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European ChemSex forum report 2018

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[ C o m p a n y A d d r e s s ]FORUM REPORT

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TABLE OF CONTENTS
INTRODUCTION.............................................................................................

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European ChemSex forum report 2018

  1. 1. [ C o m p a n y A d d r e s s ]FORUM REPORT
  2. 2. 1
  3. 3. 2 TABLE OF CONTENTS INTRODUCTION......................................................................................................................3 DATA / EVIDENCE DAY..........................................................................................................5 Welcome Speeches.....................................................................................................................................................5 Let's work together....................................................................................................................................................6 Input from training day...........................................................................................................................................6 Let's talk without stigma about sex and drugs..............................................................................................7 ChemSex trends and challenges...........................................................................................................................9 Panel 1: What do we we know about medical issues (HIV, HCV, Co-infections, STIs) and ChemSex?............................................................................................................................................................. 9 1. Medical issues (HIV, Hepatitis C, STIs).............................................................................................9 2. “We are talking about me?” The Swiss HCVree trial..............................................................10 Panel 2: What do we know about ChemSex and psychological & psychosexual issues?.........12 Panel 3: What do we know about ChemSex and sexual assault, violence, breach of consent and/or rape?............................................................................................................................................................13 Panel 4: What do we know about ChemSex-related needs in important communities (EECA, trans people, migrants, people of colour and ethnic groups, sex workers)?................................17 COMMUNITY MOBILISATION DAY .....................................................................................19 Keynote: ChemSex, health and social wellbeing.......................................................................................19 Who says it is problematic? Introducing the Online ChemSex care plan.......................................20 Towards effective community responses: Examples of community mobilisations...................22 Sexual drug use among clients of Swiss HIV testing Centres ..............................................................24 Workshop: Building multisectoral reponse teams..................................................................................26 NEXT STEPS.........................................................................................................................29 Key findings:............................................................................................................................................................29 Key agenda moving foward...............................................................................................................................30 ANNEXE.................................................................................................................................31 Programme ..............................................................................................................................................................31
  4. 4. 3 INTRODUCTION Building on the 2016 European ChemSex Forum, a preliminary intelligence gathering and networking event, the second European ChemSex Forum took place on 22-24 March 2018 in Berlin. Calling for concrete actions at the local level to provide strategic resources to Chem- Sex responders, the Forum aimed to provide a platform to engage in international, cross- sector, multi-disciplinary dialogue and discussions around ChemSex – defined by the use of specific drugs ("Chems") in modern, Smartphone-age sexual contexts by gay, bisexual, and other men who have sex with men (which includes Trans people); and to facilitate coordi- nated responses to ChemSex issues in settings where ChemSex related harm is a problem, or where Chemsex-related harms can be reduced, regardless of size and impact. The Forum was hosted by International HIV Partnerships (IHP) and Professional Briefings, with the sup- port of AIDES, Gilead, Schwulenberatung Berlin, ViiV Healthcare, individual donors, and en- dorsed by x number of organisations. Some clear guiding principles informed the 2nd Forum: • The Forum focus was on problematic ChemSex, not drug use and sex per se. Prob- lematic ChemSex is defined, as such, by the individual in interaction with his peers and care providers, and includes a focus on harm reduction support to avoid any use becoming problematic. • As a group, the conference planners recognised that various harms related to Chem- Sex are occurring, including HIV, hepatitis and co-infections, STIs, drug overdoses, depressions, rapes, and deaths. The objective of the Forum was to address those harms forthrightly, not make generalisations about drug use or sexual behaviour. The Forum programme focussed on 3 key work areas: • Responding to loneliness, boredom, social media and apps and other key factors which contribute to problematic ChemSex • Multi-sectoral responses; and • Information gathering. While ChemSex responders and concerned service and care providers have been able to encourage practical responses to ChemSex trends in some key cities in Europe, overall the response to ChemSex has not kept pace with its developing impact across Europe. Chem- Sex "mature" cities like London, Paris and Amsterdam are mounting joined-up responses from both community and health services. In other cities however, ChemSex and its harms are still not fully acknowledged as a normal part of life in their gay communities. In this context, the Forum aimed to provide participants with: • An improved understanding of the benefits of a range of therapeutic responses; • The tools to develop and improve multi-sectoral responses, identify possible re- sponders, appropriate to their settings
  5. 5. 4 • The tools to develop and improve information gathering, appropriate to their set- tings. 243 participants took part in the Forum over three days, bringing together healthcare provid- ers, researchers, therapists, policy makers, service providers and service users from 32 countries. The Forum started with a training day for 65 frontline staff from the WHO European region and was followed by two full days of presentations and discussions, with Day One looking at data and evidence across Europe and Day Two focusing on the community re- sponse to ChemSex. The Forum included presentations, panels, debates, small group workshops and poster dis- plays allowing participants to engage in rigorous information exchange. The community and services response was complemented by community and service information stands. Even- ing events, demonstrating the European response to ChemSex, also took place over three evenings. The agenda is provided in the appendix. This meeting report synthesises and summarises the proceedings and outcomes of the 2nd European ChemSex Forum and has been prepared by the organising committee in consul- tation with key partners. Presentations, posters and audio files from the Forum are available here.
  6. 6. 5 DATA / EVIDENCE DAY WELCOME SPEECHES The Forum was opened by Bryan Teixeira, Meeting Chair, and included welcoming speeches by Arndt Bächler, Addiction therapist at Schwulenberatung, Berlin; Dr. Martin Viehweger, HIV doctor and ChemSex responder, Berlin; Fred Bladou, Addictologist at AIDES in Paris; Dinah de Ringuet-Bons from PvDA Nederland, and Ben Collins, IHP Director and ReShape Con- venor. Bryan Teixeira welcomed participants to the second gathering of the ChemSex Forum and stated that the focus of this forum would be on problematic ChemSex. Delegates would ex- plore responses in terms of harm reduction, multisectoral collaboration and community mo- bilisation. While the first forum had focussed on evidence, the second forum was expected to more about mobilisation. Arndt Bächler, warmly welcomed participants to Berlin and opened his address with a brief history of the Berlin gay scene. He noted that Berlin was always one of the gay sex capitals of the world but in the past few years, new powerful drugs had appeared, promising wonderful sex lives. Since then, many gay men had lost control of their drug use and some had died. In the 80s and 90s, many gay men had died of HIV and, as a community, taking care of each other, supporting friends and lovers and educating ourselves on ChemSex were essential components to avoiding a repeat of this era. Martin Viehweger thanked the organisers and expressed his wish for the Forum to focus on developing networks and harvest the energy and motivation of the delegates who had come together to learn and to share. Fred Bladou and Dinah de Ringuet-Bons reminded the delegates that since the last forum in London, lovers, friends, neighbours, colleagues had died of HIV, Hepatitis C or overdoses related to ChemSex. They urged the forum to carry on the fight out of respect for them and to improve the situation. Dinah, speaking on behalf of the sex worker community, stated that they had lost many young people who had been struggling with their identity and chems and she asked the audience to observe a minute of silence to remember them. A minute silence was observed in memory of all of those who died as a result of ChemSex. After welcoming the participants, Ben Collins gave an overview of the demographics among the participants: 243 people from 32 countries around Europe were in attendance. This second forum had seen a huge increase in the number of participants from Eastern Europe and Central Asia, where the history of drug use was being impacted by the intro- duction of new drugs. He emphasized that not all the experts would be on the stage: the forum participants them- selves were experts who were all expected to contribute to the dialogue, helping to build new responses and collaborations.
