Chemsex: @davidastuart @56deanstreet David - Stuart@chelwest - Nhs.uk

CHEMSEX
@davidastuart @56deanstreet [email protected]

@davidastuart
Gay drug use trends have changed
Ten years ago Today
ChemSex; a working definition
ChemSex is NOT the same as recreational drug use.
It is a specific form of recreational drug use.
Defined as any combination of drugs that includes Crystal Methamphetamine,
Mephedrone and/or GBL, used before or during sex by gay, bisexual, or other Men
who have Sex with Men (MSM) - including Trans* people; MSM being a specific
group representing a high prevalence of HIV/HCV/STIs and a cultural tendency to
have a higher number of sexual partners.
Associated with
Extended sex for many hours/several days.
More extreme sexual practices/traumatic sex
Multiple partners
Extreme sexual disinhibition/extreme sexual focus
Unpredictable drug interactions (eg; GBL & alcohol)
Increased injecting use amongst an injecting-naïve population; BBV risks & injecting-related harms
Poor condom use
Poor ARV adherence*
Frequent STI’s (including a current Shigella outbreak), HIV infections, HCV infection/repeated re-infections
Multipile and repeated use of PEP
Psychosis/ physical dependence/ overdoses
Stuart D and Collins S, Methmephangee - ChemSex vs recreational drug use: a proposed
definition for health workers. HIV Treatment Bulletin, Volume 16 Number 5/6, May/June 2015.
Published online ahead of press.
ChemSex and HIV epidemiology
@davidastuart
IS THIS A SEX PROBLEM

OR A
DRUG PROBLEM?
CAN WE SIMPLY REFER THESE PATIENTS TO

SUBSTANCE MISUSE SERVICES?
2 men & 1 woman
walk into a drug service….
@davidastuart
@davidastuart
BE ALERT TO THESE RISKS

High number of sexual partners per ChemSex episode
High frequency of ChemSex episodes
Long gaps between GUM/HIV screens/poor engagememt with GUM/HIV/HCV appointments
Consistently poor condom use when using Chems
High number of STIs in last 6 months/multiple HCV re-infections
High frequency of PEP presentations (if HIV-neg)
Seroconversion symptoms that might be disguised as a ‘drug high’ or drig ‘comedown’.
HIV-positive but not on treatment
Consistently poor ARV adherence if HIV –positive (enough to increase infectiosness/jeopardise

viral suppression)
Dependent GBL use (daily, beyond 7 consecutive days) which can be associated with
potentially fatal withdrawal symptoms if use is abruptly discontinued.
Simplifying access to treatment
@davidastuart
Identifying need; survey your cohort
Are you; ☐ Male ☐ Female ☐ Other; _____________
Do you have sex with: ☐ Men ☐ Women ☐ Both
In the last 6 months have you used any of the following drugs before or during sex? (please tick all that apply)
☐ GBL/GHB (G, Gina)
☐ Crystal Meth (Tina, T, Ice)
☐ Mephedrone (Meph, MKat)
☐ Other ________________________
☐ None
If you have used any drugs in the last 6 months, please continue.
Does your drug use impact the choices you make regarding safer sex? ☐ Yes ☐ No ☐ Sometimes
Does your drug use have any undesirable effects on your social or professional life? ☐ Yes ☐ No ☐ Sometimes
What percentage of your sex life is sober (drug-free)? 0 10 20 30 40 50 60 70 80 90 100
If you wanted advice about drug use, where would you prefer to go?
☐ General Practitioner ☐ Drug Service ☐ sexual health clinic ☐ LGBT charity
☐ Somewhere else _______________________________________________________
(A downloadable & extended survey can be found at

http://www.chemsexsupport.com/Drug%20use%20survey%20GUM%20brief.pdf )
Multi-disciplinary approach
Front Line staff; questions for all MSM
Have you used drugs before or during sex in the last 6 months?
If yes, Which? - Mephedrone/GBL/Crystal Methamphetamine? Other?
(i.e; emphasis on the recreational drugs that are associated with greater sexual disinhibition/sexual risk-
taking).
If yes - Did you inject?

(To highlight those needing needles/injecting advice, and to alert non-sexually transmitted infection risks).
(Finally a question that could trigger a call to action/reflection)
Examples;
- Are you happy with your level of drug use?
- When did you last have sober sex? Do you want to discuss this with a specialist
worker?
- Do you feel your drug use is negatively impacting your sex life or general wellbeing?
Would you like to discuss this with a specialist worker?
Questions to ask; probing further
A client/patient who is using Chems, but refuses help, or claims it is not a
problem, may permit (if asked kindly) a few further questions.
•“How long do you stay awake for?”
•“Have you had any bad experiences?” (eg; paranoia)
•“Do you sometimes regret the choices you make when high?”
•“When did you last have sober sex?”
•“What’s your non-sexual/non-clubbing social life like?”
•“Are you slamming (injecting) ?”
•“Do you want to talk to someone about being safer with drugs?”
Welcome/assessment in ChemSex Clinic
Welcome to 56 Dean Street ChemSex support.
Today, do you want to;
☐ Speak to a nurse/doctor about sexual health symptoms, or a sexual health risk that might have occurred?
☐ Speak to a Chems Advisor about gay sex and drugs, App use or dating/finding partners?
☐ Speak to a drugs worker about injecting, addiction/detox or to get some clean needles?
Further questions might include
Which drugs are being used (before or during sex)?
How are the drugs taken? (smoked, snorted, injected, taken orally or anally)
How frequently is this happening?
When did you last have sober sex?
How many partners might a typical ChemSex episode include?
How consistent is condom use during ChemSex episodes?
If HIV positive; are you on ARV treatment? Do you sometimes forget to take your medicine when on chems?
(clinicians should be alert for Drug/Drug Interactions)
If HIV negative; how many previous PEP courses have you done? Are you aware of what seroconversion
symptoms might be? Are you taking PrEP?
How many other STIs have you had in the last 6 months?
Are you aware of safer ChemSex practices to avoid hepatitis C?
Are any of the drugs being used daily/consistently/dependently? (GHB/GBL being the urgent concern)
Reflecting on use; setting boundaries
Making changes; a Care Plan
ChemSex CARE PLAN
OUTCOMES/Successes
Patients are generally invited to a 6 week “Take a break” programme of abstinence.

