7. 8 Chemsex

Over the last 10-20 years, problems linked to the use of long-acting recreational drugs by gay and bisexual men have become increasingly common, especially in cities with established LGBT communities.

The main three drugs are crystal meth (Tina), mephedrone (meph) and GHB/GBL (G). The use of these specific drugs in a sexual context is called chemsex and can include injecting drugs.

Sometimes other drugs are also used, including cocaine, or ketamine, depending on local availability. However, many drugs that are used in this setting, including poppers (aykyl nitrates), erectile drugs (sildenafil etc) and marijuana are not categorised as chemsex drugs.

Chemsex also coincides with the increasing use of social media that can make it very easy to meet partners, including in group settings.

These drugs are different from other recreational drugs because they have a longer lasting effect, heightening sexual feelings and very high levels of inhibition. It is common for users to report extended use, often for several days without sleeping or eating.

Many people use chemsex drugs as an important part of their life without becoming addicted and without having other complications. Chemsex is common and sometimes normalised for some gay and bisexual men. Even with higher levels of use, many me do not consider themselves as dependent on these drugs.

Chemsex is commonly linked to increased rates of STIs, including HIV, hepatitis C and LGV; and poorer outcomes from ART. including lower adherence and higher risk of viral failure.

Direct side effects, combined with limited sleep can cause psychiatric complications including psychosis and extreme paranoia, overdose (especially with G), sexual assault and withdrawal symptoms if extensive use is stopped. Social outcomes include people loosing their jobs, income, housing and friends.

Access to support services is difficult. Many people who have difficulties with chemsex do not identify as injecting drug users and will not access services developed for heroin use since these are mainly aimed at heterosexual people.

Many HIV clinics still urgently need to develop and provide support services that cover the range of complications linked to chemsex.

Links and further reading

Galicia, M. (2023), Editorial comment on: Amphetamine-related intoxications in people living with HIV: An observational study in an emergency department in Barcelona (Spain) from 2018 to 2020. HIV Med. https://doi.org/10.1111/hiv.13387

Perelló R, Losada A, Chen J, Supervía A, Slagado E, Smithson A, XipellM, Inciarte A, Valdecillo G. Amphetamine-Related Intoxications in People Living with HIV: an Observational Study in an Emergency Department in Barcelona (Spain) from 2018 to 2020. HIV Medicine in press.
https://onlinelibrary.wiley.com/doi/full/10.1111/hiv.13365

Giorgetti R et al. When “chems” meet sex: a rising phenomenon called “chemSex”. Curr Neuropharmacol. 2017;15(5):762-770. doi: 10.2174/1570159X15666161117151148.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5771052