Inside the Rising Chemsex Response in Europe

November 26, 2019

Having too many people itching to talk about their activism is a good problem to have. For the organizers of the third annual European Chemsex Forum, that seemed to be the case.

“We’re not as worried about proving it’s happening,” said Bryan Teixeira, the event’s chair, during the wrap-up for the first full day of the conference, held in Paris from November 14-16. Addressing issues around sexualized drug use within queer and trans communities, it convened over 200 activists, service providers and directly-impacted people from across Europe and Central Asia. The hosting hotel bustled with attendees speaking English, French or Russian as they picked up safer consumption kits, condoms and pamphlets from organizations’ tables.

One attendee had questioned Teixeira about whether the theme for the November 15 session—”Evidence and Data”—was accurate, given that the program seemed to be everything but that, featuring plenaries on the role of pleasure and quality of life in chemsex, and workshops on drug checking and Amsterdam’s STI prevention efforts.

The only workshop that overtly fit the theme was on chemsex research in Eastern Europe and Central Asia—a region that continues to be understudied. “It’s like being in a darkroom in a gay bar,” said one Russian harm reduction activist. “You know something’s going on but you can’t see clearly. That’s what chemsex is like for us in the region.”

But the general de-centering of epidemiology and quantitative research isn’t necessarily a bad thing. Teixeira said that sharing data was critical for past Forums, but that the tide has turned. “Now we’re talking about what are we going to do.”


The Growth of Risky Chemsex

Sex, drugs and gay culture have long been a distinctive combination. Historically, urban gay men have used drugs at higher rates than their straight counterparts. But queer sexualized drug use didn’t take shape as “chemsex”—as London-based expert David Stuart first coined it to the public health community—until the explosion of geolocation gay hook-up apps like Grindr and Scruff at the beginning of the decade.

Public health research has shown that chemsex participation has swelled over the past decade,  accompanied by unaddressed harms.

In addition to the role of technology and prevalence of group settings, chemsex is distinguished from other sexualized drug use by the loneliness experienced in a gay-specific culture of rejection, and by the trauma experienced by many gay men from the AIDS crisis of the ’80s and ’90s, Stuart has written.

Public health research has shown that chemsex participation has swelled over the past decade or so,  accompanied by unaddressed harms. For example, between 2005 and 2012, the number of gay and bisexual men utilizing a London LGBTQ health service around use of the three primary drugs associated with chemsex—crystal meth, GHB/GBL and mephedrone—rose by 85 percent.

The associated harms seem to be better understood than the scale: Chemsex participation increases the likelihood of engaging in riskier sexual behavior, which has been driving increases in new HIV infections and putting people at greater risk of sexual violence. Large proportions of chemsex participants using the depressant GHB/GBL overdose; and many are facing severe mental health consequences—like depression, paranoia and psychosis—related to problematic meth use.

But to be clear, chemsex is not a problem for everyone. “Some people are curious about some products. Some might try it. Some might return to it or not. Some people retain a curiosity for it. Some can choose when they use it. It’s only [without] the freedom to choose when, where and with whom … to do chemsex, it becomes a problem,” said Alexandre Aslan, a doctor at Hôpital Saint-Louis in Paris.

London remains one of the best-studied locales, though other major urban centers in Western Europe have also been researched, with similar findings.


The Response: Its Strengths and Challenges

Western European countries have seen robust public health responses. For Ben Collins, director and founding member of International HIV Partnership—the organization behind the Forum—the Amsterdam Chemsex Network is “an excellent example of these organizations working together to ensure people’s overall and holistic needs are addressed.” The Network—a multidisciplinary coalition of 16 organizations, including Mainline, GGD and Pink in Blue—prioritizes four “pillars”: harm reduction, physical health, mental health and personal safety.

“Those organized responses were invariably arguing for more holistic approaches to include good, sensitive and friendly surveillance to identify and support key populations and drug users; HIV, HCV and STI prevention and treatment; direct or effective referral to support and care services; [and] housing and support,” Collins told Filter.

But chemsex programs’ proliferation is not necessarily due to a financial boost. For organizations serving some of the most marginalized chemsex users, like Trans United Europe, money remains a problem. Asked by Filter what the biggest obstacle was to expanding chemsex resources, Transgender Europe Strategic Director Dinah Bons responded with one word: “Funding.”

“Care providers are needing to do more with less. Many of the care providers participating in the Forum were showing incredible engagement and ingenuity,” said Collins. Bons, a trans woman of color who has participated in chemsex while doing sex work, spearheads drop-in centers in Paris and Amsterdam that truly meet migrant trans sex workers “where they’re at.”

In Paris, [trans women] come from [sex] work, and they’re so fucked up. They don’t have anywhere to go,” Bons told Filter. “If they go to their house and they see their landlord, they’re at risk of being evicted. Sleeping in the park in this weather is not fantastic. So this is what we do: We see them in all these stages, so we have a very clear picture of what this person is going through.” 

Slamming has grown in popularity in Madrid due to unique factors. The practice of injection has become culturally eroticized.

Apoyo Positivo, a Madrid organization that operates a one-stop chemsex service delivery program on a shoestring budget, is another example. Providing a comprehensive program, even with a minimal budget, was imperative when other health centers and drug user services were not competent in queer culture and many clients did not identify as drug users, making it less likely for them to utilize those other resources, reported Apoyo Positivo psychiatrist Javier Curto in a presentation.

