1. A clinical perspective of Chemsex
Dr Jake Bayley
Consultant Sexual Health and HIV
Barts Health NHS Trust
Slides courtesy of Dr Adam Bourne, LSHTM

2. Use of drug in last year, British Crime Survey 2007/8
All respondents
Men
Straight % (n/N)
Gay/Bisexual % (n/N)
Adjusted Odds Ratio* (95%CI)
Cannabis
7.1
(1593/22309)
9.4
(946/10011)
18.8
(46/245)
1.73
Cocaine
2.2
(495/22374)
3.1
(311/10045)
7.4
(18/244)
1.92
Amyl nitrite
1.4
(307/22421)
(142/10069)
24.4
(60/246)
23.04
Ecstasy
1.3
(299/22393)
1.8
(182/10053)
6.5
(16/245)
2.88
Amphetamine
1.1
(244/22352)
(132/10039)
3.7
(9/246)
2.28
Tranquilisers
0.5
(111/22438)
0.4
(45/10076)
2.8
(7/247)
4.33
Magic mushrooms
(81/22420)
(50/10065)
5.14
Ketamine
0.3
(65/22437)
(31/10079)
10.01
LSD
0.2
(52/22414)
(31/10063)
1.6
(4/247)
4.03
Crack
0.1
(28/22428)
(19/10072)
0.8
(2/247)
2.68
Heroin
(26/22438)
(17/10077)
2.90
Annual prevalence of drug use by sexuality in British Crime Survey 2007/8
Unpublished data from the British Crime Survey 2007/8. Data personal communication from Jacqueline Hoare (Home Office Statistics Unit); analysis by Ford Hickson (Sigma Research)

3. Current trends in drug use
Name of drug
Street names
Delivery
Mephedrone
Meow Meow, MCAT, plant food
Snorted as a powder, injected or administered rectally
GHB/GBL
G, Gina, liquid ecstasy
Swallowed in small liquid doses
Crystal meth
Crystal, Ice, Tina, T
Snorted as powder, smoked in glass pipe, or administered rectally
Ketamine
K, special K, Green
Swallowed as tablet, snorted
What we believe we may have seen over the past few years is a migration away from those drugs previously popular to newer psychoactive substances. We don’t yet have published national level data to reinforce this for gay men, but health practionner discourse – what they’re seeing in clinic and in services – overwhelmingly supports this switch, especially the case with mephedrone.
I’ve added Ketamine to this list because while it’s not a key factor on the UK chemsex scene, I’m aware it is in other countries.
Chemsex: “Sex between men that occurs under the influence of [these] drugs taken immediately preceding and/or during the sexual session”

4. Chemsex 'prevalence' (UK)
European MSM Internet Survey (EMIS)
15,423 MSM living in England
0.7% had used crystal meth in previous 4 weeks (London 2.9%)
2.9% had used mephedrone in previous 4 weeks (London 10.2%)
1.6% had used GHB/GBL in previous 4 weeks (London 5.5%)
Chemsex drug use highest among HIV positive gay men
8.6% of HIV positive men used crystal meth Vs <1% negative or untested men
13.5% of HIV positive men used GHB/GBL Vs <3% of negative or untested men
(i.e. 8 crystal use 8 times higher)

5. Chemsex & sexual health
Maintenance of safer sex behaviour
Pre-determined unprotected anal intercourse
Unintended sexual risk under the influence of drugs
Drug use associated with increased odds of UAI during group sex
Three-fold increase in odds of UAI associated with use of crystal meth
A proportion of men in both studies had decided to (nearly) always have sex without condoms
Generally such men had diagnosed HIV
All had condomless sex with men they believed to also be positive – Serosorting
STIs often seen as inevitable part of lifestyle
High rates of Hepatitis C (and re-infection) but limited awareness of protective behaviours
A third of men had engaged in unintentional sexual risk behaviour
Drugs had myopic effect
Drugs could be cognitively incapacitating

6. Chemsex & broader well-being
Impact on mental health
Anxiety attacks
Acute paranoia
Sexual dependency
Impact on physical health
Overdose
Disturbed sleeping problems
Injection site injuries
Sexual consent concerns
Bourne et al, 2015a; 2015b; Fourer et al, 2014; Knoops et al, 2015)

7. Conclusions – What we know
The drugs most popular among MSM appears to have shifted
Injection drug use has emerged as a source of concern for MSM
Use of drugs in general is higher among MSM with diagnosed HIV
Newly popular drugs lend themselves to use in sexual settings
Chemsex is associated with a higher risk of HIV/STI transmission behaviour
MSM using drugs are exposed to (and experience) a range of physical and mental health harms

8. “CHEMSEX”
Tadgh Crozier & Louis Driver
Senior Engagement Workers

9. WHO ARE WE?
Lifeline Project – Registered charity providing national Drug & Alcohol Treatment.
AFTER PARTY SERVICE – Started 2014
London based outreach service
Supported and funded by the Elton John Aids Foundation
One-to-one support, Harm reduction, Group work and Training.
Focus on sexual health, HIV Prevention and provision Self Test HIV Kits.

