As chemsex evolves, information and support are key

Chemsex is becoming more popular and more dangerous, according to Monty Moncrieff MBE, Chief executive of London Friend, a charity dedicated to the health and mental wellbeing of LGBT people and a participant of AFEW Autumn School in Bishkek. He spoke to us about how chemsex is changing and spreading around the world, and how best to provide support to those who are doing it.

Monty, why is chemsex such a serious issue?

Chemsex is characteristic of a distinct change in the way gay and bi men are using drugs to enhance sex. In the late 2000s we started to see a shift towards three new drugs in the UK: methamphetamines, mephedrone, and GHB/GBL. Previously, these drugs were not widespread – mephedrone wasn’t even known before then – so we don’t have a good understanding of their risks. They present a greater risk of harm than drugs that were being previously used recreationally and for clubbing, so we’ve seen a big increase in the number of people experiencing problems with them. There are sexual health, physical health, and especially mental health harms that can affect people who engage in chemsex.

How do we know when chemsex is becoming a problem for an individual?

We look at this quite holistically. It doesn’t have to be dependency on the drug itself that is an indicator of when things become problematic. It might be that you’re starting to miss work on a Monday morning, or that arguments with your partner or friends are increasing. It might be causing financial difficulties, or it might be having a negative impact on your mood, motivation or mental wellbeing generally. You might be starting to use alone, or feel you can’t have sex without chems, or you might be finding it difficult to form emotional bonds with a sexual partner. Lots of different things could suggest a problem.

How can we increase social awareness about chemsex and its consequences?

I think we need to talk about it frankly and factually. The media likes to sensationalise chemsex – ‘Sex! Drugs! Danger!’ – but that isn’t going to resonate with people who are doing it and might be beginning to experience difficulties. Gay men have had access to factual, objective information about sexual health and HIV for years, so they want their information about drugs and chemsex to be factual and objective too. They need to feel they are informed and are making choices from a place of knowledge. We know that the types of campaigns that simply emphasise the dangers of chemsex aren’t effective.

Good harm reduction works – we know this because the number of people becoming physically dependent on GHB/GBL has dropped, thanks to effective information about how to reduce the risks of this happening.

So how can we create a supportive environment for those who are doing it?

For us at London Friend, the most important thing is to avoid stigmatizing people. There’s already enough stigma around being gay or living with HIV, and this can be a real barrier for those who might otherwise seek support.

At Antidote, our LGBT drug and alcohol support service, we work really hard to create positive, welcoming environments, so that it’s as easy as possible for someone to ask for help. People need to feel they can be open, honest and frank when talking about these issues, and that they won’t be judged in any way. It’s really difficult for people to talk about these very intimate things and it might bring up feelings of shame or embarrassment. It’s vital that we can have honest discussions about everything that’s connected to their chems use and the sex they’re having. The workers and volunteers that provide support need to be fully informed about the issues related to chemsex, about the newer drugs that are being used, which may still be unfamiliar to a lot of healthcare workers, and the issues that affect gay and bisexual men. It’s vital that the cultural competence is there, so people feel understood when they ask for support – otherwise they might not come back.

Is chemsex widespread in the Eastern Europe and Central Asian region?

Chemsex still feels relatively new in many parts of the EECA region, but it’s clear that it is becoming more common. There’s a lot of awareness of it in western Europe and other parts of the world, like the USA, Australia and so on. People working in the EECA region can familiarise themselves with what’s happened there, so they’re not starting from zero in their own local areas. However, chemsex isn’t the same everywhere – there are different drugs being used, depending on what’s available locally. Organisations need to monitor what is happening in each region and tailor their approach so that it’s culturally appropriate for the way gay and bi men access information and support in their own areas.

I’m already seeing some great resources in Russian, Polish etc. from local groups, and we’ve had more people from the EECA region attending and speaking at the European Chemsex Forum events that have been bringing health workers and activists together since 2016. There’s an active online group that has developed from these events, where a lot of resources and experience are shared. You can join up at https://chemsex.groups.io/

Finally, what precautions should people take during the COVID-19 pandemic?

