Chemsex is the sexualized use of substances before or during sexual activity to enhance, prolong, remove inhibition or increase the sexual experience and intimacy. Chemsex is often observed in men who have sex with men (MSM), trans- and non-binary people.
At the second European Chemsex Forum, 230 respondents from the community members, clinicians, researchers, counsellors came together to explore the underlying reasons for the phenomena. Some of the reasons for chemsex use are daily problems, loneliness, isolation, and lack of sense of belonging.
In chemsex, potent drugs are used. They include crystal methamphetamine, mephedrone, GHB/GBL and cathinones, used in the context of sex and facilitated by gay hookup applications. The drugs used vary by region and subculture of GBMSM populations. The sessions may be hours or days and involve multiple sexual partners, risky behaviors, polydrug use, and sometimes physical and emotional traumas.
All chemsex carries a degree of harm to the user. The risks of chemsex depend on the user and rationale for the use of chemsex. For some, chemsex allows them to explore sexuality outside personal boundaries; for others, chemsex can bring about harmful consequences. The forum noted there is a set of skills required to manage chemsex use safely and reduce self-harm. The necessary skills “include harm reduction strategies, setting and safeguarding boundaries, an ability to care for oneself and for others, and an appreciation of sober life and sober recreational activities.”
Problematic chemsex use may be dependent on the user. Is the user able to manage their work, lifestyle, and personal relationship well or not? This knowledge is dependent on the conversation with the user, and assessment, and diagnosis by a healthcare provider. If the user does not acknowledge chemsex use is problematic and the healthcare provider has no knowledge of the underlying determinant that predisposes the user to problematic chemsex use, it is challenging for the provider to provide meaningful support.
The 230 respondents lay out the stages of the pathway to the problematic chemsex journey. The intersecting factors include adverse childhood experiences, member of LGBTQ group, HIV/AIDS, syndemics, loneliness and emptiness, inhibition, search for connections, sex apps, sexual connections, drugs and alcohol, disinhibition, chemsex, chemsex connections, problematic chemsex, job loss, helplessness, HIV, HCV, STIs, transactional sex, severe health impact, overdose.
The pathway is a valuable guide to consider the development of prevention, treatment interventions, and support along the way. At each stage of the path, there are opportunities for service providers to intervene and assist users in stepping out of the harm, utilize harm reduction strategies, develop skills to connect with the community and peers for meaningful connections.