緒論：進行「藥愛」，或在性交之前或期間使用精神藥物或非法藥物可能導致人類免疫缺乏病毒 (Human Immunodeficiency Virus, HIV)和其他性傳染病 (Sexually Transmitted Infections, STIs)感染率的增加。在菲律賓，特別是在使用毒品的族群中，人類免疫缺乏病毒及其他性傳染病的預防和治療服務使用偏低，而菲律賓人之中的藥愛仍然是一個尚未被探索的現象。因此，本研究可用以確定菲律賓男男間性行為者進行藥愛與人類免疫缺乏病毒及其他性傳染病風險之相關性以及此現象之存在。

方法：在2019年8月3日至12月1日期間，使用方便取樣針對491名菲律賓男男間性行為者進行了橫斷式網路調查。收集人口學資料、性相關資料、用藥行為、藥愛經驗、愛滋病毒狀況和性傳染病史，並使用描述性統計資料進行定量分析。雙變量和多變量回歸分析用於確定進行藥愛的菲律賓男男間性行為者與不進行藥愛者相比之下，其人類免疫缺乏病毒及其他性傳染病的風險。

研究結果：進行藥愛的菲律賓男男間性行為者普遍年齡較大 (M=33.6 vs 29.8； p=.02)，但與不進行藥愛者相比之下接受大學或高等教育者比例較少 (84.6% vs 91.5%；p=.008)。甲基苯丙胺 (Methamphetamine)是最常被選用的藥物，此外，進行藥愛者更有可能注射毒品 (100% vs無，p<.001)，且70%的藥物注射者會共用針頭。在用藥和無套肛交期間共用針頭與是否進行藥愛有關。在控制年齡、第一次吸毒年齡、最後一次吸毒和第一次插入性行為的年齡後，從事藥愛的人與HIV陽性相關的可能性增加三倍 (Adjusted Odds Ratio (AOR)=3.10, 95% Confidence Interval (CI)=1.409-6.825, p=.005)；在進行藥愛者當中，性傳染病的可能性高出四倍 (AOR=4.27, 95%CI=1.843-9.888, p=0.001)。

結論：進行藥愛，尤其是近期的藥愛，與人類免疫缺乏病毒及其他性傳染病顯著相關。因此，在以醫院和社區為基礎的介入措施中都應提供同樣積極的減害計劃。提供甲基苯丙胺造成之影響的教育，識別潛在的用藥過量以及適當的醫療管理，應是菲律賓菲律賓男男間性行為者進行藥愛族群的健康教育優先事項。

Introduction: Chemsex, or the use of psychotropic or illicit drugs before or during sexual intercourse may be attributed to the increasing rates of HIV and other STIs. In the Philippines, intake of HIV/STIs prevention and treatment services remains low especially among Filipinos who use drugs and Chemsex remained an unexplored phenomenon in the Philippines. Thus, this study determined the existence of Chemsex and its association to the risk for HIV and other STIs among Filipino MSM.

Methods: Between August 3 and December 1, 2019, a cross-sectional online survey of 491 Filipino MSM was conducted using convenience sampling. Demographic profiles, sexual profiles, drug use behavior, Chemsex experience, HIV status, and history of STIs were gathered and quantitatively analyzed using descriptive statistics. Bivariable and multivariable regression analyses were used to determine the risk of HIV and other STIs among Filipino MSM engaged in Chemsex compared to those who are not.

Results: Empirical data suggest Filipino MSM engaged in Chemsex were generally older (M=33.6 vs 29.8 years old; p=.02) but less likely to have reached college or higher education (84.6% vs. 91.5%; p=.008) than those who were not engaged in Chemsex. Methamphetamine was the most preferred drug. Moreover, those engaged in Chemsex were more likely to be injecting drugs (100% vs none, p<.001) and 70% of those who injected reported to have shared needles. Sharing needles during drug use and condomless anal intercourse was associated with Chemsex engagement. Those who were engaged in Chemsex were three times more likely to be HIV-positive when adjusted for age in years, age of first drug use, last drug use, and age of first penetrative sex (Adjusted Odds Ratio (AOR)=3.10, 95% Confidence Interval (CI)=1.409-6.825, p=.005); STIs were four times more likely (AOR=4.27, 95%CI=1.843-9.888, p=0.001).

Conclusion: Chemsex engagement, especially recent chemsex, is significantly associated with HIV and other STIs. Thus, both hospital-based interventions and community-based ones should provide access to equally aggressive harm reduction programs. Health education for the subpopulation of Filipino MSM who are engaged in chemsex should prioritize raising awareness of the effects of methamphetamine as well as identifying potential overdose and proper medical management.