During COVID-19 in the UK we’re encouraging people who don’t live with a sexual partner to avoid hooking up with new or casual partners to help reduce the risk of exposure to the virus. If people are already thinking of taking a break from chemsex, or stopping completely, this could be a good opportunity to do so.

What does coronavirus (COVID-19) mean in regard to chemsex? David Stuart.

Author – David Stuart. 

The great majority of us human beings here on planet Earth will contract coronavirus (COVID-19) this year. People who engage in chemsex are even more likely to, because in many cases (not all) chemsex includes lots of transmission possibilities within those chemsex scenarios; it also often (not always) involves higher numbers of new partners over two to three day periods. For the great majority of us, the symptoms will pass and we’ll be fine.
So despite the fear and alarm associated with this pandemic, we really shouldn’t be frightened of that inevitability.

However, there is a minority of people among our chemsex communities who will develop more complicated symptoms when they contract COVID-19; and for a certain number of those, the symptoms will be fatal.

So. We all have a responsibility to protect that minority – vigilantly – from catching COVID-19; from us, from our communities.

That means doing our best to avoid that minority of people when we are potentially infectious.
Given the amount of COVID-19 peaking within our communities this year, it would be unwise and very unkind to hook up with/have chemsex with a COVID-19-vulnerable person;
– especially if we have had other partners in the previous days/weeks
– especially if we have not been vigilant about hand-washing, face touching in the previous days/weeks
– especially if we have been close to anyone with symptoms of cough or high temperature in the previous days/weeks
– especially if we have been around any confirmed cases of COVID-19 in the previous days/weeks
– especially if we have a new persistent cough, shortness of breath or a high temperature (self-isolate for 7 days in this case)

Who are the people most likely to develop the more dangerous complications from COVID-19?
– elderly people, over 70
– people with cancer
– people with high blood pressure
– people with problematic diabetes
– people with chronic kidney disease

– people with chronic heart disease
– people with chronic lung disease
– people with respiratory problems
– people with compromised immune systems.

HIV

COVID-19 is very new, so there is not a lot of evidence to give absolute reassurances on the following.

COVID-19 affects our respiratory tract mostly; the stronger our immune systems are, the better we can fight it. The HIV virus weakens the immune system if left untreated for too long. This time can vary person to person.

(For the information below, I consulted an HIV specialist, who I thank dearly.)

– Nearly all people living with HIV and on treatment with undetectable viral loads have strong immune systems, so COVID-19 would not necessarily pose a higher risk to them than anyone else. Take comfort in this; be reassured. (The British HIV Association recommends that HIV positive patients make sure they’re up to date with their annual flu vaccination and the pneumonia vaccination; both are common at this time of year, both are preventable; avoiding those illnesses will reduce the burden on our health services and hospitals during this COVID-19 pandemic.)

– It’s possible that people living with diagnosed HIV, but who are not taking any HIV medicines, or people who have only recently started treatment might be at greater risk of developing the more complicated symptoms of COVID-19; but this isn’t known for sure. Talk to your doctor or HIV healthcare team as soon as possible about this. They’ll be able to answer this more exactly.

– If people have HIV but do not know it, their immune system might have been damaged, putting them at risk of developing infections and other illnesses. It’s possible that they might not be able to fight off infections like COVID-19 as people who don’t have HIV, or people with HIV who are taking treatment. Therefore, if you haven’t tested recently (or ever), it is a good idea to have a test so that if it’s positive, you can start treatment as soon as possible.

– For some people, going for an HIV test is a scary thing; but it really shouldn’t be. HIV medicines work brilliantly and the protection they give to your immune system should make it easier to fight infections like COVID-19. Now is a very good time to get tested for HIV. While you are there; ask about condoms, ask about PEP; ask what “undetectable” means, and ask about availability of PrEP. These are all HIV prevention tools, and now is a really good time to avoid a new HIV infection. A new HIV infection is quickly followed by some HIV seroconversion symptoms; these symptoms vary person to person, but they could complicate a COVID-19 infection if they happened simultaneously. HIV prevention is especially important during this COVID-19 outbreak.

