Chemsex-Related Risk Behaviors in Sexual Health Contexts

Chemsex refers to the use of specific psychoactive substances immediately before or during sexual activity, most commonly among men who have sex with men. Substances such as methamphetamine, mephedrone, gamma-hydroxybutyrate (GHB) and ketamine are employed to amplify arousal, prolong encounters and reduce inhibitions. This practice has been linked to elevated rates of condomless intercourse, higher numbers of sexual partners and increased prevalence of HIV and other sexually transmitted infections. Social environments, including community networks and digital platforms, shape access to drugs and norms around risk. Moreover, mental health challenges and minority stress often intersect with chemsex participation, creating syndemic conditions that compound physical, psychological and social harms. Public health responses are now emphasising tailored harm reduction, integrated sexual health services and culturally competent outreach to mitigate adverse outcomes while respecting the lived experiences of affected communities.

Research from Nature Portfolio

Recent studies have applied a social network perspective to understand variation in chemsex-related outcomes. By mapping the social connections of individuals engaged in sexualised drug use, distinct network types—ranging from diverse community ties to chemsex-restricted circles—have been identified. Findings reveal that those embedded in chemsex-centred networks experience stronger peer influence towards drug-enhanced sex and reduced engagement in other community activities, whereas network quality indicators such as emotional closeness better predict sexual health outcomes than mere social support. Long-term participants report more adverse sexual health consequences and lower satisfaction, underscoring the need for interventions that address both the structure and quality of social relationships within chemsex contexts.

Chemsex-Related Risk Behaviors in Sexual Health Contexts publication trend

The graph below shows the total number of articles in chemsex-related risk behaviors in sexual health contexts across all publications each year (not limited to Nature Index journals).

Technical terms

Chemsex: Use of specific psychoactive drugs to enhance, prolong or intensify sexual activity.

Polydrug use: Concurrent or sequential use of multiple substances within a defined period.

Harm reduction approach: Strategies to minimise morbidity and mortality associated with high-risk behaviours without requiring abstinence.

Self-efficacy: An individual’s belief in their capacity to execute behaviours necessary to produce desired outcomes.

Social network typology: Classification of individuals’ relational environments based on the composition and quality of their social ties.

References

1. Social networks of men who have sex with men engaging in chemsex in Germany: differences in social resources and sexual health. Humanities and Social Sciences Communications (2024).
2. ChemsexPH: The association between chemsex, HIV status and adherence to antiretroviral therapy among men who have sex with men in the Philippines. Journal of the International AIDS Society (2024).
3. Web-Based Harm Reduction Intervention for Chemsex in Men Who Have Sex With Men: Randomized Controlled Trial. JMIR Public Health and Surveillance (2023).
4. Differentiating the role of alcohol in young men’s use of substances with sex: A qualitative study. Harm Reduction Journal (2023).