Abstract
In the United Kingdom, the term chemsex typically refers to the intentional use of psychoactive substances to facilitate or enhance sexual activity, particularly among gay, bisexual, queer men and men who have sex with men (GBQMSM). While chemsex is often portrayed through the lens of HIV and STI risk, this thesis argues that such framings are overly narrow, and fail to account for the broader cultural, emotional and psychosocial dimensions of drug use within queer sexual (sub)cultures. Through a mixed-methods study, this research explores the lived experiences of GBQMSM accessing chemsex-related support in England, with the aim of informing more inclusive, holistic, and culturally competent service provision.The research employs a two-stage methodology. First, 70 participants completed an online survey analysed using descriptive statistics to identify common behaviours, needs and service experiences. Second, 11 GBQMSM who had accessed drug counselling or sexual health services for chemsex-related support participated in in-depth qualitative interviews. These were analysed using Interpretative Phenomenological Analysis to capture the meanings and complexities participants ascribed to their experiences.
Findings reveal a pressing need to move beyond singular risk-based discourses and towards a more nuanced understanding of chemsex. Participants often engaged in health-conscious practices such as PrEP use, serosorting, and harm reduction strategies, challenging dominant portrayals of chemsex as inherently reckless. Many advocated for education, drug testing, and non-judgemental support over abstinence-based or punitive approaches. The study also finds that chemsex continues to be heavily stigmatised, especially compared to alcohol-related sexual behaviours, which contributes to shame, underreporting of sexual assault and barriers to accessing care. Notably, support remains uneven across England, with rural and non-metropolitan areas facing significant service gaps.
Terminological clarity emerged as a key concern, with participants expressing that the term chemsex no longer adequately reflects the diversity of substances and practices involved. More inclusive terms such as CDU (chemsex-related drug use) or SDU (sexualised drug use) may create more responsive and inclusive services. Peer-led, harm-reduction initiatives like Controlling Chemsex were highlighted as accessible and relatable models, while conventional drug counselling and sexual health clinics were often viewed as ill-equipped to meet the nuanced psycho-sexual needs of chemsex-engaged GBQMSM.
This thesis calls for the development of integrated chemsex-specific care pathways that combine sexual, psychological and community-informed support without mandating abstinence. It highlights the need for training frontline professionals in queer-informed harm reduction, the expansion of digital and rural-access services, and the open discussion of consent violations in chemsex contexts. Broader public discourse must also evolve to recognise chemsex not only as a site of risk but also of pleasure, intimacy and cultural meaning. In doing so, this research contributes to a growing call for evidence-informed, affirming and intersectional approaches to supporting those engaged in chemsex.
| Date of Award | 23 Oct 2025 |
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| Original language | English |
| Awarding Institution |
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| Supervisor | Dennis Gough (Supervisor), Aaron Pycroft (Supervisor) & Lisa Sugiura (Supervisor) |
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