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Executive summary Chemsex is a pandemic that is not widely known, with information about its dangers and safe practices relating to it not readily available to users. This lack of information is a serious cause for concern due to HIV and STI transmission, and other harmful health consequences, including death. Chemsex campaigns are sorely needed, and because chemsex campaigns are relatively new, a lot of learning is happening in the process. Part of this learning is how to run a successful chemsex campaign. Successful chemsex campaigns require the following:
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Chemsex refers to the practice of using intentionally stimulating drugs as part of one’s sex life. An important part of the use of chemsex occurs in sex parties that last hours and often days, involving multiple persons, during which basic safety practices are generally not followed in regard to needle sharing, sexually transmitted infections (STIs), including HIV, and other drug-related health issues.
Chem users live in a time where ARV, PrEP, and PEP are widely available, but the routine of taking these medications and practicing safety becomes less of a priority during chemsex practices and parties.
The highly addictive and dangerous nature of many of the substances involved is leading to high rates of HIV infection, a sharp increase in HIV-related illnesses, and high numbers of overdoses. Due to this, some people refer to chemsex as the “new gay pandemic”.
David Stuart, a UK-based HIV activist, says, “Technology, smartphones, dating apps, and other social media made chemsex not only possible, but one of the fastest growing methods to access sex, while at the same time numbing the pain of loneliness and low self-esteem. Sex while using drugs, or more specifically, chemsex, was never as easy as it is nowadays, and not as fast-paced! – It is not only about causing new HIV infections, but also that people who were previously undetectable are again at risk.” In reality, chemsex is a public health dilemma as there is an increase in HIV reinfection, and STI infections like Hepatitis B or C.
Why is it important to address chemsex?
Several organizations have raised concerns about the lack of awareness of chemsex and the risks it involves. Despite the global call from sexual health and LGBTIQ+ organizations to create awareness of these unsafe practices, there have been very few successful chemsex awareness-raising campaigns.
Carlos (pseudonym), a Mexican-based gay man and ex-chemsex user, concurs that the gay community is generally ignorant about chemsex, and that chem users do not really know what these particular drugs and combinations of drugs do to their bodies until they are harmed, and it’s too late to address the harm caused.
Ben Collins is a community organizer and the founding director of ReShape/International HIV Partnerships, as well as co-founder of the European Chemsex Forum. Ben explains that “most of the drug overdoses that are happening within the LGBTQ community are chemsex overdoses. There’s not enough knowledge about it. Because of stigma related to drug use, there is a resistance and shame from LGBTQ organizations to address this issue publicly.”
Aspects of a successful chemsex campaign
More than any other HIV, harm reduction, or campaigns on other addictions, planning a successful chemsex campaign requires a deep knowledge about and engagement with pre-existing mental health conditions, loneliness, internalized homophobia, stigma, rejection, and an intersectional approach to experiences of endemic trauma.
Information
While information alone will never be enough to significantly drive behavior change, one important aspect of Chemsex campaigns does relate to information. And it has to be approached in a way that directly speaks to the target audience.
In Belgium, chemMEN’s Jasper Janssens says that a no-nonsense approach to a chemsex campaign is the most effective. The chemMEN project at the MSOC Free Clinic in Belgium gives honest advice, candid information, and does not tiptoe around the harsh realities of chemsex. They give advice about slamming in terms of how to do it correctly, as a lot of men who access their clinic engage in slamming, but have very little knowledge about it. Most men are taught at parties by other users how to slam, and many times, unsafe and unsanitary injecting techniques are used. ChemMEN provides information about the substances used and the combinations thereof. In many healthcare settings, slamming is talked about as taboo or is not spoken about at all. Most men are therefore surprised by chemMEN’s approach, where the health worker not only speaks about slamming, but demonstrates how to slam correctly. They also have a nurse on their team who can assess and treat possible injuries caused by slamming. This treatment also serves as an opening point for a group discussion about the dangers of slamming.
Language
Knowledge about the global and local jargon or language used by chem users and in chemsex circles is essential. Using the correct language makes chemsex users who want to quit chems feel more understood. It creates a sense of trust in the activists, medical professionals, and organizations running the campaigns.
