男同志和雙性戀男性有問題藥愛者，是於性和心理–社會上有明顯風險的多元群體

資料來源：Michael Carter； 2019年7月15日；aidsmap news，財團法人台灣紅絲帶基金會編譯

根據發表在「性感染症」醫學雜誌上的一項研究顯示，因藥愛( chemsex )而尋求支持的男男性接觸者（MSM）是一個多元的群體，並且有一系列的行為造成他們的身體健康和心理–社會福祉處於高風險中。在分析尋求Antidote（這是英國倫敦一項由專家提供服務以支持有藥物和/或酒精問題的LGBT族群）支持的男同性戀和雙性戀男性的需求後，該研究顯示，參與藥愛的男男性接觸者其愛滋病毒感染的盛行率很高（47％），許多是當前或在過去為注射藥癮者，並且自殺的想法很常見。但是，根據幾個社會人口學變項，包括年齡、種族和愛滋病毒感染狀況，所使用特定藥物及其相關的健康結果會有所不同。

作者認為他們的研究結果，對於有藥愛問題的男男性接觸者族群之支持服務的設計上具有重要意義。

「這項分析顯示…… Antidote服務的有藥愛相關藥物使用之男男性接觸者是高風險族群」，作者寫道。「服務應以整合型照護模式提供，無論是在單一屋簷下提供服務，還是透過在不同服務體系之間建立有效、快速的照護轉診途徑」。

藥愛已被確定為男同性戀者的主要公共衛生問題。但是，關於有問題藥愛而尋求支持的人其特徵的數據很少，而且需要這些訊息來塑造適當和有效的服務。

因此，Antidote的研究人員設計了一項橫斷面研究，包涵了在2012年至2018年間，接受了他們的服務的大約2,300名男男性接觸者。在轉診進來時，要求個人提供有關他們遇到的藥物問題/經歷到問題的藥物種類治等相關的訊息，愛滋病毒和C肝病毒感染狀況，以及他們的藥物使用和性風險行為；更還獲得其社會人口學上的相關的訊息。

研究人員比較了因藥愛問題尋求支持之男男性接觸者（使用甲氧麻黃酮，甲基安非他命，GBH / GBL）和使用其他藥物產生問題（例如古柯鹼，大麻，酒精）等個體的特徵。

然後報告有藥愛問題的個體則根據他們使用的藥物進行分析。第二項分析則檢視了有問題藥愛的HIV陽性男性的特徵和其風險行為。

HIV陽性且報告有藥愛的個體中，有一半將其HIV血清陽轉歸因於藥愛。

總體而言，93％的參與者確認了一種主要關注的藥物，其中88％的人正在對藥愛的一種藥物尋求支持。大約四分之一的人指認了一種令人擔憂的藥物，三分之一報告了兩種令人擔憂的藥物，近一半的人表示他們擔心使用三種以上的藥物。

對於使用藥愛藥物的患者相較於非使用藥愛藥物的患者，報告一種以上藥物問題的可能性超過三倍（aPR = 3.37; 95％信賴區間為2.88-3.94，p <0.0005）。

甲氧麻黃酮是最常報告的藥物（71％），其次是GHB / GBL（69％）和甲基安非他命（64％）。在非藥愛者當中，酒精（57％），古柯鹼（42％）和大麻（21％）是最常被引用的物質。

幾乎所有男性都被認定為同性戀（95％），三分之二是英國人且有84％是白人。大多數人有職業為受僱者（68％），中位年齡為35歲。

年齡較年輕者（45歲以下），確定為同性戀且為黑人、源自亞洲和少數族裔（BAME）等都與藥愛有關。

大多數參與者為HIV陰性（53％），其中三分之一的人在前一年曾使用過暴露後預防投藥。超過一半的人在目前或是過去為注射藥癮者（53％），且大多數報告有酒精消費上之障礙（59％），三分之二的人表示在過去90天內至少有六個性伴侶，15％的人報告了有自殺的想法。

在目前仍為注射藥癮者中，40％表示他們共用注射設備，而HCV感染的盛行率為9％。

藥愛與HIV陽性者、靜脈注射藥物、使用PEP以及有更多性伴侶等有關。

進一步分析顯示，對藥愛問題尋求支持的男性是一個高度多樣化的群體，會依其所關注藥物而有不同的社會人口學上特徵和風險行為。

例如，較年輕和目前就業者與有問題的使用甲氧麻黃酮有關（p <0.0005），而年齡較大且為BAME（黑人、亞裔和少數族裔）與使用甲基安非他命有關（p <0.0005）。

有甲氧麻黃酮使用問題的個案較不會感染HIV或HCV陽性，或採注射方式施打或報告有自殺念頭。然而，甲氧麻黃酮的使用會與問題飲酒有關。而選擇施用甲基安非他命者則與上述所有的特徵相關，只有問題飲酒除外。

