Chemsex in AsiaA community manual on sexualised substance use among men who have sex with men.
For community and fieldworkers across Asia.
Chemsex impacts the lives of many men-who-have-sex-with-men (MSM) in Asia. There is an urgent need to understand this phenomenon. And there is a need to create effective responses to reduce harms and to support individuals as well as communities of MSM.
As a first step, a team of researchers – Laura Nevendorff (Indonesia), Theresia Puspoarum (Indonesia) and Doan Thanh Tung (Vietnam)– created a comprehensive manual on chemsex in Asia. It offers practical tools for community-based organisations across Asia, allowing them to respond to the specific needs of men who engage in chemsex.
This web-page offers a brief overview of the manual and links to the full report as well as to available external resources for those who are interested to learn more.
The manual was developed as part of the Asia Catalyst programme, with support of the Global Fund to Fight AIDS, Tuberculosis and Malaria.
This digital summary is designed by Mainline. Technical support was offered by Karyn Kaplan (Asia Catalyst) and Palani Narayanan (GFTAM)
What is Chemsex?
Chemsex refers to the use of drugs in a sexual setting. But, while many different people use various types of drugs before or during sex, the term chemsex is reserved for male-to-male sex and sexual sessions that may involve multiple partners. Most experts exclude ‘mild’ drugs from the definition of chemsex and instead focus on those drugs that induce a distinct sexual pleasure, desire or disinhibition. They are meth-amphetamine, mephedrone and GHB/GBL. Out of these three drugs, meth-amphetamine is most commonly used in the Asian chemsex scene, often in combination with drugs that are used to treat erectile dysfunction.
Sexualised substance use (general)
A wide range of drugs used just before or during a sexual activity – usually includes all popular drugs, including: methamphetamine, poppers, ecstasy, foxy, ketamine, mephedrone and other new psychoactive drugs.
Any combination of methamphetamine, mephedrone, and GHB/GBL used by men before or during sex to facilitate a long sexual session with multiple sex partners.
“In dating apps, we call it high fun or HF.
We usually type HF [in the profile] or put” fire” emoji as the logo.”
Chemsex in Asia
Several studies across Asia aimed to understand how many men who have sex with men engage in chemsex. Estimates range from 3.1% to 30.8%. Despite the variation in these estimates, there is no doubt that drug use in a sexual context is a common practice across Asian countries.
Chemsex almost always involves the use of more than one type of drug in a single sexual session. Also, around 88% of MSM who engage in chemsex had used more than one drug in the past 6 months.
“We still maintain a level of 1-1 because, at that level, I find myself shaking and excited, and there is no need to change… 1-1 means a half of Ice pill and a half of candy [MDMA]… when using, grind it, then heat it with silver paper, then the smoke comes out. We breathe in and start to smoke.”
Reasons to use drugs during sex
Asian men report several – often interacting – reasons for using drugs during sex:
A few facts from recent chemsex studies in Asia:
Men who engage in chemsex, compared to men who do not engage in chemsex:
Mostly live in the city, rather than in rural areas
Are four times more likely to be active on gay mobile apps and two times more likely to use social media
Are almost three times more likely to trade sex for money and two times more likely to pay for sex
Are seven times more likely to be involved in group sex
Are more likely to engage in unprotected anal intercourse
On average, are almost four times more likely to have sex during more than 15 occasions per month
Are more likely to have more non-steady partners and are three times more likely to have more than one male sex partners in the past 6 months
HIV positive men are more likely to engage in chemsex. But HIV negative men who engage in chemsex are more likely to use Pre-Exposure Prophylaxis (PrEP).
More frequently get an HIV test (70% compared to 57%), as well as tests for Hepatitis C (HCV) and sexually transmitted diseases
Chemsex: HIV, STIs and mental health
Being under influence of drugs impacts risk perceptions. And personal boundaries easily blur during chemsex. Men engage in group sex, report low expectation of a sex partner’s intend to use a condom and might have less concerns of a sex partner’s HIV status. Sex also tends to be longer and rougher. Factors such as these increase the risks of an HIV infection and infections with hepatitis C and other sexually transmitted diseases. The risk of transmission correlates with the intensity and frequency of drug use.
Although limited, there is evidence that Asian men – and men who engage in chemsex in general – have more mental health problems, such as anxiety, depression or psychosis. Other factors such as discrimination and internal stigma may contribute to this.
The relation between chemsex, mental health problems such as trauma and anxiety, prolonged, poly-drug use, sexual abuse and internalised homophobia is mostly unexplored.
“When we are high, we are not interested in safety measure,
we are only interested in taking drugs”.
“My problem is not a single problem. I have a problem with sex addiction,
living as a gay man in Pakistan, and drug addiction”.
FIVE CHEMSEX BEST PRACTICES
- LIGHTHOUSE, VIETNAM
“Not only listen, but engage. Men can become part of the intervention.
Trust them and engage them to contribute to the community.”
(Doan Thanh Tung – Lighthouse Executive Director)
- A community-led framework can increase the likelihood of programme utilisation and improve outcomes;
- A community advisory board is beneficial not only as community representative but also to ensure community representation, quality assurance, and making sure that the intervention is developed according to contextual need;
- In addition, engagement and collaboration with other key stakeholders such as healthcare providers, law enforcement, and the ministry of health are necessary to provide uninterrupted intervention.
- HOPE, Taiwan
- Integrating SDU with other STI services is possible to provide a more comprehensive health package for MSM who use drugs in sexual contexts;
- Using self-assessment risk behaviours enables healthcare providers to offer tailor-made health service according to client’s conditions;
- Providing user-friendly services enables the clinic to attract more potential clients;
- Ongoing healthcare improvement can be provided based on process evaluation involving their clients;
The sustainability of the services can be guaranteed by collaborating with the state hospital.
“APCOM has sexual health campaigns for MSM in Asia, and since Chemsex is currently popular among MSM we should provide the relevant information for them to protect themselves.”
[‘Bright’ Thisanut Kaewnukul – APCOM Campaign Officer]
Acknowledging different approaches and different sub-populations of MSM who use drugs requires differentiated services – combining drug and MSM issues resulting in mutual collaborations;
- Taking into account how MSM in Thailand who practice SDU communicate through online applications and using drugs together at parties;
- Integrating SDU interventions into existing HIV programs.
- MAINLINE, AMSTERDAM
“…back then, we saw there was a lack of non-judgmental information and healthcare.”
(Nick Veldwijk – Mainline Regional Manager Asia)
- Tailoring the program according to the local situations and users’ need;
- Chemsex training for healthcare providers can contribute to reduce stigma and discrimination towards the users;
- Advocacy work is necessary to ensure government’s acceptance and support towards the intervention;
- Networking and engagement with other community and stakeholders may contribute to the development of a different chemsex
“[The end goal] is to manage their use [of drugs] better…help them understand their motivation and managing the harm.”
[Associate Professor Adam Bourne – Deputy Director ARCSHS La Trobe University]
- Support for MSM users can include therapeutic groups and peer-led support;
- Harm reduction approach can be applied to encourage safe practice and encouraging wellbeing among MSM who practice chemsex;
- Chemsex program can be advanced to reach particular events where the practice is likely to occur;
Programmes, in Asia, but also in most other countries in the world – that aim to support men who engage in chemsex often struggle. It is important to take into account the following challenges when designing a chemsex response:
There is limited reliable data available
There is limited funding available for programming
Men are stigmatised and punitive laws limit service provision
“Our religion does not allow us to be ourselves, our families do not accept us.” [Pakistan]
“It is important to break the self-stigma about our drug use …”
- Men who engage in chemsex are hiding and therefore hard to reach
“They cannot guarantee the best confidentiality of the customer’s information …” [Vietnam]
“There are friends who do outreach to the community … then, we open up to them and health facilities at last …”
- Services are often not covered by health insurance
“For Chemsex, the first barrier is the law … It is important to know what should we do when we face legal issues …”
“I want to have mental health services provided by health professionals.
Currently we just have the assistances among communities.”
Chemsex intervention model
The Chemsex in Asia manual includes a full chapter with tips for community based organisations with an interest to start a chemsex-response. This visual summarises all the steps. Details can be found in section IV of the full report.
Resources and support
Although Chemsex interventions in Asia are still quite rare, there are plenty of resources out there. The most relevant:
- Various materials related to chemsex – developed by Mainline
- Information on methamphetamine and harm minimisation – developed by Mainline
- Culturally appropriate information and education by and for MSM community – developed by ACON
- Qualitative scoping review on the socio-sexual context of SDU among MSM and transgender – developed by APCOM
- Safer chemsex practice – developed by APCOM
Community and expert engagement
- European Chemsex forum – register through https://chemsex.groups.io/g/main
Training on Chemsex
Individual assessment tools
- Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) developed by WHO
- Chemsex care plan – developed by David Stuart
- Chemsex risk assessment for patients – developed by David Stuart
- Alcohol and other drug inclusive practice guideline – developed by ACON
- Technical guideline on HIV prevention, treatment, care and support for people who use stimulant drugs – developed by UNODC