Course:SOWK551/2021/Gay men with Chemsex in Healthcare
Short Summary
Literature review of how healthcare workers can better support gay men involved inChemsex in their healthcare experiences.
Author: Valerie Siu
Date: April 2, 2023
Introduction
The practice of combining substances and alcohol use with sexual activities is known as Chemsex or Party and Play (PNP), and it is used to sustain, enhance, disinhibit or facilitate the sexual experience (Bourne et al., 2015). In a 2018 publication in the International Journal of Drug Policy, the occurrence of chemsex among Canadian men who have sex with men (MSM) was estimated at 5.5%. Meanwhile, a 2020 study in the Journal of Homosexuality revealed that 40% of MSM in Canada had reportedly used drugs while engaging in sexual activity. As a result, the activity has become an increasingly pressing issue for healthcare professionals, especially within the gay male community.
This paper aims to explore research on "How can healthcare social workers provide support for gay men involved in chemsex in their healthcare service? "Through a review of current literature, this resource will provide recommendations for social work practice in healthcare and contribute to the conversation on substance use and sexual health in the LGBTQ+ community.
Literature Review: What is Chemsex
HM Government (2017) defined Chemsex as "the use of specific drugs in sexual contexts by gay men, bisexual, MSM and trans people and to sustain, enhance, disinhibit or facilitate the experience before or planned sexual activity”. The activity typically involved using specific substances, such as Methamphetamine, Mephedrone, gamma-hydroxybutyrate (GHB) and crystal methamphetamine (meth). According to a study by Bourne et al. (2015), Methamphetamine, crystal meth and Mephedrone are stimulants that increase physical energy, enhance sexual performance and induce euphoria. GHB is a depressant to relax and causes loss of consciousness. It is also commonly used as a date rape substance. These substances could bring significant impacts on both physical and mental health. In particular, the stimulants could increase heart rate and blood pressure and damage the liver, kidneys and lungs (Isaiah et al., 2006). In addition, the depressant had a significant effect in small doses, while a high dose may cause loss of consciousness, coma or even death (Degenhardt et al., 2019).
Physical and Mental health risks in Chemsex
Although using substances involved in Chemsex mentioned above would physically severely impact the body, the risk of HIV and other sexually transmitted infections (STIs) would also increase the likelihood of engaging in unprotected sex while under the influence of substances. In addition, STIs could cause many harmful effects on the body, including inflammation, pain and organ damage (Burchell et al., 2015).
In addition to physical health risks, Chemsex is associated with various mental health issues, such as anxiety, depression and social isolation. Furthermore, Bourne et al. (2015) stated that Chemsex also led to feelings of shame, guilt and low self-esteem. As such, it would exacerbate existing mental health problems or lead to new mental health concerns.
Some substances, such as GHB, could lead to amnesia or "blackout"; the unconsciousness could increase the risk of sexual assault or other forms of violence (Csete et al., 2016). In particular, those involved in marginalized employment or sex work might be susceptible to coercion and exploitation, especially when participating in Chemsex.
Factors contribute to Chemsex
Chemsex is a complex phenomenon influenced by various factors, and research has identified individual, social, cultural and systemic factors.
Individual factors, such as trauma, anxiety, depression and low self-esteem, are potential factors linked to the use of substances during sex (Sewell et al., 2019). For example, Tan et al. (2021) suggested that some gay men see Chemsex as a utility in allowing them to achieve positive emotional states, sexual enhancements and feelings of connectedness and intimacy in their study of exploring the role of trauma in underpinning Chemsex in Singapore. They also reported using substances to cope with the trauma of past experiences such as sexual abuse, unwanted and unprotected sex, domestic violence and discrimination.
