Olete RA et al.

Journal of the International AIDS Society 2024, 27:e26323

http://onlinelibrary.wiley.com/doi/10.1002/jia2.26323/full | https://doi.org/10.1002/jia2.26323

SHORT REPORT

ChemsexPH: The association between chemsex, HIV status and

adherence to antiretroviral therapy among men who have sex
with men in the Philippines
Rodenie Arnaiz Olete1,2 , Carol Strong1,§ , Katerina Leyritana2 , Adam Bourne3,4 and
Nai-Ying Monica Ko1,5
§ Corresponding author: Carol Strong, Department of Public Health, College of Medicine, National Cheng Kung University, 8F-8068, No. 138, ShengLi Rd.,

North Dist., Tainan 704, Taiwan. Tel: +886-6-2353535, ext 5963. ([email protected])
IRB #: 20190715-108-NEC (Philippine Health Research Ethics Board – National Ethics Committee)

Abstract
Introduction: Chemsex, the use of psychotropic drugs before or during sexual intercourse, is associated with various HIV risk
factors, including condomless sex and reduced adherence to pre-exposure prophylaxis or antiretroviral therapy (ART). In the
Philippines, there are still limited studies exploring the associations between chemsex, HIV status and ART adherence. This
study aims to compare recent and lifetime chemsex engagement in association with self-reported HIV status among Filipino
men who have sex with men (MSM). We further explored the association between chemsex and ART adherence among people
living with HIV engaged in chemsex.
Methods: A cross-sectional online survey of 479 Filipino MSM was conducted from 3 August to 1 December 2019. Demo-
graphic profiles, sexual behaviours, drug use, history of sexually transmitted infections (STIs), chemsex engagement and HIV
status were collected and analysed. Bivariable and multivariable logistic regression were employed to assess the association
between self-reported HIV status and chemsex engagement.
Results: Among the 479 respondents, Filipino MSM engaged in drug use and chemsex were generally older compared to
those not engaged in drug use and chemsex (average age 31−33 vs. 29 years old; p<0.05). Methamphetamine was the most
common drug for people who reported using drugs. An HIV-positive status was associated with recent chemsex engagement
(aOR = 5.18, p<0.05) and a history of STIs (aOR = 2.09, p<0.05). The subgroup analysis showed that 79% (166/200) of per-
sons living with HIV were adherent to ART. There was no significant association found between chemsex and ART adherence
in the logistic regression analyses.
Conclusions: Chemsex behaviour, particularly recent chemsex engagement, is significantly associated with self-reported HIV
status. The emerging data on MSM engaged in chemsex require integration of a more person-centred, comprehensive and
robust harm reduction programmes into the existing combination prevention strategies in the country. Health education for
Filipino MSM engaged in chemsex should prioritize raising awareness about methamphetamine effects and overdose risks,
alongside proper medical management.

Keywords: drug use; men who have sex with men; PrEP; Philippines

Received 9 January 2024; Accepted 10 June 2024

Copyright © 2024 The Author(s). Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of International AIDS Society.
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium,
provided the original work is properly cited.

1 INTRODUCTION risk. However, limited harm reduction programmes exist

for Filipino people who inject drugs (PWID), especially for
The Philippines had a 237% increase in new HIV cases MSM engaged in chemsex—an emerging phenomenon in the
between 2010 and 2018, making it one of the coun- Philippines.
tries with the highest HIV incidence in Southeast Asia Chemsex engagement involves psychotropic drug use
[1, 2]. The majority of reported HIV cases in the Philip- to enhance sexual experiences [4, 5] and the subculture
pines are among men who have sex with men (MSM), of “slamsex” involves intravenous drug injection—both
with only 3% linked to people sharing non-sterile nee- often influenced by sensation-seeking behaviours [6, 7]
dles [3]. Consequently, the HIV prevention efforts have and pose increased risks of bloodborne virus transmission
been focused heavily on male-to-male sexual transmission [8]. Common substances used in chemsex include crystal

