{
  "abstract": "Background Drug use in sexual settings among men who have sex with men (MSM) is increasing in many European settings and is a key driver of sexually transmitted infections (STIs). Importantly, chemsex is also evolving. Beyond the classic triad (GHB/GBL, mephedrone, crystal meth), new psychoactive substances (including synthetic cathinones and synthetic cannabinoids) are increasingly reported. The context of drug-related sex is also diversifying, shifting from long sessions in private homes to multiple settings such as private rooms in clubs, saunas, and night-time outdoor meeting areas, with encounters that may be brief yet supported by stimulants and disinhibition. Since our reference center regularly assesses knowledge and behavior of MSH attending the service through targeted surveys, we aimed to assess how much drug use for sex among MSM is evolving using two surveys carried out over the last 5 years.Methods We compared two cross-sectional surveys conducted at a Rome STI/HIV reference center among MSM: a 2018–2019 survey based on an anonymous self-compiled paper questionnaire, and a 2024–2025 survey collected through an anonymous online questionnaire. The main outcome was the self-reported use of drugs for sex in the previous year. Proportions were compared using Fisher’s exact test; p<0.05 was considered statistically significant.Results The surveys included 354 MSM in 2018–2019 and 331 MSM in 2024–2025, the proportion of PLWH was higher in the oldest survey (232/3563, 65.5% vs. 32.9% in 2024-2025 survey). In the more recent survey, the prevalence of several chemsex-related substances increased significantly: crystal meth (2.3% vs 8.2%, p<0.001), mephedrone (4.0% vs 9.4%, p=0.005), and GHB/GBL (3.4% vs 16.9%, p<0.001). Chemsex (defined as use of at least one chemsex drug) rose from 5.1% to 15.4% (p<0.001). Newer substances emerged, including synthetic cathinones (0% vs 2.7%, p=0.001) and synthetic cannabinoids (0% vs 0.9%). Poppers also increased (13.0% vs 20.5%, p=0.008). Any drug use for sex increased from 20.9% to 25.7%, although this difference was not statistically significant. Among people living with HIV, any drug use increased (18.5% vs 29.4%, p=0.035) and chemsex showed a marked rise (5.6% vs 24.8%, p<0.001). Thirty-one MSM also reported that they had not practiced it in the past year, although most continued to use drugs for sex ( table 1).Conclusions In our setting, drug use for sex among MSM has increased over time, with a clear expansion of chemsex and a shift toward a broader and more heterogeneous drug-sex landscape. The emergence of new substances and the diversification of contexts where drug-related sex occurs may contribute to increased STI and HIV vulnerability, challenging prevention strategies. STI/HIV services should update screening and counselling approaches, integrate harm reduction, and actively monitor evolving patterns of substance use among MSM.Abstract P204 Table 1Proportions of MSM reporting use of drugs for sex, comparing two surveys performed in a reference center in Rome",
  "authors": [
    {
      "affiliations": [
        "STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy"
      ],
      "name": "L Gianserra"
    },
    {
      "affiliations": [
        "STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy"
      ],
      "name": "C Stingone"
    },
    {
      "affiliations": [
        "STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy"
      ],
      "name": "M Zaccarelli"
    },
    {
      "affiliations": [
        "STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy"
      ],
      "name": "MG Dona’"
    },
    {
      "affiliations": [
        "STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy"
      ],
      "name": "F Di Tullio"
    },
    {
      "affiliations": [
        "STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy"
      ],
      "name": "E Giuliani"
    },
    {
      "affiliations": [
        "STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy"
      ],
      "name": "M Giuliani"
    },
    {
      "affiliations": [
        "STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy"
      ],
      "name": "A Latini"
    }
  ],
  "title": "P204 From chemsex to a broader drug-sex landscape: comparing two MSM surveys from a Rome STI/HIV reference center",
  "uid": "6e3bb0ea-7bb7-5e80-94d5-5ae09f228cf8"
}