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. 2025 Oct;29(10):3315-3323.
doi: 10.1007/s10461-025-04778-9. Epub 2025 Jun 9.

High Rates of Drug Use and Chemsex Among PrEP Users and People with HIV in Milan Highlight Need for Targeted Interventions

Chiara Fusetti  1 , Enrico Caruso  2 , Andrea Giacomelli  3   4 , Daniele Calzavara  2 , Maria Vittoria Cossu  3 , Nicoletta Frattini  2 , Francesco Caruso  3 , Pietro Vinti  2 , Chiara Atzori  3 , Francesco Petri  3 , Spinello Antinori  3   4 , Andrea Gori  3   4   5 , Massimo Cernuschi  2 , Davide Moschese  3   2
Affiliations

High Rates of Drug Use and Chemsex Among PrEP Users and People with HIV in Milan Highlight Need for Targeted Interventions

Chiara Fusetti et al. AIDS Behav. 2025 Oct.

Abstract

Chemsex, the use of psychostimulant substances during sexual activity particularly among men who have sex with men (MSM), is a growing public health concern. This study aimed to assess drug use, engagement in chemsex, and related knowledge among pre-exposure prophylaxis (PrEP) users and people with HIV (PWH) attending two sexually transmitted infection (STI) services in Milan, Italy. An anonymous online survey was conducted between January and March 2024 at a hospital-based clinic and a community-based center. The questionnaire explored demographics, HIV/PrEP status, drug use, chemsex, its disclosure to healthcare providers, and perceptions of drug use trends. Among 420 respondents, of whom 365 (84%) PrEP-users and 55 (13%) PWH, 167 (40%) reported current drug use and 68 (16%) engaging in chemsex. Polydrug use was also common (96/167, 57%). Commonly used substances included cocaine (50/167, 30%), mephedrone (45/167, 27%), 3,4-methylenedioxymethamphetamine (36/167, 22%), gamma-hydroxybutyrate/gamma-butyrolactone (33/167, 20%) and ketamine (29/167, 17%). The use of methylenedioxypyrovalerone (25/167, 15%) and crystal methamphetamine (10/167, 6%) was also consistent. Of the drug users, 62 (37%) did not disclose their substance use to healthcare providers, frequently citing lack of inquiry by clinicians or the perception that disclosure was not relevant. A total of 223/420 (53%) respondents knew people who used substances, and of these, 90.6% (202) perceived an increase in substance use within their community. In conclusion, the study revealed high rates of drug use and chemsex in Milan underscoring the need for increased healthcare provider awareness, and stigma-free environments to support risk reduction for chemsex users.

Keywords: Chemsex; Drug use; HIV; PrEP; Risk reduction; Survey.

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Conflict of interest statement

Declarations. Conflict of Interest: The authors reported no conflict of interest for this manuscript. The authors did not receive support from any organization for the submitted work.

References

    1. Bourne A, Reid D, Hickson F, Torres-Rueda S, Steinberg P, Weatherburn P. Chemsex and harm reduction need among gay men in south. Lond Int J Drug Policy. 2015;26(12):1171–6. https://doi.org/10.1016/j.drugpo.2015.07.013 . - DOI
    1. Strong C, Huang P, Li CW, Ku SWW, Wu HJ, Bourne A. HIV, chemsex, and the need for harm-reduction interventions to support gay, bisexual, and other men who have sex with men. Lancet HIV. 2022;9(10):e717–25. https://doi.org/10.1016/S2352-3018(22)00124-2 . - DOI - PubMed
    1. Amundsen E, Muller AE, Reierth E, Skogen V, Berg RC. Chemsex among men who have sex with men: a systematic scoping review of research methods. J Homosex. 2024;71(6):1392–418. https://doi.org/10.1080/00918369.2023.2170757 . - DOI - PubMed
    1. Font-Mayolas S, Calvo F. Polydrug definition and assessment: the state of the art. Int J Environ Res Public Health. 2022;19(20):13542. https://doi.org/10.3390/ijerph192013542 . - DOI - PubMed - PMC
    1. Bunting AM, et al. Are you thinking what i’m thinking? Defining what we mean by ‘polysubstance use’. Am J Drug Alcohol Abuse. 2024;50(1):1–7. https://doi.org/10.1080/00952990.2023.2248360 . - DOI - PubMed

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