Some of this language is often used in the bios of chemsex users in hook-up and sex app profiles. Instead of using written language on their profiles, chemsex users use symbols or emojis. This allows them to be discreet and escape legal detection, while conveying to other users that they are chemsex users as well as exactly which drugs they use, without the need for explanation. The following symbols or emojis are used.
According to Carlos, the first two symbols generally refer to chemical drugs. The person will just write in their profile “I use candies” or “uso dulces” as it is written in Spanish in Mexico, and then further specify using the other emojis. The diamond represents crystal meth, or “crystal”, “crysky” and “criko”, as it is known in many Latin American countries. The sugar/rice bowl emoji represents cocaine, the syringe represents slamming (injecting) crystal meth and mephedrone, and the 3-leaf clover represents marijuana.
| Madrid’s Apoyo positivo conducted a study within the chemsex community to understand the practices of chemsex users and the terminology that they use. They also started a blog that’s a collaborative work between professionals and users. It addresses safe sex practices, safer chemsex practices, and all the known related psycho-social issues.
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Beyond harm reduction
Many campaigns focus on the negative impact of Chemsex. According to Ben Collins and the Chemsex Forum, the main focus of a chemsex campaign is “to convince the chemsex user why it is important not to neglect the physical and mental health implications of such a practice”.
Socio-psychological dimension
An integral aspect of a successful chemsex campaign is understanding that the campaign should be about more than addressing drug use and its health implications.
“People who are using drugs have a lot of problems”, says Carlos. Amanita, a Trans Woman and ex-Chemsex user, agrees: “drug abuse is the result of many other different things, that have nothing to do with the existence or availability of the drugs”. Chemsex campaigns need to address psycho-social issues, and a successful chemsex campaign cannot ignore the psycho-social elements of the demographics of the chem sex population.
As Carlos says, “There is a history behind a person. The use of drugs is just the tip of the iceberg.”
Campaigns, therefore, need to be aware of the particular histories of their target group, with a special consideration to intersectional factors of stigma and discrimination, making some parts of the community particularly vulnerable to chemsex.
It is essential to understand that many individuals who engage in chemsex have experienced trauma.
This trauma is not just linked to the past, but occurs throughout the life of many chem users in the form of marginalization. Psycho-socially speaking, in general, queer people deal with many limitations based on homophobic, transphobic and queerphobic prejudices created by society at large, which leads to rejection and feelings of shame, which then results in low self-esteem, isolation and loneliness. Unfortunately, people on dating sites experience even more prejudice at the hands of each other. There is a list of standards to comply with, based on race, age, social class, status (including financial), gender (cisgender or transgender), body type, general attractiveness, and other prejudices. Anyone falling outside of what is acceptable is further rejected and shamed, leading to increased isolation and loneliness. Carlos* says, “I am brown skinned, fat, ugly, and that makes me already susceptible to rejection, added on top of dealing with childhood trauma or other types of trauma and issues of rejection.” Amanita adds: “I am 100% sure the addiction comes from a place of pain, it is driven by the sex and beautiful moments experienced in the few hours of chemsex-driven sex and intimacy that tells you that you are not the monster society made you believe you are.”
| For more on the connection between trauma and addiction, check out this interview with Dr Maté. |
Amanita explains, “I can tell you, at least for my experience I do this, and in my millions and millions conversations I had with other chem users; if you heard over and over your entire life that your sexual orientation and preference for love makes you a monster, makes you disgusting, makes you unlovable, an outcast from society, then the easiest way to break that, to find the validation you need from your caretakers [parents] peers, society at large – the best way to do that is through sex. If someone is having sex with you, it means something is right”.