  7. 7. 6 LET’S WORK TOGETHER David Stuart 56 Dean Street David Stuart formally opened the 2nd European ChemSex Forum in Berlin by defining ChemSex as a cultural phenomenon unique to modern gay hook-up culture, born of the impact the HIV epi- demic had had upon the experience of homo-sex and gay communities, and of the impact that sex apps and the introduction of new drugs had had upon the same communities, The convergence of these phenomenons had resulted in a syn- demic that had profoundly impacted gay and queer men’s concepts of sex and pleasure and community; a syndemic named ChemSex. David discussed the need to be mindful of cul- tural differences when addressing ChemSex in- ternationally, and with international guests at the Forum. While in some environments one could talk about the right to pursue pleasure and the right to enjoy drugs, other communities (such as Queer Black communities in the USA that had been particularly devastated by methampheta- mine and ChemSex), will have differing and sometimes emotional concepts of the role drugs and ChemSex might play within those communities. David also referred to the hurtful and reductive terms used by some, when referring to chemsex; such as a tendency within Aca- demia to refer to gay men who engage in ChemSex as simply a “sub-population of a sub- population”. He reminded attendees, that the millions of gay men who died of AIDS were, in actual fact, just a “ sub-population of a sub-population” - but that it would be insulting, disre- spectful and reductive to refer to them as such. The same is true for gay communities that are struggling with the cultural impact, and deaths, of men within global gay communities. David emphasised the need to be mindful of all these sensitivities, differing cultural concepts, differing opinions, differing definitions. He spoke of how moving he found people’s passionate opinions in regard to ChemSex conversations, the degree to which people care, acknowl- edging that sometimes these differing opinions, these passions, these conversations, can become heated, and that we can sometimes forget that we are all working toward the same goal: the safety and improved wellbeing of our beloved communities. David reminded us, and asked us all, to hold dearly on to our passion, and to build upon it, respectfully and kindly, so as to generate the best outcomes and to enjoy a productive European ChemSex Forum. INPUT FROM TRAINING DAY Bernard Kelly Courtyard Clinic, London Bernard Kelly reported on the training day, entitled “ChemSex Encounters”. He informed the Forum that there had been 170 applications for 65 places, demonstrating the needs for such a programme. It was hoped that the participants would become the catalysts for contin- uing the discussion in their own environments. Bernard noted that both the training and previous speakers had reminded him of the difficul- ties and demands of ChemSex work: how do you persuade people not to go back to heaven when they had been there?
  8. 8. 7 Key messages from the training day for the development and management of effective ChemSex services, as presented by Stuart Fenton, a counsellor at Resort 12 in Thai- land: • Develop cultural competence in the topic and knowledge of its demographics • Privilege a holistic approach, looking at the person as a whole: mental health, physical health, sexual health & drug use • Develop pathways and partnerships and foster creative thinking • Conduct more research and evidence gathering, both for funding or commissioning pur- poses but also to identify potential responses and needs • Focus on confidentiality and non-judgemental engagement • Realise the multifocal realities of clients: gay men, sex workers, trans people and mi- grants • Evaluate and measure what is being done • Share expertise • Distribute educational resources in appropriate spaces for target populations • Create a safe space for people to hear and process what is being said in confidentiality • Pay attention to the impact on HIV but also to other areas impacted by ChemSex: other STIs, depression, anxiety and other mental health issues, as well as community cohe- sion. • Move on from the idea of relapse to look through the lens of re-learning. LET’S TALK WITHOUT STIGMA ABOUT CHEMS AND SEX Leon Knoops Mainline Foundation, the Netherlands Leon Knoops, gave a key note address focussing on the following 3 questions: ➢ What is problematic drug use? ➢ How can we decrease stigma surrounding drug use, gay sex, HIV and bare sex? and ➢ What is a possible effective response? Leon Knoops started his presentation by noting that the use of drugs during sex was a growing global phenomenon, which had been greatly helped by the arrival of dating apps that facilitated easy access to ChemSex sessions and access to drugs. He revealed that the use of new psycho-active substances and Slamming (Injecting) were steadily increasing in certain sex networks. While some men could use drugs sensibly, oth- ers had lost control of their consumption, with a profound negative impact on their lives, and were facing a difficult and isolated route to recovery. These were the individuals that concerned the ChemSex Forum, not the ones who were “happy users”. Unfortunately, drug services were often badly informed and ill-prepared or prejudiced around drug use in relation to gay sex, leading to men dropping out of services. To be ef- fective and engaging to men looking for help around ChemSex issues, drug services needed to work more closely with mental and sexual health services and offer holistic treat- ment, looking at sexual identity in association with drug use and psychological issues.
  9. 9. 8 Loneliness and lack of meaningful connections were often cited as underlying issues as well as lack of self-confidence, sense of shame and internal stigma associated with gay sex, isolation, peer pressure and society’s lack of acceptance. Leon noted that most answers to these issues will have to come from within the gay scene itself. Gay men have to start the discussion around safe drug use and learn to support each other and rebuild their community. LATE ADDITION: BRIEF COMMENT ABOUT INFORMATON GATHERING AND SHARING Teymur Noori from the European Centre for Disease Prevention and Control briefly ad- dressed the Forum about data gathering. He observed that, to date, there was no good Eu- ropean data on ChemSex, only anecdotal evidence. From a policy and programmatic pro- spective, the absence of hard data meant that the issue simply did not exist. A standard data set was needed to monitor trends across countries. The next EMIS survey should have some important information on ChemSex and its results will be published in the next few months. Teymur also noted that there was very little literature on ChemSex in scientific journals, and he encouraged the Forum participants to start publishing their abstracts and submit them to journals. CONCLUSIONS: WHAT WE CAN DO As services: • Provide safe space where the men can talk about the use of chems without being stigmatised or judged • Provide activities based on the principles of Harm Reduction • Integrate harm reduction and abstinence so they can work in harmony. There should not be a conflict between the two. • Provide holistic treatment, looking at sexual identity, drug use and psychological issues combined As individuals: • Help rebuild the sense of community and support people to reframe their sex lives • Talk about chems and sex in the gay community, overruling taboo and stigma • Talk about risks, underlying issues • Question the focus on body image and disconnected sex • Be supportive and compassionate • Avoid the passive stigmatisation of people who are not using drugs • Be careful around the use of stigmatising language such as saying people are “clean”
  10. 10. 9 CHEMSEX TRENDS AND CHALLENGES Panel 1: What do we know about medical issues (HIV, HCV, Co-infections and STIs) and ChemSex 1. Medical issues (HIV, Hepatitis C, STIs) Mark Pakianathan, St George’s Hospital, London Mark presented the evidence collected in South London on ChemSex or event-level drug-use in relations to STIs, HIV, HCV and gave an overview of what was known on sexualised sub- stance use among gay men. He remarked that the data gathered internationally showed sexualised substance use was higher among gay men compared to heterosexual men. This was associated with a greater number of partners and condomless anal sex. There was also some evidence that the use of methamphetamine was associated with an increase in HIV acquisition. In South London, data has been collected since 2014 as part of an integrated HIV/STI outpa- tient service, where the assessment of sexual health, drug use and mental health was inte- grated as part of the clinic’s routine HIV patient care. Since 2014, data has been collected on 2752 gay and bisexual men, 63.6% of whom were born in the UK, and 18% were HIV positive. Key findings: • 40% disclosed drug use, 58% of those in the context of ChemSex, with over a third disclos- ing injecting drugs • Mephedrone was the most popular drug but 80% of respondents used more than one sub- stance. • ChemSex participants were 5.5 times more likely to have had more than 5 partners in the last 3 months, with 26.5% requesting PEP and 61.4% reporting group sex. Heavy drinking was more common. • STI diagnosis was more likely (73.3% vs 40%), HIV diagnosis was 5 times more likely and Hep C 8 times more likely • 71% of ChemSex participants perceived negative consequences as a result of ChemSex. • There was anecdotal evidence that people setting boundaries (maximum drug use, maxi- mum monthly spending, time limit etc.) reported less problematic drug use. In conclusion: ChemSex in the South London service was commonly reported after introducing routine pro-forma assessment including ChemSex questions. People participating in ChemSex reported higher risk behaviours and greater alcohol consumption overall. They were also more likely to be diagnosed with acute rectal or bacterial STIs, HIV and Hep C.
