We need to talk about ChemSex: risks of Hep C and HIV are high
More gay men in the UK are presenting to clinicians with complicated issues associated with drug use and consent to sex in ChemSex environments (taking recreational drugs during sex and attendance at sex parties). David Rowlands highlights the issues around this controversial topic based on responses to his February online poll.
The latest poll asked: 'If a gay man, highly intoxicated on (self-ingested) GBL (gamma- Butyrolactone), later regrets the sex he had, or had trouble remembering what happened... Was this consensual? Or is it sexual assault?'
This controversial scenario sparked strong opinions and debates across social media sites. There were 190 respondents, with 57 per cent agreeing that it was consent. A fifth felt it was sexual assault and one in four people were unable to answer the question. This shows the complexity of this subject, with many regretting choices they had made in the past while highly intoxicated.
The poll showed:
• Ability, decisions and consent to sex can be impaired when high on drugs.
• ChemSex gives people the ability to negotiate and explore the sex they desire.
• People need to take responsibility for their knowledge and pride in their attitude.
• Sex without chemicals can be hard for some individuals because they have low self-confidence.
• People feel they need to re-learn what intimacy is without using chemicals for sex.
• Some gay men take drugs to be reckless.
• Gay men using drugs while having sex are willing participants.
• People need to take the time to learn about the dangers of ChemSex and play smarter.
• When highly intoxicated and you can't remember, you are vulnerable to sexual assault.
• Before going to a ChemSex party you should take the time to get to know who will be there and discuss with them your expectations.
• People should be aware of how to access ChemSex support and counselling services.
Was it consent?
Section 74 of the Sexual Offences Act 2003 defines consent as 'A person consents if they agree by choice, and have the freedom and capacity to make that choice'. It also says: 'The amount someone has had to drink can also affect a person's ability to consent.'
New guidelines have been launched by the Crown Prosecution Service and police forces in England and Wales. This document specifies that consent cannot be given where someone is incapacitated through drink or drugs. The advice forms part of a wider drive known as the Rape Action Plan which was launched in January and is aimed at securing more successful prosecutions for rape.
"In Scotland, sexual attacks on men have been legally classed as 'rape' for the first time"
In Scotland the law relating to rape has recently changed. It now concentrates more on what 'consent' means and the fact that consent can be withdrawn at any time. In addition, sexual attacks on men have been legally classed as 'rape' for the first time. The 'we can stop it' campaign has been launched by Police Scotland, partially to raise awareness of these changes.
According to the definitions of the Metropolitan Police:
What is rape?
A person commits rape if they intentionally penetrate the vagina, anus or mouth of another person with their penis without consent.
What is sexual assault?
A person commits sexual assault if they intentionally touch another person, the touching is sexual and the person does not consent.
What is a serious sexual assault?
Assault by penetration - a person commits assault by penetration if they intentionally penetrate the vagina or anus of another person with a part of the body or anything else, without their consent.
Specialised sexual health services are the best place to support gay men who are regularly taking these high risks
56 Dean Street, a sexual heath and HIV clinic based in Soho, London, has produced a booklet 'ChemSex and Hepatitis C' to aid clinicians who wish to better understand the contexts and language associated with ChemSex, and to confidently discuss these issues with their patients.
Community dialogue addressing hep C stigma, as well as more robust screening in GUM clinics is crucial to address a burgeoning new epidemic
David Stuart, substance use lead at 56 Dean Street and Chelsea & Westminster hospital said, "ChemSex has become one of the most worrying public health concerns in cities that host (the larger) gay scenes around the world. It is associated with extended and extreme high-risk sexual activity with multiple partners, poor condom use, poor ARV [antiretroviral] adherence, STIs [sexually transmitted infections], PEP [post-exposure prophylaxis] presentations and HIV [human immunodeficiency virus] infections. Issues around consent/sexual assault and losing the ability to engage in satisfying sober sex are also worrying concerns.
"Gay men in London are injecting more than ever in recorded history, and often with a naivety about safer injecting techniques"
"It's important to add that ChemSex is also associated with a lot of enjoyment and much desired disinhibition, despite the varying degree of consequences. Just beneath the radar, however, is the worrying potential for a boom in hepatitis C infections. Gay men in London are injecting more than ever in recorded history, and often with a naivety about safer injecting techniques.
"GUM [genitourinary medicine] clinics robustly screen HIV+ve MSM [men who have sex with men] and injecting drug users for hep C; yet evidence is emerging of increased numbers of HIV-ve MSM who do not inject drugs, contracting hep C, and often multiple re-infections. A ChemSex environment is rife with the possibilities of hep C infection, and clinicians can sometimes have a less than robust concept of the context of ChemSex play. Additionally, the stigma and avoidance of hep C discussions on sexual networking sites/Apps translates to greater risk and ignorance amongst those most at risk."
We need to encourage the community to engage and debate ChemSex on a range of media platforms, which will enable people to make informed decisions
Matt Spike, a London-based artist, has produced a collection of ChemSex photographs. Matt said, "There are two ways of looking at the images I have produced. The first way is to simply see the pictures as erotic art. In some ways that's what they are. But fetish photography can also be used as a way of documenting and exploring negative behaviours and not simply celebrating them.
"So what is it about these photographs that gives out a warning? On the surface, there appears to be no particular criticism of harmful sexual practice. Look closer and each image represents a situation in which a person is being pressured into ChemSex, therefore making a distinction between healthy behaviour and dangerous, 'peer pressure' behaviour brought about by the perception of glamour. It is this distinction that needs to be understood if the battle against ChemSex is to be won.
"If you are able to take care of yourself and make the right choices, you will be able to spot the sadness in these photos and not the sex."
You can view the photographs here.
The MSM community is suffering serious harm and is in danger of spreading HIV by having unprotected sex while under the influence of illegal drugs
A UK study by Sigma research, 'Exploring sex and drugs among gay men in south London' has shown that cheap, easily available drugs, a burgeoning number of social and networking apps and websites enable men to arrange to meet for sex at private parties.
Nearly a third of men found it difficult to control their behaviour while under the influence of drugs and engaged in HIV and STI transmission-risk behaviour, which they subsequently regretted. These were often men who had pre-existing problems negotiating safer sex, which were exacerbated by the presence of drugs. Three had been sexually assaulted after passing out, and two others had seen that happening or heard of it happening from friends.
Data collected: 1-24 February 2015, via online hosting at www.Design-Redefined.co.uk and social networking sites.
The March poll will examine issues around testing for hepatitis C, particularly in emerging markets. Vote here.
About the author:
David Rowlands is the director of Design-Redefined.co.uk, delivering effective healthcare communications to professionals and patients.
His key objective is to design, develop and deliver community projects to enable people living with, or affected by, HIV and/or Hepatitis C (HCV) to become better engaged with their treatment and care.
Working over a number of media platforms, across the public, private and third sector, he is able to establish a link to these sometimes hard-to-reach communities.
Have your say: What are your views on ChemSex and hep C?
Read the results of the previous poll on HIV presentation in the media: