Chemsex: The Underreported Gay Epidemic?

Open up any hookup app and it's not hard to find users offering to "parTy" or looking for "Party and play (PnP)". Consuming drugs, including legal ones like alcohol, is usual for many people, whether gay or straight. But the emergence of a PnP (or chemsex) underground scene is ruining the lives of gay men across the world, who are being caught in a culture of unsafe sex and risky drug use.

Drug-fueled sex sessions, often with multiple partners and without protection, are being enabled by the drug methamphetamine, also known as crystal meth, Tina, or simply T. This highly addictive stimulant lowers inhibitions, increases energy levels, and reduces appetite, at the same time as functioning as an aphrodisiac for the predominantly gay men who use it.

It's not just crystal meth that is used during chemsex (also called slamsex), with GHB (also known as G) and mephedrone also being widely used. During these group sex parties, crystal meth is typically snorted or mixed with water and injected. Some men inject it inside the anus, a practice called booty bumping.

The advent of gay dating apps, like Grindr and Scruff, offering no-strings-attached hookups, has made access to sex far easier than before, with dozens of men looking for sex being able to find it in a matter of minutes.

Lonely gay men or those from other cities or countries looking to find friends and community on dating apps can be pulled into this scene and became trapped before they even realize the extent of the problem.

'My life fell apart'

For the gay men who fall into this world, where heavy drug use and hours-long group sex is the norm, it can take just days to get addicted and years to escape. "I was doing G every day, I was smoking meth practically every day, I was injecting at least twice or three times a week. My life fell apart," says Ignacio Labayen de Inza, chemsex specialist advisor and CEO of Controlling Chemsex, who is now using his first-hand experience of the damage chemsex can cause to help others.

Between 2012 and 2015, Inza says, chemsex dominated his life and he couldn't do anything else except for trying to survive. "This obviously gave me a completely different perspective, not just as a professional, but also as someone who had to go through that."

Originally from Spain, Inza left everything behind and moved to London to work with a charity focused on alcohol and substance issues. But it quickly became apparent that the gay men the charity served were increasingly getting involved in chemsex.

'We had to learn from minute-to-minute because there was no school where we could learn how to help someone who wants to stop using G – there was no information around," he explains.

At the peak, Inza was seeing up to 15 men a week in one-to-one sessions to help them get back control of their lives and leave the chemsex cycle behind. Alongside David Stuart, the chemsex and addiction expert who coined the term chemsex, Inza helped created a document about how to support people who were struggling with this problem.

While one of the first goals was to share this information with professionals to give them the knowledge of how to support patients who wanted help to stop using, Inza had the idea to bring this advice directly to those men most at risk – on Grindr.

"I created a profile on Grindr just to deliver this leaflet, and in the first year around 13,000 people contacted that profile. But people were also contacting us because they needed help – they didn't know where to go," he says.

Beyond practical reasons, such as not having the right level of health insurance or being in a rural location without access to qualified doctors in this area, some men hesitate to reach out for support as they may be concerned about a friend or acquaintance seeing them in the waiting room.

"The reality was getting worse and worse – no [charity or LGBT organization] really wanted to do anything more than what they were already offering."

At the beginning of 2020, just before the first lockdown in the UK, he decided to create an organization called Controlling Chemsex with colleagues to offer virtual support to people who couldn't go to clinics in-person.

"The idea initially was just to give support on Grindr and Scruff. But we realized that there were people who were asking for help and they didn't know where to go. We started to help them online on a weekly basis. There were also [volunteers] contacting us on Grindr, saying, 'I've had problems with chemsex in the past myself – I want to help'."

Inza and his team created a training program for peer mentors, with there now being a team of around eight psychosexual therapists and 10 peer mentors working with Controlling Chemsex. "We are doing the best we can. We are getting messages from people from all over the world, asking us for support."

The chemsex epidemic isn't isolated to a single country, with countless cities across the world where large numbers of gay men live seeing active chemsex scenes. The team behind Controlling Chemsex have supported people living in everywhere from Bangkok, to Turkey, to South Africa, to California, and many more areas.