Adjusted according to degree of success or failure to achieve goals
Goals re-assessed at 6 week completion; invitation to extend programme.
Outcomes monitored at 6 sessions;

Reduced frequency of ChemSex episodes
Confidence in negotiating sexual health risks
Confidence in negotiating injecting risks
Sense of control over drug use
Experienced less sexually transmitted infections
Confidence to introduce chem-free (sober) sex into their lives.
Improvement in non-sexual/non-clubbing social life
Cessation of ChemSex
Ceased injecting use only
Referrals to structured therapy/keywork/support groups
OUTCOMES/Successes
The most successful interventions included;
Motivational Interviewing techniques
The repeated achievement of short term goals (most often, “taking a short break from chems”)
Lightweight discussions focused on;
•gay life
•gay sex
•Grindr
•gay scene pressures and expectations
•sex, desire, relationships & intimacy
•HIV stigma
•pursuing sex a little differently.
Encouraged to repeat-attend on drop-in basis for an ongoing dialogue about their sexual
wellbeing/Chem-use
@davidastuart
DS16
WWW.CHEMSEXSUPPORT.COM
(FROM 56 DEAN STREET)
For chem users

How to access support
Tips for safer use/drug info/sexual health info
Behaviour change video library (craving
management, reduction tips, sober sex advice,
safer play information)
List of London recreational/social alternatives to
bars, clubs, saunas, chems
@davidastuart
WWW.CHEMSEXSUPPORT.COM DS17
(FROM 56 DEAN STREET)
For professionals
• A working definition, ChemSex
• Referral information
• Video tutorials/conducting
ChemSex interventions
• Resources/tools for working with
ChemSexers
• Papers on adapting services
to be ChemSex efficient
• ChemSex research
• Drug–drug interactions
Perfect storm of:
•A promiscuous population
•High HCV/HIV prevalence
•High-risk sex practices
•Increased (naïve) injecting use
•Confusion amongst clinicians about appropriate care pathways
•Lack of awareness and knowledge among clinicians of the ‘ChemSex environment’
•Shame/stigma amongst patient group, inhibiting honest disclosure
•Potential clusters of acute infections in a concentrated, but expanding population
•Complex psychological drivers
This population’s ambivalence to make changes, or to identify drug use as problematic -

-is the greatest challenge.
We need to be aware, communicate effectively with our patients, improve

proformas/assessments, and affect happy referrals to appropriate ChemSex support, to
treat early, and avoid continued behaviour that leads to co-morbidities, multiple re-
infections and onward transmissions
Partnership, partnership, partnership
@davidastuart

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CHEMSEX

@davidastuart @56deanstreet [email protected]

IS THIS A SEX PROBLEM

CAN WE SIMPLY REFER THESE PATIENTS TO

walk into a drug service….

BE ALERT TO THESE RISKS

High frequency of ChemSex episodes

Long gaps between GUM/HIV screens/poor engagememt with GUM/HIV/HCV appointments

Consistently poor condom use when using Chems

High number of STIs in last 6 months/multiple HCV re-infections

High frequency of PEP presentations (if HIV-neg)

Seroconversion symptoms that might be disguised as a ‘drug high’ or drig ‘comedown’.

HIV-positive but not on treatment

Consistently poor ARV adherence if HIV –positive (enough to increase infectiosness/jeopardise

What percentage of your sex life is sober (drug-free)? 0 10 20 30 40 50 60 70 80 90 100

☐ General Practitioner ☐ Drug Service ☐ sexual health clinic ☐ LGBT charity

☐ Somewhere else _______________________________________________________

(A downloadable & extended survey can be found at

If yes - Did you inject?

(Finally a question that could trigger a call to action/reflection)

•“How long do you stay awake for?”

•“Have you had any bad experiences?” (eg; paranoia)

•“When did you last have sober sex?”

•“What’s your non-sexual/non-clubbing social life like?”

•“Are you slamming (injecting) ?”

Patients are generally invited to a 6 week “Take a break” programme of abstinence.

Outcomes monitored at 6 sessions;

Lightweight discussions focused on;

•gay scene pressures and expectations

•sex, desire, relationships & intimacy

•pursuing sex a little differently.

For chem users

This population’s ambivalence to make changes, or to identify drug use as problematic -

We need to be aware, communicate effectively with our patients, improve

Partnership, partnership, partnership

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