Prevalence of Sexualized Substance Use and Chemsex in the General Population and Among Women: A Systematic Review and Meta-Analysis of Cross-Sectional Studies

Abstract

Background and Objectives: Sexualized substance use (SSU) and chemsex have garnered increasing attention in public health research, particularly among men who have sex with men (MSM). However, the prevalence and implications of these behaviors in the general population and among women remain underexplored. This systematic review and meta-analysis aimed to synthesize existing evidence on the prevalence of SSU and chemsex in the general population, with a specific focus on women. Materials and Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, PubMed, ProQuest, Scopus, Web of Science, Cochrane, and PsycINFO were searched for studies published before 18 February 2025. The keywords included "chemsex", "sexualized substance use", "prevalence", and "women". Studies were included if they reported prevalence data on SSU or chemsex in the general population or among women. The exclusion criteria included studies focused exclusively on MSM, adolescents, or specific drug toxicity. The pooled prevalence estimates were presented using forest plots, and the heterogeneity was assessed using I² statistics in RStudio (version 4.3.2). Results: The findings reveal that SSU and chemsex are significant phenomena, with pooled prevalences of 19.92% in the general population and 15.61% among women. The higher prevalence of SSU (29.40%) compared with chemsex (12.66%) in the general population suggests that substance use during sex is a broader behavioral pattern. Among women, the prevalence of chemsex was notably lower (3.50%) than SSU (25.78%). Conclusions: This study underscores that SSU and chemsex are significant public health concerns extending beyond the MSM community. The findings highlight the need for inclusive public health strategies that address these behaviors across the general population. Future research should focus on standardizing definitions, exploring contextual factors, and developing targeted interventions to mitigate associated risks, such as sexually transmitted infections, substance dependency, and mental health disorders.

Keywords: chemsex; general population; harm reduction; meta-analysis; prevalence; public health; sexual behavior; sexualized substance use; substance use; women.

Figure 1

PRISMA flowchart of study inclusion.

Figure 2

Forest plot of the pooled mean SSU prevalence: (a) general population; (b) female population [35,36,37,38,39,40,41,42,43,44,45,46,47].

Figure 2

Forest plot of the pooled mean SSU prevalence: (a) general population; (b) female population [35,36,37,38,39,40,41,42,43,44,45,46,47].

Figure 3

Heterogeneity assessment of the pooled mean SSU prevalence among the general population: (a) influence analysis; (b) leave-one-out analysis [36,37,38,39,40,41,42,43,44,45,46,47].

Figure 4

Heterogeneity assessment of the pooled mean SSU prevalence among the female population: (a) influence analysis; (b) leave-one-out analysis [35,36,37,38,39,40,41,42,43,44,45,46,47].

Figure 5

Funnel plots: (a) general population; (b) female population.