ABS-CBN News (2017). How many drug users are there in PH? DBB chief defends varying figures. ABS-CBN News Online. https://news.abs-cbn.com/news/05/23/17/how-many-drug-users-are-there-in-ph-ddb-chief-defends-varying-figures
ABS-CBN News (2019). War on drugs is working, says PNP; touts survey results. ABS-CBN News Online. https://news.abs-cbn.com/news/02/17/19/war-on-drugs-is-working-says-pnp-touts-survey-results
Ball H. L. (2019). Conducting Online Surveys. Journal of human lactation : official journal of International Lactation Consultant Association, 35(3), 413–417. https://doi.org/10.1177/0890334419848734
Benotsch, E. G., Lance, S. P., Nettles, C. D., & Koester, S. (2012). Attitudes toward methamphetamine use and HIV risk behavior in men who have sex with men. The American journal on addictions, 21 Suppl 1, S35–S42. https://doi.org/10.1111/j.1521-0391.2012.00294.x
Bourne, A., Reid, D., Hickson, F., Torres-Rueda, S., & Weatherburn, P. (2015). Illicit drug use in sexual settings ('Chemsex') and HIV/STI transmission risk behaviour among gay men in South London: findings from a qualitative study. Sexually transmitted infections, 91(8), 564–568. https://doi.org/10.1136/sextrans-2015-052052
Bui, H., Zablotska-Manos, I., Hammoud, M., Jin, F., Lea, T., Bourne, A., Iversen, J., Bath, N., Grierson, J., Degenhardt, L., Prestage, G., & Maher, L. (2018). Prevalence and correlates of recent injecting drug use among gay and bisexual men in Australia: Results from the FLUX study. The International journal on drug policy, 55, 222–230. https://doi.org/10.1016/j.drugpo.2018.01.018
Cabalza, D. (2017, November 28). PDEA raid catches 11 in drug-fueled sex orgy. Inquirer.net. https://newsinfo.inquirer.net/948126/pdea-raid-drug-bust-war-on-drugs-bgc-2
CNN Philippines Staff (2019, March 1). DOH officer, 6 others nabbed in drug buy-bust. CNN Philippines. https://cnnphilippines.com/news/2019/02/28/DOH-doctor-drug-buy-bust.html
Centers for Disease Control and Prevention (2021, April 21). HIV and injection drug use. https://www.cdc.gov/hiv/basics/hiv-transmission/injection-drug-use.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fhiv%2Frisk%2Fidu.html
Dargan, P. I., & Wood, D. M. (2012). Recreational drug use in the Asia Pacific region: improvement in our understanding of the problem through the UNODC programmes. Journal of medical toxicology : official journal of the American College of Medical Toxicology, 8(3), 295–299. https://doi.org/10.1007/s13181-012-0240-4
Daskalopoulou, M., Rodger, A., Phillips, A. N., Sherr, L., Speakman, A., Collins, S., Elford, J., Johnson, M. A., Gilson, R., Fisher, M., Wilkins, E., Anderson, J., McDonnell, J., Edwards, S., Perry, N., O'Connell, R., Lascar, M., Jones, M., Johnson, A. M., Hart, G., … Lampe, F. C. (2014). Recreational drug use, polydrug use, and sexual behaviour in HIV-diagnosed men who have sex with men in the UK: results from the cross-sectional ASTRA study. The lancet. HIV, 1(1), e22–e31. https://doi.org/10.1016/S2352-3018(14)70001-3
Department of Health (2021). Interim Guidelines on Pre-Exposure Prophylaxis (PrEP) for the Prevention of HIV Infection in the Philippines. Regulations, Licensing, and Enforcement Division. http://ncroffice.doh.gov.ph/RLED/Details
Department of Health – Epidemiology Bureau (2020). HIV/AIDS & ART Registry of the Philippines: December 2020. National HIV/AIDS and STI Surveillance and Strategic Information Unit. Dec 2020 Issue, 1-3. https://doh.gov.ph/sites/default/files/statistics/EB_HARP_Oct_AIDSreg2020.pdf
Department of Health – Epidemiology Bureau (2018). 2018 Integrated HIV Behavioral and Serologic Surveillance (IHBSS) Factsheets. NHSSS, p1. https://www.aidsdatahub.org/sites/default/files/resource/philippines-2018-ihbss-factsheets-2020.pdf
Department of Health – Epidemiology Bureau (2015). Integrated HIV Behavioral and Serologic Surveillance (IHBSS) Factsheets. NHSSS, p24-26 https://doh.gov.ph/sites/default/files/publications/Philippines_2015_IHBSS_Fact_Sheets_Nov2017_22JUN2016.pdf
