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Chemsex − The London

Chemsex − The London Experience Chemsex deserves a non-alarmist, but proportionate health response David Stuart, London Infektionsrisiken durch die Verbreitung neuer Drogen nehmen zu. Chemsex wird zur Herausforderung. Was macht Chemsex aus – und wie damit umgehen? David Stuart verantwortet die „ChemSex support services” in der Londoner Dean Street, der Klinik für Sexualkrankheiten in Großbritannien. Connexi dokumentiert seinen Vortrag im Rahmen des dagnä-Workshop 2016 im Original. What is chemsex? ChemSex is a word invented on geo-sexual networking apps by gay men (and adopted by the gay men’s health sector) that defines a syndemic of specific behaviours associated with specific recreational drugs, and is particular to a specific, high risk population. Though the media spotlight may have distorted the term to define the use of any drugs in sexual contexts by any population, ChemSex actually refers to the use of any combination of drugs that includes crystal methamphetamine, mephedrone and/or GHB/GBL by Men who have Sex with Men (MSM) before or during sex. It is less of a traditional sex and drug issue; instead it’s related to the use of changing technologies, easy availability of certain recreational drugs via these technologies, and is adopted by Sexual health/HIV medical team Addressing STI/HIV/HCV prevention, treatment and epidemiology Traditional Drug support worker Addressing acute harms of addiction/withdrawal/overdose Provision of clean needles/advice Referrals to rehab Psychosexual therapist ChemSex advisors workers/volunteers/gay peers familiar with gay ChemSex contexts; sex-App use, gay scene norms, gay sex challenges Addiction psychatrist Conferences Abbildung 1: 56 Dean Street multidisciplinary approach. 32

Chemsex − The London Experience a small, (international) but very sexually active group of men who are far more likely to contract HIV through this behaviour than their non-MSM counterparts (due to high prevalence within that population). ChemSex is also often associated with some cultural idiosyncrasies unique to gay cultures that may complicate sex for gay men. It is important that the health sector remains vigilant in providing care for anyone using drugs for sex, but also that a particular focus is given to gay and bisexual men using these drugs in this context as this represents a particular challenge to public health and communities, and some redesigning of the way in which care is delivered. David Stuart david.stuart@me.com Drugs associated with ChemSex and their effects Although drugs and alcohol have often been used in sexual contexts throughout history, crystal methamphetamine, mephedrone and GHB/GBL provide a particular sexually-disinhibiting “high”, which represents a different public health concern than that associated with other drugs more commonly used in the past. These three drugs have unfortunately become very common and readily available within gay “scenes” over the last decade, and their use has been accompanied by higher-risk sexual activity than has ever been observed or associated with any other kind of drug use. Users of these drugs can feel invulnerable to harm, supremely confident, dismissive of consequences, sexually adventurous, experience a heightened sense of pleasure, and can possess a stamina and endurance that may keep them awake for many days. When used in sexual contexts, this can translate into a reduced concern for safer sex practices and contact with a higher number of partners during a short, concentrated period of time. Unwanted side effects while under the influence can include aggression, paranoia, hallucinations/perceptions of persecution, overdose and more. The role of geo-sexual networking Apps (eg. Grindr) in the rise of ChemSex Geo-sexual networking apps have served a beneficial function in gay men’s lives in some ways, though there have also been some negative consequences. Sex for gay men is often associated with risk and danger; this is a consequence of an HIV epidemic that (in the UK) has particularly affected gay men. Many other gay men struggle with sex and intimacy having grown up struggling with a different sexual identity, cultural (or internalised) homophobia or a desire to fit in and avoid rejection. Apps were adopted very quickly by gay communities as a way to date and seek sex; yet communicating one’s sexual and emotional needs via the use of abbreviations, word counts and photo-shopped Conferences 33

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