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Health agencies should challenge the idea that most gay men use drugs
Roger Pebody, 2016-11-29 06:30:00
Drug use generally and chemsex more specifically are
perceived to be common and normalised behaviours among gay men involved in
those scenes in London, but this perception is contradicted by survey data. As
social norms influence health-related behaviour, health promotion interventions
should challenge the idea that drug use and chemsex are widespread, argue
authors from Sigma Research in the International
Journal of Drug Policy.
Survey data show that only a minority of gay men use drugs in a
sexual context, but that the practice is more common in some cities and social
groups. For example, data from 519 gay men attending six sexual health clinics
throughout England in 2013 and 2014 has recently been published by researchers
from Public Health England in Sexually
Transmitted Infections. The men were asked whether, in the past three
months, they had been under the influence of recreational drugs with a sexual
Twelve per cent said they had, with the most commonly
reported drugs being mephedrone (10%), GHB/GBL (7%) and cannabis (7%).
Similarly, data from Sigma Research’s 2014 Gay Men’s Sex
Survey show that among men living in England:
- 2% had used crystal meth in the past month, and 8% had ever
- 5% had used mephedrone in the past month, and 17% had ever
- 3% had used GHB or GBL in the past month, and 13% had ever
used these substances
- 2% had injected drugs (other than anabolic steroids and
prescribed medicines) in the past year,
and 3% had ever done so.
However these behaviours are much more common among men
living in London, Brighton and Manchester, as well as among men with diagnosed
HIV. For example, in the whole sample of men living in England, 7% had used any of the three
chemsex drugs mentioned above in the last month. The figure was 14% for all men
living in London, 22% for all men living with diagnosed HIV in England, and 33%
for men living with diagnosed HIV in London. Injecting drugs in the past year
was reported by 3% of all men living in London, 11% of all men living with diagnosed
HIV in England, and 14% of men living with diagnosed HIV in London.
Moreover, individuals may choose to socialise and meet
partners in social and sexual networks where these behaviours are even more
common, giving men the impression that chemsex is a typical practice of most
Several theories of health behaviour and behaviour change
suggest that social norms influence people’s health decisions and behaviour.
Social norms have been defined as social attitudes of approval or disapproval
that specify what ought and ought not to be done. The psychologist Alan
Berkowitz argues that an individual’s false perceptions about how members of
their social groups think and act can lead to an overestimation of certain
behaviours and therefore encourage individuals to engage in these behaviours
themselves. According to this theory, talking up risk behaviours becomes a
In 2013 and 2014, Sigma Research conducted in-depth
interviews with 30 gay men living in south London who practiced chemsex, as
well as focus group discussions with a further 12 gay men living in the area who
did not necessarily engage in chemsex. Focus groups can be particularly useful
for highlighting community perceptions, social norms and expectations. (Other
findings from the study have already been reported by aidsmap.com).
Most men taking part in the research felt that drug use was
ubiquitous among gay men. Men using dating apps, saunas and nightclubs could
see signs of drugs being used or sold. One man said:
“Rampant. It’s just
everywhere. I mean, even if you go to – you think – no, it’s everywhere. I
mean, I can’t think of anywhere where I’ve not seen drugs being taken. Yeah,
that’s the reality.”
Chemsex more specifically was also thought to be
commonplace. Just under a third of interviewees said they believed drug
use and sex to be inextricable. Others claimed that drug use in social settings
like clubs will usually lead to sex or that they now used drugs exclusively to
Men who used nightclubs narrated a progression of events
that involved using drugs in clubs but moving to
private homes at the end of the night to engage in chemsex. Other men bypassed
the clubs and went directly to sex parties, arranged on dating apps.
“And it started to
become, ‘We’re paying twenty quid to get into a place. Why not have drugs at
home, with a sex party?’ You know, this is the alternative; and we’ve got apps
that can help to facilitate that need, and make that happen… People stay long
hours being very bored in clubs and bars, sometimes, and all they wanted was
just a shag.”
Private homes were seen as easier and safer spaces to engage
in chemsex. Use of mobile apps was widespread among the study participants,
both to arrange sexual encounters and to get hold of drugs.
Chemsex was felt to be different from sober sex, both in
terms of what was permitted and what was expected. Certain acts were felt to be
more acceptable in a context of chemsex. Some men described a culture of men
pushing themselves to their sexual and drug-use limits. Other men spoke about a
shifting of standards during chemsex. They themselves, or men that they knew,
would exchange drugs for sex with a younger/more attractive man, or exchange
sex with an older/less attractive man for drugs.
Moreover, many men drew upon a discourse around the
disinhibiting effects of drugs to help rationalise their actions, particularly in
relation to risky or esoteric sexual practices. Phrases such as ‘being carried away with the moment’, ‘not
caring as much’, and ‘feeling more
reckless’ were used throughout the interviews in a way that allowed the men
to make sense of their experience.
The researchers comment the media often presents chemsex as
a causative factor in HIV transmission risk behaviour when in fact there may be
range of other factors that influence risky sex, but which are harder to
articulate. Moreover, media reports tend to turn a blind eye to the variety
of lifestyles and experiences of gay men, while stigmatising those men who do
engage in chemsex.
“The perception that most gay men in South London are
participating in chemsex contradicts survey data measuring its actual
prevalence,” the researchers say. They argue that health promotion
interventions should challenge social norms relating to drug use and chemsex.
“Social norms interventions focus on correcting false
consensus by providing believable information on actual behaviours (what
members of a group actually do). A social norms intervention in London could
potentially attend to misperceptions regarding the ubiquity of chemsex,” they say.
Moreover, interventions should try to prevent further stigmatisation
of men involved in chemsex, as it is unlikely to help men access support