Factors associated with chemsex in Portugal during the COVID-19 pandemic

Chone, Jeremias Salomão; Lima, Shirley Verônica Melo Almeida; Fronteira, Inês; Mendes, Isabel Amélia Costa; Shaaban, Ahmed Nabil; Martins, Maria do Rosário Oliveira; Sousa, Álvaro Francisco Lopes

doi:10.1590/1518-8345.4975.3474

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Revista Latino-Americana de Enfermagem

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Original Article • Rev. Latino-Am. Enfermagem 29 • 2021 • https://doi.org/10.1590/1518-8345.4975.3474 copy

Factors associated with chemsex in Portugal during the COVID-19 pandemic^* * This article was originally made available as a preprint, with DOI nº 10.1590/SciELOPreprints.1524.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective:

to investigate the factors associated with the practice of sex under the influence of drugs (chemsex) among Portuguese men who have sex with men during the period of social distancing to prevent the COVID-19.

Method:

online survey applied in May 2020 to a sample of 1,301 participants living in Portugal, recruited according to Respondent Driven Sampling and via social media Facebook^®. Descriptive and bivariate analyses were performed along with logistic regression to calculate adjusted Odds Ratio (ORa).

Results:

the prevalence of chemsex was 20.2%. The likelihood of practicing chemsex increased with group sex (ORa: 28.4, 95%CI 16.93–47.49); unprotected sex (ORa: 7.1 95%CI 4.57–10.99); the use of pre-exposure prophylaxis (PrEP) to prevent COVID-19 (ORa: 4.2, 95%CI 2.71–6.39) and COVID-19 testing (ORa: 1.9, 95%CI 1.15–3.10).

Conclusion:

the practice of chemsex among men who have sex with men during the COVID-19 pandemic in Portugal was very frequent and may support greater understanding of the role and impact of sexual behavior on the COVID-19 transmission rates and the current pandemic situation in Portugal.

Descriptors:
Sexual and Gender Minorities; Coronavirus Infections; Public Health Nursing; Pandemics; Sexual Behavior; Illicit Drugs

Interest variable	Chemsex^* * Chemsex = Sex under the influence of drugs; †p = Statistical significance obtained through a Chi-square test; ‡HIV = Human Immunodeficiency Virus; §PrEP = Pre-exposure Prophylaxis; \|\|Truvada = brand name for the combination of tenofovir disoproxil fumarate (TDF – 300 mg) and emtricitabine (FTC – 200 mg)					%	p^† * Chemsex = Sex under the influence of drugs; †p = Statistical significance obtained through a Chi-square test; ‡HIV = Human Immunodeficiency Virus; §PrEP = Pre-exposure Prophylaxis; \|\|Truvada = brand name for the combination of tenofovir disoproxil fumarate (TDF – 300 mg) and emtricitabine (FTC – 200 mg)
	Yes		No		Total
	n	%	n	%	N
Sociodemographic characteristics
Age (years old)							0,001
<35	207	21,3	763	78,7	970	74,5
≥ 35	56	16,9	275	83,1	331	25,4
Gender identity							0,096
Cisgender man	251	19,6	1030	80,4	1281	98,4
Transgender man	12	60	8	40	20	1,6
Education (complete years)							0,001
≤9	52	77,5	311	85,7	363	27,9
>9	211	22,5	727	14,3	938	72,1
Lives in the metropolitan region
Yes	252	95,8	955	92	1207	92,8
No	11	4,2	83	8	94	7,2	0,033
Current relationship							0,001
Stable	28	10,6	173	16,7	201	15,5
Open/polyamory	7	2,7	82	7,9	89	6,8
Single	228	867	783	75,4	1011	77,7
Live with sexual partner	18	6,8	149	14,4	167	18,6	0,001
Use dating apps to seek partners	214	81,4	774	74,6	988	75,9	0,021
Sexual health
Tested for HIV ^‡ * Chemsex = Sex under the influence of drugs; †p = Statistical significance obtained through a Chi-square test; ‡HIV = Human Immunodeficiency Virus; §PrEP = Pre-exposure Prophylaxis; \|\|Truvada = brand name for the combination of tenofovir disoproxil fumarate (TDF – 300 mg) and emtricitabine (FTC – 200 mg) in the last 12 months	106	40,3	559	39,3	665	57,1	0,239
HIV^‡ * Chemsex = Sex under the influence of drugs; †p = Statistical significance obtained through a Chi-square test; ‡HIV = Human Immunodeficiency Virus; §PrEP = Pre-exposure Prophylaxis; \|\|Truvada = brand name for the combination of tenofovir disoproxil fumarate (TDF – 300 mg) and emtricitabine (FTC – 200 mg) diagnosis
Unknown	12	4,6	124	11,9	136	10,4
HIV^‡ * Chemsex = Sex under the influence of drugs; †p = Statistical significance obtained through a Chi-square test; ‡HIV = Human Immunodeficiency Virus; §PrEP = Pre-exposure Prophylaxis; \|\|Truvada = brand name for the combination of tenofovir disoproxil fumarate (TDF – 300 mg) and emtricitabine (FTC – 200 mg) -	206	78,3	728	70,1	934	71,8	0,002
HIV^‡ * Chemsex = Sex under the influence of drugs; †p = Statistical significance obtained through a Chi-square test; ‡HIV = Human Immunodeficiency Virus; §PrEP = Pre-exposure Prophylaxis; \|\|Truvada = brand name for the combination of tenofovir disoproxil fumarate (TDF – 300 mg) and emtricitabine (FTC – 200 mg) +	45	17,1	186	17,9	231	17,8
Use PrEP ^§ * Chemsex = Sex under the influence of drugs; †p = Statistical significance obtained through a Chi-square test; ‡HIV = Human Immunodeficiency Virus; §PrEP = Pre-exposure Prophylaxis; \|\|Truvada = brand name for the combination of tenofovir disoproxil fumarate (TDF – 300 mg) and emtricitabine (FTC – 200 mg) / Truvada ^‖ * Chemsex = Sex under the influence of drugs; †p = Statistical significance obtained through a Chi-square test; ‡HIV = Human Immunodeficiency Virus; §PrEP = Pre-exposure Prophylaxis; \|\|Truvada = brand name for the combination of tenofovir disoproxil fumarate (TDF – 300 mg) and emtricitabine (FTC – 200 mg)	104	29,2	252	70,8	356	30,6	0,001