Social and cultural factors, such as peer pressure, social isolation and misunderstanding LGBTQ+ community, were also significant contributors to Chemsex (Gaudette et al., 2023; Bourne et al., 2015). Bourne et al. (2015) stated that Chemsex could be a way for gay men to cope with societal discrimination and homophobia. Hence, the trend of dating apps or online dating platforms was also identified as a contributing factor as they provided easy access to partners, substances or related Chemsex information, according to a report from the University of Amsterdam (2018). They found out that MSM who use dating apps were more likely to engage in Chemsex than those who did not use online dating platforms. The normalization of the LGBTQ+ community also worked as an active contributor to using substances during sex (McBride et al., 2019).
Systematic factors such as criminalization and stigma associated with substance use and sex work could also contribute to the prevalence of Chemsex. Bauer et al. (2015) stated that the criminalization of substance use and sex work had led to a lack of harm reduction resources and services for gay men engaged in Chemsex. The intolerance from society and bias on particular behaviour also hindered this population and contributed to their substance use.
Impact of Chemsex on relationships
The use of substances during sex could have a profound impact on relationships, particularly intimate partnerships.
Increased sexual risk behaviour is one significant impact, such as engaging in unprotective sex with multiple partners, which can lead to STIs and HIV transmission (Bourne et al., 2015). Furthermore, this behaviour might cause tension and mistrust between partners, especially if one partner is unaware or uncomfortable with the other's participation in Chemsex. Additionally, the physical and emotional effects of substances could impair judgement and consciousness, leading to a potentially dangerous situation and causing further damage to the relationship (Hegazi et al., 2017).
Another impact on a relationship was the potential for addiction and substance dependence. Bourne et al. (2015) stated that addiction could lead to secrecy and dishonesty in relationships and would prioritize substance use over the relationship itself. They noted that Chemsex could focus on sex as a primary activity in the relationship rather than emotional intimacy and connection. The shift could result in a lack of communication and emotional distance between partners, damaging their bond.
Barriers to accessing healthcare services
Milhet and colleagues (2019) conducted in-depth interviews with 33 gay men and other MSM engaged in Chemsex aged 31-39 in this qualitative study. The results showed that one of the difficulties was the lack of language to express the bodily pleasures of Chemsex. Even if they did, they mentioned it would not be understood by a non-practicer (Pennant et al., 2009).
Another barrier to accessing healthcare services for MSM was the lack of culturally competent care. LGBTQ+ individuals often face discrimination, stigma and prejudice when accessing healthcare services; Grant et al., 2011 stated the lack of trust and avoidance of care would restrict them from seeking help or disclosing their difficulties. As such, this population would have higher rates of substance use, mental health issues and STIs.
Furthermore, the criminalization of substance use and sex work could also create barriers to accessing healthcare services due to the fear of legal consequences, such as arrest and incarceration, which would deter individuals from seeking medical care (Csete et al., 2016). The reluctance to care leads to a lack of testing and treatment for STIs, mental health issues and substance-related harm. Criminalization also limited the availability of harm reduction services such as safe injection sites and clean needles (Bauer et al., 2015). For example, in the Mental Health Act, physicians' duty of report or police involvement in healthcare services would become a barrier for MSM to disclose and access services with dignity.
In addition, negative hospitalizations or experiences would impede MSM from seeking services. Dodge et al. (2008) suggested that MSM may experience trauma related to their interactions with healthcare providers as their prejudgment and attitudes would create an unsafe and unwelcome environment. Hence, healthcare may also hold stigmatizing attitudes toward MSM or those engaged in sex work, which can result in a lack of empathy and inadequate care (Hegazi et al., 2017). Fulcher and colleagues conducted a qualitative research in semi-structure interviews with 33 MSM to identify their needs and preferences regarding treatment and services in British Columbia, Canada. Participants expressed a desire for support and assistance with their substance use but shared that the services were lack of connection with healthcare professionals. This study also pointed out that healthcare professionals used a "one size fits all" approach but did not adequately meet their needs, while Chemsex was a complex issue requiring a multi-faceted approach. It showed a lack of understanding, knowledge, early assumptions, and judgements that would lead to misdiagnosis or inappropriate treatment (Bauer et al., 2015) and further harm. It contributed to a cycle of trauma in avoiding healthcare services (Hegazi et al., 2017).