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Olete RA et al. Journal of the International AIDS Society 2024, 27:e26323
http://onlinelibrary.wiley.com/doi/10.1002/jia2.26323/full | https://doi.org/10.1002/jia2.26323

methamphetamine (“shabu” in the Philippines) and gamma 3.1.2 ART adherence

hydroxybutyrate [9–11].
Both HIV and sexually transmitted infections (STIs) among For respondents who reported an HIV-positive status, a visual
MSM involved in chemsex are frequently associated with fac- analogue scale (VAS) was used to ask their adherence to
tors such as slamsex-related needle-sharing [6, 12–15], con- ART, representing 0−100% adherence. Categories were either
domless anal sex (CAS) [16–18], non-adherence to antiretro- “adherent” (≥90%) or “non-adherent” (<90%). The cutoff for
viral therapy (ART) [18–21] and decision-making disinhibition adherence was set at 90% based on the previous study [29].
leading to risk-taking behaviours [7, 22, 23]. However, there
are still limited studies clarifying the complex associations 3.2 Independent variable
between chemsex, HIV and ART adherence. In the Philippines, 3.2.1 Chemsex engagement
ART accessibility has improved yet enrolment and treatment
retention remains a challenge [24]. A facility-based study con- The independent variable of interest was chemsex engage-
ducted in Metro Manila found that people living with HIV ment asked by “When was the last time you used drugs while
(PLHIV) engaged in both injecting drug use and condomless having sex?” with answers corresponding to four groups of
sex exhibited lower ART adherence [24]. MSM: (a) non-C/DU, representing non-engagement in drug
Dearth in Philippine-based chemsex-related research use or chemsex; (b) DU, indicating experience in drug use
remains despite global evidence linking chemsex to HIV but not for chemsex; (c) CDU, indicating chemsex engagement
incidence among MSM [5, 26, 27]. A comprehensive review but not recently; and (d) CDU6, indicating recent chemsex
in Asia-Pacific in 2010−2021 did not identify any recent engagement within the last 6 months.
Philippine-based chemsex study [28]. Hence, this study aims
to address this gap by comparing recent and historical 3.3 Covariates
chemsex engagement among Filipino MSM and determine 3.3.1 Demographic profile
its association with self-reported HIV status. Additionally, a
subgroup analysis was conducted to assess the association This included measures such as age in years, location in the
of chemsex engagement with ART adherence among Filipino Philippines (categorized as Metro Manila/Luzon or the rest of
PLHIV. This study underscores the necessity for country- the Philippines), education level (high school or lower vs. col-
specific data in the Philippines to inform tailored prevention lege or higher) and employment status. Location is a covariate
and harm reduction approaches, cautioning against solely because residing in major cities like Manila and Luzon is asso-
relying on findings from other countries. ciated with higher accessibility to illicit drugs and HIV care
facilities.
2 METHODS 3.3.2 Access to ART, and access to pre-exposure
prophylaxis
An anonymous cross-sectional online survey was conducted
between 3 August and 1 December 2019, using voluntary This measured access to antiretroviral medications after they
response sampling posted on social media (i.e. Facebook, Twit- responded to the HIV status question wherein HIV-negative
ter/X), consisting of four main parts: informed consent (placed respondents were directed to questions on access to pre-
at the first part of the online survey where the nature and exposure prophylaxis (PrEP), while respondents who reported
purpose of the study were explained and ensuring confiden- and HIV-positive status were directed to questions on access
tiality) and inclusion criteria screening, demographic profile, to ART.
sexual health status including STI and HIV information, and
drug use and chemsex experiences. Then, respondents were 3.3.3 Condomless anal sex
screened based on the following inclusion criteria: (1) Fil-
This measured the occurrence of penetrative anal or vaginal
ipino citizen living in the Philippines at least within the last 6
sex without using a condom, categorized as “≤6 months ago”
months at the time of data gathering; (2) 18 years old and
or “>6 months or never.”
above; and (3) identifies as cisgender man having sex with
men. The survey was voluntary and non-incentivized, with
3.3.4 History of STIs
the approval of the Philippine Health Research Ethics Board
(20190715-108-NEC). Respondents were asked “Have you ever been diagnosed with
any STIs other than HIV in the past?” with responses catego-
rized as “Yes,” “No” or “Unknown.” Those who answered “Yes”
3 VA R I A B L E S
were directed to select a specific number of STIs they had in
the past: one versus two or more.
3.1 Dependent variables
3.1.1 Self-reported HIV status 3.3.5 Characteristics of drug use
The dependent variable in this study was self-reported HIV Only respondents who answered as DU, CDU or CDU6 were
status. Respondents were asked to report their HIV status directed to the following questions: “What is your primary drug
based on their most recent HIV testing. The responses were of choice?” (single selection from a list of specific drugs, with
categorized into three groups: HIV positive, HIV negative and an option to specify “others”), “Have you used two or more drugs
unknown status. at the same time?” for engagement in polydrug use; “Have you

