A chemsex crucible: the context and the controversy

Abstract

The public health response to chemsex, when understood objectively, is actually a simple model of multidisciplinary interventions. Just as opiate addiction requires behavioural therapies, medicine, community engagement, and an understanding of the motivations for use, chemsex requires – well, exactly the same. Many excellent models of chemsex support already exist internationally.1–3 Unfortunately, however, you can't remove the sex from chemsex; and where there is sex, there are moral and religious judgments and stigmas. Make that gay sex, include HIV, and chemsex becomes something that can require some untangling before an effective public health response can be mounted. The untangling must, therefore, begin with a definition. Chemsex is a word invented on geo-sexual networking apps by gay men (and adopted by the gay men's health sector) that defines a syndemic of specific behaviours associated with specific recreational drugs, and is particular to a specific, high-risk population. Though the media spotlight may have distorted the term to define the use of any drugs in sexual contexts by any population,4 chemsex actually refers to the use of any combination of drugs that includes crystal methamphetamine, mephedrone and/or gammahydroxybutyrate (GHB)/gammabutyrolactone (GBL), used before or during sex by men who have sex with men (MSM). These …