The implication of practice: What can be suggested to enhance the services
While Canada strives to promote gender-sensitive and respectful healthcare environments, there is still room for improvement in addressing the needs of marginalized groups. By synthesizing information from multiple sources, various practice implications are recommended to be implemented to serve this population better.
Awareness of ethical considerations: Ethical considerations are critical in healthcare, particularly in providing equitable and respectful services to marginalized groups. One important consideration is the need for healthcare providers to be non-judgemental and free from discrimination based on sexual orientation or gender identity. This includes using appropriate pronouns and avoiding assumptions about an individual's sexual orientation or gender identity. It is also suggested to prioritize informed consent to ensure individuals fully understand the potential risks and benefits of any interventions, including those related to Chemsex (Canadian Medical Association, 2020).
Training for healthcare providers: Physicians, therapists, social workers or other practitioners involved in healthcare service should all have adequate training to create a safe, welcoming and supportive space for MSM without coming with fear of stigma and discrimination. The training involves trauma-informed practice, addressing trauma and concerns, cultural awareness and knowledge about harm reduction strategies and resources available in their settings. Social workers are expected to collaborate with other healthcare professionals to develop holistic care plans that address multiple needs. Social workers are believed to have a crucial role in supporting MSM, in developing approaches that account for the fine line between stigma and care. A study by Gaudette and colleagues (2023) found that social workers trained in harm reduction strategies were better equipped to support MSM. This showed that providing and advocating culturally sensitive care can help reduce the harm associated with Chemsex and promote clients' health and wellbeing.
Educate with harm reduction approach: Besides assisting in accessing resources, healthcare social workers have a crucial role in educating MSM engaged in Chemsex using a harm reduction approach, aiming to reduce the transmission risk of HIV and other STIs (Fulcher et al., 2022). For example, they can provide counselling on safer sex practices and emphasize the importance of regular STI testing to promote their clients' health and wellbeing. Furthermore, social workers can advocate for providing safe sex supplies and testing kits in their offices or specific wards to promote safer and healthier sex practices.
Building partnerships with community organizations: Healthcare social workers can gain valuable insights into the unique needs and challenges faced by MSM engaged in chemsex. As harm reduction programs play a crucial role in promoting the health and welling-being of this population, healthcare social workers can ensure clients are provided with holistic and culturally competent care in partnering with a community organization. Efficiency is crucial to healthcare services, particularly in a hospital care setting. However, the constraint of time can pose a significant obstacle in meeting the needs of patients, as discussed in a recent study by Fulcher et al. (2022). As such, partnering with community services can help bridge the gap between healthcare services and community-based resources to promote a more seamless and coordinated approach to care.
Promoting policy changes: Healthcare social workers can work toward creating policies, including increased access to affordable healthcare and mental health services or policies that address discrimination and stigma toward this population. Social workers can work with policymakers to promote harm reduction approaches such as safe injection sites, specialized wards or free access to safe kit supplies. Plus, healthcare social workers can also work towards increasing funding for research on the health and social impacts of Chemsex on gay men. This can help us to understand this population better and advocate for the inclusion of gay men engaged in Chemsex in research studies and clinical trials to promote the dissemination of research findings to inform a better inclusion policy.
Limitation
This study focuses on the experience and impacts of gay men involved in Chemsex and addresses their barriers to healthcare service. However, it only focused on gay men but did not cover other LGBTQ+ groups who may also be engaged in Chemsex. In addition, although there were serval studies that found gay men and bisexual men were more likely to report using drugs during sex compared to lesbian and bisexual women (Bourne et al., 2015; Dodge et al., 2008), it is essential to note that these studies are not necessarily representative of all LGBTQ+ individuals, and more research is needed to fully understand the patterns of substance use during sex in this population.
Conclusion
Chemsex, including its definition and the physical and mental health risks it poses, as well as its impact on relationships and the factors contributing to its prevalence in the gay community, was explored in this paper. The study also analyzed the obstacles faced in accessing healthcare services and proposed practical recommendations for improving them. Finally, it emphasized the critical role of healthcare social workers in creating a safe and respectful environment for this population. However, further research is necessary to reduce the risks associated with the LGBTQ+ community.
