Sex, drugs and techno – a qualitative study on finding the balance between risk, safety and pleasure among men who have sex with men engaging in recreational and sexualised drug use

Abstract

Background Recreational and sexual drug use among men who have sex with men may result in increased risk of poor health. The aim of this study was to better understand drug use and harm reduction techniques among Swedish men who have sex with men traveling to Berlin in order to improve the health of this population and inform public health strategies. Methods A qualitative study based on semi-structured interviews with 15 Swedish men aged 23–44 with experience of drug use were recruited through network sampling. Interviews were conducted in Stockholm and Berlin and analysed using content analysis. The interview guide included questions on drug use, context, health and safety. Results The participants engaged in drug use in both settings and in various contexts. Participants saw themselves as capable of finding a balance between pleasure, safety and risk with the aim to maximize positive effects while minimizing negative ones. The different risks of drug use were known, and participants relied on knowledge, harm reduction strategies and self-defined rules of intake to stay safe and healthy in a broad sense, both short term (i.e. during each session) and long term. Choice of drug and, frequency of intake, multi-use, risk of overdose, risk of HIV, purpose and context of use, how often, etc. were all part of the overall strategy. Knowledge of these methods was spread within the community and on-line rather than from counsellors or other health care providers. However, it did not always translate perfectly into practice and some had experienced overdoses and problematic use. Conclusions The findings of this study point to the need for increased adoption of harm reduction techniques in this population focusing on mitigating harm and prevention of risk of problematic use or starting injection drugs. Existing traditional services require adaptations to become more accessible and acceptable to sub-groups of drug users, including low-threshold services providing non-judgemental, evidence-based information. This will require funding of alternative providers such as STI/HIV clinics, among others, and health care providers to increase adoption of prevention strategies, specifically pre-exposure prophylaxis for HIV.

Needs and experiences of people practising chemsex with support services: toward chemsex-affirmative interventions

“…Consequently, awareness-raising must respond to the second principle of affirmative intervention, namely, to acknowledge the impacts of homophobic and transphobic discrimination on the well-being of people who identify as sexual diverse or gender diverse. Specifically in the context of chemsex, it seems all the more necessary to consider the repercussions of the discrimination experienced by psychoactive substance users on their well-being, particularly people using methamphetamine, as this substance is particularly stigmatized [37]. For example, health professionals must acknowledge that the stigmatization associated with methamphetamine use has an impact on the well-being of the people concerned and on their access to health care [38].…”

Conceptualizing safer sex in a new era: Risk perception and decision-making process among highly sexually active men who have sex with men

“…This research is part of a larger qualitative project exploring travel, drug use and sexual health among highly sexually active Swedish MSM who spend time in both Sweden and Berlin [64,65].…”

“…The men interviewed also described experiencing a broad range of sexual practices in both cities, such as sex on the premises of club venues, group sex, and fisting. Fifteen of the men experienced using drugs in club and/or sex settings [65]. The names used in the Results section are fictitious.…”

Understanding Sexualized Drug Use: Substances, Reasons, Consequences, and Self-Perceptions among Men Who Have Sex with Other Men in Spain

“…However, not all male sexualized drug users report problematic use [5]. The type of substance, route of administration, and frequency of use could be behind the more adverse outcomes of sexual experience-enhancing drug use [6].…”