  11. 11. 10 2. “We are talking about me?” The Swiss HCVree trial, research on equal terms with the patient Benjamin Hampel, University Hospital Zurich, Switzerland and Patrizia Künzler, Hospital St Gallen/University of Basel, Switzerland Benjamin Hampel and Patrizia Künzler presented data from the Swiss HIV cohort study that had enrolled 20 000 people with HIV in Switzerland, followed since 1987. The data covered 75% of all HIV positive people living in Switzerland. At the beginning of the cohort study, the data on HIV/HCV co-infected people showed that hepatitis C was an epidemic amongst people who used intravenous drugs. In the last dec- ade however, the epidemic shifted to men who had sex with men and ChemSex drugs were observed as being on the rise amongst MSMs. The study found a strong correlation between hepatitis C and use of methamphetamine and GHB/GBL. A sub-study within the Swiss HIV Cohort Study covered 122 MSMs co-infected with HIV/HCV. Participants with no or inconsistent condom use were invited to participate, alongside HCV treatment, in an E-health assisted behavioural intervention called “HCVree and me” focussing on the patients and their individual goal settings. The programme was developed with the participation of the target population. It consisted of 4 individual ses- sions, exploring client’s feelings and reflecting preferences connected to sexual and drug- using behaviour, setting individual goals and planning how to achieve these goals and at the end to evaluate the plan. The counsellors were all nurses trained in communication and motivational interview techniques and the sessions were done in parallel to medical ap- pointments during HCV treatment. The study results exceeded expectations. Community viral load was eliminated in more than 90% of this population. Recommendations • ChemSex assessments of gay and bisexual men should be a routine part of clinical care. • Information should be given about Shigella and Hepatitis C prevention. • HIV negative men who participate in ChemSex should be identified for PrEP. • Open access to regular STI screening and HIV testing and early treatment to prevent onwards transmission is needed. • Alcohol assessments should be routine. • Longitude and qualitative work in all studies are needed. There is not enough infor- mation on non-problematic drug-use and the risks and protective factors for the people who do not develop problematic use.
  12. 12. 11 Panel 2: What do we know about ChemSex and psychological and psychosexual is- sues? 1. Ben Collins, International HIV Partnerships, London Ben Collins opened his presentation by thanking all the sponsors, funders and endorsers of the Forum, as well as the people who acted as advisors to put the programme together and those who helped with the organisation of the Forum. Ben began the discussion by noting the changes that had been happening in the psychoso- cial and community responses to ChemSex, with the focus switching from the shock of ChemSex to looking at the environment in which ChemSex was becoming commonplace. He paralleled this shift with a brief history of his personal journey, highlighting how his inter- est and work had moved from an HIV perspective to a sexual health and social wellbeing perspective, with more focus on self-stigma. Working with David Stuart, they began planning the first European ChemSex Forum in 2015. The first forum focussed mainly on Chems, looking at the actual dynamics, the Key messages: • Hepatitis C is an important issue in the ChemSex scene • The target population needs to be integrated early in the development of behavioural interventions • Individual tailoring is essential to success • Communication and motivational interviewing skills are important tools to be valued and resourced
  13. 13. 12 impact of potent drug combinations on brain and bodies with some discussion on harm re- duction. There was almost no discussion of sex, no discussion of sex addiction and com- pulsion and hardly any mention of loneliness. As the second forum was being planned, a complete sea change in discussion was ob- served. Loneliness, boredom, alienation within the community were recognised as key pro- pelling forces behind problematic ChemSex. A cyclical model reminiscent of the HIV Life cycle response: ChemSex, Ben stated, just as HIV, was an indicator of discriminations and of a large num- ber of problems affecting many minorities, some of them internal to our own gay commu- nity. Ben remarked that giving up chems, could also for many gay men, mean a return to loneli- ness. This was a much-tweeted quote from the forum. Responses to ChemSex have been rich and varied, ranging from: harm reduction, periods of abstinence, outreach, education materials, one-to-one intervention or group therapy, apps management, trigger responses etc. Looking back to the early day of HIV, before successful treatments, people used a number of strategies to help themselves. Ben noted that similarly it would be key for ChemSex re- sponders to invite people to talk about what they needed rather than impose what we be- lieved worked. The knowledge of this complementary approach was already there. Recommendations: • Implementation of a person-centred response recognising intersectionality • Give people resources to self-assess, online or otherwise • Development of safe spaces to break isolation • Adoption of a holistic approach, integrating drug use, sexual health and mental health
  14. 14. 13 2. Bernard Kelly, Courtyard Clinic, London Bernard Kelly’s presentation consisted of slides of artworks, comics and photographs with quotes and comments. He told the story of the Great Library of Alexandria where a fire destroyed some 40,000 book scrolls. One man venturing in the burnt library found the last page of a book describ- ing how to change base metal into gold with the alchemist stone. The stone could be found on shore of the Black Sea. It would be recognisable, as it would glow like the sun in the hand. For 20 years, the man picked up stones on the shore and, if they stayed cold, threw them into the sea. One day, the stone he picked up glowed in his hand, but, out of habit, he threw it away like all the others. Bernard compared this story to the path gay men can find themselves on their quest for happiness and acceptance, which is then too easily thrown away once it has been found. He went on to say that actions, rather than being motivated by desire, were often motivated by boredom, disgust, or trying to get unattainable things. This excess of appetite, or greed, was really a form of despair. The challenge for gay men, is how to develop healthy appe- tites, where feelings of satisfaction and fulfilment can be allowed and experienced, instead of being devoured by desperation. Bernard noted that gay men created communities where dichotomies existed between the world in their head and the world they actually lived in. This environment was very hard for young people to join: “It’s like you emerge from the closet expecting to be this butterfly and the gay community just slaps the idealism out of you. It was really horrifying. It’s made by gay adults, and it’s not welcoming for gay kids. You go from your mom’s house to a gay club where a lot of people are on drugs and it’s like, this is my community? It’s like the fuck- ing jungle.” Anonymous Bernard called upon members of the community to reclaim themselves as Fairy godfathers and godmothers, so that those following on could flourish. Going forward with research, with interventions, with public health measures, it was im- portant, he stated, to remember that the real solution was probably to be found in small acts of kindness. Panel 3: What do we know about ChemSex and sexual assault, violence, breach of consent and/or rape? 1. Chris Ward & Rebecca Evans, Manchester University Foundation Trust, UK Chris Ward and Rebecca Evans led a presentation on the growing emergence of sexual assault in England and Wales among ChemSex users and some of the coercion and vul- nerabilities they face. Data from the crime survey for England and Wales estimated that around 2.5% females and 0.4% males had been victims of a sexual offence in the last 12 months. However, re- search done by Survivors UK, a male sexual assault charity, reported that only 3.9% of men actually reported their experiences to the police or service providers (compared with 15% of women). Chris noted that definitions of rape and sexual assault varied according to countries’ individual laws. The barriers to reporting for men are different: They are often unaware that what happened to them was actually a crime; they worry it will reflect badly on their masculinity or are afraid of being arrested for drug use. However, Chris noted that the main issues in the context of ChemSex were around the ability to consent when high on drugs and what constituted con- sent. Chris identified consent as agreeing to each sexual act with each sexual contact.
