Adnkronos (Adnkronos) – Chemsex, the intentional use of psychoactive substances to facilitate or prolong sexual intercourse, is a phenomenon "still too little researched," the prevention of sexually transmitted infections "insufficiently structured," and "there remains a lack of integration between Addiction Services and specialized centers." This picture presents significant critical issues, as emerged from the national FeDerSerD survey on infectious diseases related to substance use, presented in Naples at the 15th National Congress of the Italian Federation of Addiction Department and Service Providers.
The survey, conducted between May and July 2026 through 390 questionnaires completed by SerD professionals from across Italy, mostly doctors, highlights a system that has consolidated significant expertise in screening for infectious diseases, but still has gaps in its ability to intercept new risk behaviors and ensure integrated prevention and treatment pathways.
The most significant data concerns the difficulty in building networks and care pathways for these issues: “68,5% of SerDs do not have formalized collaborations with local centers specialized in sexually transmitted infections (STIs).
Added to this is another critical issue: only 36,7% of services provide a sexual history or structured counseling, while over 56% do not provide one – according to a statement from FeDerSerD – These numbers highlight a critical issue that deserves attention, especially considering that people with substance use disorders can be exposed to multiple infectious disease risk factors and require personalized prevention, diagnosis, and treatment interventions.
"The survey results send us a very clear message: we can no longer consider sexual health and infection prevention as secondary aspects of addiction treatment," emphasizes Daniele Pini, medical director, member of the FeDerSerD National Board of Directors, and president of FeDerSerD Piedmont and Valle d'Aosta. "In this context, some aspects remain to be explored further, including sexually transmitted infections: a topic that deserves greater attention from health services today."
Of course, we must also take into account the already known difficulties, including those related to staff shortages and limited resources, which often pose significant challenges. The survey was useful precisely because it allowed us to focus not only on the positive aspects of the overall situation, but also on the critical areas requiring intervention.
The picture emerging regarding chemsex is particularly significant, "a phenomenon that raises complex issues in terms of addiction, sexual health, infection risk, and psychological well-being." According to the FeDerSerD survey, "only about a quarter of services investigate the phenomenon in depth, while 37,4% don't investigate it at all. This situation risks hindering the early identification of risky behaviors and access to targeted interventions. Among the main difficulties reported are the lack of specific training among professionals, the stigma that still surrounds certain sexual behaviors, and the inadequacy of dedicated support networks, including those in collaboration with the voluntary sector."
Chemsex is certainly a hidden phenomenon, affecting a relatively small portion of the population. However, addiction services need to increase their attention to this issue. The survey revealed that addiction services, in general, still do not address chemsex as a priority, nor do they systematically investigate it during patient consultations. A first step would therefore be to delve deeper into the topic during patient intake, to understand whether we are facing a significant emergency and whether specific interventions are necessary, especially in terms of prevention and treatment.
The survey also helped highlight this situation. "These are relatively new aspects for addiction services," explains Pini, "traditionally accustomed to dealing with more established issues, such as HIV. Today, however, the epidemiology is changing profoundly, even with regard to addiction-related infections. We are witnessing a progressive shift: it's no longer just infections traditionally associated with intravenous transmission, because sexual transmission has often become more frequent. Chemsex represents, in this context, a specific issue that deserves particular attention."
Integration challenges also emerge in the management of viral infections. The survey highlights how "hepatitis C screening is now widely practiced in SerDs, yet only 5,6% of services are organizationally equipped to directly manage antiviral drug treatment. In the vast majority of cases," the Federation emphasizes, "patients are referred to external specialist centers, with the risk of the care pathway being interrupted between diagnosis and the actual start of treatment. This criticality is linked to organizational obstacles, distance from specialist centers, difficulty adhering to treatment, and social stigma, which is still too often present today." Hence the need, emphasized by FeDerSerD, to strengthen proximity strategies, rapid testing, and 'test and treat' models to make treatment more timely and accessible.
The survey thus confirms the central role of Addiction Services "not only in the treatment of pathological addictions, but also in the overall health protection of a particularly vulnerable population. The goal is to overcome regional disparities, strengthen the training of professionals, and develop multidisciplinary care pathways, with greater integration between community services and specialized facilities."
The research findings were presented by Liliana Praticò, from the Addiction Complex Operating Unit at the Papa Giovanni XXIII Health Authority in Bergamo, during the conference session dedicated to addiction-related infectious diseases. Tullio Prestileo, from the Civico Hospital in Palermo and a member of the FeDerSerD National Scientific Committee, also participated in the conference, providing an in-depth discussion on integrated pathways from prevention to treatment. "The challenge is first and foremost to ensure greater consistency in interventions nationwide," Pini explains. "Unfortunately, this aspect will still take time to achieve. Indeed, alongside situations where important best-practice interventions have been implemented, there are still situations characterized by organizational difficulties. This is a problem we must continue to highlight. Another challenge is to enhance the role of SerDs as local services fully integrated into the healthcare system, essential for addressing the health problems of vulnerable individuals. Health care must go beyond substance or behavioral addiction and provide the broadest and most comprehensive care possible. We must therefore enable SerDs to reach a greater number of people and respond to their needs. Addiction," Pini concludes, "is the initial reason for accessing the service, but behind that problem lies the whole person, with health needs that must be considered as a whole."
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