Acute Hepatitis C: High Chemsex Rates & Care Gaps Among MSM

A significant study conducted in Madrid, Spain, and published by the European Medical Journal (EMJ), has brought to light a concerning trend in the transmission of acute Hepatitis C virus (HCV) infection. The research, which tracked 92 cases of acute or recent HCV infection between January 2023 and January 2025, found that an overwhelming majority (98.9%) occurred in men who have sex with men (MSM). One of the most striking findings was the high prevalence of 'chemsex' among these patients, with 78.3% reporting intentional use of psychoactive substances during sexual activity. Further exacerbating the risk, 52.8% of those engaging in chemsex also reported 'slamsex,' defined as injecting drugs during sex. These practices significantly increase vulnerability to bloodborne infections like HCV, as well as HIV and other sexually transmitted infections (STIs). 'Chemsex' is a term commonly used across Europe and Asia, and in other regions it may be referred to as 'party and play' (PnP) or 'high fun'/'chemfun' in Southeast Asia. It typically involves the use of stimulant drugs such as crystal methamphetamine, mephedrone, and GHB/GBL to facilitate, prolong, or intensify sexual encounters, often with multiple or casual partners over extended periods. The inherent risks include not only direct drug-related harms like overdose and mental health issues but also a heightened likelihood of engaging in unprotected anal intercourse, fisting, or group sex, which are known to increase STI and bloodborne virus transmission. The Madrid study revealed that most infected individuals (76.1%) were living with HIV, and another 20.7% were using HIV pre-exposure prophylaxis (PrEP). This highlights a particularly vulnerable subgroup within the MSM community, where overlapping sexual health risks are pronounced. The median age of patients was 43 years, with a notable proportion (26.1%) over 50. Viral load analysis indicated substantial viraemia in many cases, with HCV RNA exceeding 6 log in 44.6% of patients, suggesting high infectivity. A critical observation from the study was the low rate of spontaneous HCV clearance, with only 6.8% of those initially managed with watchful waiting achieving natural resolution of the infection. Consequently, a vast majority (93.2%) of the reassessed patients proceeded to direct-acting antiviral (DAA) therapy. This finding underscores significant gaps in the continuum of care, from early detection to successful treatment, and emphasizes the need for timely intervention to prevent chronic infection and further transmission. The European Medical Journal (EMJ) itself is a credible, peer-reviewed, open-access medical journal dedicated to advancing medical knowledge and research globally. Its mission to elevate healthcare quality across 18 therapy areas, backed by an expert editorial board and rigorous peer review, lends significant weight to the study's findings. While this specific study was conducted in Madrid, its implications are global. The phenomenon of HCV transmission linked to chemsex among MSM is a recognized international public health concern. The World Health Organization (WHO) has highlighted the high burden of HCV infection in MSM populations globally, noting that rates of new infections are particularly high among HIV-positive MSM and HIV-negative MSM on PrEP who engage in high-risk behaviours. Injecting drug use is a major driver of the HCV epidemic in MSM, and high-risk sexual practices further facilitate transmission. For an Indian audience, these findings are highly relevant. While direct studies on 'chemsex' using this specific terminology might be less prevalent in India compared to Western countries, the underlying risk factors are present. India has an estimated HCV prevalence of 3.23%, with transmission primarily linked to blood transfusions, intravenous drug use, and unsafe healthcare practices. However, studies in India have also indicated a higher prevalence of HCV among HIV-positive MSM, and identified injection drug use as a significant risk factor. Reports suggest a changing landscape, where 'chemsex' and mucosally traumatic sexual practices are increasingly implicated in HCV transmission even among HIV-negative MSM in high-income settings within India, though data gaps remain. An older study from Chennai noted a potential association between HCV infection and male-male sexual practices, although it appeared infrequent in that specific population after excluding injection drug users. Therefore, this Madrid study serves as a critical alert for public health initiatives in India. It emphasizes the urgent need for integrated sexual health services that address drug use within sexual contexts, provide comprehensive harm reduction strategies, and ensure routine and timely HCV screening, diagnosis, and treatment for all at-risk populations, particularly MSM, those living with HIV, and those on PrEP. Addressing these care gaps and implementing targeted interventions are crucial steps towards mitigating the spread of acute Hepatitis C and working towards its elimination globally and within India. The insights from this European study offer valuable lessons for developing more effective and culturally sensitive public health strategies for vulnerable populations in India.

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