‘Chemsex’: a public health issue

“At the beginning of my time, I started by playing.” Oscar came to Barcelona from Galicia with the challenge of making a place for himself in the city and found in the “culture of chemsex” an open door. “He was less shy, more sociable, more empathic, more forward… Then things got complicated.”

The “sexualized use of drugs” is nothing new in our society, but it is approached as a phenomenon with its particularities when “it is linked to the sexual culture of the community LGBTQ+”, explains to RTVE.es the sociologist and consultant in ‘chemsex’ Raúl Soriano. Under the sum of the words ‘chems’ (chemical) and ‘sex’ these practices on the rise in Spain are collected, whose consequences are already considered a matter of public health.

“It is mainly practiced by gay, bisexual men or other men who have sex with men, but it has also been detected in trans people and their sexual partners,” Soriano specifies. The phenomenon has its own slang for encounters (“session, chill, high”) and drugs, among which can be found mephedrone, GHB, GBL, cocaine, ketamine, methamphetamine, and poppers. “The effects of some of these substances cause euphoria and one disinhibition disproportionate,” he clarifies.

Therein lies the enchantment and, in the words of Óscar, The whirlwind begins for some. “Many times behind a ‘chemsex’ problem there is something else: loneliness, a duel that has not been able to be faced, misunderstanding or self-esteem problems”, recalls this former user and volunteer of StopSida, who believes that the approach without judgment or stigma involves “listening” to those who ask for help.

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‘Chemsex’ on the rise

To “listen to them”, you have to start talking without prejudice about the subject. The Action Plan on Addictions 2021-2024 agreed by the Ministry of Health and the autonomous communities includes for the first time the prevention of this specific use of drugs, but different civil associations have been dealing with it for years, with risk reduction campaigns and group and psychological support for those who need it.

“Six years ago we already put on the table that we were beginning to see a problem in the city of Seville to which no response was being given, ”says Alejandro Berto, manager of Adhara – Sevilla Checkpoint, a community center for the detection of HIV and other sexually transmitted infections. A local sex exchange in the city gave them the alarm when they found syringes in the bins and the association decided to include the question in their regular questionnaires. Have you seen someone use drugs in a sexual context? “It went beyond what we had imagined,” he recalls. “Now already it is the users themselves who come and tell you: I have a problem”.

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in environments urban like Madrid and Barcelona, ​​’chemsex’ has had more travel, but until now it had been difficult to define the national scope due to the lack of data. A recent study coordinated by the NGOs Apoyo Positivo and Imagina Más and led by Daniel Íncera has tried to shed light, first of all, with regard to men who have sex with men. “38% of the people we interviewed had engaged in sexualized drug use”, specifies in an interview with RTVE.es Íncera, health psychologist and clinical neuropsychologist.

“A majority have university studies and there are certain subgroups in which these practices are more frequent, such as men with the HIVthose of origin Latin American and those who exercise prostitution”, adds the sociologist and consultant Raul Soriano to complete the profile, according to data from different studies and services that attend to people who practice ‘chemsex’ in Spain.

In the rise of drug use in a sexual context, many eyes point to the dating apps like ‘Grindr’. “They have played a very important role in its development, not only when it comes to contacting other people to practice ‘chemsex’, but also when it comes to acquiring substances,” says Íncera. From Positive Support, the psychiatrist Javier Curto recognizes his role, but believes that “We cannot fall into a technological determinism” and limit ourselves to pointing to social networks. However, voices such as that of the sexual health activist and expert David Stuart have harshly criticized the lack of commitment of these technology companies against substances.

“I hope one day it will be told how ‘Grindr’ – one of the largest online illicit drug markets – has spread a historic epidemic of addiction among gay men by refusing to acknowledge/cooperate with support organizations,” he wrote. in a tweet Stuart, who has been at the forefront of caring for people with ‘chemsex’ problems in London and is often said to have coined the term.

On the edge: a maelstrom of physical and mental health problems

Óscar met in Barcelona the one who would be his partner for almost four years. “Once a month or every two months we would do ‘chemsex’ sessions, just him and me. In the end, the relationship began to open up and HIV came into my life. My partner’s reaction was horrible and I was lost, scared.” tells us.

His fears, fueled by the stigma and guilt that is poured on an infection that with treatment can become undetectable and untransmittable, led him to “take refuge” in the sexualized use of drugs, a “vortex that lasted almost two years”. “I crossed a red line that I had always had: to inject myself with the substance. slamthey call it. And a very negative spiral began towards the bottom of the well ”: his character changed, he distanced himself from his family and friends forever. “Anything they say to you, even if it’s to help, you take it as an attack or a criticism,” she says.

