Prevalence of chemsex and sexualized drug use among men who have sex with men: A systematic review and meta-analysis

Background: Sexualized drug use (SDU), including chemsex, is prevalent within LGBTQI+ communities, particularly among men who have sex with men (MSM). This study conducts the first systematic review and meta-analysis to assess the global prevalence of SDU and chemsex among MSM. Methods: A systematic search was performed in PubMed, Embase and Scopus with no language restrictions until April 1, 2024. We included studies that reported the prevalence of chemsex, overall SDU and SDU specifically regarding crystal methamphetamine, gamma hydroxybutyrate/ gamma butyrolactone (GHB/GBL), mephedrone, ketamine, cocaine, amphetamine, alkyl nitrites (poppers), ecstasy/MDMA and marijuana. Data were extracted independently by two researchers and analyzed using a random-effects model. Subgroup analyses were performed according to MSM population categories, region and time period of reporting. Results: A total of 238 studies (380,505 participants) met inclusion criteria. The pooled prevalence of chemsex in MSM was 0.22 (95% CI:0.19-0.25), while SDU had a pooled prevalence of 0.25 (95% CI:0.23-0.28). Meth-amphetamine use for sex showed a pooled prevalence of 0.08 (95 % CI:0.07-0.10), GHB/GBL 0.13 (95 % CI:0.10-0.16), mephedrone 0.07 (95 % CI:0.05-0.10), and ketamine 0.04 (95 % CI:0.03-0.06). Cocaine use for sex demonstrated a pooled prevalence of 0.10 (95 % CI:0.08-0.13), alkyl nitrites 0.23 (95 % CI:0.19-0.27), amphetamine 0.05 (95% CI:0.03-0.08), ecstasy/MDMA 0.09 (95% CI:0.07-0.11), and marijuana 0.18 (95% CI:0.15-0.20). Conclusions: Our study demonstrates the high prevalence of chemsex and sexualized drug use among MSM, emphasizing the urgent need for comprehensive education on substance-related risks to encourage safer sex practices.