Information in this blog was originally presented at the Australia Federation of AIDS Organisations (AFAO) Members Meeting, 24-25 July 2018.
Crystal meth, mephedrone and GHB/GBL raise the heart rate, blood pressure and sex drive. They are key ingredients in Chemsex – sex between men that occurs under the influence of drugs taken immediately before or during sex. In Australia this is also known as Party and Play (or PnP).
Chemsex is associated with more intense sexual activities, often group sex, usually organised through sexual networking apps. Research also suggests it happens regularly at sex on premises venues and saunas. Chemsex has been the focus of a great deal of recent attention and concern, with suggestions it is a factor in rising STI rates.
Chemsex usually occurs in private homes, is associated with group sex, sexual longevity and high partner turnover, and can commonly involve transactional sex (e.g. sex in exchange for drugs). It can also include the injection of drugs (also known as “slamming”), but this is less common.
Motivations for chemsex have been reported to include increasing arousal and restoring libido, increasing sexual confidence, losing inhibitions which help facilitate sexual adventure, increasing sexual longevity, intensifying sexual sensations and enhancing intimacy and connection.
The Flux Study is one of the biggest studies of drug use among gay men in the world, run by the Kirby Institute at the University of New South Wales. Crystal meth users in this study most commonly reported fun (71 per cent) as their reason for using it.
Gay and bisexual men in the Flux Study who had used drugs in the last six months were asked to consider whether they felt their use was problematic. Just over half (50.8 per cent) had used an illicit drug within the previous 6 months. Of those, 15.7 per cent considered their use problematic. While a smaller proportion of men were using crystal meth, a higher proportion within that group considered their use problematic (44.1%).
Chemsex can impact mental and physical health including anxiety attacks, acute paranoia, sexual dependency, injection site injuries, sexual consent concerns, overdose and increased risk of acquiring HIV and STIs.
There are some excellent examples of substance support services run by community organisations in Australia. These include services from Victorian AIDS Council and ACON, who provide harm reduction information as well as a range of psychotherapeutic and counselling interventions aimed at helping LGBT people manage problematic substance use. ACON’s ‘Rovers’ program visits LGBT social spaces and big events like the Mardi Gras after party, to provide on-the-spot drug related first aid for those in acute need.
Mainstream health services often lack the nuance and focus needed to treat people struggling with chemsex. Services may not have familiarity with drugs popular on gay or chemsex scene, or the personal, social and sexual contexts of use. There may also not be acceptance or tolerance of gay individuals and culture at all services.
Better cultural competency training for staff working with gay men and other men who have sex with men provides a path forward. There could be a key role for sexual health clinics in this space, with cross-training required between sexual health and drug services.