Meth-sex. Chemsex. Party and play. Whatever the name, the use of certain drugs, such as methamphetamine, GHB, ketamine, and mephedrone, in conjunction with sex take a heavy toll on the lives of many gay men. Chemsex (my favorite term) is responsible for overdoses, arrests, infection with HIV and hepatitis C, the devastating destruction of drug addiction and even death. It occurs, of course, among other populations as well. The transgender community is particularly affected, as are bisexuals and heterosexuals. But it’s the alluring appeal of chemsex to alleviate shame, loneliness, connection-seeking, and even boredom among gay men that I think is particularly disturbing and that our community has to deal with directly.
Mood-altering drugs, including alcohol and harsher substances like methamphetamine, have long been circulating in the gay community, but the tsunami of stimulants that hit us in the new millennium has been different. Drugs for HIV and AIDS-related fatigue have changed the sexual landscape, new methods of production by the Mexican cartels have made drugs more pure and cheaper, and technology in the form of websites and apps has made social and sexual connection with other men easier than ever. Certainly, not everyone who uses methamphetamine and other drugs for sexual purposes experiences such harmful effects, but an honest examination of his gay social network in any urban center around the world will reveal that he does. there is no shortage of men in difficulty.
I believe chemsex in the gay community is a syndrome encompassing behaviors and characteristics that go far beyond the effects of specific drug molecules on the brain. Gay men have always looked for heightened sexual experiences. But sex over chemicals can quickly escalate into empty, sometimes abusive, and often unsatisfying high-risk sexual behavior that leaves the user feeling more disconnected and alone than before. While chemsex can serve as a sort of social leveler, allowing men of diverse racial and socio-economic backgrounds to interact, such opportunities can open the door to the exploitation of power and privilege, particularly noticeable in the rise. marked by chemsex in young people. black men and Latinx. It is true that chemsex momentarily erases self-doubt, low self-esteem and shame, replacing them with a sense of reckless invincibility and an insatiable libido. But with continued use, such intensity resets the amount of stimulation the brain needs for arousal, resulting in an escalation of behaviors (usually towards more risks and taboos) to trigger the dopamine surge.
It worries me a lot that, despite the known risks, so many gay men continue to use chemsex on a regular basis. Here are some actions that I believe are necessary to address this serious concern.
- Conduct an open community dialogue: There is a reluctance to speak openly about chemsex, perhaps because drug use (in the US) is confused with moral failure. Open dialogue not only elicits community solutions, but also effectively reduces stigma. Many men I know who use chemsex experience shame and stigma and gradually tighten their social networks to include only other users. We need to involve the community in this issue, just like we did with HIV.
- Provide specific information: Facts alone are not the only solution, but they could surely save lives. Gay men deserve safe, non-judgmental sources of accurate information about various drugs, their effects and risks, and how to intervene if necessary. Harm reduction practices should be discussed for those who wish to make their drug use safer or, for those considering abstinence, information should be provided to help with this decision and, if necessary, to find community resources. for the treatment.
- Improve processing capacity: The unique aspects of chemsex and the properties of its drug components require specialized knowledge and treatment, which is still lacking. Methamphetamine, for example, uniquely hijacks the brain’s reward system and destroys its ability to distribute dopamine, damage that takes up to 24 months to repair. During this time, a person is likely to suffer from persistent depression, poor cognitive performance, and increased impulsivity. These factors increase the risk of relapse unless clients and professionals understand them.
- Foster connection opportunities: The issue of loneliness and isolation in the gay community, an aggravated problem for people living with HIV, has started to receive well-deserved attention. Chemsex is a bigger problem than any group of men or than social division based on physical appearance, income or ethnicity. We must actively create welcoming communities for everyone, including men who may feel unworthy or have compassion for themselves. We all need to belong.
- Stay HIV positive: Any discussion of chemsex in the gay community should be open and tolerant of sexual behavior. The goal isn’t to define acceptable sexual behavior or put limits on kink, but rather to support men in defining what works for them. For those looking to change their self-defined problematic sexual behavior, open dialogue with peers and professionals can be instructive. Men who drop out of chemsex often fear they will be doomed to a life of vanilla sex or no sex at all, yet many men who recover from chemsex for a long time describe an intimacy and sexual connection far more rewarding than they are. have never known one with drugs.
- It cannot be done alone: Getting beyond problematic chemsex requires a lot of support. While few treatment facilities have developed skills to treat chemsex in gay men, outreach and treatment resources are beginning to be found in urban areas. Support groups such as Crystal Meth Anonymous and SMART Recovery are often available, and for those who are concerned about stigma or cannot access support groups, a growing number of online resources exist, such as In the Rooms. .
A friend that I respect once told me that chemsex, and meth in particular, is the “HIV” of this generation. It saddens me and terrifies me, but also pushes me towards action and advocacy.