DAVID STUART: «CHEMSEX IS A COMPLICATED PUBLIC HEALTH ISSUE»
David Stuart manages the ChemSex support services at 56 Dean Street addressing the sexualised drug use by gay men.He has been instrumental in placing ChemSex issues firmly on international Public Health agendas and has been consulted by the governments and public health bodies of many countries across Europe, Australia and USA, including the World Health Organisation/UNAIDS.
In addition to his management and practitioner roles, David is a researcher, policy-maker, educator, writer and lecturer on the issues of sexual wellbeing/culture, substance use and HIV..
It seems chemsex is on the rise. Is there a typical user profile?
When many people “picture” the typical drug user, they often see street homeless people, struggling with poor hygiene and life circumstances. When it comes to gay men, ChemSex is less discriminating; most are introduced to the trend via geo-sexual networking apps, and it pans age-groups, HIV positive and HIV negative status’, socio-economic groups, ethnicities and country/area of origin. The one thing that tends to be typical is a desire to enhance or medicate the sexual experience.
«ChemSex is a word invented by gay men, and adopted by the gay men’s health sector, to describe a unique sex and drug trend».
It is often said that chemsex is an issue which affects homosexual men. Is this true? Is there any data about heterosexuals who engage in chemsex activities or women-only chemsex sessions?
I think this really depends on how ChemSex is defined. There are many people besides homosexual men who use drugs and/or alcohol in sexual contexts, many problematically. Different populations and cultures are differently vulnerable to certain risks and harms. ChemSex is a word invented by gay men, and adopted by the gay men’s health sector, to describe a unique sex and drug trend, and defined by a syndemic of behaviours and circumstances uniquely connected to gay culture; they can include a tendency to have a higher number of partners from populations disproportionately affected by HIV and other STIs (and associated stigmas), issues around sex that can be connected to internalised or societal homophobia, certain recreational drugs that are particularly normalised, uniquely provide a sexual disinhibiting effect and are disproportionately available to gay men via geo-sexual networking Apps, and a hooking-up culture that emerged from the Smartphone sex-app revolution a decade ago. This is the generally accepted definition of ChemSex, though it’s important to continue to be vigilant about the needs and care of any population that might be using alcohol or drugs in sexual contexts.
Is there any link between chemsex and not being able to coming to terms with users being homosexuals?
There are many reasons why people might engage in ChemSex; the reasons can be as varied and unique as our fingerprints. Certainly, many people experience unease about gay sex; including those who enjoy it. Societal homophobia impacts us as young people in school playgrounds, in the family church, synagogue or Mosque, or even in the family home. Some people’s coming out experiences can be traumatic. And this can often cause conflict with our sexual desires, fantasies, or things we watch in gay pornography. Chems which serve as disinhibitors, can certainly resolve these conflicts for us, remove the unease or shame that we may be taking into the bedrooms with us. It is important to mention that there can be many other reasons that gay men engage in ChemSex, including peer pressure, HIV stigma, sexual confidence or body-image issues, intimacy issues, or simply because it “feels good”.
There is a long recorded historic usage of recreational drugs in the LGBT scene. Could we say we are facing a change in the way these drugs are being used?
Yes indeed; gay men have used very high amounts of recreational drugs (10 times more than their heterosexual counterparts, according to some studies). In the 1980’s, 1990’s and early 2000’s, gay men were using ecstasy, cocaine, MDMA and alcohol in large numbers. Many too, were using these drugs to facilitate sex. During those decades, we didn’t see large numbers of gay men accessing Emergency departments with the harms of these drugs. We didn’t see gay men seeking addiction support or safer injecting equipment from addiction services in particularly large numbers. We didn’t see worrying numbers of deaths occurring in saunas from the use of these drugs. And we didn’t see a particular rise in HIV or sexually transmitted infections directly attributable to these drugs. But in the early 2000’s, we saw new recreational drugs replace these drugs as the most commonly used by gay men; these drugs were crystal methamphetamine, mephedrone and GHB/GBL. These drugs became normalised almost overnight, and were made more easily available and dispersed than their forbears by the geo-sexual networking App revolution, and the “hook-up” culture that arrived with it. Suddenly, we were seeing more gay men presenting to emergency services, with overdoses and drug-induced psychoses. We saw more gay men accessing addiction support, seeking clean needles to inject drugs, and we heard more reports of chem-related deaths in saunas. And we saw rises in HIV infections and risks directly attributable to these drugs. So ChemSex is more than just a change in which historic drugs are being used, but in fact a syndemic of behaviours and circumstances that represent a phenomenal cultural shift in the way we seek and enjoy sex and recreation
To which degree can we blame the porn industry for disseminating the idea that engaging in chemsex sessions is just an enticing or even normal kink? Some porn producers chose to film extreme barebacking or even explicit chemsex: are they placing earning money before healthy habits?
Porn is a part of our lives, whether we like it or not, and it certainly can play a part in our developed understanding of sex and intimacy, as well as introducing us to new fantasies and fetishes. Many dangerous or risky fantasies are portrayed in pornography; within the realm of our imagination and fantasies, this ought not be a problem, nor something we should feel shame about.. The problem develops when our filter that helps us separate what belongs in fantasy, and what we might enjoy in real life becomes dysfunctional. Many of us are capable of enjoying risky fantasies in safe role-plays with trusted partners, but not all of us care about ourselves, or our partners during periods of poor mental health or poor self-worth. And Chems release an enormous amount of dopamine into our brains, making us feel invulnerable to harm, and pushing our sexual fantasies into more extreme places, often ignoring the risks. I don’t think we ought to be “blaming” the porn industry for normalising or fetishising ChemSex, but I do think we can ask the industry to take a more responsible role in our communities’ wellbeing, particularly as ChemSex appears to become more of a widespread problem.