References
Bauer, G. R., Scheim, A. I., Pyne, J., Travers, R., & Hammond, R. (2015). Intervenable factors associated with suicide risk in transgender persons: A respondent driven sampling study in ontario, canada. BMC Public Health, 15(1), 525-525.
Bourne, A., Reid, D., Hickson, F., Torres-Rueda, S., & Weatherburn, P. (2015). Illicit drug use insexual settings (‘chemsex’) and HIV/STI transmission risk behaviour among gay men in south london: Findings from a qualitative study. Sexually Transmitted Infections, 91(8), 564-568.
Bourne, A., Reid, D., Hickson, F., Torres-Rueda, S., Steinberg, P., & Weatherburn, P. (2015). “Chemsex” and harm reduction need among gay men in south london. The International Journal of Drug Policy, 26(12), 1171-1176.
Burchell, A. N., Allen, V. G., Gardner, S. L., Moravan, V., Tan, D. H. S., Grewal, R., Raboud, J., Bayoumi, A. M., Kaul, R., Mazzulli, T., McGee, F., Rourke, S. B., OHTN Cohort Study Team, & on behalf of the OHTN Cohort Study Team. (2015). High incidence of diagnosis with syphilis co-infection among men who have sex with men in an HIV cohort in ontario, canada. BMC Infectious Diseases, 15(1), 356-356.
Canadian Medical Association. (2020). CMA code of ethics and professionalism.
Chemsex Forum Organisation Comittee 3rd European Chemsex Forum Paris. 2019.
Csete, J., PhD, Kamarulzaman, A., Prof, Kazatchkine, M., Prof, Altice, F., Prof, Balicki, M., MD, Buxton, J., Prof, Cepeda, J., PhD, Comfort, M., PhD, Goosby, E., Prof, Goulão, J., MD, Hart, C., Prof, Kerr, T., Prof, Lajous, A. M., Prof, Lewis, S., Prof, Martin, N., DPhil, Mejía, D., Prof, Camacho, A., Prof, Mathieson, D., MA, Obot, I., Prof, . . . Beyrer, C., Prof. (2016). Public health and international drug policy. The Lancet (British Edition), 387(10026), 1427-1480.Daley, A., Solomon, S., Newman, P. A., & Mishna, F. (2007). Traversing the margins: Intersectionalities in the bullying of lesbian, gay, bisexual and transgender youth. Journal of Gay & Lesbian Social Services, 19(3-4), 9-29.
Degenhardt, L., Prof, Charlson, F., PhD, Stanaway, J., PhD, Larney, S., PhD, Alexander, L. T., BA, Hickman, M., Prof, Cowie, B., PhD, Hall, W. D., Prof, Strang, J., Prof, Whiteford, H., Prof, & Vos, T., Prof. (2016). Estimating the burden of disease attributable to injecting drug use as a risk factor for HIV, hepatitis C, and hepatitis B: Findings from the global burden of disease study 2013. The Lancet Infectious Diseases, 16(12), 1385-1398.
Dodge, B., Jeffries, W. L., & Sandfort, T. G. M. (2008). Beyond the down low: Sexual risk, protection, and disclosure among at-risk black men who have sex with both men and women (MSMW). Archives of Sexual Behavior, 37(5), 683-696.
Fulcher, K., Berlin, G., Taylor, K., Wells, A., Nguyen, T., Moore, D., Hull, M., & Lachowsky, N. J. (2022). Understanding the service needs and preferences of men who have sex with men who use crystal methamphetamine in british columbia, canada: A qualitative study. International Journal of Mental Health and Addiction,
Grant, J., Keisling, M., Harrison, J., Mottet, L., Herman, J., Tanis, J., National Center for Transgender Equality, & The National LGBTQ Task Force. (2011). Injustice at every turn: A report of the national transgender discrimination survey
Gaudette, Y., Flores-Aranda, J., & Heisbourg, E. (2023). Needs and experiences of people practising chemsex with support services: Toward chemsex-affirmative interventions. Journal of Men's Health, 18(12), 57-67.