Department of Health (2018). DOH - Health Programs (A-Z). DOH Website. https://www.doh.gov.ph/health-programs
Devi, S. (2019). Stigma, politics, and an epidemic: HIV in the Philippines. The Lancet World Report, 394(10215), 2139-2140. https://doi.org/10.1016/S0140-6736(19)32939-3
Drückler, S., van Rooijen, M. S., & de Vries, H. (2018). Chemsex Among Men Who Have Sex With Men: a Sexualized Drug Use Survey Among Clients of the Sexually Transmitted Infection Outpatient Clinic and Users of a Gay Dating App in Amsterdam, the Netherlands. Sexually transmitted diseases, 45(5), 325–331. https://doi.org/10.1097/OLQ.0000000000000753
Esguerra, D. J. (2019, January 8). Palace rejects psychologists’ call for ‘scientific, humane approach’ vs drugs. Inquirer.net. https://newsinfo.inquirer.net/1070561/palace-rejects-psychologists-call-for-scientific-humane-approach-vs-drugs
Evers, Y. J., Geraets, J., Van Liere, G., Hoebe, C., & Dukers-Muijrers, N. (2020). Attitude and beliefs about the social environment associated with Chemsex among MSM visiting STI clinics in the Netherlands: An observational study. PloS one, 15(7), e0235467. https://doi.org/10.1371/journal.pone.0235467
Evers, Y. J., Van Liere, G., Hoebe, C., & Dukers-Muijrers, N. (2019). Chemsex among men who have sex with men living outside major cities and associations with sexually transmitted infections: A cross-sectional study in the Netherlands. PloS one, 14(5), e0216732. https://doi.org/10.1371/journal.pone.0216732
Hoornenborg, E., Coyer, L., van Laarhoven, A., Achterbergh, R., de Vries, H., Prins, M., van der Loeff, M. S., & Amsterdam PrEP Project team in the HIV Transmission Elimination Amsterdam Initiative (2018). Change in sexual risk behaviour after 6 months of pre-exposure prophylaxis use: results from the Amsterdam pre-exposure prophylaxis demonstration project. AIDS (London, England), 32(11), 1527–1532. https://doi.org/10.1097/QAD.0000000000001874
IBM Corp. Released 2017. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp.
Khosropour, C. M., Dombrowski, J. C., Kerani, R. P., Katz, D. A., Barbee, L. A., & Golden, M. R. (2016). Changes in Condomless Sex and Serosorting Among Men Who Have Sex With Men After HIV Diagnosis. Journal of acquired immune deficiency syndromes (1999), 73(4), 475–481. https://doi.org/10.1097/QAI.0000000000001128
Khosropour, C. M., Dombrowski, J. C., Swanson, F., Kerani, R. P., Katz, D. A., Barbee, L. A., Hughes, J. P., Manhart, L. E., & Golden, M. R. (2016). Trends in Serosorting and the Association With HIV/STI Risk Over Time Among Men Who Have Sex With Men. Journal of acquired immune deficiency syndromes (1999), 72(2), 189–197. https://doi.org/10.1097/QAI.0000000000000947
Koblin, B. A., Murrill, C., Camacho, M., Xu, G., Liu, K. L., Raj-Singh, S., & Torian, L. (2007). Amphetamine use and sexual risk among men who have sex with men: results from the National HIV Behavioral Surveillance study--New York City. Substance use & misuse, 42(10), 1613–1628. https://doi.org/10.1080/10826080701212519
Li, C. W., Ku, S. W., Huang, P., Chen, L. Y., Wei, H. T., Strong, C., & Bourne, A. (2021). Factors associated with methamphetamine dependency among men who have sex with men engaging in Chemsex: Findings from the COMeT study in Taiwan. The International journal on drug policy, 93, 103119. https://doi.org/10.1016/j.drugpo.2021.103119
Lim, S. H., Cheung, D. H., Guadamuz, T. E., Wei, C., Koe, S., & Altice, F. L. (2015). Latent class analysis of substance use among men who have sex with men in Malaysia: Findings from the Asian Internet MSM Sex Survey. Drug and alcohol dependence, 151, 31–37. https://doi.org/10.1016/j.drugalcdep.2015.02.040
Maxwell, S., Shahmanesh, M., & Gafos, M. (2019). Chemsex behaviours among men who have sex with men: A systematic review of the literature. The International journal on drug policy, 63, 74–89. https://doi.org/10.1016/j.drugpo.2018.11.014