Interest variables	Chemsex^* * Chemsex = Sex under the influence of drugs; †p = Statistical significance obtained through a Chi-square test; ‡HIV = Human immunodeficiency Virus; §PrEP = Pre-exposure Prophylaxis						p-value^† * Chemsex = Sex under the influence of drugs; †p = Statistical significance obtained through a Chi-square test; ‡HIV = Human immunodeficiency Virus; §PrEP = Pre-exposure Prophylaxis
	Yes		No		Total
	n	%	n	%	N	%
Social distancing period
Duration of social isolation/distancing (days)							0,060
Less than 29	44	16,7	114	11	158	12,1
Between 30 and 45	116	44,1	502	48,4	618	47,5
More than 45	88	33,5	374	36	462	35,5
Did not adhere to social isolation	15	5,7	48	4,6	63	4,9
How many partners did you have since social distancing measures were imposed?							0,001
None	0	0	466	44,9	466	35,8
1 partner	20	7,6	397	38,2	417	32,0
More than 2	243	92,4	175	16,9	418	32,2
During the social distancing you:
Had sex with penetration without condoms	145	55,1	121	11,7	266	20,5	0,001
Paid for sexual intercourse	16	6,1	35	3,4	51	3,9	0,043
Group sex (sex with 2 or more people simultaneously)	156	59,3	35	3,4	191	14,7	0,001
Protective measures adopted in casual sex to prevent COVID-19
Avoided kissing during sexual intercourse	147	55,9	195	18,8	342	48,7	0,003
Sanitized the place where you had sex	143	54,4	198	19,1	344	48,8	0,017
Washed hands with water and soap	148	56,3	197	19	345	49,9	0,003
Verified whether the sexual partner had signs and symptoms of COVID-19	158	60,1	457	35,1	615	63,7	0,031
Used PrEP ^‡ * Chemsex = Sex under the influence of drugs; †p = Statistical significance obtained through a Chi-square test; ‡HIV = Human immunodeficiency Virus; §PrEP = Pre-exposure Prophylaxis / Truvada	112	42,6	64	6,2	176	25,1	0,001
COVID-19 testing
Yes	83	31,6	167	16,1	250	19,2
No	180	68,4	871	83,9	1051	80,8	0,001
Diagnosed with COVID-19
Yes	41	15,6	58	5,6	99	39,6	0,026
No	42	16	109	10,5	151	60,4

