From chemsex to a broader drug-use for sex landscape: Comparing two cross-sectional surveys on men who have sex with men in Italy.

BackgroundDrug-use in sexual settings among men who have sex with men (MSM) is increasing across Europe and is a key driver of sexually transmitted infections (STIs). Chemsex is evolving with increasing use of new psychoactive substances and diversification of context, shifting from private homes to diverse settings. Our aim was to assess changes in drug-use for sex among MSM who attended our STI/HIV reference center in two different periods over the last 8 years.MethodsWe compared two cross-sectional surveys conducted at the STI/HIV center of the San Gallicano Dermatological Institute (Rome, Italy) in 2018 (using paper-based, self-administered questionnaires) and 2024-2025 (using online self-administered questionnaires). The main outcome was the self-reported sexualized drug-use and chemsex (i.e., use of any of the three classic "chems": crystal methamphetamine, mephedrone, and GHB/GBL) in the previous year. Proportions were compared using Fisher's exact test or chi-square test, as appropriate.ResultsThe surveys included 354 MSM in 2018 and 331 MSM in 2024-2025. Overall, chemsex significantly increased from 5.1% in 2018 to 19.0% in 2024-2025 (p < 0.0001), both among MSM living with HIV (p < 0.0001) and MSM not living with HIV (p = 0.0005). A significant increase was observed in the use of crystal meth (2.3% vs 8.2%, p = 0.0005), mephedrone (4.0% vs 9.4%, p = 0.005), and GHB/GBL (3.4% vs 16.9%, p < 0.0001). Synthetic cathinones (from 0 to 2.7%, p = 0.001) and cannabinoids (from 0 to 0.9%, p = 0.112) emerged as new substances reported only in the most recent survey.ConclusionsIn our setting, drug-use for sex increased over time among MSM, with expansion of chemsex and diversification of substances. This behavioral change may increase STI/HIV transmission. Public health & STI/HIV services should update screening, counselling and harm reduction strategies to address these evolving patterns.