"It's really sad – things are getting worse and worse every day. For the first time we are seeing straight men coming to our services, who are having sex with trans women. For the first time, we are also seeing straight women who have sex with men on chems."

"We are growing very fast. But the reason why we are growing fast is because things are getting terribly worse, and any support is very limited."

High-risk Sex

Despite the devastating damage inflicted by crystal meth and other chemsex drugs on gay men from London to New York, this developing epidemic has gone largely unreported in both mainstream and queer media. The lack of reporting and discussion within the gay community about this issue only adds to the shame and isolation felt by those men trapped in the cycle of sex and drug addiction.

The sustained growth of chemsex has also been cited as contributing to new HIV cases. Several studies conducted over the last decade found those men who take part in chemsex or slamsex report higher levels of sexually transmitted infections and have engaged in high-risk sexual behavior.

A study published last year of 101 Spanish men who have sex with men (MSM), who are living with HIV, and who engage in chemsex "participate in more risky sexual practices and make less use of condoms with occasional partners, which leads to a greater risk of STD infection."

According to the Rutgers University's Center for Health, Identity, Behavior and Prevention Studies, regular crystal meth users have a 400% higher chance of contracting HIV compared to non-users.

There's no question that gay men are at a particular risk of engaging in chemsex. So why exactly are so many gay men taking part in chemsex?

According to Dr David Fawcett, a certified sex addiction therapist who has worked with clients on addiction issues for over 30 years, there are a number of intertwined issues around stigma, shame, the legacy of AIDS, internalized homophobia, and other psychosocial factors that continue to play out in the community.

"The combination of the temporary escape provided by the chemical effect of the drugs, along with the social connection, whether it is sexual and/or social, has been appealing to many men despite the severe consequences of addiction that often follow," he explains.

For the men dealing with methamphetamine addiction who want to leave chemsex behind, little meaningful support is usually available. Reaching out for help can be an extremely difficult action for many with a drug or sex addiction; if the person they contact for assistance in the first instance doesn't have the right tools, it's possible they won't ask for help again.

"As a therapist I've had many clients say they could speak to their gay doctor about anything except their drug use," explains Fawcett.

"Part of the solution is asking gay men to move past their embarrassment or shame and ask for help. But part of the solution is also making sure the provider is able to receive that information without judgment and provide resources for those patients."

Fear of getting shamed or judged for engaging in drug use and chemsex stops many gay men from taking the first step to getting help with their addiction. Internalizing these feelings of shame can then lead to higher levels of drug usage and risky sex.

One of the first avenues of support, the primary care doctor, is usually either unaware of what chemsex is, or doesn't have the right knowledge to refer their patient to a medical professional who can offer the right help.

For LA-based Jim Mangia, who is the president and chief executive of St. John's Well Child and Family Center, gay leaders and organizations have shown an "abject lack of leadership" in directly addressing the chemsex issue.

"The free expression of gay sexuality is a very recent phenomenon and it is still shrouded in shame," Mangia adds. "Hatred of LGBTQ+ people is ongoing. The search for, and, at the same time, the aversion against intimacy are deep psychological reverberations that rise out of the historic oppression of gay people. All of these factors, and more, contribute to this frightening dynamic."

An essential way to combat this epidemic, in Mangia's view, is for comprehensive educational campaigns to be launched that go beyond traditional prevention campaigns. "If we were serious about addressing this issue, we would need to invest the resources, as a nation and as a community, in developing the concepts and strategies for programs that would be effective."

A coordinated response from a range of stakeholders, including the gay community, the health services sector, and government agencies, is needed to ensure the chemsex epidemic is effectively confronted, Mangia sex.

"It's not a comfortable issue to discuss, many gay men are rightfully concerned about a public discussion of sexual dynamics within the gay male community given historical experiences," concludes Mangia. "But that is not an excuse for ignoring the issue, as gay men literally die from addiction often fueled initially by chemsex/party and play (PnP) culture."