Apoyo Positivo’s presentation on November 15

The stakes of providing comprehensive services for chemsex users in Madrid are raised by particularly risky consumption practices there. More than half (58 percent) of clients surveyed by Apoyo Positivo reported currently or occasionally “slamming” (injecting), drugs during chemsex. Injection drug use is far riskier than inhalation or smoking because of its association with viral transmission and physical wounds like abscesses and collapsed veins, as well as its relation to overdosing and overamping.

Slamming during chemsex has grown in popularity in Madrid due to unique factors. In particular, the practice of injection has become culturally eroticized, in part through “the proliferation of amateur videos on pornographic websites in which men having sex while they inject themselves with various substances, such as methadone, methamphetamines or MDMA,” according to a 2016 Apoyo Positivo  report.

The austerity facing many chemsex organizations across the region seems most intense in Eastern Europe and Central Asia. Western European countries like France, Germany and the UK have some of the best supported programs, while Eastern Europe faces “issues [that] are more structural,” said Collins. “Gains in the West are often made in the context of healthcare systems that are at least open to, or in fact incredibly supportive of, sexual health, harm reduction and drugs services. Huge overlapping HIV, HCV TB and drug epidemics are happening across Eastern Europe and Central Asia” in contexts that include “healthcare systems in need of modernization” and “authoritarian governments.”

In the face of this, the Moscow-based Andrey Rylkov Foundation has been able to launch a chemsex program despite government fines of thousands of dollars for publishing “drug propaganda” (actually a harm reduction guide that didn’t encourage drug use). The organization has been able to raise $3,000 to offset the damage. Meanwhile the Russian government criminalizes open speech about LGBTQ issues and maintains a drug user registry that strips people who use drugs of key rights and resources.

“We are actively seeking separate financial support for a harm reduction project in the context of chemsex,” Malyshev told Filter in February. “This gives hope and faith that so many people support the foundation despite government repression.”


What the US Can Learn From—And Teach—Europe

Filmmaker Micheal Rice is one of the few US-Americans who is pushing forward the public conversation around sexualized methamphetamine use within urban gay male communities, specifically those that are predominantly Black and Brown.

He was invited to present his film, parTy boi, at the Forum to introduce European responders to the particular ways that Black gay men are being devastated by the lack of harm reduction resources and treatment options for party ‘n’ play (PnP), as chemsex is more popularly known in the United States.

Rice was one of the few attendees representing the most marginalized people struggling with problematic chemsex or PnP. “As far as I could tell, I was the only Black man,” Rice told Filter. He was surprised, given that cities like Paris and London, which were well represented, have large populations of LGBTQ people of color.

I was also disappointed to see very few transgender women at the Forum. Although one panel was dedicated to marginalized groups within the chemsex response, I wished that they could simply have been more represented throughout.

“We need more stories and data from sex workers, marginalized gay men, trans people and migrants.”

Forum organizer Collins recognizes this issue. “While we had a session on under-represented populations and there were a few good studies about sex workers and decent mention of migrants, clearly we need more stories and data from sex workers, marginalized gay men, trans people and migrants,” he said. “We made some efforts. Not enough.”

But he noted that representation can only represent what’s happening on the ground, and services themselves too often overlook the most marginalized chemsex users in the first place. As he works to expand who’s included for the next Forum, he notes the importance of changing how services are delivered.

“It’s essential that organizations, including sex worker and trans organizations, at least discuss whether chemsex and broader drug and sexual health issues should be priorities,” he said. “If they’re under-capacitated to respond, then let’s work together to identify potential responders.”

US providers often similarly under-serve trans people and people of color when it comes to PnP. But there are far fewer dedicated programs to begin with. Some major cities, like San Francisco and New York City, do have existing PnP-centered programs. The San Francisco AIDS Foundations offers a harm reduction counseling group for queer and trans Black men and a support program for trans men and trans women, and NYC-based Gay Men’s Health Crisis operates Re-Charge, a health and wellness program for people who use meth.

This month, some leading US harm reduction organizations published a toolkit for other harm reductionists and syringe service programs. The Chicago Recovery Alliance, AIDS United and the Humboldt Area Center for Harm Reduction organized a document outlining substances frequently used, potential models for program development and harm reduction strategies.

While attending the Forum, Rice realized just how far behind US-American harm reductionists, activists and service providers are when it comes to queer sexualized drug use. In Europe, “it’s more intense than what we have in the states—in the accuracy of creating programs that can actually be used by people in the community, like 24-hour hotlines, apps about harm reduction, safe spaces and treatment,” Rice said. “The tone isn’t the same in the United States. It gets blurred with opioids.”


Micheal Rice, right, responding to questions mediated by Ben Collins, left, after the screening


Per his tendency to push the envelope, Rice is planning to take action. With a colleague, he is in the early stages of organizing a 24-hour program for queer and trans people struggling with problematic meth use. “I see a place where harm reduction is used, a safe space where you can stay the night, a facility with staff trained for people dealing with chemsex,” he elaborated.

Even though Western Europe has more developed programs, the challenges ahead of European, Central Asian, and US chemsex responders are steep. “Too many people are not being reached in friendly and effective ways about their core needs. Full stop,” said Collins. “And those core needs are not just chemsex or just HIV prevention. We are all very complex people with overlapping issues and needs.”

Photographs from the European Chemsex Forum by Sessi Kuwabara Blanchard.

Sessi Kuwabara Blanchard

Sessi is an independent drug journalist and drug-user activist. She lives in New York City.

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