Venturing beyond the “Behavioural MSM”: Sex, Chems, & Satisfaction in their Syndemic Contexts

BACKGROUND: The health and well-being of thosesexual-minority men who are often behaviourally definedas men who have sex with men (MSM) is affected by asystem of interlinked factors that interact on the structural,interpersonal, and individual levels. Recently, two of themost common MSM health issues have been (a) the risksof acquiring sexually transmitted infections (STIs), mostlyHIV, and (b) the sexualized use of addictive substances,known as chemsex. AIMS: On the basis of the firstcomprehensive Czech dataset to integrate several mutuallyinterlinked factors on the behavioural, as well as thepsychological and structural domains, we attempt to shedlight on the barriers to HIV testing and adherence to safersex practices, including the most thorough descriptionof the chemsex phenomenon that is available. We aim togo beyond the behavioural perspective and draw linksto the well-being and satisfaction of this sexual minorityand their sex lives. METHODS: A series of descriptivestatistical analyses was conducted on a sample of 547respondents obtained within a self-administered onlinesurvey. RESULTS: More than half of our respondents(55%) and three-quarters (72%) of the men youngerthan 25 years have never been tested for HIV. One-thirdof the respondents considered testing services to beinsufficiently friendly to gay, bisexual, or other men, andthey also reported stigmatization and discrimination byhealthcare workers as a problem that exists. 84% of theMSM have experience with anal sex; 43% of them alwaysuse condoms. Of all the respondents, nearly 6% have hadat least one chemsex experience during their life. Only46% of the MSM reported being satisfied with their sexlives; 52% of those who were dissatisfied attributed thisto “not having a steady partner” and 49% to “not havingany sex”. CONCLUSION: The sexual behaviour of MSMand their experience with HIV testing, chemsex, perceivedstigma, and satisfaction with their sex lives are among thephenomena that deserve to be more regularly coveredby relevant epidemiological examinations. Although ourcurrent analysis was more exploratory than in-depth, itmay contribute to a better understanding of the syndemicand multifactorial conditions that influence the sexualbehaviour of MSM, including the minority stress thatmay be rooted in deficiencies in our understanding ofthese populations.