Hegazi, A., Lee, M., Whittaker, W., Green, S., Simms, R., Cutts, R., Nagington, M., Nathan, B., & Pakianathan, M. (2017). Chemsex and the city: Sexualised substance use in gay bisexual and other men who have sex with men attending sexual health clinics. International Journal of STD & AIDS, 28(4), 362-366.
Isaiah Green, A., & Halkitis, P. N. (2006). Crystal methamphetamine and sexual sociality in an urban gay subculture: An elective affinity. Culture, Health & Sexuality, 8(4), 317-333.
International journal of drug policy issues 11 research articles in february 2018 edition; journal. (2018, ). Targeted News Service (TNS)
Kattari, S. K., Walls, N. E., & Speer, S. R. (2017). Differences in experiences of discrimination in accessing social services among Transgender/Gender nonconforming individuals by (dis)ability. Journal of Social Work in Disability & Rehabilitation, 16(2), 116.
McBride, K. R., Reece, M., Sanders, S. A., & Dodge, B. (2019). Exploring the complex realities of chemsex: a narrative review. Substance Use & Misuse, 54(2), 259-269.
Moreno-Gámez, L., Hernández-Huerta, D., & Lahera, G. (2022). Chemsex and psychosis: A systematic review. Behavioral Sciences, 12(12), 516.
Milhet, M., Shah, J., Madesclaire, T., & Gaissad, L. (2019). Chemsex experiences: Narratives of pleasure. Drugs and Alcohol Today, 19(1), 11-22.
Pachankis, J. E., Hatzenbuehler, M. L., Rendina, H. J., Safren, S. A., & Parsons, J. T. (2015). LGB affirmative cognitive-behavioral therapy for young adult gay and bisexual men: A randomized controlled trial of a transdiagnostic minority stress approach. Journal of Consulting and Clinical Psychology, 83(5), 875-889.
Pennant, M. E., Bayliss, S. E., & Meads, C. A. (2009). Improving lesbian, gay and bisexual healthcare: a systematic review of qualitative literature from the UK. Diversity and Equality in Health and Care, 6(3).
Pufall, E., Kall, M., Shahmanesh, M., Nardone, A., Gilson, R., Delpech, V., Ward, H., Hart, G., Anderson, J., Azad, Y., Elford, J., Sullivan, A., Mercer, C., McOwan, A., Peck, J., Cassell, J., Musonda, J., Bruton, J., Positive Voices study group, & The Positive Voices study group. (2018). Sexualized drug use (‘chemsex’) and high‐risk sexual behaviours in HIV‐positive men who have sex with men. HIV Medicine, 19(4), 261-270.
Reports from University of Amsterdam Describe Recent Advances in HIV/AIDS (Chemsex Among Men Who Have Sex With Men: a Sexualized Drug Use Survey Among Clients of the Sexually Transmitted Infection Outpatient Clinic and Users of a Gay Dating App ...). (2018, May 21). AIDS Weekly, 126
Strategy, D. (2017). Drug strategy. HM Government.
Sewell, J., Cambiano, V., Speakman, A., Lampe, F. C., Phillips, A., Stuart, D., Gilson, R., Asboe, D., Nwokolo, N., Clarke, A., & Rodger, A. J. (2019). Changes in chemsex and sexual behaviour over time, among a cohort of MSM in london and brighton: Findings from the AURAH2 study. The International Journal of Drug Policy, 68, 54-61.
Tan, R. K. J., Phua, K., Tan, A., Gan, D. C. J., Ho, L. P. P., Ong, E. J., & See, M. Y. (2021). Exploring the role of trauma in underpinning sexualised drug use (‘chemsex’) among gay, bisexual and other men who have sex with men in singapore. The International Journal of Drug Policy, 97, 103333-103333.
|
