Chemsex practice in national surveys in France on relationships to sex among men who have sex with men: Developments between 2017 and 2023

The Rapport au Sexe Survey (ERAS) is a cross-sectional, self-administered, voluntary survey, done online, of men who have sex with men (MSM); four editions have been carried out since 2017 (2019, 2021, 2023). The aim of the article is to describe the evolution of chemsex practice within these national surveys and the characteristics of MSM who practice it as of ERAS 2023. Since 2017, the practice of chemsex has been stable over time, whatever the indicator used. Thus, in 2017, 5 percent of respondents had practiced chemsex during their last sexual interaction, compared to 6 percent in 2023. In 2021, 12 percent had practiced chemsex in the six months before the survey, compared to 13 percent in 2023. Compared with respondents who don’t practice chemsex, those who do are more likely to be aged 25–45, live in urban areas, be unemployed, be financially less well-off, be attached to gay sociability and sexual performance values, be HIV-positive, or HIV-negative and use pre-exposure prophylaxis (PrEP). They are more likely to have multiple partners, and to use condoms less systematically for anal sex with occasional partners. The practice of chemsex is associated with high-risk behaviors for HIV and other STIs, but also with signs of psycho-social distress that remain to be explored. Services adapted to the practice of chemsex, addressing the issues of risk reduction, sexual health, and psychosocial care for MSM, need to be deployed to ensure appropriate prevention and interventions to promote the well-being of this population.