Rising risks: revealing the relationship between internet ‘hook-ups’, methamphetamine use, STIs and HIV in Bangkok.
New study maps HIV risk factors among men who have sex with men in Thailand, showing internet ‘hook-ups’, methamphetamine use and chemsex to be the new big drivers of HIV.
Deep associations between methamphetamine use and HIV infection among men who have sex with men in Bangkok are revealed in a new study. These ‘twin epidemics’ have been mapped for the first time, to reveal a web of mutually associated factors that together have led to increased HIV incidence among men who have sex with men in Bangkok.
The prevalence of drug use among Thai men who have sex with men has increased substantially during the past decade. In 2003, less than 5% of Bangkok-based men who have sex with men reported using drugs. By 2014 this had increased to more than 40%. At the same time, HIV prevalence among this group almost doubled, rising from 17% to 30%.
The use of methamphetamine is part of a global trend of rising stimulant and other drug use, including erectile dysfunction drugs, among men who have sex with men. Methamphetamine is thought to increase sexual energy, libido, and stamina while lowering people’s perception of risk – all of which can lead to increased sexual risk behaviours in men.
Researchers based at the Silom Community Clinic, an HIV testing and research centre in central Bangkok, recruited over 1,700 men who have sex with men between 2006 and 2010.
Just over 1,300 of those recruited tested negative for HIV, each of whom was enrolled in the study and visited the clinic every four months over a period of five years. During each visit, participants were tested for HIV and completed questions on their sexual behaviours.
During the follow-up period, 128 men reported using methamphetamines. This equates to an incidence of 14.9% of the study population. HIV infections among this group were much higher, with 14.2% of those using methamphetamines being diagnosed with HIV, compared to 5.5% of those who had not used the drug.
After adjusting for other risk factors, researchers found HIV incidence to be high among participants who reported methamphetamine use for sexual pleasure. Younger people and those who had received money for sex were both more likely to use methamphetamine and also become HIV positive.
Finding casual sex partners online, attending chemsex parties, using erectile dysfunction drugs and anal sex were also associated with becoming HIV positive and accelerated in the presence of ulcerative STIs.
The study suggests that harm-reduction programmes and education about drug-use, along with increased decriminalisation of recreational drug use and acceptance of sub-cultural drug-use patterns and sexual habits among men who have sex with men are urgently needed to halt the spread of HIV among this group, both in Thailand and elsewhere.
They also emphasize the role online HIV prevention information has to play with more men who have sex with men using the internet to find casual sexual partners.