LAUSR

Background Sexualized drug use (SDU) refers to drug use before or during sex, and includes the party and play and chemsex phenomena described amongst MSM. Previous studies have reviewed associations between SDU and sexual risk behaviour, finding evidence for consistently positive associations for methamphetamines. We sought to summarize and quantify person-level associations between SDU and STBBI diagnoses in MSM. Methods We searched MEDLINE, Embase, and CINAHL up to May 2018. We included primary English language studies that quantified the association between STBBI and SDU among MSM in high-income countries. Only studies where SDU overlapped with or preceded STBBI diagnoses were included. We used the Meta Quality Appraisal Tool to assess study quality. We used a random-effects model to meta-analyze the data and estimate the association between SDU and STBBIs. Results Of 2,671 unique citations, 17 met our inclusion criteria, and referred predominantly to methamphetamine, poppers, GHB/GBL, ketamine, and cocaine. Ten studies reported SDU associated with bacterial STIs, three reported human immunodeficiency virus (HIV), and five reported hepatitis C virus (HCV). The pooled crude ORs were: for bacterial STIs 2.81 (1.85, 4.26; n=6), for HIV 3.93 (2.37, 6.51; n=2), and for HCV 5.25 (3.08, 8.94; n=5). The pooled adjusted ORs were: for bacterial STIs 2.17 (1.51, 3.14; n=8), for HIV 2.90 (0.97, 8.64; n=2), and for HCV 6.08 (2.46, 14.99; n=3). Conclusion Associations between SDU and bacterial STIs and HCV remained after adjustment, suggesting that SDU itself is a cause of or contributor to STBBIs or a proxy indicator for other risk factors (e.g., particular sexual networks). However, given the attenuation of ORs after adjustment for sociodemographic characteristics, an alternative hypothesis that SDUis part of a syndemic with social causes of ill health (e.g., stigma, discrimination) merits further study.