South African harm reduction guideline for chemsex

Abstract

The intentional use of psychoactive substances to enhance sexual experiences is known as chemsex. Chemsex is one form of sexualised substance use. Chemsex is primarily, but not exclusively, practised by key population groups including gay, bisexual and other men who have sex with men (GBMSM), transgender people, people who use drugs, and sex workers. The potential harms result from the intersecting stigma and risks relating to substance use, criminalisation of drug use and possession for personal use, sex work, HIV and other sexually transmitted infections (STIs), prolonged and higher-risk sexual practices, substance-use disorders, mental health conditions, and sexual- and gender-based violence. Chemsex is not always problematic, but some people may develop health and/or social issues with this practice. While data on the prevalence of chemsex in South Africa (SA) are limited, HIV and STI programmes for key populations regularly reach people who engage in chemsex. Chemsex sessions are frequently posted on GBMSM social networking and dating applications. This phenomenon is taking place in the context of increasing psychoactive substance use and a high prevalence of HIV and other STIs among key populations in the country. Locally, there is a lack of knowledge, services, and support for people who engage in chemsex. This exacerbates their risk of exposure to HIV and other STIs, heightens barriers to accessing comprehensive care, and intensifies potential harms. This guideline provides recommendations to address the key health and psychosocial aspects relating to chemsex in SA. Box 1 summarises the key components of chemsex harm reduction services. Recommendations are aligned with international evidence and informed by the professional experience of the authors, and research on the values and preferences of South African GBMSM who engage in chemsex. This guideline was thoroughly reviewed by external peer reviewers. This guideline should be viewed within the context of the Southern African HIV Clinicians Guidelines for Harm Reduction. SCOPE AND PURPOSE • Provide an overview of chemsex in SA. • Offer evidence-based clinical guidance for chemsex harm-reduction services. • Provide a directory of useful resources and sensitised providers.