ssh-chemsex-study-final-main-report

A few men described a very clear transition in their
sexual behaviour since beginning to engage in chemsex,
from someone who was very risk aware and sexually
cautious to someone who engaged in sex that carried a
risk of HIV/STI transmission, which they later regretted.
Sometimes such risky behaviour was confined to
occasional ‘slip-ups’ or one-off risk incidents, whereas
other men found themselves frequently engaging in risky
sex and struggling to find a route out of it.
“ For me it [crystal meth] was very overpowering and
it increased my sex drive. It made me actually want
to explore myself sexually and have sex and with no
regard or responsibility in terms of using condoms and
who I was having sex with and how rough it was or
how long it went on for and so I think more long-term
it shifted my attitudes towards sex.
[Aged 24, last
”
tested HIV negative]
Finally, there were men who described being so
cognitively incapacitated by heavy drug use that they
simply did not remember what they had done, including
whether they had used condoms with unfamiliar
sexual partners. Several others described feeling so
overwhelmed by the effects of drugs that they had no
conscious awareness of their actions.
“ I try to have protected sex but the thing is that when
you’re in a euphoric state, things happen. You might
not be totally aware of what actually people are doing
[to you] because you are that fucked.
[Aged 50, last tested
”
HIV negative]
When UAI did occur, HIV negative men were sometimes
able to rationalise their actions by acknowledging the
modality of their intercourse (e.g. they told themselves
they were insertive and thus less likely to catch HIV), or
that they were not in receipt of ejaculate, or expressed
their belief that their positive sexual partner was likely
to have an undetectable viral load. Others rationalised
that despite being technically risky, their UAI with
an unfamiliar party had felt ‘safe’ because he had no
visible signs of being HIV positive, or lived in wealthy
surroundings which, at the time, they did not associate
with men who have HIV. Regardless of the tactics used
to manage the risk of infection, across the whole sample
around a third disclosed that they had been diagnosed
with an STI in the previous year.
While four men explicitly mentioned seeking postexposure
prophylaxis (PEP) after instances of UAI with
sero-discordant or sero-unknown partners, this usually
only occurred when a personal ‘red line’ had been
crossed – such as UAI in group settings or receptive
UAI with someone they knew to be infected with HIV.
Most experiences of UAI were not followed by this
action, sometimes because men had not felt capable of
accessing health services within the time period that PEP
is recommended (in order to be effective, it is crucial that
individuals access PEP within 72 hours of exposure to
HIV).
“ I have thought actually, maybe I’ll go to [* sexual
health clinic] today. Like I said, having blood drawn
from me, I can pass out, it’s quite a mission to have it
done so I think actually, I’ll just take my chances and
not. I think if people come inside me, then I’ll probably
kind of be like “yes, I’ll go and do this”. But there have
been times when, I was at a party for so long if I picked
anything up, PEP wouldn’t work by the end.
[Aged 32, last tested HIV
”
negative]
However, two of the professional clinic-based
interviewees described how it was not uncommon for
men to arrive at their clinic on a Monday morning, after a
weekend of chemsex, seeking PEP.
“For me it [crystal meth] was very overpowering and it increased
my sex drive. It made me actually want to explore myself sexually
and have sex and with no regard or responsibility in terms of using
condoms and who I was having sex with and how rough it was or
how long it went on for...”
The Chemsex Study | 6. THE ROLE OF DRUGS IN HIV/STI TRANSMISSION RISK BEHAVIOUR 53