  15. 15. 14 Using different case studies as examples, Chris and Rebecca informed the conference that almost a third of their service users reported non-consensual sex or sexual assault. They were often young MSMs. Chris highlighted the role of the first ChemSex conference in Lon- don in improving the reporting of non-consensual sex in the clinic. Following the confer- ence, the clinic had realised that discussing consent was more complex in this particular cohort and the discussion moved towards a conversation around unwanted sexual atten- tion, coercion and negotiating sex rather than standard questions around rape and sexual assault. This change in interviewing strategy led to a two-fold increase in reporting. This approach also showed that presentation in this cohort was much more subtle and re- porting less likely as people were reluctant to disclose, believing they had left their rights to consent at the door when attending ChemSex parties or other sex venues. Individuals were also worried about acting as whistle blowers in their community. Chris explained that discussions around non-consensual sex sometimes also led patients to realise that they had been the perpetrators, which could be extremely challenging for the service provider. He noted that ChemSex users could be both victim and perpetrator in a ChemSex context. Other forms of coercions were also routinely reported. In cases where a culture of coercion and assault seemed to be present, the clinic would report anonymously to the police for the benefit of the wider community. Chris and Rebecca concluded that more work around information and awareness of sexual violence and consent in a ChemSex context was needed in the community but also with the police and healthcare workers. Recommendations: • Review standard discussions in clinics around sexual assault • Improve understanding of sexual consent among healthcare workers for this cohort • Ask routine questions around ChemSex in the clinic • Open conversation around sexual activities patients did not want to have or were not aware they were having until later • Ensure robust pathways and training are in place for appropriate referrals • Work with patient on self-confidence, negotiating sex and understanding of consent • Improve understanding around sexual consent in the community
  16. 16. 15 PANEL DISCUSSION Continuing with the theme of ChemSex and sexual assault and consent, the discussion ex- amined the legal environment, the difficulties around starting the conversation, both for the service providers and the service users and the lack of response from the community itself. Ferenc Bagyinszky, from AIDS Action Europe, stressed that stigma and discrimination stopped individuals from seeking support and accessing services, and that besides cover- ing consent in a ChemSex setting, a broader legal coverage of the environment was also necessary. Criminalisation inhibited health-seeking behaviours and was a barrier to report- ing assault to the police if it meant facing possible criminalisation procedures. He noted that for working purposes, the legal environment needed to be understood: what would happen if someone called an ambulance? Would the ambulance report to the police if drug use was involved? Does the ambulance know? Literacy in law and legislation also needed to be improved, both for users and providers. The drug and harm reduction movement and sex workers movement could teach us a lot on the issue. LGBTQ+ organisations, whose priorities were elsewhere, also needed to be more engaged. David Stuart, from 56 Dean Street, stressed that it was a very confusing and complicated for healthcare providers and people engaging in ChemSex to have these awkward conver- sations. David gave timeline of complex behaviour and circumstances that commonly hap- pen during a 3 day ChemSex episode, that includes guilt, victimhood, joy, rejection, trauma, bliss, loathing, cruelty, crime, assault, unkindness and more. He described how a person might have been as guilty of cruelty in one moment, as they might be the victim of it in an- other moment, during the course of a long ChemSex episode. He emphasised how confus- ing and complex this can be for the person involved, let alone a healthcare worker trying to help him to untangle this mercurial series of traumatic events. Some drugs also affected the SESSION PARTICIPANTS Chair : Bryan Teixeira Panellists : • Ferenc Bagyinszky, AIDS Action • Europe • David Stuart, 56 Dean Street • Chris Ward, Manchester University Foundation Trust • Rebecca Evans, Manchester University Foundation Trust KEY THEMES OF THIS SESSION • Criminalisation inhibits access to ser- vices and reporting to the police. • Literacy in law and legislation needs to be improved • Consent, assault and rape discus- sions need to be approached differ- ently with MSM. • Creating a safe space to disclose is more important than asking the right questions.
  17. 17. 16 way trauma was being processed: While some people would have intense memories, oth- ers would struggle with lost time/poor memory. In the end, it came down to having a chat and asking questions around what was traumatic, what was uncomfortable, what felt good. David also noted that as a professional, unless there was an immediate risk of harm to the individual or others, the priority should always be to keep the individuals engaged in care. Monty Moncrieff from London Friend Antidote confirmed that data in England was not get- ting through as assaults were not reported to the police. However, the Police in London had a sexual assault unit, with a LGBT sub-group, who had taken the issue seriously and had engaged with services. With the help of Antidote, they had produced a ChemSex toolkit for sexual assault specialist officers. He suggested that this might be a model for other areas around Europe. Monty noted that the work was changing and gathering pace, as it was becoming a more prominent issue. With a different cohort coming into contact with the Criminal Justice Sys- tem, drug related offences in the gay community were growing as well as convictions for sexual assault. Rebecca Evans from Manchester University Foundation Trust felt that there was a general avoidance of talking about traumatic experience, and there was a lot of self-blame amongst ChemSex patients as they felt they had put themselves in this position. Staff members in clinics and services were often not confident talking about sexual assault. However, the fo- cus had to be around creating a safe space and giving people the opportunity to talk, rather than thinking about asking the right questions. People must be made to feel they can dis- close. Once they had disclosed, staff could work on building resilience with their patients and make forward plans.