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http://onlinelibrary.wiley.com/doi/10.1002/jia2.26323/full | https://doi.org/10.1002/jia2.26323

ever shared needles while injecting drugs?”; and “Age of first drug 5.2 Characteristics of drug use among Filipino
use” (answered with “before 18 years old” or “at 18 years old MSM engaged in chemsex
or older”).
Among the 124 who reported using drugs and engaging
in chemsex, the most common drugs used were metham-
3.3.6 Age of first penetrative sex phetamine (19.4%) and nalbuphine/Nubain (8.9%). There were
23.4% who reported polydrug use, and 12.9% engaged in nee-
This variable captured the age of first engagement in vaginal dle sharing during injection.
or anal penetrative sex and was categorized “before 18 years
old” or “at 18 years old or older.”
5.3 Association between chemsex and
self-reported HIV status
4 A N A LY S I S Both univariable and multivariable regression analyses
showed significant associations between chemsex and HIV
Data analysis in this study was conducted using IBM SPSS status (Table 2). Compared to HIV-negative non-C/DU group,
Statistics version 25 (IBM Corp., 2017). Descriptive statistics an HIV-positive status was more likely associated with the
summarized population characteristics, while inferential statis- CDU6 group (aOR = 5.18, 95% CI = 1.63−16.43, p = 0.005)
tics employed univariable and multivariable logistic regres- and those with a history of STIs (aOR = 2.09, 95% CI =
sion utilizing purposeful covariate selection method [30]; sig- 1.28−3.41, p = 0.003). Moreover, having an unknown HIV
nificant covariates at p<0.05 level in the univariable logis- status was also more likely associated with the CDU6 group
tic regression model were included in the final multivariable (aOR = 6.88, 95% CI = 1.15−14.11, p = 0.035) and having
model. The subgroup analysis of association between ART an unknown STI history (aOR = 9.82, 95% CI = 3.75−25.75,
adherence and chemsex among PLHIV used similar covari- p<0.001) but was less likely associated with recent CAS (aOR
ate selection criteria as the main regression analysis. Variance = 0.23, 95% CI = 0.10−0.53, p<0.001).
inflation factor tests were done to ensure no multicollinearity.
5.4 Subgroup analysis: association between
chemsex and ART adherence among PLHIV
5 R E S U LT S Among respondents who reported HIV-positive status and
had access to ART, there were 83% (166/200) who were
Out of 716 survey responses initially received, 237 were
adherent to ART (Table 3). Among the four groups, the
excluded due to duplication (8.4%), inconsistent information
highest proportion of ART adherence were among non-
(16%), non-residency in the Philippines during data collection
C/DU group (85.3%), while the highest proportion of ART
(6.8%) or not identifying as MSM (68.8%). The final data anal-
non-adherence were among the CDU6 group (29.6%). Both
ysis involved 479 Filipino MSM (response rate = 66.9%).
univariable and multivariable logistic regression analyses
revealed no significant association between ART adherence
and chemsex. Notably, both univariable and multivariable
5.1 General characteristics of the respondents
regression analyses showed that recent CAS within the last 6
The age of respondents ranged from 18 to 56 years old months was negatively associated with ART adherence (OR =
(Median = 30; IQR = 24−34). Nearly half (47.0%) of the 0.27, 95% CI = 0.12−0.64, p = 0.003 and aOR = 0.29, 95%
respondents were from Metro Manila and Luzon Regions, and CI = 0.12−0.71, p = 0.007, respectively).
64.7% held a college degree or higher education. Moreover,
74.1% of the respondents were employed. Over half (65.1%)
reported having their first penetrative sex at 18 years old or 6 DISCUSSION
older, while 34.9% had their first penetrative sexual experi-
ence before the age of 18 (Table 1). This nationwide survey conducted in the Philippines assessed
Among 479 respondents, 74.1% reported never using drugs chemsex as an emerging phenomenon among MSM, with
nor engaged in chemsex (non-C/DU), 7.3% reported drug use methamphetamine being the primary drug of choice among
but not for chemsex (DU), 10.2% had engaged in chemsex, but Filipino MSM, and associated behaviours resonating with pre-
not recently (CDU) and 8.4% engaged in chemsex within the vious research [21, 24, 31]. Findings also reveal that 18.6%
last 6 months (CDU6). Approximately 6.1% of Filipino MSM of Filipino MSM have chemsex engagement, surpassing the
reported having first used drugs before the age of 18, while 13% regional average in East and South Asia [21]. More-
19.8% began using drugs at 18 years old or older. Regard- over, the unique approach of comparing four groups of Fil-
ing self-reported HIV status, about 47.6% were HIV negative, ipino MSM noted that the proportion using drugs in a sex-
43.8% were HIV positive and 8.6% reported an unknown HIV ual context rather than recreational. Drug use among Filipino
status. MSM is context-dependent as explored by previous studies
There were 95.2% (200/210) reported having access to [7, 23]—potentially as a form of experiential experimentation,
ART among respondents reporting an HIV-positive status, coping mechanism, intimate connection, sexual disinhibition or
while 93.9% (214/228) reported to have no access to PrEP performance enhancement among employees working longer
among those reporting HIV-negative results. shifts. This requires a combination of prevention strategies

