Chemsex – the use of drugs during sex, often over the course of a couple of days – is increasingly becoming a problem for a section of the UK's male gay community.
Besides drug addiction and the crushing comedowns of a three-day binge, drugs like GHB/GBL are notoriously dangerous: take the right amount and ride a wave of euphoric horniness; take just a little bit too much and it's a spasming descent into a temporary coma. Some men have even died from G overdoses. Crystal meth and mephedrone are both known to incite paranoid psychosis, where guys who haven't slept for days start hearing voices, and long-term crystal use can cause physical damage to the body.
The sex itself is often without condoms, contributing to rising STI rates. Add "slamming" – the injection of crystal meth or mephedrone mixed with water – to the pot and there's an additional path for viruses like HIV and hepatitis C to body-hop on a needle's prick.
It's important to note that not every gay drug user has a problem with chemsex; that chemsex is still a relatively small issue, in terms of the number of people engaging in it; and that some are able to do so without it affecting their lives too much. But that clearly isn't the case for everyone; the rise of people (mostly, but not exclusively, gay men) using drugs during sex has prompted experts to issue a public health warning about chemsex.
As we see in the new VICE documentary CHEMSEX, there are various factors involved in its rise: the allure of drugs and sex is the obvious starting point, but for many there's more to it than that – issues around identity, self-worth and a sense of wanting to belong all come up regularly. So how do we go about tackling the chemsex epidemic when there are so many potential causes to address? I asked five experts for their opinions.
THE CHEMSEX EXPERT
David Stuart, Substance Use Lead, 56 Dean Street
Competently addressing chemsex is challenging, because though it may be perceived as a drug problem, it's more of a sex problem; a cultural problem associated with how gay men understand and pursue sex, intimacy and relationships.
A gay man can come out of the best rehab facility, but is still grossly unprepared for what he might encounter on the gay scene: widespread normalisation and availability of chems; a culture that can be defensive about its right to use drugs; HIV stigma; online rejections; and body-fit, masculine, porn-star expectations.
A dialogue within our gay communities about how lovely – and very real – our vulnerabilities are would be a great start. There's a huge reluctance to admit we're vulnerable as a population. Let's address our needs to fit in, avoid rejection and seek affirmation, particularly via sexual avenues. If that dialogue extended to gay-inclusive relationship and sex education in schools and homes for our young people, then we could protect future generations of gay men from chemsex.
At the public health level, chemsex is best addressed in sexual health clinics, where the consequences of chemsex are most acute. In the UK, sexual health clinics not only treat and assess sexual health risks, but they talk comfortably about gay sex, they have the favour of gay men and they have robust psychosocial support services to address sexual behavioural issues.
THE MEDICAL AND PSYCHOLOGY EXPERT
Dr Owen Bowden-Jones, Consultant Psychiatrist for the Club Drug Clinic
Drugs have always been used by some to facilitate sex, both by straight and LGBT communities, but there is something new about the recent trend known as chemsex. At the Club Drug Clinic, we have seen drug use and sexual intimacy bound together, some where you can't find one without the other. Sober intimacy can become unthinkable, as does drug use without sex. Some manage to find a balance, but those who come to the clinic asking for help have lost control.
The challenge for the clinic is to help people untangle the chemsex knot. As with most problems related to drugs, the key issue is not just the drugs, but why people are using them. This is particularly true for chemsex. Fear of intimacy, low self-esteem and internalised aggression are just some of the reasons we work with.
Although chemsex is largely a problem for men who have sex with men, it is important to remember than most gay men don't have chemsex. Challenging stereotypes is part of our work at the Club Drug Clinic, keeping the door open for those who need help, while avoiding stigma for those who don't.
THE HIV EXPERT
Matthew Hodson, Chief Executive at GMFA
Some gay men use drugs to escape because they feel unable to cope with their lives, or because of difficulties they've experienced coming to terms with their sexuality, or because they're struggling to cope with an HIV diagnosis. Tackling that hurt and damage that some gay men feel as they come to terms with their sexuality, even if it were simple to do, may not be enough.
But we should not lose sight of the main reason that many gay men take drugs: because, just like our heterosexual brothers and sisters filling the clubs in Ibiza or Ayia Napa, we think they're fun. A report by the Advisory Council on the Misuse of Drugs found that campaigns intended to stop people taking drugs were not effective and, in some cases, increased the chance of people taking drugs.
At GMFA we're not going to tell men to stop using drugs. That simply won't work. Instead we concentrate our efforts, through our campaigns and the information we provide to gay men, on reducing the harms that may come from drug use, whether that's sexual harm, or other health harms that can arise from prolonged use or overdosing.
THE LGBT CHARITY EXPERT
Monty Moncrieff, Chief Executive at London Friend
Antidote gives men a safe space to talk, and they really value having a specialist service. Ninety percent of our clients tell us it's important to have an LGBT service, and only 12 percent say they'd be happy going to mainstream drug treatment. Sexual health clinics have a big role to play here, too, as guys will go there for PEP or to get a STI treated much sooner than they'd come to a drug service, so setting up outreach in clinics like Mortimer Market and 56 Dean Street was important for us.
The wider LGBT community can help lead the discussion about chemsex through events like Let's Talk About Gay Sex and Drugs. These are a great opportunity for the community to shape our own responses and talk to our peers, and not stigmatise others' drug use and sexual choices. When problems occur with chemsex they're connected to much wider issues about belonging, identity, relationships and intimacy, and our confidence to navigate all of this improves when we understand and support each other.
For Antidote it's about helping people do it safely, if they choose to, and helping them recognise when it's not so much fun any more, providing opportunities to get some support, hopefully before it becomes a bigger problem.
THE RESEARCH EXPERT
Dr Adam Bourne, Sigma Research, London School of Hygiene & Tropical Medicine
Perhaps surprisingly, I actually think one of the priorities needs to be around helping gay men who choose to use drugs to do so more safely.
There are lots of guys who don't know enough about basic harm reduction – about dosing of G, timings, potentially dangerous interactions with other drugs or alcohol. The UK is a world leader in drug harm reduction, but we haven't previously focused on the drugs most popular with gay men nowadays. Drug use isn't going to stop, so we need to provide the information to help men use them more safely.
In relation to sexual health and wellbeing, it's important that gay men are encouraged to reflect on whether the sex they're having on chems is what they really aspire to. I'm not anti-drugs and I'm absolutely not saying that guys engaging in chemsex are doing anything wrong. But I am saying that so many of the men I've interviewed about this didn't actually seem to be happy with their sex lives. Reflection and contemplation is the first big step in behaviour change. We have a responsibility as a community and as health or social care professionals to start those conversations.
Chemsex support is available in most sexual health clinics. 56 Dean Street offers one-to-one chemsex support; visit chemsexsupport.com. Antidote (London Friend) offers drug and alcohol support for the LGBT community. Call 0207 833 1674.
CHEMSEX is released in the UK on Friday the 4th of December. To see a full list of cinemas showing the film, click here.
CHEMSEX will be released on DVD and On-Demand in the UK on the 11th of January.
To read the rest of the articles from our Chemsex Week – a series exploring the people, issues and stories in and around the world of chemsex – click here.