  18. 18. 17 Panel 4: What do we know about ChemSex-related needs in important communities (EECA, trans people, migrants, people of colour and ethnic groups, sex workers)? This panel brought the discussion to specific communities. Trajche Janushev spoke about his own experience as a migrant, sex worker and Eastern European, noting the intersectional nature of the sex worker community. Trajche noted that the situation in Eastern European Countries was very different to that of Western Europe with very little dialogue happening around ChemSex due to the criminali- sation of drug use, sex work and/or homosexuality. As far as he was aware, there was no available data around sex work and ChemSex. Dinah de Riquet Bons also highlighted the vibrant intersectionality of sex workers. She thought that many of the issues observed in a ChemSex context often originated from a place of trauma brought upon by the intolerance of the political and cultural environment. Underlying issues were not yet streamlined into the medical system, with no linkage be- tween mental health and sexual health. Peer to peer support groups were essential to help people deal with issues around their identity and sexuality, drug use, financial hardship, de- pression and other problems in a safe space. Involving key populations in programmatic decisions was essential to identify these underlying issues and move forward. Viken Darakjian informed the Forum that in countries like Armenia, homosexuality was highly stigmatised and discriminated and finding sex was difficult. For this reason, it was frequent for MSMs to visit other countries and seize the opportunity to have sexual encoun- ters. They often did not know about Chems at the time but were prepared to take them in order to have sex. A small study in Armenia showed that many MSMs now knew about ChemSex, and had engaged in ChemSex and had unprotected sex. This is a situation replicated throughout the old Soviet Union where gay men feel very pressurised. Following this study, 4 training workshops were organised with NGOs to pass on practical information about ChemSex, SESSION PARTICIPANTS Chair : Bryan Teixeira Panellists : • Viken Darakjian, Positive People Arme- nian Network • Trajche Janushev, SWAN • Dinah de Riguet Bons, France & Netherlands • Andrii Chernyshev, Ukraine • Ford Hickson, Sigma Research, UK (Data and Evidence day round-up) KEY THEMES OF THIS SESSION • Criminalisation of drug use, sex work and/or homosexuality in Eastern Eu- rope impedes dialogue around Chem- Sex and associated issues • HIV stigma and criminalisation of drug use have a negative impact on the im- plementation of efficient public health policy • Involvement of key populations in pro- grammatic decisions is essential to identify underlying issues • Linking people to peer groups from key communities through social media such as Facebook groups is easy to set up and efficient
  19. 19. 18 such as information on the drugs involved and harm reduction strategies. 80 participants have participated in these trainings so far and the demand is increasing. Andrii Chernyshev presented the data of a quantitative and qualitative research con- ducted amongst 100 MSMs in Ukraine who had experience of ChemSex. Results high- lighted low condom use (26%), multi-drugs taking for sex, and problematic alcohol con- sumption as one of the risk factors. The most widespread drugs were amphetamines with very few cases of G or Crystal Meth. Ecstasy and MDMA were also widely used. Almost 50% of the population surveyed had experience of overdoses and 12 % reported non-con- sensual sex. Unfortunately, HIV stigma and criminalisation of drug use had a negative impact on the im- plementation of efficient public health policies. Ford Hickson brought the Data and Evidence day of the 2nd ChemSex Forum to a close with a quick round-up of the key themes explored during the day: Key themes from Data & Evidence Day: • Morbidities hang together in the same people, HIV underlying issues are very similar to ChemSex underlying issues • Continuity of issues that have faced gay communities for decades and exclusion from legal redress • Normalisation of drug use and of non-consensual sex in the gay community • Problems with creating and maintaining a sense of community • Importance of the online world and ease of access leading to fragmented social net- works • New stimulants have been taken on by gay men as they touch on things that were al- ready prevalent in the gay community
  20. 20. 19 COMMUNITY MOBILISATION DAY KEYNOTE: CHEMSEX, HEALTH AND SOCIAL WELLBEING Jan Großer Schwulenberatung, Berlin Jan Großer opened the Community Mobilisation Day with an overview from Berlin, focusing on the challenges presented by the rise of ChemSex and on developments needed to ade- quately respond to them. Berlin, Jan stated, had a long history of openness towards alter- native sexualities and subcultures, and since reunification, Berlin has cemented its place as a gay holiday destination, attracting international crowds. The Berlin experience politically is one of great freedom alongside increasing stigmatisation and homophobic aggression from the growing new right movement. In this context, ChemSex has swollen like a tsunami. In search of sexual encounters, people have been moving from other drugs to crystal meth, moving from smoking to finally injecting and running into huge problems. Unlike HIV/AIDS in the 80s/90s, ChemSex is largely out of public sight and men struggle in relative silence, mostly unacknowledged while drug problems are still viewed by many as individual failure. Meanwhile, partners feel unsupported in their struggle with grief and guilt feelings. Jan reported that men presented to the numerous community organisations with problems that did not always appear to be obviously related to ChemSex but in fact were. Due to the complex structure of the German health care system, services were very frag- ments and the delivery of healthcare and prevention in one place was very difficult. This was particularly problematic in relation to ChemSex, which required competencies in the culture of sexual minorities, HIV and sexual health, and drug use in a sexual setting. This led to very little cross coordination and joint planning. Furthermore, the classification of drug-use disorders by substances and the way data was collected lumped together people who might be using the same substances but had very different addiction problems. In- stead, social and cultural settings, narratives and individual and group psychology should be considered. Furthermore, prohibitionist drugs policies have failed. There has been a huge rise in the availability of toxic and harmful substances and the way they were being used. These poli- cies created an evolutionary pressure on drug use, so from a gay perspective, the commu- nity has moved on from relatively harmless substances to very powerful synthetic drugs with high potential for abuse, addiction and mental disorders and other health problems. These drugs can be produced near the market where they are being used, adding to their easy availability. The criminalisation of drugs is preventing a lot of people from seeking help. Internationally, there is a growing movement to change drugs policies at UN level and the gay community needs to join this discourse, be represented and drive the message home. Jan noted that gay men had always positively identified with shared sexual spaces, which traditionally have provided safety and solidarity, and found it difficult to acknowledge that there were problems with these spaces. A new narrative of gay sexuality encouraging ex- pression of self-acceptance and self-love, with a realistic views of limitations and a healthy balance between needs and desire will lead to better sex through richer emotional experi- ence and deeper personal connections. The way forward for organisations was to build networks to share communication, espe- cially in the absence of practical data, do a joint analysis of needs and service provision and work together to ease care pathways through the various agencies. Mapping changes and evaluating responses will need to be done in a sensitive way to ensure data protection and confidentiality. Jan also highlighted the importance of sharing stories, seeing it as a complementary step to data collecting. Anecdotal evidence from professionals and organi- sations can contribute to providing a complete picture, he stated.
  21. 21. 20 WHO SAYS IT IS PROBLEMATIC? INTRODUCING THE ONLINE CHEMSEX CARE PLAN David Stuart 56 Dean Street, London David Stuart started his presentation by noting that the majority of people supported by 56 Dean St did not define their drug use as problematic. The clinic provided clean needles, regular testing for HIV and a space for people to talk about their sex lives and drug use. The overall objective of the clinic was to keep people safe before it becomes problematic. The service did not seek to stop people’s right to have sex and seek pleasure. It was very person centred and worked with whatever goals the person chose. Recommendations: • Build networks, co-ordinate, communicate • Share stories, build a bigger picture • Gather data • Think ChemSex in all encounters with clients/patients • Move beyond feelings of shame and guilt; do not let others dictate what can be talked about • Do not look away; do not stay silent • Let’s change the culture with better sex through deeper personal connections • Change ineffective and harmful drug policies • Be nice!
