The Region adds 44 acute infections since 2021, which represents a sharp increase linked to sex parties in which injected drugs are consumed
The emergence of new treatments against hepatitis C from 2015 was a real revolution in the approach to this disease. The effectiveness of these antivirals is very high, which has given rise to hopes of cornering the virus, reducing transmission to a minimum. In recent years, ambitious plans have been developed that go through the active search for patients with chronic infection in order to treat them. But this strategy towards the elimination of hepatitis C as a public health problem has suddenly come up against a very notable increase in acute infections, largely linked to what is known as ‘chemsex’: sexual parties (without protection) in those who use drugs, often injected.
The Region of Murcia has added 44 cases of acute hepatitis C since the beginning of 2021. It is a figure that contrasts with the 33 infections detected over the previous seven years, between 2013 and 2020. «Usually, we had about 4 or 6 cases per year but, suddenly, in June of last year we detected five. We contacted Epidemiological Surveillance, which reviewed the data, confirmed that there was an uptick and raised the alarm,” says Carlos Galera, head of the La Arrixaca HIV and STI (sexually transmitted disease) Unit.
“Usually we had between 4 and 6 cases a year, but suddenly we detected five in a month, and we gave the alert”
According to data provided by the Ministry of Health, in 2021, 24 acute infections were reported throughout the Region, ten of them related to ‘chemsex’ sessions and nine to ‘slamming’ (injected drug use during these sexual encounters). So far in 2022, another 20 cases have been registered: 8 of these people report having practiced ‘chemsex’ and 4 ‘slamming’.
In the majority of all these new infections, Epidemiology points to unprotected sexual intercourse as the main route of transmission. There is also a high rate of patients with HIV coinfection.
However, other experts qualify the data. “I think there are many more cases in which the route of transmission is actually ‘slamming’, the consumption of injected drugs, even if they are attributed to the sexual route. It is not easy to talk openly about these things, and many people do not tell you in the first consultation, nor in the second. The reality is that in ‘chemsex’ there are sometimes more drugs than sex,” warns Bartolomé de Haro, of Active Support, an organization that offers psychosocial support to patients in La Arrixaca, and that works in the field of prevention and early detection. “The risk of contracting hepatitis C when intravenous drug use is very high,” recalls Carlos Galera.
STI increase
But the context of ‘chemsex’ is conducive not only to the increase in cases of hepatitis C, but also to the transmission of many other infections. The latest report from the Epidemiology service reflects a generalized increase in the incidence of STIs. Thus, in 2021, 278 cases of gonococcal infection were detected in the Region of Murcia, compared to 186 the previous year. In syphilis, it has gone from 77 cases in 2020 to 107 in 2021. However, behind these figures there is also an improvement in the notification systems.
“We are facing an important public health problem, both due to its magnitude and the complications and sequelae if early detection, diagnosis and treatment are not carried out that allow rapid control of transmission to other people,” underlines Epidemiology.
«I got hooked quickly and entered a spiral from which I could not get out»
Félix, a 48-year-old from Murcia (the name is assumed to preserve his privacy), contracted hepatitis C not once, but twice, during the ‘chemsex’ sessions he regularly attended over two years. It all started one night “with a ball”, he recalls. «I came to ‘chemsex’ in an unplanned way. You just drink, lose your inhibitions and, suddenly, you find yourself there, at one of those parties. Someone offered me drugs, and I took them.” He didn’t think he would end up hooked on these sessions of sex and synthetic drugs, but that’s what happened.
“From the first time to the next, quite a few months passed. I ended up going back, and there I did enter a spiral from which I could not get out », she confesses. Unprotected sex was coupled with a rampant use of methamphetamine, mephedrone and Alpha-PVP. At first, the substances were smoked or sniffed, but later came the ‘slam’, the injected consumption. “She is the heroine of the 21st century. Maybe she doesn’t act so fast, but she definitely destroys you. I’ve seen people lose everything, starting with their jobs, and completely deteriorate,” she says.
“We are not ready”
After a long journey through this hell, he reacted a year ago. “Partly it was thanks to my partner. He saw how I had changed, how I had become someone who was short-tempered at one point and euphoric at another.” She went to the Drug Addiction Care Center (CAD) in June. «Two nurses gave me a wonderful interview, and then they transferred me to the psychiatrist. She gave me the feeling that she didn’t know this ‘chemsex’ and ‘slam’ thing very well, but I have no complaints. The problem is that it took almost four months to give me an appointment with the psychologist. It was the same because it was summer, but I had no choice but to look for a professional privately. I had come to ask for help and I felt abandoned », he laments. Later, the consultations have been more regular, but “insufficient” to treat this addiction.
In Madrid or Barcelona there are specific resources to deal with ‘chemsex’. “My feeling is that this region is not ready, and what comes with this problem is a ‘tsunami,'” he warns.
Leaders in epidemiological surveillance, but with shortcomings in prevention
The Region of Murcia has a powerful Information System for new diagnoses of hepatitis C (SinhepaC), a leader in Spain. Only Navarra has such complete epidemiological data that it allows monitoring from incidence to transmission routes. This contrasts with the shortcomings to deal with phenomena such as ‘chemsex’, denounce the organizations that work in the field of prevention. “We need more facilities in access to early detection tests; It is not understood that Health is not more proactive on this issue, ”reflects Bartolomé de Haro, from Active Support.
The opening of community centers like those that already exist in many capitals is also a long demand. Murcia City Council plans a resource of these characteristics taking advantage of the infrastructure of its health service. Experts also ask to influence mental health. Men who have relationships with men participate in ‘chemsex’ above all and who, in many cases, “carry problems of self-acceptance, rootlessness, with very late ‘coming out of the closet’,” warns Félix, a regular at these meetings. “There are men over 40 who fall into these practices and, in many cases, they had not even taken drugs before,” he explains.
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