Chemsex is often hidden from public view, yet it can carry serious risks for sexual health, mental health, substance use, and access to essential support.
Chemsex, the use of psychoactive substances in connection with sexual activity, is an often-hidden sexual health and public health issue.
It can increase risks linked to STIs, HIV, overdose, substance dependence, and mental health, while stigma and lack of awareness can prevent people from seeking support.
A 2024 systematic review and meta-analysis of 32 studies found that people engaging in chemsex had higher levels of these sexual risk behaviours, as well as HIV and STI prevalence, compared with those who did not engage in chemsex.(1✔ ✔Trusted Source
The Risks for HIV and Sexually Transmitted Infections Among Men Who Have Sex with Men Who Engage in Chemsex in Low- and Middle-Income Countries: A Mixed Methods Systematic Review and Meta-Analysis
What Exactly Is Chemsex?
Chemsex refers to using psychoactive or recreational drugs before or during sexual activity, often with the intention of enhancing sexual experiences, increasing confidence, or prolonging sexual activity.
Substances commonly associated with chemsex include methamphetamine, mephedrone, GHB (gamma-hydroxybutyrate)/GBL (gamma-butyrolactone), and cocaine.
The practice has become an important sexual health and public health concern because drug use during sex can affect judgment, increase sexual risk-taking and contribute to HIV, STIs, overdose, substance dependence and mental health problems.
The term is particularly discussed in relation to men who have sex with men (MSM), although chemsex can occur among people of different sexual orientations and genders.
What Makes Chemsex a Sexual Health Concern?
“Chemsex” refers to using psychoactive substances before or during sexual activity to enhance or prolong sexual experiences.
While experiences vary, combining drug use and sex can affect decision-making, consent, sexual boundaries, and the ability to follow safer-sex practices.
It can also be associated with substance dependence, overdose, mental health concerns, and sexual health risks, making chemsex an important public health issue.
How Chemsex Can Increase HIV and STI Risks?
Chemsex may increase exposure to HIV and sexually transmitted infections (STIs) when drug use is associated with condomless sex, multiple or new sexual partners, or prolonged sexual activity.
A 2024 systematic review and meta-analysis of 32 studies found higher levels of sexual risk behaviors and HIV and STI prevalence among people engaging in chemsex compared with those who did not.
HIV prevention, STI testing, condoms, and PrEP can play important roles in reducing sexual health risks.
A Chemsex Crisis Hidden in Plain Sight
A striking example emerged from Soweto, South Africa, where community organization OUT LGBT Well-being identified a network of chemsex houses during the COVID-19 lockdown period.
Researchers and community workers eventually connected with 127 men using these spaces, many of whom reported frequent drug use and sexual activity in crowded environments.
The findings revealed significant sexual health, substance-use, and mental health concerns.
More than half of the men were living with HIV, but only 31% knew their status, while just 42% of those living with HIV were regularly taking antiretroviral therapy (ART).
Methamphetamine was the most commonly reported drug, with 77% using it and 40% combining it with other substances.
The psychological burden was also substantial. Around half of the participants showed symptoms of anxiety or depression, while 54% showed signs of psychosis and 28% reported suicidal thoughts. Harmful alcohol and drug use were also widespread.(2✔ ✔Trusted Source
South African harm reduction guideline for chemsex
How Community Support Helped Reduce Chemsex-Related Risks?
Presentations at the 26th International AIDS Conference (AIDS 2026) in Rio de Janeiro highlighted the links between chemsex, HIV, substance use, and mental health.
A South African program by OUT LGBT Well-being provided counselling, CBT, peer support, and skills training.
The programme was associated with a 31-35% reduction in anxiety, depression and suicidal thoughts, while symptoms of psychosis fell by 63% and harmful drug use by 35%.
Regular ART use also increased to 83%, but dropped to 68% after funding ended, highlighting the importance of sustained community-based support and HIV care.
Breaking the Silence: Safer Sex and Harm Reduction
Reducing the health impact of chemsex requires non-judgmental support, harm reduction, and accessible sexual health services.
Regular HIV and STI screening, appropriate HIV prevention such as PrEP, safer-sex practices, and access to substance-use support can help people reduce potential harms.
Addressing chemsex stigma is equally important because fear of judgment can discourage people from seeking healthcare, addiction support, or mental health services.
As the saying goes, “A problem shared is a problem halved.” Breaking the silence around chemsex can help people access care without fear or stigma.
References:
- The Risks for HIV and Sexually Transmitted Infections Among Men Who Have Sex with Men Who Engage in Chemsex in Low- and Middle-Income Countries- (https://pubmed.ncbi.nlm.nih.gov/38878136/)
- South African harm reduction guideline for chemsex – (https://pmc.ncbi.nlm.nih.gov/articles/PMC12506591/)
Source-Medindia