Melendez-Torres, G.J., Bonell, C. (2017). Littoral Spaces of Performance: Findings from a Systematic Review and Re-analysis of Qualitative Studies on Men Who Have Sex with Men, Substance Use and Social Venues. Sexual Res Soc Policy, 14, 259–269. https://doi.org/10.1007/s13178-016-0247-8
National Institute on Drug Abuse (2020, July). Drug use and viral infections (HIV and hepatitis) DrugFacts. US Department of Health and Human Services, National Institutes of Health. https://www.drugabuse.gov/publications/drugfacts/drug-use-viral-infections-hiv-hepatitis
Nyato, D., Kuringe, E., Drake, M., Casalini, C., Nnko, S., Shao, A., Komba, A., Baral, S. D., Wambura, M., & Changalucha, J. (2018). Participants' accrual and delivery of HIV prevention interventions among men who have sex with men in sub-Saharan Africa: a systematic review. BMC public health, 18(1), 370. https://doi.org/10.1186/s12889-018-5303-2
O’Connor, C., Leyritana, K., Calica, K., Gill, R., Doyle, A. M., Lewis, J. L., & Salvaña, E. M. T. (2021). Risk factors affecting adherence to antiretroviral therapy among HIV patients in Manila, Philippines: a baseline cross-sectional analysis of the Philippines Connect for Life Study. CSIRO Publishing – Sexual Health, 18(), 95-103. https://doi.org/10.1071/SH20028
O’Connor, C., Leyritana, K. T., Olete, R. (2018). Integrating harm reduction principles into HIV/AIDS healthcare delivery in the Philippines: Readiness of HIV care providers and drug rehabilitation care providers [Conference presentation abstract]. 22nd International AIDS Conference, Amsterdam, The Netherlands. http://programme.aids2018.org/Abstract/Abstract/7706
Olete, R., Leyritana, K., & O’Connor, C. (2019). Effectiveness of a 5-point modular training program for health providers in achieving holistic care for PLHIV who use drugs in the Philippines: A pilot study [Conference presentation abstract]. The 2019 International AIDS Society Conference, Mexico City, Mexico. http://programme.ias2019.org/Abstract/Abstract/646
Olete, R., O’Connor, C., Salisi, J., Binay, G., Bona, R., & Leyritana, K. (2018, July 23-27). Barriers to accessing quality care for HIV and substance use in the Philippines: In-depth interviews with PLHIV who use drugs [Conference presentation abstract]. 22nd International AIDS Conference, Amsterdam, The Netherlands. http://programme.aids2018.org/Abstract/Abstract/8202
Phillips, D., & Clancy, K. (1972). Some effects of “social desirability” in survey studies. American Journal of Sociology, 77(5), 921–940
Philippine Congress (2002). Republic Act 9165: Comprehensive Dangerous Drugs Act of 2002. The Philippine Official Gazette. https://www.officialgazette.gov.ph/2002/06/07/republic-act-no-9165/
Psychological Association of the Philippines (2019, January 7). A statement on promoting a scientific and humane approach to addiction and substance use [Position statement]. https://www.pap.ph/position-paper/13
Pufall, E. L., Kall, M., Shahmanesh, M., Nardone, A., Gilson, R., Delpech, V., Ward, H., & Positive Voices study group (2018). Sexualized drug use ('Chemsex') and high-risk sexual behaviours in HIV-positive men who have sex with men. HIV medicine, 19(4), 261–270. https://doi.org/10.1111/hiv.12574
Reback, C. J., Fletcher, J. B., & Swendeman, D. (2018). Associations between Sociodemographic Characteristics and Sexual Risk Behaviors among Methamphetamine-using Men who Have Sex with Men. Substance use & misuse, 53(11), 1826–1833. https://doi.org/10.1080/10826084.2018.1436566
Restar, A., Nguyen, M., Nguyen, K., Adia, A., Nazareno, J., Yoshioka, E., Hernandez, L., & Operario, D. (2018). Trends and emerging directions in HIV risk and prevention research in the Philippines: A systematic review of the literature. PloS one, 13(12), e0207663. https://doi.org/10.1371/journal.pone.0207663
Restar, A., Surace, A., Adia, A., Goedel, W., Ogunbajo, A., Jin, H., Edeza, A., Hernandez, L., Cu-Uvin, S., & Operario, D. (2022). Characterizing Awareness of Pre-Exposure Prophylaxis for HIV Prevention in Manila and Cebu, Philippines: Web-Based Survey of Filipino Cisgender Men Who Have Sex With Men. Journal of medical Internet research, 24(1), e24126. https://doi.org/10.2196/24126
