Chemsex and chemsex associated substance use among men who have sex with men in Asia: A systematic review and meta-analysis

Haoyi Wang*, Kai J. Jonas*, Thomas E. Guadamuz*

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review


BACKGROUND: The prevalence of chemsex has been reported by multiple systematic reviews among men who have sex with men (MSM) focussing predominantly on the Global North. An Asian perspective with meta-analytical evidence is missing. This meta-analysis summarised the prevalence of substance use associated with chemsex, and chemsex activity among MSM and MSM sub-populations in Asia, as well as the likelihood for chemsex among MSM living with or without HIV.

METHODS: We utilized PubMed, Web of Science and medRxiv to search for literature describing chemsex and its associated substance use among MSM and MSM sub-populations in Asia from January 1, 2010 to November 1, 2021 to conduct three meta-analyses with both frequentist and Bayesian approaches.

RESULTS: We identified 219 studies and included 23 in the meta-analysis. Based on the frequentist models, methamphetamine was the default substance associated with chemsex among MSM in Asia (prevalence = 0.16, 95 %CI:0.09-0.22), followed by GHB/GBL (prevalence = 0.15, 95 %CI:0.03-0.27) and ketamine (prevalence = 0.08, 95 %CI:0.04-0.12), but hardly any cocaine (prevalence = 0.01, 95 %CI:0.00-0.03). Compared to a general MSM population (prevalence = 0.19, 95 %CI:0.15-0.23), MSM engaging in transactional sex showed a higher prevalence of chemsex (MSM sex work clients [prevalence = 0.28, 95 %CI:0.11-0.45]; MSM sex worker [prevalence = 0.28, 95 %CI:0.17-0.26]). MSM living with HIV also showed higher odds of chemsex activity (OR = 3.35, 95 %CI:1.57-7.10), compared to MSM living without HIV. Both meta-analytic models converged, indicating robust evidence.

CONCLUSIONS: Our meta-analyses showed that chemsex is not uncommon among MSM, and MSM engaging in transactional sex in Asia. We confirmed that MSM living with HIV have a higher likelihood of engaging in chemsex, too. Chemsex prevention and management strategies in Asia should be adjusted accordingly.

Original languageEnglish
Article number109741
Number of pages11
JournalDrug and Alcohol Dependence
Publication statusPublished - 1 Feb 2023


  • Male
  • Humans
  • Homosexuality, Male
  • Unsafe Sex
  • Illicit Drugs
  • Bayes Theorem
  • Sexual and Gender Minorities
  • Cross-Sectional Studies
  • Substance-Related Disorders/epidemiology
  • Asia/epidemiology
  • HIV Infections/epidemiology
  • Sexual Behavior


Dive into the research topics of 'Chemsex and chemsex associated substance use among men who have sex with men in Asia: A systematic review and meta-analysis'. Together they form a unique fingerprint.

Cite this