Mainstream awareness about "chemsex,” a little-discussed public health issue in the gay community, is on the rise. Programs like BBC Radio 4’s July segment on chemsex in London and Vice Media’s upcoming documentary on chemsex in England and Ireland shed light on what some say is a growing phenomenon of men using hardcore club drugs to fuel hours- or days-long sex sessions.
Chemsex generally involves taking substance like GHB, crystal meth or mephedrone (known as meow meow) to enhance or prolong sexual activity, primarily among a subset of city-dwelling gay men. Crystal meth and meow meow stimulate sexual arousal and euphoria, while GHB removes inhibitions.
Researchers suspect that the practice could be driving London’s rising HIV rates among young men, but the practice is so covert and the population of participants so small that not enough research exists about the topic.
In response, a small group of sex health and drug abuse specialists wrote an op-ed in the current edition of the prestigious British medical journal BMJ, calling for authorities to recognize that the consequences of chemsex should be a public health priority. In the face of budget cuts for specialized sex and drug health services, they write, centers that combine both would be cost-effective and provide a rich source of data to understand this little-researched practice.
The op-ed's lead author Hannah McCall, a senior nurse at the Central and North West London NHS Foundation Trust, specializes in sexual and reproductive health serving the large LGBT community that comes to live in London. Citing a landmark 2014 chemsex study, she writes that men who engage in the activity say they use the drugs to “manage negative feelings, such as a lack of confidence and self-esteem, internalized homophobia, and stigma about their HIV status."
The 2014 study included 15,000 gay and bisexual men who live in England, 1,142 of whom lived in South London -- an area with a large LGBT population and nightlife scene. In it, anonymous sources describe what draws them to chemsex. "I have never really been able to have sober gay sex," one man wrote.
"If you get rejected and you are on mephedrone it doesn’t really matter," another man said. "The club is full of other people. It has kind of, like, separated you from the reality of that sting."
Understanding the risks
Chemsex is not a pervasive problem in the general population, and is only practiced by a very small segment of men in the gay community. About 5.9 percent of gay men in South London had ever used or injected non-prescription drugs in general, and only 3.5 percent had done it in the past year.
However, among the gay men in South London who did use drugs, use rates of substances linked to chemsex -- namely, meow meow, crystal meth and GHB -- were two to eight times higher compared to men living in wider London and England.
Despite the small pool of people who engage in chemsex, the health repercussions can be devastating, and can contribute to public health issues including drug addiction and increasing risk of HIV and hepatitis C virus. On an individual level, McCall writes, men who have chemsex say they lose track of essential functioning, not sleeping or drinking water for up to three days straight. What's more, research suggests unprotected sex “is the norm” during chemsex, with men taking an average of five partners during a single session.
One researcher called chemsex a “perfect storm” for both HIV and hepatitis C transmissions, although there are signs that not all sessions are unprotected. Some participants even “sero-sort,” or choose partners according to their HIV status, but research shows sero-sorting is not a reliable way to prevent transmission.
Notably, it's concerns about drug use -- not sexual practice -- that keep people who engage in chemsex from seeking help, McCall wrote. For instance, a July 2015 study of 30 gay men who have had chemsex found they were looking for advice on the proper dosing of the drug, ways to avoid overdoses and and how to negotiate sexual consent. However, the majority of drug help services are centered more around opioid abuse (prescription drugs and heroin) than they are the party drugs linked with chemsex.
Of course, chemsex is not a new phenomenon. Ron Stall, co-director of the University of Pittsburgh's Center for LGBT Health Research, has been studying the practice for nearly 30 years. Stall says chemsex is a documented part of urban gay culture around the world, but emphasized how rare it is overall.
"The vast majority of gay men do not combine methamphetamine-like drugs with sex and many men actively discourage the practice,” Stall told The Huffington Post.
Stall points out that combining drug use and sex is extremely dangerous for the general population, not just those who engage in chemsex. For example, drug use and HIV go hand in hand, not only because of the blood-exposure risks that come from sharing needles but also because people who use drugs are more likely to have riskier sex or transactional sex -- acts that could increase someone's risk of contracting HIV. On its own, occasional drug use can metastasize into full-blown drug abuse that destroys a person’s ability to work, relate to others and stay out of jail.
Why men have chemsex
Stall’s research on the practice has focused on how emotional and physical violence from widespread homophobia in society affects gay children and teens, making them more prone to engage in risky behaviors like chemsex.
"The life-long effects of homophobic attacks, starting in childhood with many men, predict a set of psychosocial health problems that in turn predict vulnerability to drug abuse,” Stall said, and this abuse could turn into internalized homophobia as the gay teen grows up. But men who both come to terms with the abuse they suffered, as well as recognize its effects on the way they view themselves, may defeat the cycle of shame and despair.
"Men who do better in terms of resolving internalized homophobia are less likely to suffer from an interlocking cluster of psychosocial health problems, and so [are] less likely to be vulnerable to drug abuse," he said.
To combat the risks of drugged-up sex, McCall suggests that routing funding to clinics that specialize in chemsex as well as treatment for “party drug” addictions could help men receive more targeted support for medical care. Because healthcare funding for sexual health and for drug use are two separate (and ever-diminishing) streams in the United Kingdom, she says creating centers that combine both services in one could go a long way to be a cost-effective solution to care.
In the U.S., Stall proposes a wider research and prevention scope that focuses not just on chemsex, but substance use disorder in general.
"While the risks for HIV and [hepatitis C virus] infection are real and alarming among gay men, calls to deal with these problems would be stronger if they also called for research to develop gay-specific substance abuse programs and community-based programs to prevent substance abuse before it spirals into addiction,” he said.
It’s unclear how widespread chemsex is around the globe, because most studies that examine the link between drug use and sex are about HIV risk, not sex party behavior. Those studies that do focus on chemsex are focused on the U.K., the U.S. and Australia, noted the authors of the 2014 study. It’s this lack of data that limits how doctors can care for men seeking help, McCall argues. What is clear, she concludes, is that chemsex-related disease should be a priority for public health authorities.
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