A recent BMJ editorial (3rd November) calls for ‘chemsex’ (the term used by the gay community to designate sex under the influence of drugs taken to heighten pleasure) to be made a ‘public health priority’. The editorial has evidently been triggered by the publication of findings from a research project conducted by Sigma Research and commissioned by the London Boroughs of Lambeth, Southward and Lewisham (LSL). These have recently appeared both in the official report (Executive Summary), and in papers in various journals, including STIs (see Bourne & Weatherburn (STIs)).
So far as the nature of chemsex itself is concerned, there is an informative short guide produced by 56 Dean Street that offers a down-to-earth insight into the nature of ‘chemsex’ events (ChemSex and heptatis C/STIs/blog). On importance of the phenomenon for STI transmission within the MSM community, however, there would seem to remain considerable uncertainty – at least according to the editorial. Evidence for condom use and sero-sorting in this setting would be a helpful indicator of degree of risk, but is apparently a contested issue in the current literature.
So what does the Chemsex Study itself have to contribute on these issues? Concerning the extent of the chemsex phenomenon, it gives a ‘quantitative context’ on the basis of data from EMIS (European Men-who-have-sex-with men Survey). The analysis of this data indicates a proportion of MSM living in LSL who have used drugs known to be employed for chemsex that is respectively seven-fold (GHB/GBL), and eight-fold (crystal meth), what we find amongst MSM elsewhere in the UK – as against a proportion for other drugs that is two or three-fold.
Regarding risks posed by behaviours associated with chemsex events – the question discussed by Bourne & Weatherburn (STIs) – the Chemsex Study employs qualitative data from a thematic analysis of 30 interviews conducted with MSM having participated in such events from LSL.
The researchers isolate four key ‘narratives’. (1) More than a quarter, all sero-positive, had made a conscious decision to engage in unprotected anal intercourse (UAI) with those they believed were sero-concordant. (2) A third found it hard to control their behaviour under the influence of drugs, and took risks they subsequently regretted. (3) A ‘small sample’ sought out risky sex. (4) A ‘sizeable minority’ felt perfectly in control of their actions, and relatively safe, while engaging in chemsex. The authors do not indicate whether, and how far, these four groups overlap, and how the membership of any but the first correlates with HIV sero-status.
They conclude there is little evidence that use of drugs had influenced engagement in UAI, though their use had facilitated sex with more men and for longer. Much, it would seem, remains to be clarified by future studies.