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What is chemsex?
ChemSex is a word invented on geo-sexual networking apps by gay men (and adopted by the gay men’s health sector) that defines a syndemic of specific behaviours associated with specific recreational drugs, associated with some gay cultural uniquities, and is particular to a specific, high risk population.
Though the media spotlight may have distorted the term to define the use of any drugs in sexual contexts by any population, ChemSex actually refers to the use of any combination of drugs that includes crystal methamphetamine, mephedrone and/or GHB/GBL by Men who have Sex with Men (MSM) before or during sex.
"Chems"; drugs associated with ChemSex and their effects
Although drugs and alcohol have often been used in sexual contexts throughout history, crystal methamphetamine, mephedrone and GHB/GBL provide a particular sexually-disinhibiting “high”, which represents a different public health concern than that associated with other drugs more commonly used in the past.
These three drugs have unfortunately become very common and readily available within gay “scenes” over the last decade, and their use has been accompanied by higher-risk sexual activity than has ever been observed or associated with any other kind of drug use. Users of these drugs can feel invulnerable to harm, supremely confident, dismissive of consequences, sexually adventurous, experience a heightened sense of pleasure, and can possess a stamina and endurance that may keep them awake for many days. When used in sexual contexts, this can translate into a reduced concern for safer sex practices and contact with a higher number of partners during a short, concentrated period of time. Unwanted side effects while under the influence can include aggression, paranoia, hallucinations/perceptions of persecution, overdose and more.
The role of geo-sexual networking Apps (eg, Grindr) in the rise of ChemSex
Geo-sexual networking apps have served a beneficial function in gay men’s lives in some ways, though there have also been some negative consequences. Sex for gay men is often associated with risk and danger; this is a consequence of an HIV epidemic that (in the UK) has particularly affected gay men. Many other gay men struggle with sex and intimacy having grown up struggling with a different sexual identity, cultural (or internalised) homophobia or a desire to fit in and avoid rejection.
Apps were adopted very quickly by gay communities as a way to date and seek sex; yet communicating one’s sexual and emotional needs via the use of abbreviations, word counts and photo-shopped avatars can be very challenging for many people, and can often lead to unenjoyable sexual encounters. “Chems” have become a tool used by many to negotiate or overcome these challenges and are often commonly available via these technologies in some big cities that host large gay communities.
Global prevalence of ChemSex is not known, as it is a relatively new syndemic for researchers – many still struggle to define ChemSex, let alone quantify it. Anecdotal reports of varying concern have emerged from gay community organisations and sexual health services in the United States, Australia, Canada, Mexico, Australia, Asia and Europe. The UK, and in particular London, has had the most robust response to the trends, with 56 Dean Street becoming a global model for ChemSex support. There are enough reports and emerging data to prioritise ChemSex as a public health concern and to develop effective responses, and to do so, quickly, sensitively, and without moral judgments, even if robust evidence is lacking.
NB; the pusuit of quantifying the percentage of any gay population engaging in ChemSex is unlikely to be the most productive use of resources, unlikely to even be accurately achievable, and the curiosity behind such a pursuit might possibly be more emotional than academic; gay community, gay identity, gay sexual politics have endured a crippling few decades, with fights for equal rights, the HIV epidemic, societal homophobia and sexual/moral/religious condemnation; many of us, consciously or otherwise, might be emotionally invested in the outcome of the ChemSex prevalence question. A certain outcome might tar the gay sex-positivity movement with a drug-using, promiscuous brush; another outcome might whitewash the devastation ChemSex has caused within smaller communities, or dilute the potency of community concern that this issue might deserve. Others fear, (and wish to control) the media backlash against gay hedonism that devastated the gay liberation movement in the 1980's AIDS era. Gay men are passionate about this subject, polarisingly so, and the passion is not always conscious. Sensitivity to this, and benign, objective research that can deliver useful data is the key.
Measuring ChemSex prevalence might better be focused within smaller, geographical populations where the outcomes can be used to implement public health/individual health responses.
The harms associated with ChemSex are many; GHB/GBL toxicity (overdose) is responsible for the death of 1 gay Londoner every month. Suicides born of Chem use (either comedown depressions, or drug-induced psychosis) fill our social media newsfeeds. The impacts on mental health, quality of life, relationships and communities are immeasurable. Poor sexual wellbeing, and damage to a person's concept of arousal, intimacy and relationships are evident. Sexual assaults while under the influence of drugs in sexually charged environments are common, and the very issue of consent to sex in relation to ChemSex is one that individuals and health services are grappling to understand & address. The infections (STIs, hepatitis C) that can occur within ChemSex environments equate to a public health concern. HIV is perhaps the most devastating to an individual, and costly to public health. Every city is different in regard to how much infectious HIV exists within its' sexually active (or injecting drug using) populations. London has a particularly high prevalence; 1 in every 8 gay men in London is HIV positive (2016), with approximately 20% of these unaware of their infection (and therefore infectious). It is a credible assumption that the prevalence of infectious HIV that exists within chem-using populations, is higher than this still.
The larger majority of gay men seeking ChemSex support are not seeking support with a drug problem or an "addiction" issue; mostly they are seeking resolution to the sexual health consequences of their drug use. Those presenting for help with the actual ChemSex behaviour, are identifying issues around seeking sex and relationships, struggling with online and App use behaviours, issues around HIV fear and stigma, struggling in their pursuit of connection and community, and many other gay cultural idiosyncrasies that impact their sex and romantic lives.
For these men, it is not a drug problem, but a gay sex problem.
The best way to reduce the harms of ChemSex, is to develop a robust understanding of what we want our sex and romantic lives to be like, to set some goals and boundaries around that - and having the awareness and communication skills to pursue these goals/protect those boundaries. if we all enjoyed good sexual wellbeing, born of a cultural dialogue about the role sex and intimacy plays in our lives, then ChemSex related harms would be better avoided. It is important that sexual health clinics and gay community organisations provide services that go beyond simple testing and prescribing of medicine, which also support our patients and communities to develop good sexual and general wellbeing, including adapting to cultural changes that many may be struggling to adapt to.
1. The increasing availability/use of sexually-disinhibiting drugs...
2. by a population of people that represent high HIV prevalence...
3. making use of technologies that facilitate easy pursuit of sexual partners...
4. exacerbated further by some complex gay-cultural uniquities...
does indeed equal a public health concern that deserves a non-alarmist, but proportionate response. It is also a concern that deserves our compassion for a vulnerable group of people that are struggling with cultural changes associated with sex and relationships, and will certainly not benefit from further stigma or judgment, despite the sensationalist potential of these behaviours.
The above is the expert opinion of David Stuart