  22. 22. 21 The online interactive ChemSex Care Plan was designed to help the many people around the world needing support with ChemSex, many of whom lived in areas that did not have skilled, targeted ChemSex support. The Care Plan simplified the process of starting a dia- logue around ChemSex. It guided people, via online prompts, through a journey of reflec- tion about the kind of sex they wanted, and the role Chems might be playing in their sex lives. It then supported them to make changes or to be safer regarding ChemSex by help- ing them identify an achievable goal to work towards, ranging from harm reduction to the very ambitious goal of abstinence, and by identifying the best ways to reach whichever goal the person chose. When people did not really know what they wanted, the care plan contained specific pages for people who were only reflected on their behaviour and choices, not necessarily ready, willing or needing to make any changes. These pages included basic questions to help them think about their drug use and sexual behaviour and to reflect on the role sex and drugs were playing in their lives. Using motivational interviewing techniques, the plan helped individuals to decide whether addressing their drug use was important or not. If it was, the plan helped them to identify triggers, times when they might be vulnerable to crav- ings and it gave them the skills to overcome these difficulties while giving them the confi- dence to make changes. Setting realistic goals that were achievable empowered individu- als to celebrate their successes and bask in a feeling of accomplishment. The online questionnaire could be completed at home in one’s own time or with the help of a health care worker. If done with the help of a healthcare worker, the way questions were formulated meant that there was no need for the healthcare worker to be an expert on gay sex or addictions to guide the client through the plan. David also informed the Forum that this tool did not collect data on individuals, and no one aside from the concerned individual could see what boxes were being ticked. The information was purely for the benefit of the individual to help him make choices. David took a moment to thank his international network of friends and peers who had helped him translate the online tool in 17 languages so far. Responding to questions at the end of his presentation, David reasserted the need to con- sider ChemSex in a sexual context rather than in the context of drug addiction. Gay sex was at the very centre of it, and the definition of ChemSex was about gay hook-up culture, and how gay sex had evolved over the last 40 years, defined by a range of crises and the advent of gay hook-up sites. ChemSex Care Plan – Step by Step: • Chose a goal (Abstinence, Taking a break, Harm reduction, Not entirely sure) reflect on drug use/behaviour to select goal • Rate confidence level of achieving that goal with an option to chose a more achieva- ble one if needed • Rate importance of achieving this goal • Identify triggers • Identify most vulnerable times • Manage cravings differently – what can be done differently next time to manage trig- gers/craving • Identify ways to play more safely and to reduce harm
  23. 23. 22 TOWARDS EFFECTIVE COMMUNITY RESPONSES: EXAMPLES OF COMMUNITY MO- BILISATIONS Ben Collins and community responders Community responders from differ- ent countries came on stage to talk about how they had built responses from the ground up and mobilised their community, exploring topics such as information gathering, safe spaces, project development and other ChemSex related issues. Adam, described as a “ChemSex graduate” defined his recovery pro- cess as a journey in search for meaning. When ChemSex was taken away from his life, he reported, his entire social structure had to be re-established. Because all his activities, friends and life revolved around ChemSex, safe places became the centre point of his recovery journey, where he was able to re-engage with the community and reconnect with his gay peers on a social level. The very first safe place was David Stuart and Patrick Cash’s “Let’s talk about gay sex and drugs”, a London community event where one was able to express oneself and everyone was welcome. There was hunger for people to come together and this space gave some validity to peo- ple’s experience and gave meaning to what had happened. Other safe places were places where one could just have fun and relax with one’s peers. A quick search revealed a variety of social networks, ranging from running to pole dancing groups. These groups could be set up at a grass root level with some networking in the community, with very little funding or other forms of support. Kai, from Berlin explained that his ChemSex experience went back to New York City in 2000. He eventually realised that a lot of his sexual impulses, and the nourishment he had been looking for, were released through touch and connections. Following this realisation, he founded Authentic Eros in 2003, offering a variety of gatherings, workshops, training and sessions aiming to facilitate a deep connection between body, mind, sex and spirit. Authen- tic Eros creates safe spaces and new narratives for gay sexuality where intimacy and sexu- ality become new references. Over the years, a new culture was created with a desire for a more permanent space, and the Village was created in Berlin. The Village is a community centre where people who have become members can self-organise and create their own events. There are currently around 30 events a month, covering different needs. A non- profit organisation is also being set up specifically for people coming out from ChemSex to create events where new concepts can be tried out: how to say no, how to communicate needs, how to respond to touch etc. Martin, an HIV clinician in Berlin, explained how he had been inspired by ‘Let’s Talk about gay sex and drugs’ in London during the 1st ChemSex Forum. Subsequently, the event was franchised and adapted to Berlin where it was made accessible to a broader audience (trans* people and women). This worked very well and the event caught the awareness of the media. Co-organised with legendary Berlin drag queen Pansy, the event has been very political, with open talks about substance use, STIs, etc. This had an impact on the audi- ence and allowed the information to go out to the public. Through his connection with the medical world, Martin could bridge the gap to the medical field and ChemSex has now reached their agenda with people from NGOs and community leaders invited to speak about the issue. Taking advantage of this unique position, a round table was also organised where clinicians, doctors from private practices, NGOs, activists all sat together to start the conversation on developing guidelines and a programme of training for professionals.
  24. 24. 23 Martin also stated that they participated in festivals and other events to talk about Chem- Sex, substance use and STIs and free testing was offered during these events. Other insti- tutions had shown interest with a pilot currently in development in Zurich. The event can be adapted to various communities. Jorge, from Apoyo Positivo in Madrid, explained that the city was a gay hot spot where peo- ple came to holiday from all over the world. His organisation had been working on HIV re- sponses since 1993, but in the past year, they had started to see more and more MSM us- ing drugs in a sexual setting. They quickly realised that this was becoming an issue in the gay community but organisations were not responding to it, more interested in political and legal issues. Consequently, they opened a programme called Sex, Drugs and You. It’s an open space where people can come and talk about sex and drugs with a variety of profes- sionals from the community (psychologists, psychiatrists, ChemSex specialists, etc). They realised that it was not enough to help individuals with sexual addiction and loneli- ness, but that it was also necessary to rebuild a community and talk about internal stigma. To do so, a community centre is being built, offering different activities such as mindful- ness, yoga, different leisure opportunities, theatre etc. A protocol was also developed by all the different stakeholders to deal with emergency responses, training people from hospital, and STI clinics to bring people to the right place to get the care they need. Moving on to information gathering, Sini from Finland, explained that in 2015 her commu- nity organisation, HIV Finland, that had been working with MSMs and HIV for over 20 years, realised that more information was needed about what was actually happening on the ground. The original survey, conducted in 2015, asked many questions about sex but did not include any information about drugs. Two years later, it became evident that drug use was becoming an important issue and the second survey conducted in 2017 included questions about ChemSex and other substances. An organisation working with substance use and rehabilitation was asked to collaborate to design the survey. The survey showed that getting information in this way was relatively cheap and obtaining information was needed in order to move forward. Matthias from Zurich demonstrated how a group of community activists could have a big impact with little resources and some ingenuity. LoveLazers, an independent group of indi- viduals working towards PrEP access, took the opportunity of Pride to distribute small cards with QR codes to partygoers. When the QR codes were scanned, an automatic letter was generated and sent to various official bodies in Switzerland asking for immediate PrEP ac- cess. The campaign was very successful in generating a lot of interest and media attention. Ben noted that although anecdotal information was not enough, it still needed to be docu- mented as a first step to smart and timely research. Followed up with support and research gathering, it could lead to collaboration and programme design.
