Most measures of sexual behaviour also declined over the follow-up period. MSM engaged in recreational drug use, and in particular chemsex, are at significant risk of both STI and HIV infection, as well as other harms, and should be a focus for targeted prevention interventions such as regular HIV and STI testing and treatment, PrEP initiation and chemsex support, which is potentially only necessary for select, and relatively short periods of time