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Table 1. Cross-tabulation of demographic, sexual and HIV/STI profiles with chemsex engagement among Filipino men who have
sex with men (N = 479)

MSM engaged
MSM not MSM engaged MSM engaged in recent
engaged in in drug use in chemsex chemsex in
drug use nor but not for but not the last 6
chemsex chemsex recent months
[Non-C/DU] [DU] [CDU] [CDU6]
Demographic profile Overall (N = 355; 74.1%) (N = 35; 7.3%) (N = 49; 10.2%) (N = 40; 8.4%) p-value

Age in yearsa
Median (Interquartile range) 30 (25−34) 29 (25−33) 31 (27−34) 33 (27−39) 33 (29−37) 0.001b
Location in the Philippinesc 0.010b
Metro Manila and Luzon 225 (47.0) 151 (42.5) 20 (57.1) 31 (63.3) 23 (57.5)
The rest of the Philippines 254 (53.0) 204 (57.5) 15 (42.9) 18 (36.7) 17 (42.5)
Educationc 0.418
High school or lower 169 (35.3) 128 (36.1) 9 (25.7) 15 (30.6) 17 (42.5)
College or higher 310 (64.7) 227 (63.9) 26 (74.3) 34 (69.4) 23 (57.5)
Employment statusc 0.609
Employed 355 (74.1) 262 (73.8) 28 (80.0) 38 (77.6) 27 (67.5)
Unemployed 124 (25.9) 93 (26.2) 7 (20.0) 11 (22.4) 13 (32.5)
Age of first penetrative sexc 0.017b
<18 years old 167 (34.9) 113 (31.8) 11 (31.4) 21 (42.9) 22 (55.0)
≥18 years old or never 312 (65.1) 242 (68.2) 24 (68.6) 28 (57.1) 18 (45.0)
Age of first drug used <0.001b
< 18 years old 29 (6.1) 32 (91.4) 39 (79.6) 24 (60.0)
≥ 18 years old 450 (93.9) 355 (100.0) 3 (8.6) 10 (20.4) 16 (40.0)
Condomless anal sex (CAS)c <0.001b
≤ 6 months ago 252 (52.6) 172 (48.5) 17 (48.6) 29 (59.2) 34 (85.0)
> 6 months or never 227 (47.4) 183 (51.5) 18 (51.4) 20 (40.5) 6 (15.0)
History of sexually transmitted <0.001b
infections (STIs)d
No STIs 246 (51.4) 196 (55.2) 20 (57.1) 18 (36.7) 12 (30.0)
Had STIs 130 (27.1) 71 (20.0) 10 (28.6) 24 (49.0) 25 (62.5)
Unknown 103 (21.5) 88 (24.8) 5 (14.3) 7 (14.3) 3 (7.5)
HIV statusd 0.002b
HIV negative 228 (47.6) 186 (52.4) 18 (51.4) 20 (40.8) 7 (17.5)
HIV positive 210 (43.8) 144 (40.6) 13 (37.1) 25 (51.0) 28 (70.0)
Unknown 41 (8.6) 28 (7.9) 4 (11.5) 4 (8.2) 5 (12.5)
Access to antiretroviral therapy 0.809
(ART)d,e
No 10/210 (4.8%) 8/144 (5.6%) 1/25 (4.0%) 1/28 (3.6%)
Yes 200/210 (95.2%) 136/144 (94.4%) 13/13 (100%) 24/25 (96.0%) 8/28 (96.4%)
Access to pre-exposure 0.103
prophylaxis (PrEP)d,e
No 214/228 (93.9%) 172/183 (94.0%) 17/18 (94.4%) 20/20 (100%) 5/7 (71.4%)
Yes 14/228 (6.1%) 11/183 (6.01%) 1/18 (5.6%) 2/7 (28.6%)
a Level of significance calculated using Kruskal−Wallis test.
b Significant p-values <0.05.
c Level of significance calculated using chi-square tests.
d Level of significance calculated using Fisher’s Exact tests.
e Access to ART used the denominator corresponding to the total number of self-reported HIV-positive status, while access to PrEP corre-