  25. 25. 24 SEXUAL DRUG USE AMONG CLIENTS OF SWISS HIV TESTING CENTRES Axel J. Schmidt Sigma Research, London School of Hygiene & Tropical Medicine Axel J. Schmidt presented data about sexualised drug use among clients of HIV testing centres in Switzerland. He noted that data collection on sexualised drug use had been a direct result of the previous ChemSex Forum when, in November 2016, a new set of ques- tions were added to the anonymous questionnaires completed by clients of all testing cen- tres before their counselling sessions. The clients are now asked if they take drugs, which drugs and whether they use drugs when having sex. The resulting data collected from Nov 2016 until December 2017 showed that 7.7% of MSM testing for HIV were using chems (GHB/GBL, Ketamine, Crystal Meth or Mephedrone, but mainly GHB/GBL and Ketamine) when having sex, either always or often. This compared with 1.0% among women and 1.4% among other men. This data reflected national figures of all clients visiting an HIV testing centre during the above period in Switzerland. Axel informed the forum that the results from the EMIS 2017 study (the current European MSM Internet Survey) had just collected data from 130,000 MSM in Europe and Canada and that LAMIS 2018 (identical questionnaire, still running when the Forum took place) had already recruited 40,000 MSM in Central and South America. The two surveys provide in- formation on illicit drug use, sexualised drug use, stimulant drug use for sex, and sober sex. The first results could be expected this year. Recommendations: • Move the narrative forward and away from the technical aspects of sex and drug- use to talk about self-care and the emotional element. • Challenge dominant images of gay identity • Gay sex and cultural norms should be celebrated but issues in sexual and social spaces need to be acknowledged • Rebuild a sense of community through safe spaces and alternative social activities • Bridge the gap between the gay community, activists, and scientific communities and encourage networking and collaboration, looking at both short and long term in- terventions • Develop guidelines and information for professionals • Collect anecdotal information AND gather data
  26. 26. 25 Axel also reported on a drug-checking service available in all major Swiss cities, run by the city administration itself, allowing Swiss drug users to find out exactly what the pills they had bought contained. This service aims at informed decision-making and harm reduction, and therefore de facto acts as prevention for over-dosing. He suggested that installing drug-checking services in sexual health clinics would lower the threshold for talking about drug use and harm reduction strategies. Everyone can apply for a newsletter containing updated information about tested drugs. Key points: • A substantial and non-negligible minority of MSM engages in ChemSex, and those who do, do it regularly. The composition of drugs used in ChemSex varies across countries. • Although the narratives may be fundamentally different, one should not ignore sexu- alised stimulant use in non-MSM and monitor the trends, where possible. • Using questionnaires already implemented to anonymously query sexual behaviour prior to counselling questions is a great opportunity to implement questions on ChemSex and sexualised drug use at almost no extra cost. Harmonisation of ques- tions asked for clients in testing centres throughout the country is further useful to gather large amounts of data and evidence-based interventions. • Drug checking services can combine drug composition information with pragmatic harm reduction information, helping to open honest conversations about keeping safe. • Drug checking services can also identify trends in drug markets
  27. 27. 26 WORKSHOP: BUILDING MULTI-SECTORAL RESPONSE TEAMS This session looked at two groups, Mainline from the Netherlands and AIDES from France, that were putting together a multisectoral integrated approach to programmes. 1. Ingrid Bakker, Mainline, Netherlands Ingrid reported that Mainline, a small NGO working on harm- reduction in the Netherlands, started to see an increase in stories related to crystal meth use among MSMs in 2015. It quickly became apparent that something was changing on the gay scene. To follow up on these stories and find out more about it, Mainline conducted a survey with 27 people who en- gaged in ChemSex, leading to the publication of a report called “Tina and Slamming”. The report was presented in English and Dutch to a wide array of stakeholders internationally and put ChemSex on the agenda in the Netherlands. Since then, training has been provided to professionals on an ongoing basis. The Amster- dam municipal health service sexual health clinic has opened a peer project inspired by 56 Dean St in the UK and a range of educational material have been developed specifically for MSM on the ChemSex scene. Mainline is also running weekly support groups and re- searchers have started collecting data on the issue. Ingrid went on to explain Mainline's basic principles in their response to ChemSex: • Identify needs, set priorities and be pragmatic, for example: - Men had poor injecting skills so a booklet on injecting safely was produced - Men had regular contact with sexual health & HIV services so a training online module on ChemSex was designed for HIV/Sexual health care professionals • Look for co-responders for bigger impact and work with them in accordance to your specific goal: ChemSex community; sexual health & HIV organisations; LGBT organisations; harm reduction and drug use organisations; mental health professionals; medias; researchers; policy makers; the police force. • Persist: Be an advocate for ChemSex support and care • Don’t reinvent the wheel: use what is already available taking advantage of digital options and collaborate with colleagues around the world.
  28. 28. 27 2. Stéphan Vernhes & Fred Bladou, AIDES, France Fred Bladou: Global strategy for ChemSex users: Fred Bladou introduced AIDES, a French NGO fighting AIDS and Hepatitis C since 1984. AIDES was doing sexual prevention and harm reduction for different key populations until a few years ago when it started to integrate sexual prevention with harm reduction to respond to the rise of ChemSex. In France, until ChemSex, discussions with MSMs always revolved around safer sex and prevention. Although gay men were always taking drugs, it was never an important con- cern. Then some gay men started to come to AIDES with specific drug-related problems: they were starting to talk about group sex and drugs. The drugs were new synthetic prod- ucts, some, like Cathinones, taken by injection. To gain a better understanding of ChemSex and its practices, AIDES conducted a small qualitative survey among MSMs. The results indicated that gay men participating in Chem- Sex had many different partners and their HIV and hepatitis C prevalence was high. Their knowledge of harm reduction and injecting was inadequate and they were finding it difficult to manage their drug consumption and stay “happy” consumers. Following this survey, and faced with the steady rise of ChemSex and an increased number of deaths, AIDES put in place a new global strategy. It revolved around 5 key axes: 1. A new approach in sexual prevention ➢ Community-based health centre with peer to peer support, regular testing for HIV, HCV and other STIs, access to treatment, PrEP and safer sex materials 2. A new approach to harm reduction ➢ Education, free injecting equipment, product testing, education for better practices 3. A listen and support approach ➢ Peer to peer, psychological and addiction support, self-help groups 4. ChemSex emergency outreach measures ➢ Hotline, moderated Facebook group, WhatsApp 5. In-house and outreach prevention actions ➢ Dedicated ChemSex places throughout the country, interventions in places of sexual consumption Recommendations: • Empower Chems users to protect themselves and break their isolation • Combine new approaches to behavioural and bio-medicalized prevention with inno- vative risk reduction strategies • Provide non-judgmental guidance and support
  29. 29. 28 Stéphan Vernhes: ChemSex at LE SPOT in Paris: Stéphan Vernhes, from AIDES - France, introduced LE SPOT, a community-based sexual health centre located in the heart of Paris that supports MSMs, Trans people and sex work- ers. LE SPOT was launched in June 2016 along with LE SPOT Marseille. In association with 11 AIDES centres and other community-based centres, LE SPOT develops commu- nity-based activities covering HIV rapid testing, PrEP and ChemSex. In November 2016, the centre launched “Chillout ChemSex”, a weekly event providing peer-to-peer support where MSM using Chems for sex can share their experience, get sup- port and develop a new social network. At the start of each of these events, the attendees set the group rules for the evening. This collaborative rule setting is key to the success of the evenings, as they allow the participants to feel confident, comfortable and able to talk in confidentiality. As many participants come more than once, the group explores themes that are essential to them and chosen by them, such as: • Drug testing on the spot • Harm reduction • Sexuality • Pleasure • Self-esteem • Addiction • Cravings • Consequences of ChemSex on social and working life Up to June 2017, the group was about harm reduction but recently 95% of newcomers have come to LE SPOT because they wanted to quit ChemSex. As a result, every other week, the theme of the evening has been adapted to “sex or life without drugs”. Healthcare professionals, such as addictologists, psychologists, psychotherapists etc., have been invited to come along to speak and share their experience. Relevant documen- taries or films are also being screened. Promotion of the weekly event is done via social media, through a weekly Facebook event shared in 4 different gay groups; a newsletter is sent out every week with the theme of the following week; and the event is promoted on dating apps and gay French websites. At the end of the evening, participants are asked about their feedback on the meeting.
