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This article has been peer reviewed and accepted for publication. It is in production and has not been edited, so may differ from the final published form.

Beyond prevalence and risk: A qualitative study exploring pathways in and out of chemsex engagement amongst gay men living in London

Vivienne Smith , Fiona Tasker

Abstract

Background: Chemsex (the combined use of drugs and sexual experiences) by MSM is associated with the transmission of STIs and BBVs, but psychosocial factors associated with chemsex engagement and remission remain unidentified. We considered: how do gay men self-identify a chemsex problem and remain chemsex free? Methods: Using a life course perspective this qualitative interview study examined participants’ reflections to discern pathways in and out of chemsex engagement. Six participants (aged 18 years and over) were drawn from a cohort of men who had completed the tailored therapeutic Structured Weekend Antidote Programme (SWAP), run by London based LGBT non-governmental organization London Friend. Transcripts were analysed using a Labovian narrative analysis framework. Results: Each man identified a multiplicity of incidents and feelings that contributed to their engagement in chemsex, and engagement in chemsex was connected to participants’ identity development and desire to belong to a gay community. Underlying individual accounts a common narrative suggested a process through which chemsex journeys were perceived as spiralling from exciting and self-exploratory incidents into an out of control high-risk activity that was isolating and prompted engagement with therapy. Despite seeking therapeutic engagement, participants’ expressed uncertainty about maintaining a gay future without chemsex. Conclusions: Findings indicated that chemsex was associated with a positive gay identity gain, which explained the ambivalence participants’ expressed in maintaining a gay future without chemsex despite their awareness of negative consequences. This is significant both for understanding why chemsex pathways may prove attractive, but also why they may be so difficult to leave.

SH17122  Accepted 13 September 2017

© CSIRO 2017