10. What is CHEMSEX ? Having sex whilst using drugs Gay, bisexual, MSM
Specific intention to meet, use and have sex
Three main drugs: mephedrone, GHB/GBL,
crystal methamphetamine

11. Why is it a concern? Marked change in drugs used
Changing context and methods of use
Increasing presentations to services – Sexual health and counselling
Backdrop of rising HIV diagnoses & infections
Clients not identifying as ‘that type’ of drug user (STIGMA)
A move from the more traditional normalised use of recreational drugs onto harder Nps’S.

12. How have things have changed?
Different drugs being used with different routes of administration
Different harms – injecting, dependence (G), mental health (psychosis)
Interventions need to include substance use, sexual behaviour & HIV prevention
Interventions delivered in different settings - GUM clinics (motivational, preventative)

13. The drugs: Mephedrone
 MIAOW, MEPH, MEOW MEOW, M-CAT, DRONE 

14. The drugs: GHB/GBL
G, GINA, GEEBS, GBL, GBH, 

15. The drugs: Crystal Meth
METHAMPHETAMINE, TINA, CHRISTINE, METH, ICE, GLASS, CRANK, 

16. ‘Apps’ & ‘On-line’

17. What we’re seeing Sexualised drug using, multiple partners
Meeting & trading of drugs through apps
Private sex parties, sex on premises venues
High level of current sexual risk
‘Slamming’ - Injecting (Crystal meth & Mephedrone)
We have seen an increase in HIV infection as a result of Chemsex
Poor adherence to HIV meds whilst using
Lack of knowledge and understanding in relation to BBV’s
Widespread poor self-esteem issues

18. What we’re hearing
Concerns around consent whilst using – exploitation, rent, rape – Unconscious
Slamming (injecting) on the increase as criterion for sex party admission
Dealers offering needles to slamming users
Filming and webcams at parties

19. Interventions
Same principles: brief interventions, MI, CBT, SFT & relapse prevention
But with cultural adaptations: e.g. relapse prevention through management of online sexual-social profiles
Tackle sexual health and drug use together
Delivered in LGBT-specific, or LGBT-competent locations
Anecdotally 90% say ‘important’ or ‘very important’ to have LGBT specific services
Breaking free – online
Skype/telephone

20. Work in Clinics and Sauna’s
People present much earlier than they would to a drug service
Treatment of STIs
PeP or PReP
Perfect opportunity to deliver motivational & preventative interventions
Chemsex Study: preference for clinic based interventions
Caution! Approach works well for gay/bi men, may need to think differently for lesbian/bi women & trans people who experience different sexual health barriers

21. Key Messages
Increase own confidence & competence of community/MSM/LGBT issues and newer drugs
Be conscious of environment, language, attitude etc.
Non-judgmental harm reduction advice
Know where & when to refer
Be aware of potential G dependence – must see a specialist service for detox advice
Safer injecting – needle exchange
HIV, Hep, HPV and other STI advice
Monitor sexual orientation & gender identity

22. ANY QUESTIONS ??

23. RESOURCES •
London Friend: Antidote:
Out Of Your Mind report:
Antidote/Orange Nation G-Aware campaign: London Friend CEO Blog :
Chemsex Study:
NTA Club Drug Report:
UK Drug Policy Commission Report: groups-lgbt- groups/
UK Drug Policy Commission Policy Briefing: policy- briefing/
Lesbian & Gay Foundation Part of the Picture:
Lancet article of crystal meth rise in London (Jan 2013): (13)60032-X/fulltext
CNWL Club Drug Clinic:
LDAN News Nov/Dec 2012 (Club Drugs & Antidote articles): Engendered Penalties:
Sexual Orientation Monitoring Guide: Stonewall Healthy Lives mini-site:
Public Health Outcomes Framework LGBT Companion: • • •

24. CONTACT DETAILS: Tadgh.crozier@lifeline.org.uk Tel: 07584 126 904
Tel: