One "chemsex" or many? Types of chemsex sessions among gay and other men who have sex with men in Madrid, Spain: findings from a qualitative study

Background: Understanding 'chemsex' has become one of the key issues in LGBT health and HIV prevention in high-income countries, since it has been shown that this form of sexualised drug use correlates with higher risks to the physical and mental health of gay and other men who have sex with men (GMSM) who participate in chemsex sessions. Numerous studies have analysed sociodemographic characteristics, drug-use patterns or consequences of chemsex, but less research has been carried out to describe possible variations in the ways chemsex is practised. In the context of a broader qualitative study about chemsex in Madrid (Spain), we sought to explore differences among types of chemsex sessions.

Methods: 11 in-depth interviews and two triangular focus groups (N = 7) were conducted with self-identifying GMSM between the ages of 22-46 who lived in Madrid and claimed to have engaged in chemsex during the last two years. Interviews and focus groups were recorded, transcribed and subjected to thematic analysis and sociological discourse analysis.

Results: We identified four different types of chemsex sessions - "anonymous sessions", "chill-sex", "semi-closed parties among networks of friends" and "chemsex in saunas or other sex on premise venues (SPVs)" - which present differences in how they are arranged, in the way they develop and in the meanings their participants ascribe to them. They also involve different degrees and forms of exposure to risk, as well as other peculiarities that, in some cases, may even function as factors of protection.

Conclusion: This study highlights the need to elaborate a more detailed description of chemsex, since not all forms of practicing chemsex are equivalent or involve equal forms of risk. Risk reduction strategies and other HIV prevention activities would benefit from considering internal variations among forms of chemsex practice.