Practice of "Chemical Sex" by HIV Patients in Reunion Island

The term "CHEMSEX", short for "chemicals" and "sex", is used to define the consumption, regardless of the route of administration, of drugs or substances for recreational use, in a sexual context.

Although the use of drugs and narcotics is not a novelty in sexual practice, however, there is a change in behavior. Indeed, the advent of synthetic products such as cathinones, easily obtained via the internet and at affordable prices has attracted a wider audience and has allowed in less than ten years, the amplification of this worrying phenomenon.

The described effects of cathinones are just as powerful as the classic drugs that were quickly supplanted: intellectual stimulation, exacerbation of the senses, euphoria, disinhibition, sexual arousal, relaxation.

These initially ingested or inhaled products are quickly injected for a greater rapidity of their hallucinogenic and psychostimulant effects. SLAM ("slap"), is the Anglo-Saxon term commonly used to describe the intravenous use of drugs in the context of sexual practices. The subjects are gradually led to modify and increase their consumption, for ever more effect.

The consequences of this practice are multiple and serious: addiction with all the risks incurred, psychiatric and infectious complications related to the sharing of contaminated material (endocarditis, hepatitis ...) and unprotected sex ratios favoring the transmission of STIs.

In the literature, all the studies on the subject concern men having sex with men, and more particularly patients living with HIV. Indeed, the prevalence of HIV is 70 to 82% among these practitioners.

European studies, particularly in London gay festive environnement, show the increasing use of these substances resulting in risky behavior. In recent years, STIs have been increasing and more particularly in the men having sex with men population.

No published data is currently available concerning this practice in Reunion Island. However, an upsurge in cases of acute hepatitis C was observed at the end of 2016 (4 in 6 months) of which 3 were related to the practice of chemsex (data CeGGID Réunion) and the recent years have been marked by many cases related to drug trafficking and the arrival of substances still unknown on the island.

Given the rapid emergence of the phenomenon in metropolitan France and in the rest of the world, serious consequences that are both psychological, addictological and infectious, to take stock of this practice among MSM patients followed in Reunion Island seems essential. to establish a rapid, adequate and effective prevention and action plan.