Vol 15 Edition 2

Chemsex: the ‘perfect storm’ of risks and stigma

Popular among a select percentage of the gay male population, chemsex parties can see a dozen or more participants smoke drugs or inject themselves with illegal drugs before partying hard, including intense sexual activity, often with multiple partners, often without condom protection.

A significant number of chemsex participants are HIV-positive men while hepatitis C (HCV) is an ever-present danger.

The illicit drugs being used are led by crystal methamphetamine – most commonly called ‘ice’ but also known as ‘Tina’ in the gay community. GHB (gamma-hydroxybutyrate), GBL (gamma-butyrolactone), MDMA, mephedrone, ‘poppers’ (amyl nitrite) and erectile dysfunction drugs are all known to be involved to varying degrees.

Martin Holt

A report by a London clinic, 56 Dean Street, titled ‘The art of ART (anti-retroviral therapy)’ described chemsex as ‘the perfect storm’ of a highly sexual population, high HCV/HIV prevalence and high-risk sex practices. The men using drugs, especially those new to the scene, were sometimes naïve about drug use and the parties didn’t always have ‘care pathways’ to assist those who needed it, the report adds.

In Australia, chemsex parties are part of the ‘Party and Play’ (or PnP) scene, held in private homes or sex venues and enjoyed by a small but significant proportion of the male gay population, according to experts.

“I would say chemsex is a significant thing but I don’t know how major it is,” says Dr Beng Eu, from the Prahran Clinic in Melbourne. “It’s a very particular group and practice, and only a certain percentage would be involved in it, but it’s there.”

Professor Martin Holt from the University of NSW has been periodically surveying the gay community for more than a decade on behaviours relating to sex and drugs and whether sections of the community need support for their health and well-being. He worries that gay men struggling to handle the after-effects of chemsex might feel stigmatised and be reluctant to ask for help.

While some of the more experienced Party and Play enthusiasts are quite adept at managing their drug use and sex risks, he says, others may not be and that’s where doctors and NSPs need to be ready with gay-friendly, non-judgemental and non-stigmatising support. It’s not only about the usual harm reduction messages relating to injecting and sex, it’s also about being aware the client may be feeling ashamed and unsupported.

In fact, those struggling may feel a sense of double-failure, he says. “Talking to counsellors, these men might feel like: ‘I fell in with these people, my peers, my friends, and everybody seems to be having a really good time but I’m not. What have I done wrong?’“

“It’s important they don’t feel judged for being gay, for using crystal, for injecting or having sex when they use drugs … it’s a lot of things for someone to have to admit to,” Martin says.

Martin says figures suggest that between 10 and 20 per cent of gay men have undertaken chemsex, which is a high number when put against the percentage of the heterosexual general population that would use a drug like crystal meth. However Martin points out that party drug use is much more normalised in gay culture.

“If you’re going clubbing or going to parties, it’s not seen as particularly unusual to take something to help you dance and that may feed on into having sex later, if you’re awake and stimulated. People’s entry into it (chemsex) may be that way.

“With the Party and Play scene, it might be curiosity, because norms about drugs and sex are more accepted in the inner city. You may know someone who has done it, so there are your peer-based networks who you can ask about it, get an introduction, find out how to score and so on,” he says.

A danger for partygoers is that different rules may apply at each event. “At chemsex parties quite often people will report that the syringes are pre-loaded so there is a tray of injections that people inject,” Beng says.

“It’s quite different to other drug use where most people prepare their own or a friend prepares it for them. This is largely pre-prepared for use by everyone there.

“It’s not only the crystal. GHB can have terrible side effects and even be fatal through respiratory suppression. The dosage to be effective is very narrow before you become overdosed,” he says.

“Partygoers need to talk to the people hosting a party to make sure they are preparing the drugs safely. Then, while they’re having chemsex, because they’re somewhat disinhibited, they put themselves more at risk for HIV and hepatitis C as well, sexually as well as through the injecting practices.

“Hep C has been seen in that group a fair bit, historically.”

The party scene has changed dramatically over the past decade or so. Martin says that about 10 years ago, crystal meth appeared suddenly among the gay community and caused issues, both among people who used drugs – sometimes veteran drug-takers – who couldn’t cope with this highly-addictive drug and among support systems that were largely focused on HIV deterrence, rather than helping people addicted to crystal meth.

The drug disappeared for a long time but is now back in gay Party and Play circles. The core group of chemsex participants are often older men, in their forties or fifties, and Martin says men who are already diagnosed as HIV-positive “are much more likely to report injecting drug use than their HIV negative peers, and the gap is quite marked.”

“Melbourne and Sydney support certain sex and drug-based networks, particularly more adventurous scenes which can feature injecting as part of the ritual and types of drugs that are taken, that may feature group sex scenes and longer sexual encounters. Positive men tend to be more represented in those scenes,” he says.

“Study after study, when we look at men who are recently diagnosed with HIV – it’s not the only reason but drug-based sex, particularly with more than one partner, is one of those risk factors that for more than a decade has popped up in studies,” he says. “That underscores why we need effective sex- and drug-based positive action for gay men, because if they’re going to participate in Party and Play chemsex, then we prefer that they are informed, have strategies in place and don’t risk HIV infection.”

The recent development of PrEP (pre-exposure prophylaxis) and PEP (post-exposure prophylaxis) treatments has affected both the chemsex party rules and the ability of gay men who might be exposed to HIV to seek help. PrEP is now available through the Australian Government’s Pharmaceutical Benefits Scheme (PBS) and requires taking medication daily. PEP is an after-the-event treatment if a person is concerned they might have been exposed to the virus.

“It’s great that people know PEP is available, if your primary strategy is condoms and then that doesn’t work, or something else happens, like you negotiate around HIV status or whatever and then you realise something has gone wrong, or you misunderstood each other,” Martin says.

“It’s good PEP’s there but I think it is a lot more stressful for people. If you’re going to use PEP it’s usually in less than ideal circumstances where you’re a bit stressed out or very stressed, and suddenly have to talk to doctors.

“The whole planned thing about PrEP is more compatible with taking control of your sexual health and doing something proactive to reduce risk. That’s why it’s been so enthusiastically embraced by guys who Party and Play.”

– Nick Place

Language from the chemsex world as outlined by Dr Nneka Nwokolo, 56 Dean Street clinic, London

  • Slamming = injecting drugs
  • Barebacking = condomless sex
  • Booty bumping = squirting drug into the anus

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