Comment: Chemsex is causing a disproportionate amount of harm for gay men
The Chief Executive of London Friend, Monty Moncrieff, gives his response to a recent study on drug use in the gay community and says chemsex could be contributing to a rise in HIV infection rates.
Last Friday our Antidote team attended the launch of a new report examining ‘chemsex’ trends amongst men who have sex with men (MSM). Chemsex is a term used to describe the use of drugs to engage in sex and is a word increasingly being associated with the trends we see in men accessing Antidote, our specialist LGBT drug & alcohol support service.
The Chemsex Study has been produced by Sigma Research, and commissioned by the London boroughs of Lambeth, Southwark & Lewisham, areas with a higher than average MSM population, to better understand the context and harms associated with chemsex and identify recommendations for meeting the health needs of men using drugs for sex. The findings are particularly pertinent to our work: 35% of our Antidote clients are resident in these three London boroughs alone.
London Friend welcomes this timely research. It reflects many of the experiences of our service users, the majority of whom now report use of three main drugs in sexualised contexts: crystal meth, mephedrone and GHB/GBL. The research offers an insight into the prevalence of these drugs similar to our own understanding: use is still relatively low compared to drugs such as cannabis and cocaine, but they are causing a disproportionate amount of harm.
As well as drug issues the study highlights very widespread use of alcohol, with 85% of MSM having drank within the past week, and half of them within the preceding 24 hours. Alcohol was the substance most men were concerned about. Increasingly our clients talk about the role alcohol plays in their lives, with many telling us this can lead to using drugs and losing the rest of their weekends. In contrast, however, only 8% of our service users tell us it’s their primary issue, suggesting many more people may be worried about their drinking than are coming forward to seek help.
Different drugs, different norms
One of the biggest public health concerns associated with chemsex is the relationship with drug use and rising rates of HIV. The latest official data from Public Health England indicate a record number of new diagnoses amongst MSM, the majority of which occur in London. In part this rise is due to a successful drive to increase testing, but PHE warns that new infection rates are also continuing to rise. Whilst causality between drug use and HIV transmission is more problematic to pinpoint both the study and our own work in Antidote suggest a high level of unintended sexual risks associated with using. With almost 1 in 5 MSM living with HIV unaware they are positive this underlines the importance of regular testing to reduce the risk of unknowingly passing HIV on.
The study details how many men feel drug use is widespread within the gay scene, with some estimating as many as 80-90% of men using. Although we know prevalence to be considerably higher amongst LGBT populations, as the Chemsex Study points out this level is unlikely, given the levels of recent or lifetime use indicated by the research but it illustrates something we hear regularly. Immersed in a cycle of clubbing, saunas and sex parties it’s easy to think that everybody else is doing the same, and this can make it harder to see alternatives or find a way to make changes in how men socialise. With the freebie magazines picked up in our scene venues advertising other pubs, clubs and saunas the notion that this is the extent of queer culture can be artificially reinforced. At Antidote we talk to our clients about alternatives; sports, leisure, the arts – or the many social groups and activities run by us and other LGBT organisations. An intriguing figure among the data is that more men had accessed a gay group or community centre than a sauna in the last month, and that use of LGBT community services was just as popular as use of a darkroom in sex-on-premises venues.
Encouraging in the study is the fact that none of men interviewed who slammed (injected) drugs reported sharing of equipment, citing this as a very important aspect of their drug use. This is not always the experience reported by our service users, but highlights that with access to adequate needle exchange programmes there is a high likelihood that the risk of sharing would be reduced. Encouraging too is that all the men interviewed took their responsibilities around onward transmission of HIV very seriously and that a sizeable minority of men always maintained condom use whilst using drugs, challenging the perception that barebacking has to be the norm.
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A recurrent theme in both the study and our work with service users is a level of discontent with their sex lives and with the feeling that either they, or the men they meet, feel compelled to use drugs to enjoy sex. Many tell us they’d prefer to have a partner, and true intimacy, but only ever seem to meet people looking for casual sex. At London Friend we’re interested in challenging this narrative, encouraging debate on the perceived norms on the gay scene. If so many men are telling us the same thing maybe nobody is truly getting out of chemsex what they say they’re really looking for?
Accessing the right support
We were pleased to read that where men had accessed specialist support from services such as Antidote satisfaction levels were high, and the experience of services like ours in working with gay men and drugs in a sensitive and pragmatic way was valued. Since 2002 Antidote has worked hard to understand the issues affecting LGBT people around their drug and alcohol use, and to provide services that can meet their differing needs, understanding that the substances they use and the way they use them differs hugely from the heroin and crack cocaine use more typically seen within mainstream drug services. We know it’s essential to understand exactly what people are feeling and that they feel safe and able to talk about both their drug use and the sex they are having. Many in the study indicated they feel more comfortable accessing support in sexual health settings, something we have been providing for three years in GUM clinics like the Mortimer Market PEP Clinic and 56 Dean Street where we work at Code (for men using drugs for sex) and cliniQ (a specialist service for trans people).
When people come to Antidote for support we help them to look at the issues affecting them and their drug or alcohol use. We’re not just about stopping altogether; we offer support for people to gain better control over the choices they make and help them do so with better knowledge and awareness of any risks. We believe that gay and bisexual men should be able to enjoy active and healthy sex lives, with the partners they wish, and without feelings of shame. We help them to think about managing their use of sexual networking apps; to recognise the triggers that can quickly lead to a lost weekend and a sense of regret; and to develop techniques to help them achieve their own goals of treatment. We talk about strategies to reduce drug risk; to manage dosing of G; to feel more confident negotiating condom use; and to reduce their use of alcohol.
We know that LGBT people can sometimes feel health and care services exclude them or do not understand their needs. In April we will be publishing a scoping study looking at how LGBT need can be better met in drug and alcohol treatment. This will offer a series of recommendations for commissioners and providers of services, as well as policy makers and local and national Public Health bodies. The report will draw on our own extensive experience of providing drug and alcohol treatment in a range of settings, with a set of strategic and practical actions to drive improvements. The Chemsex Study is important in informing this work, which will also focus on service provision for lesbian and bisexual women and people who identify as trans.
If you’re concerned about your drug or alcohol use Antidote provides a range of support options. You can walk-in to many of our weekly services listed on our website, email us on firstname.lastname@example.org or call us Monday – Friday on 020 7833 1674. We offer free, confidential support.