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In this issue, Weatherburn et al and Pakianathan et al provide a combination of practical and empirical insights into ‘chemsex’. This is particularly relevant to clinicians working with gay and bisexual men who have sex with men (GBMSM). Here we outline further issues for practitioners working with GBMSM who engage in chemsex.
What is chemsex?
Chemsex describes GBMSM's use of new recreational drugs (primarily mephedrone, crystal methamphetamine and γ-hydroxybutyric/γ-butyrolactone) to enable, enhance and prolong sexual interactions. Unlike alcohol and most other recreational substances, chemsex drugs provide men with the ability to improve their sexual performance and experiences, by increasing arousal, stamina and pleasure.1 Arising in tandem, the proliferation of geospatial sociosexual networking apps provide access to local sexual activities and drug procurement on demand.2 Together, these developments allow multiple and group sexual hook-ups to be arranged, outside the spatiotemporal constraints of the commercial (gay) scene, which usually last many hours or even several days. As well allowing increased partner numbers and turnover, chemsex users operate within a distinct cultural ‘bubble’, where risky sex and recreational drug use are normalised and advance negotiation of drug supply/use, intravenous drug taking, specific sexual behaviours, sexual safety, HIV serostatus, pre-exposure prophylaxis (PrEP) and condom use/non-use may all take place online. These online sociosexual networks and chemsex sexual cultures are disconnected from the commercial gay scene and, therefore, associated health promotion. In addition, difficulties in engaging men via sociosexual media—and in particular men within the chemsex culture—mean that presentations at sexual health and HIV care clinical interactions may provide the …
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