Being kind

Everyone has different and varying relationships to chems; they affect us all differently.
Some of us can stop chems, take a break during a dangerous period, practice excellent hygiene, wear condoms consistently, adhere to our HIV medicines perfectly, take our PrEP perfectly.
For many of us others, those things can be difficult.

Drug cravings can be overpowering. Mental health can fluctuate.
The desire to self-care can be out of our reach sometimes, during some seasons of poor wellbeing.
Sometimes when things are bad, the lost ability to self care can be accompanied by an apathy in regard to caring for others
Choosing to take a break, or to practise meticulously safe chemsex during this COVID-19 pandemic is not something we can all accomplish. And as a community, we need to be kind, understanding and intelligently aware of this. And patient and flexible and generous. Cruelty, lack of empathy, and unkindness make epidemics worse.

Many people participating in chemsex may be run down, depressed, off their HIV medicines for a period of time.
Many people participating in chemsex may be living with undiagnosed HIV; whether that’s a month or a year.
Many of our older brothers and lovers may be participating in chemsex despite the risks, because they may have less control over triggers, cravings and compulsions to use chems.
Many older COVID-19-vulnerable people may be lonely and isolated, and taking greater risks in regard to COVID-19 prevention.
For some of our older gay brothers, this is the second epidemic within their lifetime that affects their sex lives and their ability to seek connection, intimacy, pleasure; epidemic fatigue is a real thing.

This is life, this is gay life. This is addiction, this is mental health; this is fatigue, this is fluctuating seasons of wellbeing, and this is sex and horniness. This is the need for intimacy, this is the ‘Human’ in human nature. This is our primal desire for connection. This is the nature of gorgeous and sometimes vulnerable human beings.
This is chemsex too.

If you DO want to take a break from chems during this time, but don’t feel confident that you can…

Try it this way.

1. DECIDE to do it. In your heart (That makes it easier).
2. Choose a small period of time, like 1 week; say “I’m not doing Chems for the next seven days“. Say it into a mirror. Say it to a friend. Commit to it.
3. Learn how to anticipate triggers in the coming week; so you are prepared for the cravings.
4. Learn how to manage cravings.
5. Keep yourself busy & occupied. That helps. Ask friends for help keeping you busy & occupied

Source 

Chemsex and Drug Use Among MSM in Kyiv: New Challenges

Analytical community-based participatory research report based on the results of the study “Chemsex and drug use among MSM in Kyiv: new challenges”, 2017.

According to a bio-behavioral research conducted in Ukraine every two years with the support from the ICF “Alliance for Public Health”, men who have sex with men, is a group where the prevalence of HIV continues to grow. Thus, in Kyiv at the end of 2015 – the beginning of 2016, the prevalence of HIV among MSM was 15%.

According to the observations of social workers of the PO “ALLIANCE.GLOBAL”, that carries out outreach work through gay dating mobile applications, Internet web-sites, where sex workers’ ads are published, gay clubs and saunas in Kyiv, in recent years, the number of MSM who use different chemical substances in a non-injecting way (amphetamines, ecstasy, LSD, oxybutyrate, etc.) has significantly increased, which suggests that their sexual behavior becomes riskier and significantly increases the likelihood of HIV infection, viral hepatitis, and other STIs, both in terms of getting infection as well as transmitting the infection. To assess the drug scene, the risks of using chemical substances and the possible negative effects of sex under their influence in the context of the spread of HIV, viral hepatitis and other STIs, we conducted this study, the aim of which was to develop recommendations for more effective prevention of HIV infection, drug-related harm reduction and other related means and planning of specific services for subgroups of MSM who practice sex under the influence of chemical substances.

The purpose of the research is to study how the use of drugs, psychotropic substances and / or certain medications affects sexual behavior and mental health of MSM and how to minimize the risk of transmitting infections, in particular, HIV.

Read the report here.