Methmephangee – ChemSex vs recreational drug use: a proposed definition for health workers

David Stuart, 56 Dean Street and Simon Collins, HIV i-Base.

The following definition was produced to help health workers and researchers understand differences between ChemSex and using recreational drugs for sex.

This information is also available as a PDF leaflet:
https://i-base.info/blog/wp-content/uploads/2014/12/ChemSex-definition-19dec14-FINAL.pdf

ChemSex is NOT the same as recreational drug use. It is a specific form of recreational drug use.

This is important for health workers and researchers who are working in this field but who perhaps have limited personal experience of meth, meph and G. These are the three key drugs that characterise a much more complex situation.

For lots of people, including gay men, alcohol and drugs are an important part of life. ChemSex is different to this.

ChemSex: meth, meph and G

ChemSex is a common term used by gay men  on sexual networking sites and smartphone Apps.
ChemSex is NOT the same as recreational drug use.
It is a specific form of recreational drug use.

ChemSex is defined by the use of three specific drugs (“chems”) in a sexual context.

These three drugs are meth, meph and G.

Methamphetamine (crystal/crystal meth/Tina/meth).
Mephedrone (meph/drone).
GHB/GBL* (G, Gina).

ChemSex involves using one or more of these three drugs, in any combination, to facilitate or enhance sex, with or without other drugs.

ChemSex commonly refers to sex that can sometimes last several days. There is little need for sleep or food. The heightened sexual focus enables more extreme sex, for longer, often with more partners and with less fear of STIs including HIV and HCV. Sharing injections is common.

Reasons for ChemSex are similar to using other drugs.

To feel more sexually free and to overcome intimacy issues.
To overcome fear of rejection, sexual shame.
To cope with stigma over HIV/hepatitis C (HCV).
To overcome problems in the past, including sexual abuse.
To overcome internalised homophobia.
Wanting ‘better’ sex, that lasts longer.
Loneliness.
Wanting intimacy, to connect to others, to feel part of a community.
Wanting sexual affirmation.
Because “everyone’s doing it”.
Because it is an online hook-up ‘norm’.
Peer pressure.

However, side effects from ChemSex both when high and afterwards are more severe than other commonly used recreational drugs.

ChemSex is associated with more extreme behaviour and risk:

Extended sex for many hours. A session can last several days. It is common to not sleep.
Sometimes just two people for an extended period. Sometimes multiple partners, multiple times. New people might join and leave a party over several days.
Extreme sexual disinhibition. People use ChemSex to do things that they don’t usually do. Safe sex is less important or not important.
Extreme sexual focus.
Side effects include overdose (fatal), paranoia, psychosis and black-outs.
Not being able to consent to sex when unconscious or highly intoxicated; increases risk of assault.
Drug interactions can be serious and difficult to predict (i.e. between alcohol and GBL/GHB).
Meth and meph are often injected. Injecting is called “slamming”. This risks injection-related infections and blood-borne infections like HIV and HCV.
STIs are common and frequent. This includes HIV, HCV and, currently, a shigella outbreak.
Multiple and repeat use of PEP.
Multiple HCV re-infections.
Low adherence to ART by HIV positive people on treatment.
Serious short and long term impact includes chronic depression, anxiety, weight-loss, paranoia, psychosis.
Loss of lifestyle stability in terms of employment, debt, housing, partnerships and friendships.
Increased use of GUM, STI, HIV and counselling clinics and services.

These links have been well documented at GUM/HIV clinics in London over the last decade.

London has the most concentrated ChemSex culture in Europe and perhaps globally. Similar trends have been observed in larger cities in Europe, the USA and Australia.

Other recreational drugs are also used in sexual contexts. They can also play a role in ChemSex, but this is less important than use of meth, meph and G.

* Chemical names for GHB/GBL are Gammahydroxybutyrate/Gammabutyrolactone

56 Dean Street is the first UK GUM/HIV clinic to provide ChemSex support to MSM around drug use, sexual health, and sexual wellbeing. It receives over 100 ChemSex referrals each month.

This definition was produced by ReShape’s ChemSex lab as contribution to the ongoing dialogue on MSM and sexual health. ReShape (www.ReShapenow.org) is an activist think-tank that supports the need for new community responses to ChemSex. ReShape hosts ChemSex Labs to develop strategic community response to ChemSex in the UK and Europe.