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“Not all people who participate in ‘chemsex’ have problematic implications for physical and mental health,” says Íncera, but a percentage of them can have complications. “It depends on the substances you take, the frequency, the amount…”. On the physical side, the first concern often cited is infections that are transmitted by blood or fluids, such as HIV or hepatitis C, among other. A greater risk of relaxing prevention methods (using a condom, never sharing syringes) is presumed, but the researcher asks for caution when talking about sexually transmitted infections (STIs) and ‘chemsex’ as a relationship of “cause -consequence”.

Although, according to his study financed by the National Plan on Drugs, people who practiced a sexualized use of drugs had a higher diagnosis of STIs. “These people who have STIs may already have them before practicing ‘chemsex'”, he warns. Currently, there are no data to establish this causality, for which research over the years would be necessary. The same thing happens with mental health problems: Do the “depression” and “anxiety” exist before or do they come after consumption? Íncera wonders.

In extreme cases, David Stuart warns in an interview of the “GHB/GBL overdose or suicides resulting from depression or the chaos that its regular use can cause”, as well as other consequences such as withdrawal or short-term psychosis. For the sexual health expert who has closely experienced the London situation, these are the most “urgent” problems, but others, less fatal, are also more common.

“I have been in therapy for two and a half years and I am still not fully recovered. It is difficult for me to meet people, it is difficult for me to show emotions, to have sex”Oscar shares.

why is it happening

“There is never just one reason someone develops a drug-related problem.” The chemsex consultant Raúl Soriano explains that different factors intervene in the process, but when looking for a reason for what is happening in the group, all the interviewees agree the weight of the experiences of “stigma”, “discrimination” and “violence” for belonging to a sexual minority, which can lead to “internalized homophobia”.

“LGBT people in general have had to grow up in a system that doesn’t allow us to be who we are,” summarizes Curto. Furthermore, “there are those who experience rejection from outside or within the LGTBQ+ community itself for the simple fact of having HIV, being a migrant, or using drugs”, completes Soriano.

However, sexualized drug use is not exclusive to men who have sex with men. For this reason, Alejandro Berto, from Adhara – Checkpoint Sevilla, recalls that “sex, drugs and rock and roll has been around forever” and ensures that they are also seeing a growing trend in the heterosexual population. “The way to deal with it is going to be different, because the way of living sexuality is different.”

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But the truth is that fashions act as an amplifier. “If my peer group has normalized the sexualized use of drugs, so do I, because I am part of the group,” says Íncera.

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Action and prevention: “I need to talk about this with someone”

To Óscar, a session of slam (that is, when the substance is injected) after four days of partying, it got out of hand. “There are some gaps of hours where I don’t know what happened. I don’t know if he was always consensual sex, and I scared myself a lot. So I broke everything: with drugs, with the social part… Later, with the psychologist, I knew that I even broke up with myself”. But when he realized that he was unable to meet someone without drugs, he went to Stop Sida because he “needed to talk to someone about all this”.

Years later, he is a volunteer for the ‘chemsex’ Commission together with other users and ex-users who help each other in “the process of finding oneself and managing consumption or abstinence”. There they also have psychological and sexological therapy. “If I had known there was a safe space like Stop Sidawhere to speak with confidence and be understood, I think it would have helped me understand what was happening to me and, perhaps, to be in a different way with my family”.

In fact, the need to limit the term reveals evidence: a specific approach is necessary. “We miss the presence of professionals who are trained in the area of sexology in the network of mental health and addictions”says Javier Curto, of Positive Support, where they also have a therapeutic group, another managed by users and other mental and sexual health services.

“The ‘chemsex’ cannot be treated in the same way as other addictions, even if they have points in common”, says Berto, from Adhara Sevilla, who explains that most of the time it is not about compulsive consumption. “Users tell me: if you put mephedrone, methamphetamine and GHB here, I’ll thank you, I’ll keep it and you’ll see with whom and when I spend it,” he illustrates. “Here there is a work that steps between the psychological and the sexological.”

For this reason, the NGOs that have worked closely with the problems derived from ‘chemsex’ also ask more sexual education for all of society, with information on and for the entire spectrum of sexualities: “It is not enough to intervene in the consequences.”


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George Holan

George Holan is chief editor at Plainsmen Post and has articles published in many notable publications in the last decade.

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