Chemsex Among HIV Positive Gay, Bisexual, and Men Who Have Sex with Men: Exploring the Intersections Between Sero-status, Mental Health, Substance Use, and Addiction.

Abstract

The use of amphetamines and other dissociative substances to facilitate sexual contact is part of a growing phenomenon among some groups of gay, bisexual, and other men who have sex with men (GBMSM) – particularly, those living with HIV. Colloquially known as “chemsex”, this practice is commonly discussed in extant literature in terms of its purported risks; less however, is known about the rewards this practice holds for those who participate and the motivations for engagement among HIV positive GBMSM as a unique subculture. To address gaps in nursing knowledge related to chemsex engagement among GBMSM living with HIV, critical qualitative research was undertaken. The objectives of this study were to (1) identify the dynamics, values, behaviours, and beliefs of HIV positive GBMSM engaging in chemsex; and (2) examine the effect of chemsex on the healthcare needs and risk-taking behaviours to improve overall health outcomes for this group. This research employed a critical ethnographic methodological approach using interviews as the main form of observation. Findings revealed that motivations for chemsex initiation were primarily fueled by a desire for change – particularly with respect to HIV subjectivity and mental health challenges. Within the world of chemsex, these men had the opportunity to become alternate versions of themselves and to live and participate freely and without restrictions. Chemsex subcultures were, however, also marked by a distinct set of norms (rules, values, behaviours) that marked participation. Depending on their position in a given moment in time, these norms would vary between pleasure, subjectivity, and tension. Despite the variability in their experiences, chemsex subcultures ultimately provided a sense of community to these participants. These were spaces in which they felt accepted, loved, cherished – and would go to any length to maintain the health and wellbeing of their peers. These findings suggest a depth to chemsex engagement among HIV positive GBMSM that should be met in nursing practice with flexibility. That is, future initiatives must be shaped by patient needs (and not what nurses think they require) and must acknowledge the variability in experiences of this subculture.