Case 22. Sex with Drugs: Talking About Chemsex and Harm Reduction

With guest Dr. Jeremy Kidd, Chris reviews the case of a 27-yr-old man with HIV who reports using methamphetamine to enhance sex and has unsuppressed HIV. Is this chemsex? Is the unsuppressed viral load related? How should Chris discuss this with his patient, and what should he recommend? How should he approach the topic of harm reduction if the patient is not going to stop using chemsex? References Cited:Kidd JD, Smiley SL, Coffin PO, et al. Sexual orientation differences among men in a randomized clinical trial of extended-release naltrexone and bupropion for methamphetamine use disorder. Drug Alcohol Depend. 2023 Sep 1;250:110899. Epub 2023 Jul 17. PMID: 37478502.Reback CJ. The Social Construction of a Gay Drug: Methamphetamine Use Among Gay and Bisexual Males in Los Angeles. 1997. Available online here. Accessed February 24, 2026.Trivedi MH, Walker R, Ling W, et al. Bupropion and Naltrexone in Methamphetamine Use Disorder. N Engl J Med. 2021 Jan 14;384(2):140-153. PMID: 33497547.Documentaries Mentioned:parTy boi, black diamonds in ice castlesCrystal CityRelated NYSDOH AI Guidelines and Guidance:Chemsex: Questions and AnswersSubstance Use Screening and Risk AssessmentSubstance Use Harm ReductionPrEP to Prevent HIV and Promote Sexual HealthPEP to Prevent HIV InfectionDoxycycline Post-Exposure Prophylaxis to Prevent Bacterial Sexually Transmitted InfectionsGuidance: Adopting a Patient-Centered Approach to Sexual Health