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.
Thinking upstream: the roles of international health and drug policies in public health responses to chemsex
Chemsex is a growing public health concern in urban centres and few interventions exist to mitigate the significant sexual, drug-related and social harms potentially experienced by people who participate in chemsex. In much of the world, these immediate harms are further compounded by the criminalisation and stigmatisation of both homosexuality and drug use, preventing participants fully engaging with treatment services or provision of healthcare. Gay, bisexual and other men who have sex with men participating in chemsex fall between the traditional definitions of key populations and consequently are poorly provided for by existing drug and sexual health frameworks. Aetiologically complex issues such as chemsex require multi-faceted interventions that may fall outside conventional frameworks. Existing interventions have been designed and implemented at the local level. The use of international policy to mitigate these structural barriers, however, has largely been ignored. International policy is broad in nature and its implementation is, in principle, binding for member states. We believe that despite its low international prevalence, international policy can be of use in improving the lives of people who participate in chemsex. Through stimulating a much-needed debate on the interplay between sex and drugs within global health and harm reduction frameworks, this paper aims to address the paucity of substantial discussion surrounding the applicability of international language to chemsex. We analyse international policy aimed at addressing HIV, illicit drugs, harm reduction, and development; and make recommendations for both national advocacy, and advocates working to alter the positions of member states internationally. Further keywords: men who have sex with men, gay men, injecting drug use, stimulant, sexual behaviour, UNGASS, Commission on Narcotic Drugs (CND), Sustainable Development Goals (SDGs), Joint United Nations Programme on HIV/AIDS (UNAIDS).
SH17153 Accepted 20 December 2017
© CSIRO 2017