Rosenstock, I. M., Strecher, V. J., & Becker, M. H. (1988). Social learning theory and the Health Belief Model. Health education quarterly, 15(2), 175–183. https://doi.org/10.1177/109019818801500203
Stone, J., Fraser, H., Lim, A. G., Walker, J. G., Ward, Z., MacGregor, L., Trickey, A., Abbott, S., Strathdee, S. A., Abramovitz, D., Maher, L., Iversen, J., Bruneau, J., Zang, G., Garfein, R. S., Yen, Y. F., Azim, T., Mehta, S. H., Milloy, M. J., Hellard, M. E., … Vickerman, P. (2018). Incarceration history and risk of HIV and hepatitis C virus acquisition among people who inject drugs: a systematic review and meta-analysis. The Lancet. Infectious diseases, 18(12), 1397–1409. https://doi.org/10.1016/S1473-3099(18)30469-9
Stuart, D. (2019). Chemsex: origins of the word, a history of the phenomenon and a respect to the culture. Drugs and Alcohol Today, 19(1), 3-10. https://doi.org/10.1108/DAT-10-2018-0058
Tan, R.K.J., O'Hara, C. A., Koh, W. L., Le, D., Tan, A., Tyler, A., Tan, C., Kwok, C., Banerjee, S., & Wong, M. L. (2021). Delineating patterns of sexualized substance use and its association with sexual and mental health outcomes among young gay, bisexual and other men who have sex with men in Singapore: a latent class analysis. BMC public health, 21(1), 1026. https://doi.org/10.1186/s12889-021-11056-5
Tan, R. K. J., Wong, C. M., Chen, M. I. C., Chan, Y. Y., Ibrahim, M. A. B., Lim, O. Z., Chio, M. T. W., Wong, C. S., Chan, R. K. W., Chua, L. J., Choong, B.C.H. (2018). Chemsex among gay, bisexual, and other men who have sex with men in Singapore and the challenges ahead: A qualitative study. International Journal of Drug Policy, 61(), 31-37. https://doi.org/10.1016/j.drugpo.2018.10.002
Thomson N. (2013). Harm reduction history, response, and current trends in Asia. Journal of food and drug analysis, 21(4), S113–S116. https://doi.org/10.1016/j.jfda.2013.09.047
Tordesillas, E. T. (2018). Opinion: Duterte revises his number of drug addicts in the Philippines. ABS-CBN News Online. https://news.abs-cbn.com/blogs/opinions/03/12/18/opinion-duterte-revises-his-number-of-drug-addicts-in-the-philippines
UNAIDS (2021). Country HIV and AIDS factsheets: Philippines 2019. UNAIDS. https://www.unaids.org/en/regionscountries/countries/philippines
Van der Bij, A. K., Kolader, M. E., de Vries, H. J., Prins, M., Coutinho, R. A., & Dukers, N. H. (2007). Condom use rather than serosorting explains differences in HIV incidence among men who have sex with men. Journal of acquired immune deficiency syndromes (1999), 45(5), 574–580. https://doi.org/10.1097/QAI.0b013e3180959ab7
Vista, E. (2018). Updates on sexually transmitted infections in the Philippines. Research Gate. https://www.researchgate.net/publication/328929338_Updates_on_Sexually_Transmitted_Infections_in_the_Philippines
Viswanathan, S., Detels, R., Mehta, S. H., Macatangay, B. J., Kirk, G. D., & Jacobson, L. P. (2015). Level of adherence and HIV RNA suppression in the current era of highly active antiretroviral therapy (HAART). AIDS and behavior, 19(4), 601–611. https://doi.org/10.1007/s10461-014-0927-4
Wright, J. (1998). Development and importance of health needs assessment. BMJ, 316:1310. https://doi.org/10.1136/bmj.316.7140.1310
Wang, Z., Yang, X., Mo, P., Fang, Y., Ip, T., & Lau, J. (2020). Influence of Social Media on Sexualized Drug Use and Chemsex Among Chinese Men Who Have Sex With Men: Observational Prospective Cohort Study. Journal of medical Internet research, 22(7), e17894. https://doi.org/10.2196/17894
Wong, N. S., Kwan, T. H., Lee, K., Lau, J., & Lee, S. S. (2020). Delineation of Chemsex patterns of men who have sex with men in association with their sexual networks and linkage to HIV prevention. The International journal on drug policy, 75, 102591. https://doi.org/10.1016/j.drugpo.2019.10.015