London School of Hygiene & Tropical Medicine

The Chemsex study, which was commissioned by the London Boroughs of Lambeth, Southwark and Lewisham, looks at the complex relationship between drug use and risky sexual behaviour and documents harms that some gay men experience. It is the first qualitative research in the UK into "chemsex", or sex under the influence of drugs such as crystal methamphetamine, GHB/GBL and mephedrone.

Experts from Public Health England have previously raised concerns that chemsex could be behind rising rates of HIV and sexually transmitted infections in gay men, which have been increasing nationally for several years. The report makes a number of recommendations for local authorities, the NHS, the voluntary sector, gay businesses and the wider community. In addition to its significance for the large gay and bisexual community in Lambeth, Southwark and Lewisham, the report's findings will be relevant across London and the UK as public health teams in local authorities respond to problems related to sexual health and substance use.

Researchers analysed survey data* from 1,142 gay and bisexual men living in Lambeth, Southwark and Lewisham and conducted in-depth interviews with 30 gay men from the area. They found that although chemsex was reported to increase sexual arousal and facilitate more adventurous sex, many men were using drugs to mask self-esteem or self-confidence issues. The majority of men were not happy with their sex lives and wanted a long-term partner for more intimate and emotionally connected sex.

Around a third of men interviewed found it difficult to maintain control of their behaviour or negotiate safe sex while under the influence of drugs and had unprotected sex with high risk of HIV/STI transmission, which they regretted. Overdosing, panic attacks, convulsions and sexual assault were all associated with chemsex. Many men also felt that the large amount of time they spent engaging in chemsex was detrimental to their social relationships and career progression.

The authors note that the visibility of drug use on social and sexual networking apps may be normalising the injection of drugs such as crystal methamphetamine in a sexual setting, also known as "slamming". Chemsex was most commonly reported to occur in private homes, as well as in saunas or other sex-on-premises venues.

Report lead author, Dr Adam Bourne from the Sigma Research team at the London School of Hygiene & Tropical Medicine, said: "A vulnerable section of society is using new drugs in new ways that is putting them at serious risk. Although our study shows that chemsex is uncommon overall, there is a need for specialist support for men who have sex under the influence of these drugs.

"Gay and bisexual men need better information and advice as well as access to gay-friendly drug and sexual health services that are able to address the psychosocial aspects of chemsex. We also need to work with social and sexual networking apps and websites to ensure they are supporting health promotion and harm reduction to their users."

Lambeth has the highest prevalence of HIV in the UK (14 per 1000 residents aged 15-59) and Southwark has the second highest HIV prevalence (12 per 1000).

The Chemsex Study's key recommendations include the production of resources that provide drug harm reduction information, access to gay-friendly drug and sexual health services that understand the issues around chemsex, co-ordinated work with managers of commercial sex-on-premises venues to develop harm reduction policies and procedures and engagement with commercial companies and gay media / apps to provide harm reduction as part of a corporate responsibility to their users

* Survey data from the 2010 European MSM Internet Survey (EMIS).

Report

• Adam Bourne, David Reid, Ford Hickson, Sergio Torres Rueda, Peter Weatherburn. The Chemsex Study: drug use in sexual settings among gay and bisexual men in Lambeth, Southwark and Lewisham. Sigma Research, London School of Hygiene & Tropical Medicine.