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Demographics of chemsex participants: The case of Amanita According to Amanita, a trans woman, activist, and ex-chemsex user, an important point to highlight is the huge number of trans women who engage in chemsex. She points out that this population of users goes under the radar of chemsex activists. Chemsex use within this population is currently not researched, not engaged with, and not spoken about – not within trans women communities and not within the circles of chemsex activists. This deficit of information leads to an entire population being excluded from chemsex campaigns and programs, which poses significant dangers to the lives and well-being of these users. Some of the major differences in the chemsex scene between gay men or MSM (men who have sex with men) and trans women and their sex partners, are the entry points into chemsex, and additional psycho-emotional layers as a result of the more complicated intersectional nature of trans women’s beings in terms of marginalization and thus vulnerability to chemsex. Intersectionality and privilege Amanita lives in Europe and has been part of the chemsex scene in at least three different European cities, including Copenhagen, Barcelona, and Berlin. In her experience, access to chems is determined by class, privilege, and intersectional lines. For example, in her experience in Europe, gay and MSM chemsex users are usually white, cisgender gay men who have the economic means and the privilege to organize the PnPs (parties). In opposition to this, trans women who are, for example, sex workers or migrants don’t have that same economic privilege, and they are usually driven to chemsex situations by their [often white cisgender male] sexual partners. Another aspect of chemsex participation by trans women who have sex with men that is distinctively different from the experience of white, cis gay men, is that while white, cis gay men experience psycho-social challenges like rejection, loneliness and low self-esteem, trans women (regardless of being a sex worker or not) experience these challenges as well as further challenges. For example, compared to white, cis gay men, trans women are more likely to experience situations where they choose to use meth or any other chems that are made available to them in unexpected moments for, as Amanita says, “their safety, to avoid oncoming possible violence’. The threat of violence in the form of hate crimes is a permanent fear for trans women, which is an added psycho-social stressor that white, cis gay men do not experience, as they are not in constant fear for their lives. As Amanita describes it, “this is not something that happens to gay men, because gay men are not exposed to the violence of cisgender men when it comes to sex and when it comes to sexual experiences”. One has to wonder how many of the hate crimes or reported cases of trans women being beaten up, where news reporting stated: ‘there was no force of entry or the victim knew the perpetrator’ – are in fact the result of a sexual partner abusing chems and losing control. Psycho-social aspects How do we, as society at large, look at cis men who have sex with trans women? The answer is that the general societal opinion of these sexual interactions is tainted by transphobia, internalized homophobia, and shame. Cis men who have sex with trans women do not fit into the societal ideal of heteronormativity, meaning that, most of the time, the cis man partner of the trans woman feels ashamed, because they feel that having sex with trans women is a “gay thing”, because their and society’s transphobia sees trans women not as women, but as men. This issue becomes even more complex and problematic in the chemsex arena, as chemsex is seen as a gay and MSM issue, so any trans woman who enters this arena is immediately seen as part of the gay and MSM community, if they are seen or included at all. All of this yet again erases the truth that trans women are women and that trans women who have sex with men are heterosexual, and not gay. As Amanita says, “Many of them will always say, ‘Oh, you look like a woman, you are a woman, and they are trying to convince themselves that we are women. We know that we are women. We don’t need them to tell us that we are women”. But for them, the shame of being perceived as a gay man, even in the eyes of the trans woman he has sex with, is terrible. So, yeah, in many cases, the use of chemsex by cisgender heterosexual men is also due to internalized homophobia. That shame is so prominent, it is much easier for them to get as high as they can get on chems that take away all of your inhibitions so they can go ahead and fuck you and fall in love for one night and completely disappear from your life, because as soon as they are coming down, that shame comes back. And then, on top of that, you are completely depleted of dopamine, and you just have no capacity to deal with it. You see no future, no hope, you are ashamed of what you did, and then the cycle of shame continues. But for those hours you are doing it, it really is a way to deal with the pain inflicted by society and its gender norms. For trans women, (as with my experience in different European cities) I’ve been to dates, going to a restaurant and the times when the date led to going to my apartment afterwards, the number of times the guy suddenly takes out a pipe of meth, without me even knowing he was a meth user are so high. It is just so terrifying to see how, like, trans women are basically put in this situation, over and over again. It translates to a feeling of “the only use we have for men is to be sex providers and pleasure providers, and because of their use of these types of drugs, it becomes