Variables	OR^* * *OR = Odds Ratio; †p = Statistical significance; ‡95%CI = 95% Confidence Interval; §aOR = adjusted Odds Ratio; \|\|HIV = Human Immunodeficiency Virus; ¶PrEP = Pre-exposure prophylaxis. Hosmer and Lemeshow test (p=0.61)	p-value^† * *OR = Odds Ratio; †p = Statistical significance; ‡95%CI = 95% Confidence Interval; §aOR = adjusted Odds Ratio; \|\|HIV = Human Immunodeficiency Virus; ¶PrEP = Pre-exposure prophylaxis. Hosmer and Lemeshow test (p=0.61)	95%CI^‡ * *OR = Odds Ratio; †p = Statistical significance; ‡95%CI = 95% Confidence Interval; §aOR = adjusted Odds Ratio; \|\|HIV = Human Immunodeficiency Virus; ¶PrEP = Pre-exposure prophylaxis. Hosmer and Lemeshow test (p=0.61)	aOR^§ * *OR = Odds Ratio; †p = Statistical significance; ‡95%CI = 95% Confidence Interval; §aOR = adjusted Odds Ratio; \|\|HIV = Human Immunodeficiency Virus; ¶PrEP = Pre-exposure prophylaxis. Hosmer and Lemeshow test (p=0.61)	p-value^† * *OR = Odds Ratio; †p = Statistical significance; ‡95%CI = 95% Confidence Interval; §aOR = adjusted Odds Ratio; \|\|HIV = Human Immunodeficiency Virus; ¶PrEP = Pre-exposure prophylaxis. Hosmer and Lemeshow test (p=0.61)	95%CI^‡ * *OR = Odds Ratio; †p = Statistical significance; ‡95%CI = 95% Confidence Interval; §aOR = adjusted Odds Ratio; \|\|HIV = Human Immunodeficiency Virus; ¶PrEP = Pre-exposure prophylaxis. Hosmer and Lemeshow test (p=0.61)
Sociodemographic characteristics
Current relationship
Stable	1
Polyamory/open	0,52	0,145	0,22 – 1,25
Single	1,79	0,007	1,17 – 2,75
Live with sexual partner
Yes	1
No	2,42	0,001	1,44 – 4,07
Live in the metropolitan area
No	1
Yes	1,99	0,030	1,04 – 3,79
Use dating apps to seek partners
No	1
Yes	1,49	0,022	1,06 – 2,09
Sexual health
HIV^‖ * *OR = Odds Ratio; †p = Statistical significance; ‡95%CI = 95% Confidence Interval; §aOR = adjusted Odds Ratio; \|\|HIV = Human Immunodeficiency Virus; ¶PrEP = Pre-exposure prophylaxis. Hosmer and Lemeshow test (p=0.61) Status
Unknown	1
HIV^‖ * *OR = Odds Ratio; †p = Statistical significance; ‡95%CI = 95% Confidence Interval; §aOR = adjusted Odds Ratio; \|\|HIV = Human Immunodeficiency Virus; ¶PrEP = Pre-exposure prophylaxis. Hosmer and Lemeshow test (p=0.61) -	2,92	0,001	1,58 – 5,39
HIV^‖ * *OR = Odds Ratio; †p = Statistical significance; ‡95%CI = 95% Confidence Interval; §aOR = adjusted Odds Ratio; \|\|HIV = Human Immunodeficiency Virus; ¶PrEP = Pre-exposure prophylaxis. Hosmer and Lemeshow test (p=0.61) +	2,50	0,005	1,27 – 4,91
During the social distancing period Group sex (with 2 or more people simultaneously)
Sexo en grupo (simultáneo con 2 o más personas)
No
Yes	41,78	0,001	27,52 – 63,41	28,4	0,001	16,93 – 47,49
Sex with penetration without condoms
No
Yes	9,31	0,001	6,84 – 12,67	7,1	0,001	4,57 – 10,99
Paid for sexual intercourse
No	1
Yes	1,85	0,040	1,01 – 3,40
Protective measures against the COVID-19 adopted during casual sex
Disinfected the place where you had sex
No	1
Yes	1,45	0,018	1,06 – 1,97
Avoided kissing during sexual intercourse?
No	1
Yes	1,58	0,003	1,16 – 2,15
Verified whether the sexual partner had signs and symptoms of COVID-19
No	1
Yes	1,41	0,031	1,03 – 1,95
Used PrEP ^¶ * OR = Odds Ratio; †p = Statistical significance; ‡95%CI = 95% Confidence Interval; §aOR = adjusted Odds Ratio; \|\|HIV = Human Immunodeficiency Virus; ¶PrEP = Pre-exposure prophylaxis. Hosmer and Lemeshow test (p=0.61) / Truvada*
No	1
Yes	4,34	0,001	3,03 – 6,23	4,2	0,001	2,71 – 6,39
COVID-19 Investigation
COVID-19 testing
No	1
Yes	2,40	0,001	1,76 – 3,27	1,9	0,012	1,15 – 3,10

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[1] *
This article was originally made available as a preprint, with DOI nº 10.1590/SciELOPreprints.1524.

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Factors associated with chemsex in Portugal during the COVID-19 pandemic* * This article was originally made available as a preprint, with DOI nº 10.1590/SciELOPreprints.1524.

Objective:

Method:

Results:

Conclusion:

Factors associated with chemsex in Portugal during the COVID-19 pandemic^* * This article was originally made available as a preprint, with DOI nº 10.1590/SciELOPreprints.1524.