This article is part of "Safe Sesh", a VICE harm reduction campaign produced in collaboration with The Loop and the Royal Society for Public Health. Read more from the editorial series here.
James is a gay man who takes methadone every day. "I was kicked out of my house at 13. I found myself on the streets and got addicted to painkillers and opiates," he says. "Having grown up in working class culture, listening to people use homophobic slurs my entire life, the drugs were a way to deal with that, but they were also the only way I could ever get over my inhibitions enough to even have a conversation about my sexuality, let alone express it, even with a partner. And I know I'm far from alone in that experience."
Much of the publicity around the UK government's "new" drug strategy that was unveiled last week gave a lot of hype to a supposedly fresh focus on issues surrounding chemsex. However, far from being unequivocally welcomed on the gay scene, the policy has provoked significant confusion, anger and feelings of betrayal across the LGBT community. James himself is clear: "I look at this policy and I see a backdoor way of morality policing the queer community – an already marginalised group – but cloaked in the rhetoric of public safety."
David Stuart from the 56 Dean Street sexual health clinic, who has worked on chemsex for years (and actually coined the term), offers a somewhat different perspective.
"Chemsex is having a very significant impact on the gay community, as well as representing some significant public health challenges," he says. "Approximately 3,000 gay men access 56 Dean Street each month with the consequences of chemsex. There is a chem-related death every 12 days in London from GBL overdoses. So, in that I welcome the inclusion of chemsex in the government's drug strategy. But although there are a number of vulnerable groups referenced in the strategy, there is an obvious omission of LGBTQ people, who are disproportionately affected by problematic drug and alcohol use. I find this to be an odd omission, as this group was referenced in the 2010 strategy."
This omission of the LGBTQ community is a theme picked up on by Emma Roebuck from the charity Querkey. "In this strategy there's one paragraph on chemsex – with no actual suggestions about how to handle it. But drug use in the LGBTQ community is so much wider than that. I see trans people purchasing off-script hormones and anti-androgens to self-medicate, then mixing them with anti-depressants and sleeping pills because of the trauma that they face day in, day out. There's nothing on that. There's next to nothing on needle sharing and HIV transmission, nothing that recognises that lesbians are four times more likely to have problems with alcohol, or that gay men are seven times more likely to use illicit drugs. Do a word search on this document for 'LGBT' and you'll get zero hits – it's a wilful blind spot."
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This blind spot has very serious implications for how services are provided at ground level. Emma continues, "If you don't have guidance from government to pay attention to at risk communities like LGBTQ, then those services get folded into the general health team. But the general team simply don't have the specialised knowledge or skills to deal with these issues. And once those skills are lost, they can take years or decades to replace. This sets up a system where the sexual health workers don't talk to the drugs workers – even though there is a massive intersection between the two fields. It affects everything from how data is collected, to how the person suffering on the street is cared for."
This is particularly pressing at a time when services are being severely cut. Trumpeting policies while savagely cutting the resources of the agencies meant to carry those very policies out is simply untenable. Emma ran a major charity, Gay Advice Darlington/Durham, but has just had to shut it down due to cuts.
"We were an LGBT, HIV, sexual health, advice, hate crime and safe space charity that worked across the North East. We were paid to support up to seven HIV+ people around their care needs – but we actually supported 15 to 20 directly, and even more indirectly. Austerity killed us, and those people will be cut adrift. I still do whatever I can, but when it comes to official interventions, mainstream services simply cannot deliver because they don't know. They're just not culturally competent with LGBT needs. At a time of fewer resources we need more targeted services, not less."
The one thing that everyone I spoke to agreed on is that probably the most damaging aspect of the new strategy is the continued emphasis on law enforcement solutions, and refusal to consider any sort of decriminalisation. This is a story James has lived. "I spent six months in prison. It just traumatised me further. Our community is already over-policed and under-protected. This law enforcement emphasis will just continue to drive things further underground."
Drawing on his vast experience in this area, David Stuart sighs: "Problematic drug use is a very troubling and upsetting mental health issue for many people. Though there are sometimes intersections with the criminal justice system, I will always see my patients as vulnerable people in need of compassionate support, and not as criminals in need of punishment."
But it is Emma who sounds the severest warning: "This strategy feels like a box ticking exercise – at a time when we desperately need fresh, innovative and engaged thinking. Unfortunately, it will probably take a tragedy – a spike in Hep C infections, a resistant form of HIV or some other nightmare – to actually wake this government up."
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