so easy for trans women to become users with them”. As with MSM and gay people, for trans women, chemsex is about trying to connect, to be validated, to be desired, to get away from pain. It is about this guy, in front of you, who offers you the possibility to reduce this pain, loneliness, and fear, and then the likelihood of continuing this cycle of finding validation and confidence through chemsex.” Chemsex interactions are psychologically confusing for all users: on the one hand, the sexual intimacy is validating and provides relief to people who feel unwanted, unattractive, and unloved. On the other hand, the lack of authentic connection and psycho-emotional intimacy leaves people believing that sex is all they’re good for. This issue is more complex for trans women, who, whether they are sex workers or not, are fetishized and seen as sex objects while at the same time not being seen as human beings. Sex worker or not, you almost become one by default, but without payment, as you are only good at providing sex and pleasure. No tangible relationship follows. The validation is short-lived and lasts as long as the chemsex lasts. Amanita says, “Today, I got a message, not from one, but from at least four messages from four different guys asking me if I am looking for sex? And I am like, ‘it is Wednesday, I am in the middle of my workday, and I am working’. And then, immediately, the response when I am replying that ‘I am not looking for sex’, is ‘okay, let’s stop texting’. And they actually tell you, if you’re not gonna have sex with me, then why are you even existing? That is the type of situation we are out in!” Given that dealing with the difficult emotions raised by continually receiving messages such as this, along with all of the other psycho-emotional issues highlighted, it becomes clear that trans women need psycho-social support in order to prevent chemsex from being a continuing option for them. Without the privilege of class, financial stability, and social status, and being marginalized as a trans woman, mental healthcare in the form of therapy or group support is a privilege that trans women cannot, in general, access. Amanita says, “It is not just that , I also have a job, I have an education, I have a temporary visa, I am not undocumented in this country. I have privileges that most trans women don’t have, and that also means that I have tools to provide myself with a sense of hope. I have the willpower to say, ‘I am not going to do this, I am not going to use it today, I am going to hold on very hard to the relationships that give me love. I am going to hold on to my job, I am going to develop other strategies. I am going to read; I am going to work out… but these are not tools trans women usually have. Because why would we, if you are unemployed and undocumented and alone. So, for most other trans women when a guy that you are attracted to, shows up with a pipe of meth, you smoke it”. |
Outreach
Behavior
In order to reach the intended target group, a deep knowledge of the behaviors of chemsex users is, of course, essential.
The scheduling of David Stuart’s “Chill Out” meetings on Mondays was based on an understanding of the practices and behavior of chem users. Monday was a day when they would be coming down after the weekend’s party. Understanding the behavior of chem users was key to this successful chemsex campaign.
Respect
Given the particular context of low self-esteem of many chemsex users, approaches based on guilt or blame are likely to produce counter effects. It is therefore particularly important to pay attention to the attitude of the treatment centers, mental health workers, therapists, and clinicians, as oftentimes their approach is judgmental, condemning, or demonizing drug use instead of focusing on the foundational problems, trauma, and mental health issues that existed before drug use started.
| Barcelona’s Stop SIDA is a pioneering campaign in many ways, leading the way for future campaigns in Spain and around the world. Firstly, the campaign was designed in a fresh and uplifting way, unlike the usual grim and gloomy stories used by other campaigns. Stop SIDA breaks the taboos and stigmas around and within the chemsex community and encourages people to talk about their experiences. Another way in which the campaign is different is that they use colorful videos that grab the attention of the community, which then provides them with an opportunity to draw focus to the launch of the chemsex service at their center. The services of this center include support groups and psycho-social support that address social isolation, shame, and other intersectional issues underlying chemsex use and the associated lifestyle.
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Involving community: Healing disconnection and trauma through connection
If disconnection, rejection, and trauma at the hands of others and society are underlying factors in chem use and chemsex participation, then the answer to these harmful experiences and situations is care and support from societal groups.
Carlos particularly advises to “educate families to not reject their gay or trans child” as a major avenue to decrease vulnerability.
Let’s leave the concluding words to Amanita: “If you wanna stop chemsex from happening, or if you wanna stop this pandemic of addiction to meth and GHB, then maybe you should be paying attention to the transphobia, homophobia and queerphobia’ – and this is a matter of Human Rights, a matter of discrimination and a matter of violence, of sexual harassment. It is not just a matter of drug abuse. Campaigns should focus on how transphobia, homophobia, and queerphobia are killing us in all other ways by deteriorating mental health in all other ways.”
