High rates of recreational drug use among HIV-positive gay and bisexual men strongly linked with condomless sex

New research published in The Lancet HIV shows that polydrug use is common among HIV-positive men who have sex with men (MSM) and is strongly linked to sex without a condom (condomless sex).

This is the largest questionnaire study of people living with HIV in the UK, accounting for about 5% of all HIV-diagnosed MSM in the UK. The findings show that half of MSM surveyed had used recreational drugs at least once in the previous 3 months. About half of those who used drugs took three or more different types of drugs, while roughly a fifth said they had used five or more different drugs in the past 3 months. Condom use was markedly lower with increasing polydrug use. For example, over three-quarters of participants who said they had used five drugs or more in the past 3 months also reported condomless sex, compared with less than a quarter of those who reported no recent drug use.

"Our findings show that polydrug use and condomless sex are closely linked in HIV-positive MSM in the UK, and that polydrug users are likely to be a group at increased risk of transmission of HIV and other sexually transmitted infections (STIs)", explains lead author Ms Marina Daskalopoulou from University College London in the UK.

"The majority of these men would not consider or self-refer to traditional harm reduction services. Our findings highlight the need for cross-agency collaboration between HIV treatment and drug support organisations to provide tailored services for HIV-positive MSM who use recreational drugs, and with national HIV and STI prevention programmes to address recreational drug use."

The study collected self-reported data on the drug use and sexual behaviour of 2248 MSM with HIV during 2011-2012 who were enrolled as part of the ASTRA study. All men were aged 18 years or older and attending eight HIV outpatient clinics in the UK.

Increasing number of drugs used was linked to increasing prevalence of sex that could pose a risk of transmission of HIV or other STIs. For example, recent users of five or more drugs were far more likely than those with no recent drug use to have sex without a condom (78% vs 24%); to have condomless sex with a partner of HIV-negative or HIV-unknown status (25% vs 10%); and to have sex with a higher risk of transmitting HIV (16% vs 4%; having condomless sex with a partner of HIV-negative or HIV-unknown status if the participant is not on antiretroviral treatment, has detectable viral load, or another recent STI).

However, the authors point out that only a minority (15%) of HIV positive MSM reported condomless sex with a partner of HIV-unknown or HIV-negative status, and fewer (7%) reported higher-HIV-risk condom-less sex.

Writing in a linked Comment, Associate Professor Martin Holt, from the Centre for Social Research in Health at The University of New South Wales in Australia points out that, "Only (7%) of the 2248 MSM included in the analysis reported such high-HIV-risk sex. This finding is heartening, and suggests that most HIV-positive MSM take care to prevent HIV transmission. Only a small proportion, it seems, need assistance in negotiating sex, drugs, and HIV treatment… A culturally appropriate evidence-based response is needed to help reduce harm in the UK without further sensationalising the issue.