Characterizing chemsex patterns and adoption of harm reduction measures among men in the South - Chemsex is a practice of drug use before or during sexual activity to facilitate, enhance, prolong, and sustain sexual pleasure. The drugs that are most commonly used in chemsex include crystalized methamphetamine (crystal meth), gamma-hydroxybutyrate (GHB), gamma-butyrolactone (GBL), mephedrone, amyl nitrite, ketamine, and ecstasy/MDMA. They are chosen for their disinhibition effects on the common social, psychological, and physiological barriers to sex, like self-consciousness, concerns about partner’s HIV status, and pain experienced during sex. The relationship between chemsex and risky sexual behaviors has been identified in various studies with potential implications for increasing HIV and sexually transmitted infections (STIs). Chemsex is prevalent among men, and it is associated with condomless sex, group sex, transactional sex, and negative health outcomes such as STIs and mental health issues. Despite the complex interplay between recreational drug use, high-risk sexual practices, and STIs among men, there is a lack of knowledge about chemsex practice patterns and harm reduction approaches, like HIV pre-exposure prophylaxis (PrEP) use among men in the South. This study will seek to identify psychosocial drivers and social contextual factors associated with chemsex among men that are amenable to intervention using ecological momentary assessment (EMA). An experienced and well-positioned research team will use a socioecological lens to examine individual factors, such as mental health issues (depression, anxiety, chronic stress, lack of self-efficacy and resilience), substance use, HIV prevention knowledge and intentions (e.g., PrEP, condom use); interpersonal factors, such as social support, peer substance use norms, community violence; and structural factors, such as availability and usage of preventive and curative services and support services. Understanding modifiable factors and knowledge of and intentions to use services are important steps in developing effective strategies for behavioral harm reduction interventions for chemsex. In this context, the current study intends to: (Aim 1) Examine features of chemsex (e.g., types and dosage of drug use, frequency, number of partners, place, psychosocial drivers, and harm reduction approaches) using in-depth interviews among 30 men; (Aim 2) Collect real-time data on drug use, sexual behavior, chemsex, psychosocial variables, and harm reduction approaches among 142 men who practice chemsex using EMA to (a) assess the usability of EMA for chemsex data collection; (b) examine the patterns of chemsex; and (c) identify the psychosocial drivers and modifiable factors associated with chemsex among 142 men who practice chemsex. This study will provide preliminary data on the patterns of chemsex; and psychosocial and other drivers of chemsex, PrEP, and condom use among men in Georgia, a Southern state with high HIV burden. This study will also evaluate the effectiveness of the EMA approach for tracking chemsex practice among men.
