Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2019 Dec:74:246-254.
doi: 10.1016/j.drugpo.2019.10.007. Epub 2019 Nov 15.

Chemsex is not a barrier to self-reported daily PrEP adherence among PROUD study participants

Charlotte O'Halloran  1 , Brian Rice  2 , Ellen White  3 , Monica Desai  4 , David T Dunn  5 , Sheena McCormack  6 , Ann K Sullivan  7 , David White  8 , Alan McOwan  9 , Mitzy Gafos  10
Affiliations
Randomized Controlled Trial

Chemsex is not a barrier to self-reported daily PrEP adherence among PROUD study participants

Charlotte O'Halloran et al. Int J Drug Policy. 2019 Dec.

Abstract

Background: Pre-exposure prophylaxis (PrEP) is a novel HIV prevention method whereby HIV-negative individuals take the drugs tenofovir and emtricitabine to prevent HIV acquisition. Optimal adherence is critical for PrEP efficacy. Chemsex describes sexual activity under the influence of psychoactive drugs, in the UK typically; crystal methamphetamine, gamma-hydroxybutyrate(GHB) and/or mephedrone. Chemsex drug use has been associated with increased HIV transmission risk among gay, bisexual and other men who have sex with men (GBM) and poor ART adherence among people living with HIV. This study assessed whether self-reported chemsex events affected self-reported daily PrEP adherence among PROUD study participants.

Methods: The PROUD study was an open-label, randomised controlled trial, conducted in thirteen English sexual health clinics, assessing effectiveness of TruvadaⓇ-PrEP among 544 HIV-negative GBM. The study reported an 86% risk-reduction of HIV from daily PrEP. Participants were asked about chemsex engagement at follow-up visits. Monthly self-reports of missed PrEP tablets were aggregated to assess adherence between visits. Univariable and multivariable regression analyses were performed to test for associations between chemsex and reporting less than seven out of seven intended doses(<7/7ID) in the 7 days before and/or after last condomless anal intercourse(CAI).

Results: 1479 follow-up visit forms and 2260 monthly adherence forms from 388 participants were included in the analyses, with 38.5% visit forms reporting chemsex since last visit and 29.9% follow-up periods reporting <7/7ID. No statistically significant associations were observed between reporting <7/7ID and chemsex (aOR=1.29 [95% CI 0.90-1.87], p = 0.168). Statistically significant associations were seen between reporting <7/7ID and participants perceiving that they would miss PrEP doses during the trial, Asian ethnicity, and reporting unemployment at baseline.

Conclusions: These analyses suggest PrEP remains a feasible and effective HIV prevention method for GBM engaging in chemsex, a practise which is prevalent in this group and has been associated with increased HIV transmission risk.

Keywords: Adherence; Chemsex; Gay, bisexual and other men who have sex with men (GBM); HIV; Pre-exposure prophylaxis (PrEP); Prevention.

PubMed Disclaimer

Conflict of interest statement

The PROUD study provided drug free of charge by Gilead Sciences plc. which also distributed it to participating clinics and provided funds for additional diagnostic tests for HCV and drug levels.

SMc reports grants from the European Union H2020 scheme, EDCTP 2, the National Institute of Health Research, and Gilead Sciences; other support from Gilead Sciences, and the Population Council Microbicide Advisory Board; and is Chair of the Project Advisory Committee for USAID grant awarded to CONRAD to develop tenofovir-based products for use by women (non-financial).

EW university fees and stipend funded by Gilead Science plc.

The remaining authors have no competing interests to declare.

Figures

Fig. 1
Fig. 1
Participant follow-up period PrEP adherence and chemsex reporting throughout trial follow-up (N = 388).
See this image and copyright information in PMC

References

    1. Ahmed A.K., Weatherburn P., Reid D., Hickson F., Torres-Rueda S., Steinberg P. Social norms related to combining drugs and sex (``chemsex'') among gay men in south london. International Journal of Drug Policy. 2016;38:29–35. - PubMed
    1. Amico K.R., Mehrotra M., Avelino-Silva V.I., McMahan V., Veloso V.G., Anderson P. Self-reported recent prep dosing and drug detection in an open label prep study. AIDS and Behavior. 2016;20(7):1535–1540. - PMC - PubMed
    1. Anderson P.L., Glidden D.V., Liu A., Buchbinder S., Lama J.R., Guanira J.V. Emtricitabine-tenofovir concentrations and pre-exposure prophylaxis efficacy in men who have sex with men. Science Translational Medicine. 2012;4(151):151ra25. - PMC - PubMed
    1. Baeten J.M., Donnell D., Ndase P., Mugo N.R., Campbell J.D., Wangisi J. Antiretroviral prophylaxis for hiv prevention in heterosexual men and women. The New England Journal of Medicine. 2012;367(5):399–410. - PMC - PubMed
    1. Bourne A., Reid D., Hickson F., Rueda S., Weatherburn P. Sigma Research, London School of Hygiene & Tropical Medicine; London: 2014. The chemsex study: Drug use in sexual settings among gay and bisexual men in lambeth, southwark and lewisham.

Publication types

Substances