In the past week the public has been alerted to “risky behaviours” among gay men in London. Triggered by an editorial in the BMJ, the media has been warning of the “dangers of chemsex”, an activity labelled an “increasing risk to public health”. While there is undoubtedly an issue here, we need a strategy for dealing with the dangers of chemsex that works, rather than one that appears to favour transmitting a moral message instead of offering straightforward information.
It’s worth noting that the editorial itself suggests that chemsex is “practised by a small minority of men who have sex with men”. For example, the European Men-who-have-sex-with-men Internet Survey (Emis), which is mentioned by the authors of the BMJ editorial, reports that of 3,826 gay male respondents in London, 95.2% had never injected any drugs, and only 2.7% had done so in the past year.
The danger is that, through exaggerated or sensationalised reporting, the public gets a distorted impression of the magnitude of this phenomenon – and that can only increase the level of collective anxiety. Once again we see gay sex being represented as embodying a new or extraordinary health threat. The result could be an inaccurate and phobic picture of gay men as self-destructive and sick.
Causes are more complex than stereotypes suggest. Sex is a primary source of sociality for both gay and straight men, and involves experimentation, adventure and transgression, but also initiation, promiscuity and risk. The majority of gay men are aware of the dangers of chemsex and have good knowledge about HIV and STD prevention. But they do not automatically accept public health messages.
One of the reasons for their resistance to those messages can be found in gay-oriented NHS programmes: addiction recovery, mental wellness, even HIV prevention adopt a pathology-focused understanding of gay sex. Health professionals require further training to understand the role that transgression plays in the sexual fantasies and practices of many gay men. It’s some 30 years since the start of the Aids epidemic, but the primary approach to gay health remains based on an attempt to create a culture of emergency. That approach – and the way it is covered by the media – may have unexpected consequences, intensifying instead of suppressing chemsex. In similar cases, treating unconventional behaviours as deviant has had a self-reinforcing effect: media reports on chemsex might result in even more attention being paid to it, but isolating those called “deviant” from the rest of society pushes them to identify more strongly with each other, fostering greater isolation.
Another major problem of this emergency culture is that coverage reflects medical professionals’ opinion, which assumes that sex is a health concern rather than a source of transgression and pleasure. Gay men are told what to do and how to behave. The failure of HIV prevention shows that gay men do not want to hear it. For example, when health workers say “you are bad when you do not use condoms”, they inadvertently encourage some gay men to not use condoms. The more doctors adopt shame, guilt and just-say-no tactics, the more they will produce the opposite effect to that which they are trying to achieve.
The tendency to consider gay sex simply as a matter of public health will have negative effects on addressing chemsex properly. Drug abuse and HIV continue to present profound challenges to the health of gay people, but a climate of moral panic and blaming the gay scene is counterproductive.
Prevention needs to look at the deep causes that drive some gay men to risky behaviours leading to drug abuse or HIV. Lack of confidence, low self-esteem and internalised homophobia are just a partial explanation. There are gay people who suffer from stigma, but who do not engage in chemsex. We need a more sophisticated analysis of the reasons driving high-risk behaviour among some gay men. Without this understanding, any future NHS responses to chemsex are destined to fail.
