Chemsex and gay men: Has the issue been overblown?

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PinkNews interviews David Stuart, substance use lead at London’s 56 Dean Street sexual health clinic, on whether chemsex could be increasing HIV transmission among gay and bisexual men.

Mr Stuart contributed to a study published last month by the London School of Hygiene and Tropical Medicine on the rise of chemsex and its wider health implications.

Researchers analysed survey data from 1,142 gay and bisexual men living in Lambeth, Southwark and Lewisham, and conducted in-depth interviews with 30 gay men from the area. The majority of interviewees had a history of recreational drug use prior to becoming involved in chemsex.

Mr Stuart started by explaining the history of chemsex. “The clinical term, which I hate, is sexualised drug use by men who have sex with men (MSM). Chemsex is a term that came from apps like Grindr, BBRT (Bareback Real Time) and others. Chemsex (chemical sex) is just the slang term for sexualised drug use by men who have sex with men. It’s usually defined by the use of crystal meth, mephedrone, GHB/GBL – just to facilitate sex.”

Asked if chemsex was an issue that was growing for gay and bisexual men, Mr Stuart replied: “Yeah, it has been growing … sex and drugs have been going on in different populations going back hundreds and hundreds of years, so it’s not incredibly new, but it has been growing recently. About ten years ago we really started to see it in an epidemiological way. It was mostly HIV positive older men, and that tells us something: why did this trend begin with HIV positive older men? It has something to do with their experience of living with HIV, their experience of sex, their experience of disclosure, their experience of what they felt in bed as sober and HIV positive, when these drugs seem to … they like these drugs very much.

“And when you say, ‘is it growing?’ [the answer is] yes, because ten years later it’s not just older HIV positive men, it’s 15-year-olds, the first time they have sex is on drugs. I’m working with people like that in the clinic. It’s also about 50/50 HIV positive and HIV negative men, it’s across the board now and chemsex is a household name in the big cities that host big gay communities across the world.”

Statistics in the Chemsex Study from 2012 by CODE (a specialist sexual health clinic catering for men on the ‘harder’ sex/drugs scene) showed that 19% of clients had used GHB/GBL in the previous 6 months, 10% had taken crystal meth and 21% had taken mephedrone within the same period. All figures of drug use were significantly higher among men diagnosed with HIV.

PinkNews asked Mr Stuart if he agreed that chemsex remained a minority activity for gay and bisexual men. He replied: “Yes compared to the global population it’s a minority, compared to the entire global gay population it’s a minority, compared to all the gay men that live in Greater London it might be a minority, I don’t know who’s counting? I rarely meet men that don’t know what chemsex is.”

The Chemsex Study said: “The use of crystal meth appears to be slowly increasing rather than rising exponentially. In 2007 a community survey of men who have sex with men in London estimated that 7.8% had used crystal meth in the last year. In this 2010 survey the figure was 8.7%.”

Alcohol by far remains the most commonly used drug and is the drug of largest concern for MSM. The rise of mephedrone over the past decade has been part of Britain’s ever-changing drugs landscape. Until April 2010 it was considered a legal high and could be sold as plant food or bath salts, but given its potency and powerful side effects the drug was reclassified.

Mr Stuart was asked if chemsex is now the activity of choice for some whereas a few years ago the same people may have predominantly been taking ecstasy in clubs.

He replied: “Yeah that could exactly be it. People weren’t rushing to accident and emergency departments from ecstasy. They weren’t rushing to sexual health clinics for PEP (Post Exposure Prophylaxis) or HIV tests because of ecstasy. This is not about drugs this is about the harm that comes from them. In one weekend we had 33 people show up for PEP, the medication you take if you think you have been exposed to HIV. At the time I didn’t work at that particular clinic I just happened to be there as I was doing some research. All 33 had come from a three-day chemsex party.”

Mr Stuart added: “I don’t care if it’s one, or a hundred, a thousand, or the minority or the majority; I want to help [them].”

The interview then moved on to the subject of HIV infection rates. “Five gay men are diagnosed with HIV in London every single day,” Mr Stuart said to “That’s a rise and it’s a rise that started happening about two or three years ago, at the same time as the rise in chemsex. So we are wondering ‘oh dear’ are these two connected? And we are now gathering the evidence to see if that is so.”

It was put to Mr Stuart that it appeared challenging at present to attribute chemsex as a source for the continued increase in HIV diagnoses among gay and bisexual men. Between 2011 and 2012, the number of men who have sex with men (MSM) taking an HIV test in London increased by 19%. One of the reasons why onward transmission has remained high is because 18% (7,300) of MSM in England who are HIV positive are unaware of their infection. New diagnoses in England reached a record high of 3,250 in 2012. Public Health England said this reflected both an on-going high level of HIV transmission and increased HIV testing for MSM. The role of chemsex in this has yet to be established.

Mr Stuart said: “Yes let’s hope the rise in HIV rates is just because more people are testing and not because of chemsex. What we need to do is find out. My post at 56 Dean Street is the first time that a fulltime drugs worker has ever worked in sexual health. I should be working in a drug clinic not in sexual health. Public Health England is very concerned about this as is various parts of the Home Office. What we are trying to do is to find out: is there a connection or is it a myth, is it a scare?”

“At the moment we have 100 people every month coming to one sexual health clinic, just one, disclosing that they are using drugs for sex and haven’t had sober sex in more than a year. A hundred a month, so that just gives you a number.

“Now what we need to do is to continue working with them, check out how many of those had a connection with the rising HIV and drug use. Let’s just see if it’s increased testing and us doing our job right and sending out the messages to come and get tested or if it is chemsex”.

When asked if he thought the rise in HIV probably was down to an increase in testing, Mr Stuart told “Yeah let’s hope it is. It probably … we have to find out that’s the point … the data that we do have is worrying enough to say let’s investigate and so we are. So I’m not saying that the rise in HIV rates is because of chemsex, I’m saying that it happened simultaneously as we are seeing more people doing chemsex, so we need to monitor it, watch it [and] learn”.

Referring to the CODE statistics showing an increase in clients using GHB/GLB, crystal meth and mephedrone, the Chemsex Study noted that “changes in clinical presentations could reflect changes in drug use among gay men broadly, but could also be the result of improved visibility and awareness of these services and improved referral pathways between professional services that work to meet the health needs of gay men.”

The increased demand at 56 Dean Street could be because its services have been given greater prominence. When asked why certain men used drugs for sex, Mr Stuart said there were many different reasons. “I know people that do drugs because when they are lying in bed they don’t feel horny. Why not? Well, sometimes growing up gay makes you feel different and you become hyper-vigilant about being judged and rejected”.

Mr Stuart added: “And drugs make it all go away. It’s also that drugs feel really good, sex does go on for a long time, for some people they don’t want to think about HIV they feel diseased when they are in bed, which is a horrible thing to say, but they don’t feel diseased when they are high and horny. There are a lot of HIV positive guys who will only sleep with other HIV positive guys to avoid disclosing it. And the drugs are a place to hide and play where those conversations don’t happen.”