In this article, David Stuart, the world’s foremost expert on Chemsex, provides context to the term “chemsex” its history and origins, and defining the culture. David brings a personal lived experience of chemsex, and he coined the term chemsex. Chemsex is often described as the sexualized use of substances by gay, bi, men who have sex with men (GBMSM). The “chem” drugs used are crystal methamphetamine, cathenones (mephedrone, 3MMC, 4MMC), and GHB/ GBL (gammahydroxubutyrate/gammabutyrolactone). But other drugs are used too, and these are Viagra, alcohol, ketamine, cocaine, amyl/alkyl nitrates (poppers) which have previously been used for sexual play. The article provides a further history of the use of “chems” in the club scene and its evolution.
The chem drugs provide the “high” and reduce inhibition, increase pleasure, desirability, and define the chemsex phenomena and chemsex can be responsible for causing more harm. When non-GBMSM people use ‘chem” in a sexual context, it is not chemsex. But for GBMSM, because of the uniqueness of gay culture, gay-sex, and sexual practices, these define chemsex phenomena. While some GBMSM manage the “high” well, others struggle with the outcomes. Others further struggle to reconcile their sexual liberation, pleasure, and the intimacy they indulged in.
The list of factors that contribute to chemsex use is varied. First and foremost is the attitude against homosexuality. This is followed by cultural and religious disapproval of gay sex and sexual orientation, the stigma of HIV, and the trauma of the AIDS epidemic, compounded with the arrival of dating apps and the technology for quick connections. The dating apps have affected and changed gay sex, love and relationships by creating subcultures and niche desirability based on age, race, body types and musculature.
Online dating apps have created various barriers of toxic masculinity for GBMSM to be authentic and to navigate the gay scene. For some GBMSM, chemsex provides a sense of confidence and determination to engage with online hook-up gay culture. The drugs are sometimes the solution to the factors identified: being free and enjoying intimacy and pleasure without the oppressive guilt of being gay. However, the international community trauma of the AIDS epidemic and HIV infections makes gay pleasure and intimacy complex, and “chems” take away the edge, reduce anxiety and fear.
Labeling sexualized drugs use is problematic. When healthcare providers label drugs as problematic, abusive, or misuse, it is subjective to how clients use it and how often it intervenes in their quality of life and daily functioning. The attempts to label a drug use behavior as problematic create barriers to communication and the client becomes defensive. It denies them autonomy to make choices based on their assessment. Forced interventions do not engage the client to build trust or develop a therapeutic relationship.
Over the years, with further discussion of chemsex, naming it has helped inform healthcare providers, government, and policymakers to identify a unique public health need for GBMSM. The awareness brought the intersection of chemsex with gay culture, a unique set of behaviors, and sexual practices. It opened up discussion on social media, researchers wrote about chemsex, healthcare providers, social services, and harm reduction services explored culturally specific methods.
With the ongoing awareness, GBMSM have a term; they can describe the cultural and clinical support and services they need. They are less isolated, less need to struggle alone, not be ashamed of their experiences, and their community understands their needs.