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Is on-Demand HIV Pre-exposure Prophylaxis a Suitable Tool for Men Who Have Sex With Men Who Practice Chemsex? Results From a Substudy of the ANRS-IPERGAY Trial

Roux, Perrine, PhD*,†; Fressard, Lisa, MSc*,†; Suzan-Monti, Marie, PhD*,†; Chas, Julie, MD; Sagaon-Teyssier, Luis, PhD*,†; Capitant, Catherine, MSc§; Meyer, Laurence, MD, PhD§; Tremblay, Cécile, MD; Rojas-Castro, Daniela, PhD*,¶,#; Pialoux, Gilles, MD, PhD; Molina, Jean-Michel, MD, PhD**; Spire, Bruno, MD, PhD*,†

JAIDS Journal of Acquired Immune Deficiency Syndromes: October 1, 2018 - Volume 79 - Issue 2 - p e69–e75
doi: 10.1097/QAI.0000000000001781
Prevention Research
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Background: Chemsex—the use of psychoactive substances during sexual encounters—among men who have sex with men is a growing concern. On-demand HIV pre-exposure prophylaxis (PrEP) may be a suitable tool to prevent HIV transmission among “chemsexers.” We used the open-label extension study of the ANRS-IPERGAY trial to describe chemsexers and their PrEP use.

Methods: Among the 361 men who have sex with men enrolled in ANRS-IPERGAY's open-label extension study, we selected the 331 with available data on drug use. A 2-monthly web questionnaire on sociobehavioral data was used to compare sexual behaviors between questionnaires where chemsex was reported and those where it was not. Using a generalized estimating equation logistic regression, we studied whether practicing chemsex was associated with correct PrEP use.

Results: Among the 331 participants, 30% reported chemsex practice at least once during follow-up and were considered chemsexers. Chemsex was reported in 16% of all questionnaires. Chemsexers were not significantly different from nonchemsexers regarding sociodemographic characteristics, although they reported greater use of anxiolytics and more sensation-seeking. Reporting chemsex was associated with more high-risk sexual practices and a higher perception of risk. After adjustment for other potential correlates, chemsex remained associated with correct PrEP use [odds ratio (95% confidence interval) = 2.24 (1.37 to 3.66)].

Conclusions: Our findings show that chemsexers were more likely to report high-risk sexual practices but also had a higher perception of risk. They were also more likely to use PrEP correctly when practicing chemsex. Consequently, PrEP may be a suitable tool to reduce HIV-risk transmission among chemsexers.

*Aix Marseille University, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France;

ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France;

Hôpital Tenon, Paris;

§INSERM SC10, Le Kremlin-Bicêtre;

Université de Montréal;

AIDES, Pantin;

#Groupe de Recherche en Psychologie Sociale (EA 4163), Université Lyon 2, Bron, France; and

**Hôpital Saint-Louis, Paris, France.

Correspondence to: Perrine Roux, INSERM U1252—SESSTIM, 27 bd Jean Moulin, 13005 Marseille, France (e-mail: perrine.roux@inserm.fr).

Supported by ANRS, the Canadian HIV Trials Network, the Fonds de Dotation Pierre Bergé pour la Prévention, and the Bill and Melinda Gates Foundation. Gilead Sciences donated the TDF-FTC and placebo used in the study, and partly funded for the pharmacokinetics analysis.

Presented at the 9th International AIDS Conference in Paris; July 23–26; 2017.

J.C. has received consulting fees from Gilead, AbbVie, and BMS. C.T. reports receiving support from Gilead Sciences and Pfizer. G.P. has received consulting fees from BMS, Boehringer Ingelheim, Tibotec, Nephrotek, Gilead Sciences, Roche, MSD, Abbott, and ViiV Healthcare, and research grants from BMS and Gilead Sciences. J.-M.M. reports receiving support as an adviser for Gilead Sciences, Merck, Janssen, Bristol–Myers Squib (BMS), and ViiV Healthcare, and research grants from Gilead Sciences and Merck. B.S. reports receiving support as an adviser for Gilead Sciences, Merck, Janssen, and BMS, and research grants from Gilead Sciences and Merck. The authors have no funding or conflicts of interest to disclose.

J.-M.M., B.S., S.-M.M., C.J., C.C., L.M., C.T., D.R.-C., and G.P. participated in the conception and the design of the study. P.R. and L.F. designed the analysis. L.S.-T., L.F., and P.R. analyzed the data. P.R. coordinated the analysis and oversaw data management. P.R. drafted the first version of the manuscript. All authors critically reviewed and approved the manuscript.

The ANRS-IPERGAY Study Team is listed in Appendix 1.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal.

Received March 15, 2018

Accepted June 15, 2018

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