Chemsex and cultural competency

Published: 01 Jun 2022
Category: Unmet health needs & health inequalities

Different people use different drugs for different purposes.
Drugs and alcohol can enhance experiences. Others can ruin an experience.
Drugs can unite estranged communities on a dance floor. Drugs can calm a traumatised mind. Drugs can disinhibit the inhibited. They can be crucial social rituals within communities.

They can be used and abused and a spectrum between.
They can be harmful. They can be helpful.
And everyone has an opinion; one person’s selfish indulgence is another person’s coping mechanism.
One person’s hedonistic freedom is another person’s social hierarchy device.

The ways in which we humans employ coping mechanisms, and the ways in which we use drugs or alcohol – are varied and diverse, unique to every person and culture. They are about personal experiences, about culture, about safety, about fitting in. About survival – whatever that means to a person in any given moment.

Certainly, about pleasure. That is core. The promise of pleasure is the one commonality all drugs share, even if the context is more complicated.

Very often, alcohol and drugs help a person in a sexual context. Sex and pleasure are organically linked in a very primal way, so they are good bedfellows. Just as drugs are complex and complicated, sex is complicated for all but the privileged few; it is often complicated by stigma, religion, abuses of power, cultural constructs, shame, power, violence, legal or moral entitlement; coercion. And so much more.

Pleasure can be complicated.

If you search for “Sexualised Drug Use” (SDU) as a topic, you’ll find information about all kinds of people and cultures that have used drugs or alcohol in sexual contexts throughout history.

Chemsex is a word that describes a very unique kind of sexualised drug use. Gay men (and other men who have sex with men) have gone through a very profound cultural upheaval in the last 40 years. Those years include a sexual liberation brought about through protest and sheer determination, resilience, and violence. Though many were fortunate enough to embrace this sexual liberation, the shame and danger of gay sex remains a crippling reality. These decades include a HIV epidemic that made the joys and pleasure of gay sex very complicated (not to mention the hetero-driven disgust of gay sex that defined those decades, and lingers). They include the technological juggernaut of Grindr and other sex hook-up apps that overnight, lifted gay men out of dark cruising grounds and public toilets, and into the bright and furious 21st century. These decades also include a wave of new(ish) drugs that became fast favorites within gay sex hook-up cultures: methamphetamine, cathenones and GHB/GBL (gamma-hydroxybutyric acid/gamma-butyrolactone) - the popularity of these propagated widely via the new hook-up technologies.

These have been challenging decades in which to find gay love, to seek sexual pleasure, intimacy, solace, love, horniness, and all those brilliant things we find in sexual connection. Chems – for all their dangers - do provide a solution to these challenges. From these difficult decades, chemsex has emerged as a widespread gay cultural phenomenon. Though many people have the skills and boundaries to manage the consequences of these drugs, disproportionate numbers of gay men are suffering poor mental health, deterioration of life, addiction, and death as a result. And though HIV prevention methods are improving significantly, there are many cities in the world where chemsex is the main driver of HIV incidence.

A lazy response to this might be to simply refer people struggling with chemsex issues to the existing addiction services we have in our cities. I don’t mean to discredit these services; they were built and designed very specifically in response to a very different drug use epidemic. The brilliant staff in these services are experienced and skilled in the culture of heroin use, crack cocaine use, problematic alcohol addiction. They understand the cultural context of this kind of drug use. They understand street homelessness, poverty and crime that so defines that epidemic. They understand the trauma, the inner turmoil and disenfranchisement that drives so many of their clients to problematic drug use. They understand the culture of it, the harms of those drugs, harm reduction for those drugs, the referral pathways. They speak the language.

Chemsex is a very different kind of drug use epidemic. It is in fact syndemic with gay health and social issues. Sexual wellbeing for gay men this end of the AIDS epidemic needs to be understood. Internalised homophobia, and shame need to be understood, particularly how it affects sexual behavior. HIV care and prevention need to be a skill set for any service claiming to offer culturally competent chemsex support. Hook up culture and technologies as it manifests in homo-sex cultures needs to be understood; for example, negotiating online availability, writing a chem-boundaried Grindr profile. Harm reduction knowledge; not only with these specific chems, but harm reduction in chemsex environments and certainly online.

London has been fortunate in that its queer communities have been very loud and effective with their activism and campaigning. They have demanded that chemsex be seen less as a “drug problem”, and more as a cultural issue. Chemsex support is available in many places where gay sex is well understood and discussed routinely. Gay charities and sexual health clinics have skilled up their teams and formed effective partnerships with drug support services. They’ve developed online information and real life one-to one support in places where gay communities feel comfortable talking about gay sex, and all the challenges it poses.

Sadly, there are too many cities in the world where LGBTQ+ experiences are not validated, or worse. The London example is hard to replicate everywhere, and there are people needing urgent chemsex support in cities where it is a crime to be gay.

But the activism continues. Health services that are tailored to the cultural needs of its local communities absolutely have better health outcomes and should not be the exception; they should be the rule in ideal circumstances and something we should always be striving for.

For help and information on chemsex, please visit 56 Dean St.

More information on David and his work can be found on his website:

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David Stuart

David Stuart was the first to name and identify 'chemsex' as an emerging gay cultural phenomenon. He developed the world’s first chemsex support services, and he fought relentlessly for greater chemsex awareness by encouraging and stimulating cultural dialogue and discussion within our international gay, bi and Queer communities. He supported international governments and communities to manage the cultural phenomenon from a place of kindness, sex positivity and cultural competence. David sadly passed away in January 2022.

More information on David and his work can be found his website: