Chemsex, HIV, and Psychiatric Diagnosis in Gay or Bisexual Men in Hong Kong

Abstract

Background: Psychotropic substance use, for chemsex in particular, is common in gay or bisexual men (GBM) with HIV infection. This case-control study examined the association between Axis I psychiatric disorders and active psychotropic substance use, and identified factors affecting the prevalence of psychiatric disorders in HIV-infected GBM. Methods: Participants were 62 HIV-infected self-identified GBM who reported psychotropic substance use in the past 1 year (cases), and 55 HIV-infected self-identified GBM without psychotropic substance use in the past 1 year and had negative toxicology tests at recruitment (controls). The Chinese-bilingual Structured Clinical Interview for DSM-IV (Axis I, Patient version) was followed to establish the psychiatric diagnoses. Socio-demographic data, level of social support, HIV-related data, and pattern of psychotropic substance use were collected. Results: Cases had lower level of social support, more depressive disorders (AOR 3.4, 95% CI 1.3-8.7, p=0.01) and psychotic disorders (AOR 7.2, 95% CI 1.2-41, p=0.03) but not anxiety disorders. Significant difference in the prevalence of psychiatric disorders was only evident for disorders with onset after HIV diagnosis. Methamphetamine dependence, weekly methamphetamine use for 2 years or more, using methamphetamine beyond chemsex, duration of HIV diagnosis were significant predictors for psychiatric disorders in the cases. Conclusion: Active psychotropic substance use in HIV-infected gay or bisexual men was associated with an overall 3-fold increase in Axis I psychiatric disorders. Coordinated efforts from HIV, psychiatric and substance use services are needed to prevent harms arising from chemsex and to identify those in need and facilitate treatment access.

Keywords:

• HIV
• gay or bisexual men
• methamphetamine
• chemsex
• Axis I psychiatric disorders
• psychotropic substance

Acknowledgements

The authors were indebted to Professor LEE Shui-shan, Dr. WONG Ka-hing and Dr. CHAN Chi-wai Kenny and the nursing staff of ITC for giving tremendous support to allow the study to be conducted at ITC. The sincerest appreciation goes to all colleagues of the participating community organisations, including A-backup, AIDS Concern, CHOICE, Chem sex support service, Heart to Heart, Hong Kong AIDS Foundation, Rainbow of Hong Kong and Poz Positive, for their extraordinary efforts in subjects’ recruitment and provision of interview venues. The authors were also grateful to Dr. WONG Ming-cheuk Michael for his support and guidance throughout the research, Professor MAK Winnie Wing-sze for her permission to use the Chinese version of MOS-SSS and the Stanley Ho Centre for Emerging Infectious Diseases of the Chinese University of Hong Kong for laboratory support. The greatest gratitude goes to all the participants for their contribution to the research.

Authors’ Contributions

All authors contributed to the study conception, design and data collection. Material preparation, data analysis and first draft of the manuscript were performed by LCK. All authors commented on the previous version of the manuscript, read and approved the final manuscript.

Disclosure Statement

The authors have no conflict of interest to declare that are relevant to the content of this article.

Ethics Approval

The research is approved by the Institute Review Board of the University of Hong Kong/Hospital Authority Hong Kong West Cluster (HKU/HA HKW IRB) with IRB reference number (UW 18-387) and the Ethics Committees of the Department of Health, Hong Kong SAR Government (LM 366/2016)

Consent to Participate

Informed written consent was obtained from all participants included in the study.

Consent for Publication

The manuscript does not contain data from any individual person.

Availability of Data and Material

The datasets used are available from the corresponding author on reasonable request.

Code Availability

The codes used are available from the corresponding author on reasonable request.

Additional information

Funding

LCK received a grant from Training and Research Sponsorship Scheme of the Queen Mary Hospital for this study. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.