Using substances for sex and socialising is not a new phenomenon. Drug use was documented among gay men and other men who have sex with men long before the term “chemsex” was coined. Chemsex, which has come to the attention of public health professionals in the past decade, involves both sexual and drug-related high risk behaviours such as multiple sexual partners, the use of multiple drugs together, and injecting drug use.
There are many definitions of chemsex, but most agree that it involves the following:
- Sex between men
- Substance use to facilitate, prolong or enhance sex
- Use of a specific set of substances (mainly stimulant drugs)
- Casual sexual partners and often group sex
- Events which last for an extended period of time
- Often facilitated by digital technology.
It has to be noted that groups other than gay men might be participating in chemsex, for example, transgender and non-binary people are also part of the chemsex scene.
Sexualised drug use and chemsex are different. The former is a wider term referring to the intentional use of drugs in a sexual context in general, while chemsex is a distinct case of sexualised drug use. Motivations for sexualised drug use can include reducing sexual inhibitions, shyness and increasing self-confidence, enabling the enactment of sexual fantasies, while increasing sexual pleasure, and extending, sustaining and/or enhancing sexual activities are also common motivations.
The criminalisation of drug use is prevalent globally, and the availability of harm reduction services is inadequate. However, harm reduction responses for sexualised drug use are even more inadequate, particularly compounded by criminalisation of sex between men. Gay men and other men who have sex with men and people who use stimulants are among the communities insufficiently served by existing or traditional harm reduction services. Furthermore, people engaging in chemsex have multiple vulnerabilities, leading to increased public health risks. For example, the risk of acquiring HIV is 26 times higher among gay men and other men who have sex with men, 29 times higher among people who inject drugs, and 13 times higher for transgender people, while the same groups also have elevated risks of acquiring hepatitis C infection. Widely supported by evidence, it is critical to provide support and access to public health services tailored to the needs of this population.