We are certainly facing a situation which can lead to potentially serious consequences for both drug consumers and the health systems. How could we face or prevent this issue?
ChemSex is becoming an increasing concern for our communities and healthcare services. It’s helpful to remember that ChemSex is little more than a health syndemic affecting a small, but particularly vulnerable sub-population; it only becomes complicated when we get lost in the scandal of it, when it becomes confused by moral or unsympathetic judgments. If we can put that aside, see it as a simple health concern; if we respond practically and objectively by developing appropriate support services, and developing dialogues within our gay communities that are sympathetic of the complex issues associated with it, then we can easily address the growing concern of ChemSex.
You have previously said that “chemsex is not a drug problem-it’s a sex problem”. People who do not engage in chemsex, however, think that having sex is an excuse to justify drug usage. To which degree is the confident, uninhibited feeling an excuse to engage in chemsex sessions?
We all deserve to feel confident and uninhibited during sex; we all do, it’s a right, and an important part of how we function, communicate, and engage with others. Some of us aren’t always capable of this, for a variety of reasons. Some of us need help to do this; it’s important that we provide spaces where our gay brothers can feel this way, that we are kind and complimentary to each other in bed and online. It’s important that the vulnerabilities we take into the bedroom are viewed as sexy, and not as shortcomings, or as unattractive. It’s important that we address the cruel rejection culture that has developed on our hook-up Apps. It’s important that our community wellbeing services provide therapeutic support to our brothers who struggle to feel confident and uninhibited in bed. And until we are doing all this, until we’re all capable of enjoying great intimate, confident and/or uninhibited sex, let us not judge anyone who uses drugs to achieve this. That’s called being a caring and brilliant gay community.
Besides 56 Dean Street being an specialised health service which is unique in Europe, it is also handling PrEP users. How is the access to the preventive pill being implemented? Is there a noticeable demand?
PrEP is not yet available for free as part of NHS (National Healthcare Services) in England. Yet there is a need to find more ways to address the increasing HIV infections that occur each year, and there is certainly demand for PrEP amongst our communities and healthcare practitioners. Until the politics and expense issues are figured out, 56 Dean Street and other sexual health clinics in England are supporting patients to access PrEP themselves more affordably through international suppliers. We provide these patients with free care once they have accessed the drug; we test the quality of the drug, and provide behavioral and medical support for as long as they may need.
56 Dean Street is at the top league of sexual health facilities; do you think that major capital cities such as Madrid should take the risk and establish similar services, such as your clinics, which are in close contact with the community and its needs? What are the advantages over a tradicional model or over not having any resources dealing with sexual health at all?
It’s been a difficult few decades for gay men; we’ve endured a devastating HIV/AIDS epidemic, we’ve been fighting for equal rights, battling societal homophobia and stigmas; we’re struggling with new technologies and newer, very harmful drugs only a screen-swipe away on our smartphones. Public Health organisations have a responsibility to provide support services to gay men (and all) that are culturally competent, that are reflective of the needs of the communities struggling with poor health. This means more than just providing test-and-treat medical services, but services that provide talking therapies appropriate to the issues that fuel sexual health epidemics and the mental health of a city’s population. It’s not just “a nice thing to do”, it actually makes good economic and public health sense. I’d be very happy to see a centre of expertise service for gay men in Madrid, given the modern challenges gay men in Madrid are facing. I’m also very proud of the amazing ChemSex response and initiatives I’ve seen my colleagues in Madrid employ, in response to ChemSex.
«Public Health organisations have a responsibility to provide support services to gay men (and all) that are culturally competent».
Madrid is the Spanish city with more infections, as well as the national capital, yet it lacks a structured resource such as a checkpoint similar to BCN Checkpoint. Despite 56 Dean Street being a community driven center, it is part of the NHS; do you think that community managed models are a proper alternative to handle problems which arise when dealing with sexual health? What can you tell us about the experience of working togeteher wih the community within a public health care system?
ChemSex is a complicated public health issue, in that we need a range of expertise to address it holistically; we do need the expertise of medically-trained sexual health/infectious disease clinicians, to test, treat, prescribe medicines for STIs, PEP, antiretrovirals and provide care for HIV positive patients; we need pharmacists and doctors who understand the drug/drug interactions between HIV medicines and chems. We need these clinicians to have a good understanding of modern gay lifestyle and sexual challenges, and they need to be at ease discussing gay sex, App use and chem use easily – otherwise gay men might be less likely to tell them the truth about their sex lives and behaviour. But we also need some people trained in drug support services, who understand drug-related risks, injecting use, addiction and withdrawal. Additionally, we need the contribution from our gay community health services; people who understand what it is like to be gay, horny and lonely on a Saturday night, with an App on your phone, or who understands sauna culture and peer pressures. We need gay men who can empathise with online rejections while hooking-up, understand internalised homophobia, or HIV stigma in the bedroom or online. 56 Dean Street has managed to pull all of this expertise together with a multi-disciplinary team, and we’ve done it so all the expertise is in one building, sharing the information, rather than sending our patients to different buildings/services across the city. I’ve no doubt there are challenges to pull all of these experts together in a single building in Madrid, but I’d enthuse and motivate your readers or activists to work toward that goal. But it would most certainly begin with a gay community response; ChemSex is an issue we gay men understand best; and we also have an extraordinary history of coming together in a crisis, of being extraordinary activists and communities. We managed to come through the AIDS epidemic as a proud, united community, if a little scathed; we can certainly unite to address our struggles with ChemSex. I have every faith.
David’s clinical and community work is recognised and resourced internationally.His work was featured in a 2015 documentary by VICE UK, titled «ChemSex».
- You can read the interview in Spanish by clicking here.