Harm Reduction Practices and Needs in a Belgian Chemsex Context: Finding from a Qualitative Study
Chemsex or party and play (PnP) is the sexualized use of drugs during sex. Chemsex is a public health concern for gay, bisexual, and other men who have sex with men (GBMSM). There are specific cultural factors that facilitate chemsex use. The cultural factors include HIV-infection, stigma, societal and internalized homophobia, discrimination, violence, shame, loneliness, and syndemics.
Chemsex use and behavior varies between regions and subcultures of GBMSM. The UK studies identified the drugs used with chemsex are crystal methamphetamine, mephedrone, GBL, and GHB. In Brusells, a study found the use of cocaine, ecstasy, and ketamine in chemsex.
Chemsex sessions are often held at private homes and involve more than two persons. The session can last a few hours to a few days. Due to polydrug use, there are numerous drug-related side-effects and harm to the health of the user. Some of the side effects include psychosis, drug overdose, dehydration, drug dependence, anxiety, depression, sexually transmitted infections, and lower adherence to HIV medication. Condomless anal intercourse may increase HIV/STI transmission with multiple sexual partners; sharing sex toys, and the prolonged sexual session may lead to STBBI, including hepatitis C infection.
Research on chemsex has documented significant needs for users of chemsex. Sexual health clinics do not know of the answers to drug use, and treatment facilities do not know or understand the GBMSM culture or sexual practices. Chemsex users wanted reliable and non-judgemental information on safe drug use, access to services at sexual health clinics and drug treatment facilities, and knowledge exchange between the two sites.
In this post-Covid research, 20 participants between 26 and 69 years of age participated, and interviews were conducted online. This qualitative research explored the local chemsex scene, self-care, and harm reduction practices used by GBMSM. The study’s primary goal was to understand risk reduction before, during, and after chemsex and to develop a mobile phone application to support chemsex users in risk reduction. Secondly, to know of the information and health care needs for GBMSM chemsex users. The qualitative interviews had semi-structured and open-ended questions to allow respondents to share their own experiences.
Participants expressed various strategies for self-care, such as participating on weekends, not more than five persons at a session, which chemsex to use, personal hygiene, and reading up on polydrug interactions, to name a few. A logbook of the drugs taken is maintained, “The vast majority of men (n = 18) mentioned that a logbook was kept with an overview of the drugs taken by each man attending the chemsex session.”. But the drugs also made it “difficult to adhere” to some self-care strategies when under the influence of drugs. Disclosure of HIV status and STIs is up to each person and takes PEP, PrEP, or antiretrovirals. Participants believed others would take care of them; however, they were ambivalent about trusting others to look after them thoroughly. Another drawback was the hesitance to notify emergency services if required, and the police informed. After the chemsex session, participants utilized different methods to recover and sometimes not fully recover.
For the health care needs of participants, the participants wanted reliable and accessible information and health care support and non-judgment services. There are two groups of participants from the research responses- the planned user and the impulsive user.
In conclusion, there are many complexities of chemsex use to learn from, and more research is needed to learn more from the two distinct groups of chemsex users.