sponds to the total number of self-reported HIV-negative status.

4
 Table 2. Regression analyses assessing the association of self-reported HIV status and chemsex engagement among Filipino MSM (N = 479)

Univariable logistic regression Multivariable logistic regression

HIV positive versus HIV HIV positive versus HIV
negative Unknown versus HIV negative negative Unknown versus HIV negative
Characteristics OR (95% CI) p-value OR (95% CI) p-value aOR (95% CI) p-value aOR (95% CI) p-value

Chemsex engagement
MSM engaged in drug use but 0.92 (0.44−1.94) 0.822 1.45 (0.46−4.61) 0.526 1.37 (0.62−3.02) 0.436 0.99 (0.98−1.37) 0.136
not for chemsex [DU]
MSM engaged in chemsex but 1.59 (0.85−2.97) 0.148 1.31 (0.42−4.12) 0.647 1.69 (0.63−4.52) 0.296 0.73 (0.13−4.11) 0.722
not recent [CDU]
Olete RA et al. Journal of the International AIDS Society 2024, 27:e26323

MSM engaged in recent 5.08 (2.16−11.97) <0.001a 4.67 (1.39−15.73) 0.013a 5.18 (1.63−16.43) 0.005a 6.88 (1.15−14.11) 0.035a
chemsex in the last 6 months
[CDU6]
MSM not engaged in drug use (Ref) (Ref) (Ref) (Ref)
nor chemsex [Non-C/DU]
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Age in years 1.01 (0.98−1.03) 0.536 1.00 (0.95−1.04) 0.829 0.98 (0.95−1.02) 0.308 1.00 (0.95−1.05) 0.924
Location in the Philippines
Manila and Luzon 1.01 (0.69−1.47) 0.977 1.50 (0.77−2.92) 0.238 1.27 (0.80−2.00) 0.311 0.69 (0.31−1.57) 0.379
The rest of the country (Ref) (Ref) (Ref) (Ref)
Condomless anal sex (CAS)
≤ 6 months ago 0.81 (0.56−1.19) 0.238 0.35 (0.17−0.71) 0.004a 1.52 (0.98−2.36) 0.061 0.23 (0.10−0.53) <0.001a
> 6 months or never (Ref) (Ref) (Ref) (Ref)
History of sexually transmitted
infections (STIs)
Unknown 0.03 (0.01−0.12) <0.001a 7.12 (2.97−17.07) <0.001a 0.03 (0.01−0.12) <0.001a 9.82 (3.75−25.75) <0.001a
Had STIs 2.18 (1.38−3.43) 0.001a 1.73 (0.48−6.22) 0.402 2.09 (1.28−3.41) 0.003a 1.24 (0.32−4.77) 0.752
Never had STIs (Ref) (Ref) (Ref) (Ref)
a Significant associations at p-value < 0.05.