  30. 30. 29 NEXT STEPS The final session of the Forum was dedicated to formulating a few key conclusions and ex- ploring the next priorities and next steps for action. KEY FINDINGS: • Gay sex is at the very centre of ChemSex, revolving around gay hook-up culture, and how gay sex had evolved over the last 40 years, defined by a range of crisis and the advent of gay dating apps. • Loneliness, isolation and lack of meaningful connections have all been cited as underlying issues, worsened by a normalisation of drug use. • Responses will have to come from within the gay community itself, starting the discussion around safe drug use and dominant images of gay identity, creating new narratives where intimacy and sexuality become new references. • Harm reduction is key to minimise the impact of ChemSex on HIV and Hepatitis C preva- lence. Harm reduction is not only about safe injecting but includes other traditional strate- gies such as tips for safer online behaviour, safer drug use, safer gay sex and safety tips for ChemSex Environments. It can be about education, prevention, or about changing the conversation to talk about individuals’ responsibilities, such as looking after somebody who has passed out. Harm reduction does not exclude or ignore the needs to support a person towards abstinence, should that be the person goal. • Gentrification and the rise of social apps have reduced safe places for gay people to con- gregate. Safe virtual and actual places are essential to find connections, seek information and support and share experiences. The changing of gay social spaces however can also provide communities with great opportunities, to steer this change towards safer gay spaces where safety is defined by venues that support ongoing dialogues around complex issues impacting gay and queer communities. • Abstinence and harm reduction can work in harmony and the response to problematic drug use should be person-centred, taking into account issues of intersectionality. The Forum’s focus on problematic drug use respects people who choose to use chems in ways that they define as non-problematic, but it should not dismiss the need to make harm reduction information and equipment available to people who do not define their use as problematic. People who use drugs in ways they define as non-problematic also deserve the right to access sexual health services without having to omit their drug use for fear of judgment. • Gay men engaging in ChemSex are less likely to access mainstream drug services. Integrated services offering non-judgmental holistic treatment, where they feel comforta- ble and safe speaking about their sexual health, mental health and/or their drug use, are key to encourage them to access services and seek support. • There is a lack of clarity about what sexual consent means. Moving from mentions of sexual assault to discussions around unwanted sexual attention, coercion and negotiating sex facilitated disclosure. The criminalisation of drugs has created barriers in terms of reporting sexual abuse under the influence of drugs as men are unsure of legal conse- quences should they report to the police. • There are still gaps in data. Coherent evidence-based data is important to identify trends and commission responsive services. • Responses can range from the personal to the structural and/or political, and can be short and long term.
  31. 31. 30 • Although ChemSex has a well-understood definition, that associates it with gay culture, there is an absence of a universally-agreed-upon academic definition; this absence cre- ates challenges for data collection, access to services and research. KEY AGENDA MOVING FORWARD • Develop a 2nd European ChemSex Forum Declaration, which will identify our communi- ties’ ChemSex-related concerns and our hopes for sexual health and social wellbeing • Develop collaborative data collection with an agreed set of core questions to produce cross-European data. • Continue and expand the ChemSex Groups.io, a platform centred around ChemSex where people can share information, access multilingual documents and continue the dialogue. • Focus on solutions: Do people who manage their ChemSex use well have skills that could be shared? • Identify strategies to facilitate social participation, community involvement, safe places and mobilisation. • Make ChemSex assessment of gay men a routine part of their clinical care, focussing on creating a safe space to disclose. • Research, publish and disseminate data.
  32. 32. 31 ANNEXE PROGRAMME Thursday 22nd March TRAINING DAY ChemSex Encounters 09.30 Registration 10:00 Welcome and introduction Bernard Kelly 10:30 A clinician’s story Mark Pakianathan 10:55 A service manager’s story Monty Moncrieff 12:15 A drug worker’s story Stéphan Vernhes 12:40 A veteran’s story Adam Schultz 13:00 Lunch 14:00 Risk assessment and care planning Mark Pakianathan 14.30 Succesful First Encounters: Introduction Bernard Kelly 15.00 Small groups 16:30 Closing with open discussion 19.00 – 22.00 Let’s talk about sex and drugs Baumhausbar Musik & Frieden Falckensteinstrasse 48, Friedrichshain/Kreuzberg Sponsored by Berliner Aidshilfe
  33. 33. 32 Friday 23rd March DATA AND EVIDENCE DAY 09.00 Registration, refreshments and poster viewing 09:30 Welcome Bryan Texeira Forum Chair Anrnd Bächler, Schwulenberatung and Martin Viehweger Berlin Dinah de Ringuet Bons PvDA Nederland Ben Collins, International HIV Partnerships 09.40 Let’s work together David Stuart, 56 Dean Street, UK 09:50 Input from training day Bernard Kelly, Courtyard Clinic, UK 10:05 Let’s talk without stigma about chems and sex DISCUSSION Leon Knoops Mainline Foundation, the Netherlands 10:35 Refreshments and poster viewing 10.55 ChemSex trends and challenges Panel 1: What do we know about medical issues and ChemSex Mark Pakianathan St Georges Hospital, UK Benjamin Hampel University Hospital Zurich and Patrizia Kunzler Hospital St Gallen/University of Basel, Switzerland 12:10 Panel 2: What do we know bout ChemSex and psychosocial and psy- chosexual issues? Ben Collins and Bernard Kelly in discussion with community groups 12.55 General participants comments about the morning 13.00 Lunch and poster viewing 14.00 Panel 3: What do we know about ChemSex and sexual assault, vio- lence, breach of consent and/or rape? Chris Ward and Rebecca Evans, Manchester University Foundation Trust, UK Followed by Panel discussion 14.45 Panel 4: What do we know about ChemSex-related needs in important communities? Panel chaired by Bryan Texeira Viken Darakjian Positive People Armenian Network, Armenia Trajche Janushev SWAN and Red Edition Vienna and Macedonia And Dinah de Riguet Bons PvDA Nederland 15.25 Refreshments and poster viewing 15.55 Small group discussions about important communities Discussion 1: EECA Discussion 2: Migrants, people of colour and ethnic groups Discussion 3: Trans people and sex workers 16.50 Summing up Bryan Teixeira
  34. 34. 33 19.00 ChemSex Monologues Wilde Oscar Theatre, Scwulenberatung Nieburhrstraße 59/60, Berlin Followed by an open discussion with theatre artists, Berliners and Fo- rum participants Saturday 24 March COMMUNITY MOBILISATION DAY 9.00 Registration, refreshments and poster viewing 9.30 Welcome 9.40 Keynote: ChemSex, health and social wellbeing Jan Großer, Schwulenberatung Berlin 10.10 Who says it is problematic? Introducing the Online ChemSex care plan David Stuart, 56 Dean Street UK 10.40 Towards effective community responses: Examples of community mobilisations Ben Collins and community responders 11.30 Break and abstract viewing 12.00 Discussion on “Effective community responses” 12.30 Plenary discussion: Key aspects of an effective ChemSex response Bryan Teixeira, chair 13.00 Lunch and poster viewing 14.00 Workshop Part 1: Building multi-sectoral response teams Mainline and AIDES present their work as case studies 15.00 Break and poster viewing 15.30 Workshop Part 2 (continued) 16.20 Next steps? Evaluations Key issues as a statement Cooperative local data collection Groups.io as resource Continuations Open discussion 16.50 Conclusion 19.00 ChemSex Monologues Wilde Oscar Theatre, Scwulenberatung Nieburhrstraße 59/60, Berlin Followed by an open discussion with theatre artists, Berliners and Fo- rum participants
  35. 35. 34 Endorsed by
  36. 36. 35 Sponsored by Organised by

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