Dr Mark takes chemsex to Rio

MEDICAL SPECIAL: DR MARK PAKIANATHAN

Dr Mark participates in the shortest yet busiest chemsex session the world has seen. It was over in 30 minutes and attended by hundreds. Here he tells Queen and Country more.

 Rio de Janeiro

Rio de Janeiro

I took chemsex to Rio this summer. As an invited speaker at the STI and HIV World Congress 2017 it was the perfect opportunity to present some of my research on a topic which has been making headlines recently. My travelling companion was Dr Aseel Hegazi, a colleague and fellow chemsex researcher. We spent the initial days attending seminars and networking but also honing down the presentation to ensure we had it pitched right for the international audience.

 Dr Mark at the STI and HIV World Congress 2017 - Rio

Dr Mark at the STI and HIV World Congress 2017 - Rio

Working in the field of sexual health spanning over 20 years, I have seen big challenges come and go, and today undoubtedly the challenge for many gay men is reconciling the agony and ecstasy of chemsex. Using drugs with sex has never been uncommon for many gay men especially if we think of poppers or alcohol.

The current cultural context of chemsex is however different. The emergence and increased availability of novel psycho active substances such as GHB/GBL, crystal methamphetamine and mephedrone have largely shaped the phenomenon.

Additionally, for the first time in history, smartphone apps are able to instantly connect people wanting drugs to people who have them.  The combined effects of the drugs used increase libido, reduce inhibitions, enhance pleasure and can keep people awake for days.  

In recent years there has been an exponential increase in gay men seeking help with a chemsex problem; when it has adversely impacted on health or social functioning. A recent study alerted rising deaths from accidental GHB/GBL overdose in the UK as probably linked to chemsex. Whilst the phenomenon appears concentrated in urban areas, there is data to suggest that this is not exclusively so.

Many studies have also demonstrated an association between chemsex and sexual risk taking behaviours. The data we presented in Rio indicate that gay men participating in chemsex are at an increased risk of contracting STIs , Hepatitis C and experiencing a 5 fold- increased risk of seroconverting for HIV.  

A number of other consequences have also been frequently reported including hospital admissions with overdose, mental health sequela, sexual assault, and not to mention the social consequences such as employment problems and, albeit less frequently, criminal activity.

Up to a quarter of men participating in chemsex disclosed the practice of injecting drugs, also known as‘slamming’ which can be associated with additional harms.

We have known for some time that gay men are more likely to use recreational drugs than the male population in general. In particular, rates of club drug use, poly-drug use, substance dependency and problematic alcohol consumption are all significantly higher amongst gay men.

The emphasis to date amongst those tasked with gay men’s health awareness has been on harm reduction or HIV prevention. However there has been limited discussion within our community about why many of us are more vulnerable.

There is published data that show gay men experience increased levels of anxiety and depression. In fact, a gay man is six times more likely to have attempted suicide compared to a heterosexual man. Undoubtedly childhood trauma including that from concealment of sexual identity, difficulties with intimacy, an HIV diagnosis are some factors that can all play a part at either a conscious or subconscious level.

The picture is a complex one but does require more open and compassionate dialogue, so we are better able to support each other as a community. Perhaps it is time for more sophisticated messaging from those in charge of health promotion.  We now need not only knowledge about how to reduce harm when we take risks but perhaps understand better why some of us may be driven to behave in risky or potentially self harming ways in the first place.  

Resources such as the ‘chemsex care plan’ by David Stuart, a pioneering chemsex specialist worker in London is a useful place to start for a person looking to make changes around chemsex.  There remains however an urgent need to develop and evaluate chemsex interventions as well as challenge those who commission services to provide LGBT-culturally competent drug and chemsex support services.

As for my Rio conference presentation, it was well received and generated positive feedback, particularly among international colleagues who also highlighted to us similar stories from around the globe.

As the sun set on Copacabana Beach on our last day, amid the bosa nova beats and beautiful people of Brazil, I couldn't help but feel satisfied at a job well done. We had got our key messages out there to a receptive and engaged audience who in turn might now make a real difference to the life of someone struggling with the consequences related to chemsex.

And then, as if by an unbelievable stroke of serendipity, a song came on my iPod entirely apt for the moment. Turning to my colleague Dr Hegazi, I started singing; ‘Her name was Lola….'

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