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Table 3. Subgroup analysis assessing the association between adherence to antiretroviral therapy (ART) among Filipino people
living with HIV who engage in chemsex (N = 200a )

Adherent to Univariable logistic Multivariable logistic

antiretroviral Non-adherent regression regression
Overall therapy (ART) to ART
(N = 200) (n = 166; 83%) (n = 34; 17%) OR (95% CI) p-value aOR (95% CI) p-value

Chemsex engagement
MSM engaged in drug use 13 (6.5) 11 (84.6) 2 (15.4) 1.06 (0.22−5.12) 0.947 1.10 (0.22−5.55) 0.905
but not for chemsex [DU]
MSM engaged in chemsex 24 (12.0) 20 (83.3) 4 (16.7) 1.16 (0.34−3.75) 0.804 1.28 (0.37−4.39) 0.694
but not recent [CDU]
MSM engaged in recent 27 (13.5) 19 (70.4) 8 (29.6) 2.44 (0.94−6.33) 0.066 1.75 (0.59−5.20) 0.316
chemsex in the last 6
months [CDU6]
MSM not engaged in drug 136 (68.0) 116 (85.3) 20 (14.7) (Ref) (Ref)
use nor chemsex
[Non-C/DU]
Age in years
Median (Interquartile range) 30 (26−35) 30 (26−35) 30 (27−34) 1.00 (0.94−1.05) 0.868 0.98 (0.92−1.04) 0.488
Region in the Philippines
Manila and Luzon 94 (47.0) 78 (83.0) 16 (17.0) 1.00 (0.48−2.10) 0.994 1.25 (0.56−2.79) 0.583
Outside Manila 106 (53.0) 88 (83.0) 18 (17.0) (Ref) (Ref)
Condomless anal sex (CAS)
≤ 6 months ago 104 (52.0) 78 (75.0) 26 (25.0) 0.27 (0.12−0.64) 0.003b 0.29 (0.12−0.71) 0.007b
> 6 months or never 96 (48.0) 88 (91.7) 8 (8.3) (Ref) (Ref)
a There were 10/210 Filipino PLHIV who reported to have no access to ART and was removed from this regression analysis.
b Significant associations at p-value <0.05.

with intensified harm reduction interventions, especially for partly due to the sensitive nature of HIV and the highly
methamphetamine users. criminalized nature of drug use in the Philippines. While
Recent chemsex is significantly associated with an HIV- indicating higher chemsex prevalence among Filipino MSM
positive status even after adjusting for significant covariates, than in international studies, the lack of direct compari-
aligning with previous research conducted in Asia [15, 28, son with national data hinders country-specific assessment.
31–33]. Furthermore, the subgroup analysis revealed findings Recruitment through social media may introduce bias by
similar to the Manila-based study [24]—the slightly higher excluding MSM without internet access, affecting generaliz-
proportion of ART non-adherent MSM who were engaged ability. ART adherence measurement may not be ideal, but
in recent chemsex, and the negative association between using VAS in this community-based survey was more compre-
recent CAS and ART adherence. These reaffirm the need hensible for respondents. The lack of timeframe only reflected
to strengthen adherence counselling among PLHIV while respondents’ current perception towards their adherence.
addressing the underlying motivations for chemsex engage- Additionally, lifetime STI history may be less relevant to
ment, assessing sexual behaviour patterns and providing risk recent sexual experiences.
reduction strategies.
The high proportion of MSM (93.9%) without access to
PrEP highlights the need for efforts towards increasing 7 CONCLUSIONS
access. It is worthwhile to note, however, that there were lim-
ited PrEP guidelines in the country at the time of data gath- This study examined and revealed the nuanced associations
ering in 2019. The Philippines started the PrEP scaleup in between chemsex, HIV status and ART adherence in Filipino
2020 through the Department of Health’s interim guidelines MSM. The significant association between ART non-adherence
and inclusion of PrEP in the formulary system [37, 38]. and recent chemsex engagement highlights the necessity
This research has limitations impacting the interpretation for interventions promoting adherence and harm reduction
of findings. The cross-sectional design prevents definitive cau- within HIV care. The complex factors influencing ART adher-
sation between chemsex and HIV transmission. Self-reported ence underscore the need to integrate person-centred and
data collection methods may have underestimated chemsex structural interventions to support informed decision-making
engagement, ART adherence and self-reported HIV status, among Filipino MSM engaged in chemsex.

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Olete RA et al. Journal of the International AIDS Society 2024, 27:e26323
http://onlinelibrary.wiley.com/doi/10.1002/jia2.26323/full | https://doi.org/10.1002/jia2.26323

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ney, New South Wales, Australia; 5 Department of Nursing, College of Medicine,
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National Cheng Kung University, Tainan, Taiwan
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COMPETING INTERESTS mitted infection outpatient clinic and users of a gay dating app in Amsterdam, the
Netherlands. Sex Transm Dis. 2018;45(5):325–31. https://doi.org/10.1097/OLQ.
All authors declare no competing interests. 0000000000000753
12. Race K, Murphy D, Pienaar K, Lea T. Injecting as a sexual practice: cultural for-
AUTHORS’ CONTRIBUTIONS mations of ’slamsex’. Sexualities. 2023;26(5–6):620–37. https://doi.org/10.1177/
1363460720986924
RAO conceived the presented research idea. RAO conducted the data gathering, 13. Maxwell S, Shahmanesh M, Gafos M. Chemsex behaviours among men who
analysis, review of collected data for quality and reliability, and verification of the have sex with men: a systematic review of the literature. Int J Drug Policy.
underlying data. RAO, N-YK and CS contributed to the interpretation of results and 2021;63:74–89. https://doi.org/10.1016/j.drugpo.2018.11.014
led the manuscript writing and took charge of the overall direction and planning. All 14. Ayerdi Aguirrebengoa O, Vera García M, Arias Ramírez D, Gil García N, Puerta
authors evaluated the manuscript and provided feedback and approved the final López T, Clavo Escribano P, et al. Low use of condom and high STI incidence among
submitted manuscript. men who have sex with men in PrEP programs. PLoS One. 2021;16(2):e0245925.
https://doi.org/10.1371/journal.pone.0245925
15. Maviglia F, Wickersham JA, Azwa I, Copenhaver N, Kennedy O, Kern M,
ACKNOWLEDGEMENTS et al. Engagement in chemsex among men who have sex with men (MSM) in
We are grateful to the Filipino MSM community for their time and willingness to Malaysia: prevalence and associated factors from an online national survey. Int J
participate in this research. We are also grateful for the support of Olivier Lermet Environ Res Public Health. 2023;20(1):294. https://doi.org/10.3390/ijerph2001
and Shell Marquez from UNODC-Philippines, as well as the research assistants 0294
during data gathering in 2019—Marcel Milliam, Bernadette Cabasa, Kim Galanza 16. Roux P, Fressard L, Suzan-Monti M, Chas J, Sagaon-Teyssier L, Capitant C,
and Stephen Quilacio. Your dedication during the conduct of this research is highly et al. Is on-demand HIV pre-exposure prophylaxis a suitable tool for men who
appreciated. have sex with men who practice chemsex? Results from a substudy of the ANRS-
IPERGAY trial. J Acquir Immune Defic Syndr. 2018;79(2):e69–e75. https://doi.org/
10.1097/QAI.0000000000001781
FUNDING 17. Ugarte A, de la Mora L, García D, Martínez-Rebollar M, de Lazzari E, Torres
The study was supported by the United Nations Office on Drugs and Crime B, et al. Evolution of risk behaviors, sexually transmitted infections and PrEP care
(UNODC)-Philippines, and National Science and Technology Council in Taiwan continuum in a hospital-based PrEP program in Barcelona, Spain: a descriptive
(NSTC 112-2314-B-006-081-MY3). study of the first 2 years’ experience. Infect Dis Ther. 2023;12(2):425–42. https:
//doi.org/10.1007/s40121-022-00733-6
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Changes in chemsex and sexual behavior over time, among a cohort of MSM
The data that support the findings of this study are available from the correspond- in London and Brighton: findings from the AURAH2 study. Int J Drug Policy.
ing author upon reasonable request. 2021;68:54–61. https://doi.org/10.1016/j.drugpo.2019.03.021
19. Bui H, Zablotska-Manos I, Hammoud M, Jin F, Lea T, Bourne A, et al. Preva-
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