{
  "abstract": "Background Chemsex - the use of psychoactive substances during sexual intercourse - has been widely discussed, yet robust data remain limited due to the strongly contextual nature of the phenomenon, which is influenced by regional economic, social and cultural factors. This study provides a territorial snapshot of chemsex practices in the Emilia-Romagna region, Italy.Methods From November 1, 2025 to January 31, 2026, an anonymous online questionnaire was administered to LGBTQ+ adults living in Emilia-Romagna. The study was open to HIV-positive and HIV-negative persons who reported at least one chemsex experience in the previous 12 months.Results A total of 217 questionnaires were collected. Overall, 27.65% of respondents reported engaging in chemsex. Among them, 95% identified as male and 4.8% as female. Most participants were employed (80%) with a medium/medium-high income, were single (55%) or in an open relationship (28%). Most of the responses come from Bologna and from gay people (Tab. 1 and 2).Among participants engaging in chemsex, 43.3% reported being HIV-positive (99% undetectable), while 6.7% were unaware of their HIV status. Nearly 40% of people living with HIV did not disclose their status. Besides, 54% had not discussed chemsex with their infectious disease specialist, mainly due to lack of opportunity, fear of judgment, or the perception that the topic was not relevant for the physician. Half of HIV-positive respondents reported feeling invisible or unsupported within the LGBTQ+ community.Among HIV-neg respondents (48.3%), 24% were not using PrEP and 7% reported informal or non-prescribed (‘sauvage’) PrEP use.Chemsex engagement had lasted more than three years for 61.6% of participants, with 30% reporting monthly sessions and 18.3% almost every weekend.The most commonly used substances were mephedrone (23.7%), sniffed cocaine (10%), GHB/GBL (8.9%), and MDPV (5.3%). A substantial part of participants also uses poppers (23%) and cannabis (13.6%).Most respondents (80%) did not report an increase in STIs associated with chemsex, 88% reported no history of overdose and 70% reported not losing control during sessions. Nevertheless, 25% reported missing workdays due to substance use, 20% experienced sexual abuse during chemsex sessions. Among HIV-negative participants, only 10% had accessed PEP, 1 to 3 times in the previous year. Overall, 58% reported feeling judged for engaging in chemsex.Conclusions This study highlights several critical issues, including limited communication between HIV+ people and IDs on chemsex, persistent difficulties in HIV status disclosure despite the U=U paradigm, and feelings of invisibility within the LGBT community. In Emilia-Romagna, chemsex appears to be relatively contained; however, some apparently contradictory responses suggest possible underreporting or normalization of risk. Further research is needed to better understand these dynamics and to inform targeted, non-judgmental interventions.Abstract P56 Table 1Respondents by cityAbstract P56 Table 2Sexual orientation",
  "authors": [
    {
      "affiliations": [
        "Plus aps - PrEP Point Plus, Bologna, Italy"
      ],
      "name": "S Mattioli"
    },
    {
      "affiliations": [
        "Plus aps - PrEP Point Plus, Bologna, Italy"
      ],
      "name": "S Cecere"
    },
    {
      "affiliations": [
        "Plus aps - PrEP Point Plus, Bologna, Italy"
      ],
      "name": "S Maugeri"
    },
    {
      "affiliations": [
        "Plus aps - PrEP Point Plus, Bologna, Italy"
      ],
      "name": "M Degli Esposti"
    },
    {
      "affiliations": [
        "Plus aps - PrEP Point Plus, Bologna, Italy"
      ],
      "name": "P Morabito"
    },
    {
      "affiliations": [
        "Plus aps - PrEP Point Plus, Bologna, Italy"
      ],
      "name": "G Spreafico"
    },
    {
      "affiliations": [
        "Plus aps - PrEP Point Plus, Bologna, Italy"
      ],
      "name": "E Richero"
    }
  ],
  "title": "P56 Between control and silence: chemsex practices, disclosure, and stigma in an Italian regional survey",
  "uid": "53df4360-69d8-5529-82ef-b4656a6136cc"
}