Chemsex and human immunodeficiency virus prevention among gay, bisexual and other men who have sex with men worldwide: a systematic review and meta-analysis
1
Faculty of Medicine, Institute of Global Health, University of Geneva, Geneva, Switzerland
2
Infectious Diseases Service, HIV Unit, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
3
The Joint United Nations Program on HIV/AIDS, UNAIDS, Geneva, Switzerland
4
Centro de Investigación Biomédica en Red, CIBERINFEC, Madrid, Spain
5
HIV Unit, Infectious Disease Division, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
6
Department of Migrant Health, Global Tuberculosis Program., Baylor College of Medicine, Houston, United States
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
Chemsex, a culturally diverse phenomenon often described among vulnerable populations, represents a growing public health concern. It intersects with stigma, social exclusion, and unequal access to human immunodeficiency virus (HIV) prevention services. Understanding its relationship with HIV prevention across income settings is crucial for equitable and inclusive responses. This systematic review and meta-analysis summarized available global evidence on HIV pre-exposure prophylaxis (PrEP) use among gay, bisexual and other men who have sex with men (GBMSM) engaging in chemsex and assessed whether chemsex is associated with higher odds of PrEP uptake.
METHODS:
We searched Medline, Embase, Cochrane Reviews and Central, APA PsycInfo, Scopus, and Lilacs for studies reporting chemsex practices and PrEP use among adult cisgender GBMSM up to July 1 2025. Evidence quality was assessed using the Newcastle–Ottawa Scale. Prevalence and associations (odds ratios, OR) with confidence intervals (CI) were pooled using random-effects models, with meta-regressions, subgroup, sensitivity, inconsistency, and publication bias analyses. PROSPERO registration: CRD42024573871.
RESULTS:
Twenty-eight studies including 36339 participants from three world regions were included. Evidence quality was low to moderate. The pooled prevalence of PrEP use among men engaging in chemsex was 39.0% (95% CI 29.0–49.0). Chemsex was associated with higher odds of PrEP use (OR = 3.44, 95% CI 2.70–4.38). Studies from low- and middle-income countries (LMICs) reported significantly lower odds of PrEP use (p < 0.05). Considerable heterogeneity in definitions of chemsex and PrEP uptake was observed.
CONCLUSIONS:
PrEP uptake is relatively common among men engaging in chemsex but remains unevenly distributed worldwide. The lack of standardized definitions contributes to high heterogeneity and limits global comparability. Evidence comes from high-income settings, with gaps in regions with high HIV burden. Expanding equitable PrEP access and integrated harm reduction interventions, particularly in LMICs, can reduce disparities, improve health outcomes, and advance global HIV elimination goals.
Chemsex, a culturally diverse phenomenon often described among vulnerable populations, represents a growing public health concern. It intersects with stigma, social exclusion, and unequal access to human immunodeficiency virus (HIV) prevention services. Understanding its relationship with HIV prevention across income settings is crucial for equitable and inclusive responses. This systematic review and meta-analysis summarized available global evidence on HIV pre-exposure prophylaxis (PrEP) use among gay, bisexual and other men who have sex with men (GBMSM) engaging in chemsex and assessed whether chemsex is associated with higher odds of PrEP uptake.
METHODS:
We searched Medline, Embase, Cochrane Reviews and Central, APA PsycInfo, Scopus, and Lilacs for studies reporting chemsex practices and PrEP use among adult cisgender GBMSM up to July 1 2025. Evidence quality was assessed using the Newcastle–Ottawa Scale. Prevalence and associations (odds ratios, OR) with confidence intervals (CI) were pooled using random-effects models, with meta-regressions, subgroup, sensitivity, inconsistency, and publication bias analyses. PROSPERO registration: CRD42024573871.
RESULTS:
Twenty-eight studies including 36339 participants from three world regions were included. Evidence quality was low to moderate. The pooled prevalence of PrEP use among men engaging in chemsex was 39.0% (95% CI 29.0–49.0). Chemsex was associated with higher odds of PrEP use (OR = 3.44, 95% CI 2.70–4.38). Studies from low- and middle-income countries (LMICs) reported significantly lower odds of PrEP use (p < 0.05). Considerable heterogeneity in definitions of chemsex and PrEP uptake was observed.
CONCLUSIONS:
PrEP uptake is relatively common among men engaging in chemsex but remains unevenly distributed worldwide. The lack of standardized definitions contributes to high heterogeneity and limits global comparability. Evidence comes from high-income settings, with gaps in regions with high HIV burden. Expanding equitable PrEP access and integrated harm reduction interventions, particularly in LMICs, can reduce disparities, improve health outcomes, and advance global HIV elimination goals.
| eISSN: | 2654-1459 |
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