當選擇GBH / GBL作為主要關注藥物的個案，其採注射方式施用或HIV陽性的可能性較小，但使用這種藥物則與自殺意念有關。

當針對有藥愛行為的HIV陽性個體的亞組進行分析時顯示，有47％的人將他們的HIV血清陽轉歸因於藥愛。一半的人表示他們的藥物使用在愛滋病毒診斷後升級，三分之一的人說他們在愛滋病毒診斷後開始使用藥物。大多數人接受抗反轉錄病毒藥物治療（85％），其中超過一半的人同意藥愛對抗反轉錄病毒藥物治療之順從性有負面影響。 HIV / HCV合併感染存在於11％的這些個體中。

「我們研究呈現，使用藥愛相關藥物的男男性接觸者其需求是異質性的，因此回應的服務應該能反映這一點」，”作者建議道。「並警告當一名25歲愛滋病毒陰性且僅使用甲氧麻黃酮者，當其不能與一個注射甲基安非他命且愛滋病毒陽性並處在共用注射設施風險者加予區別時，則不會『將每一次接觸都視為風險可能』，實際上可能會阻礙未來與服務的接觸」。

Gay and bisexual men with problematic chemsex are a diverse group with significant sexual and psycho-social risks

Michael Carter；15 July 2019

Men who have sex with men (MSM) seeking support because of chemsex are a diverse group and have a range of behaviours that pose a high risk to their physical health and psycho-social wellbeing, according to research published in Sexually Transmitted Infections. Analysing the needs of gay and bisexual men seeking support from Antidote (a specialist service supporting LGBT individuals with drug and/or alcohol issues in London), the study showed that MSM engaging in chemsex had a high prevalence of HIV (47%), that many were current or past injectors and that thoughts of suicide were common. But use of specific drugs and their associated health outcomes differed according to several demographic factors, including age, race and HIV infection status.

The authors believe their findings have important implications for the design of services to support MSM with chemsex issues.

“This analysis has shown…that Antidote’s chemsex-related drug use MSM population is one at high risk,” write the authors. “Services should be provided under a model of integrated care, whether providing services under a single roof, or through establishing effective, rapid care referral pathways between services.”

Chemsex has been identified as a major public health concern for gay men. But there are few data on the characteristics of men seeking support for problematic chemsex and this information is needed to shape appropriate and effective services.

Investigators from Antidote therefore designed a cross-sectional study involving approximately 2300 MSM who accessed their services between 2012 and 2018.  At the time of referral, individuals were asked to provide information about the drug/drugs which they were experiencing problems with, their HIV and HCV infection status and also about their drug-use and sexual risk behaviours. Demographic information was also obtained.

The investigators compared the characteristics of MSM seeking support for chemsex (use of mephedrone, methamphetamine, GBH/GBL) and individuals who were having problems with the use of other drugs (for example, cocaine, cannabis, alcohol).

Individuals reporting chemsex were then analysed according to which drug they used. A second analysis examined the characteristics and risk behaviours of HIV-positive men with problematic chemsex.

Half of HIV-positive individuals reporting chemsex attributed their HIV seroconversion to chemsex.

Overall, 93% of participants identified a primary drug of concern, of whom 88% were seeking support for a chemsex drug. Approximately a quarter identified one drug of concern, a third reported two drugs of concerns and almost half said they were concerned about the use of three of more drugs.

Men presenting for chemsex drugs were over three times more likely than those presenting for non-chemsex drugs to report problems with more than one drug (aPR = 3.37; 95% CI, 2.88-3.94, p < 0.0005).

Mephedrone was the most frequently reported drug (71%), followed by GHB/GBL (69%) and methamphetamine (64%). Among the non-chemsex service users, alcohol (57%), cocaine (42%) and cannabis (21%) were the most frequently cited substances.

Almost all the men identified as gay (95%), two-thirds were British and 84% were white. Most were employed (68%). The median age was 35 years.

Being younger (under 45 years), identifying as gay and black, Asian and minority ethnic (BAME) origin were all associated with chemsex drugs.

The majority of participants were HIV-negative (53%), of whom a third had used post-exposure prophylaxis in the previous year. Over half were current or past injecting drug users (53%) and most reported hazardous alcohol consumption (59%). Two-thirds reported a minimum of six sexual partners in the previous 90 days. Thoughts of suicide were reported by 15% of individuals.

Of the current injectors, 40% said they shared injecting equipment. Prevalence of HCV infection was 9%.

Chemsex was associated with being HIV-positive, intravenous drug use, using PEP and higher numbers of sexual partners.

Further analysis of men seeking support for chemsex showed that this was a highly diverse group and that demographic characteristics and risk behaviours differed according to the drug of concern.

For instance, being younger and employed was associated with problematic mephedrone use (p < 0.0005), while being older and BAME was associated with use of methamphetamine (p < 0.0005).

Individuals having problems with mephedrone were less likely to be HIV- or HCV-positive, to inject drugs or to report suicidal thoughts. However, mephedrone use was associated with problematic alcohol consumption. Selecting methamphetamine was associated with all the above characteristics except problematic alcohol use.

Individuals selecting GBH/GBL as the primary