Jolanta Barbara Zawilska, Natalia Wysocka-Sendkowska, Marcin Stępniak

Chemsex – an international public health concern: description, risk behaviors, substance use and health consequences

2025-01-14

Subject of the study. The subject of the research is the phenomenon of so-called chemsex. The paper presents motivations, health and social effects of chemsex, with special emphasis given to aspects related to public health, such as the risk of sexually transmitted infections, mental health, and negative impact on relationships within the family, workplace and society.

Purpose of the study. The aim of this literature review was to provide a multi-level discussion of the phenomenon of chemsex – the intentional use of substances immediately before or during sexual intercourse, mainly by men who have sex with men (MSM). The authors analyzed data on the prevalence of chemsex in various social and geographical contexts, main reasons for being involved in chemsex and the compounds used, with a particular emphasis on their toxicity. Health effects of chemsex, including sexually transmitted infections, mental disorders, and social consequences, were demonstrated. The paper also presents recommendations for prevention and intervention to reduce the negative effects of chemsex.

Materials and methods. The literature review was conducted using PubMed, Google Scholar and Web of Science databases, and employing the following keywords: chemsex, man having sex with man (MSM), sexually transmitted diseases, pre-exposure prophylactics, and mental health. The databases were searched between September and November 2024. The search was limited to full-text articles published in English between 2000 and 2024.

Results. The most commonly used drugs in chemsex are methamphetamine, mephedrone, and Ɣ-hydroxybutyric acid (GHB)/γ-butyrolactone (GBL), collectively referred to as “chemsex drugs.” Other substances used by chemsex participants include ketamine, cocaine, MDMA (ecstasy), amphetamine, alkyl and butyl nitrites, marijuana, and medicines used for erectile dysfunction. Drugs administered intravenously (so-called slamming) include mephedrone and other compounds from the synthetic cathinone group; use of ketamine and methamphetamine is less common. Chemsex involves long-term sexual sessions that can last from several hours to several days, often in groups and with multiple partners. It is associated with an increased incidence of sexually transmitted diseases, such as HIV, gonorrhea, chlamydiosis, syphilis, hepatitis C and hepatitis B. Slamming poses the greatest risk of infection with HIV, HCV and HBV. To reduce the risk of HIV infection, it is recommended to use pre-exposure prophylaxis (PrEP) with two antiviral drugs, emtricitabine and tenofovir disoproxil fumarate, which can be taken daily or as needed. Chemsex negatively affects mental health, leading to anxiety and fear, depression, psychotic disorders, suicidal thoughts and attempts. In addition, chemsex is associated with isolation and stigmatization and negatively affects social and family life and intimate relationships.

Conclusions. The phenomenon of chemsex has become a significant public health problem in recent years. Chemsex is associated with numerous negative health effects, particularly sexually transmitted infections and mental disorders. In order to reduce the negative effects of chemsex, educational programs should be developed, access to pre-exposure prophylaxis should be supported, and specialized addiction treatment programs should be offered.

Keywords: sexually transmitted diseases, GHB, methamphetamine, chemsex, mental health, sexual activity, mephedrone, erectile dysfunction agents, pre-exposure prophylactis.

© Farm Pol, 2024, 80(8): 515–522