Abstract

Sexualized substance use or ‘chemsex’ is a key element in the syndemic of violence and infection in gay, bisexual, and other men who have sex with men. Chemsex is more prolific amongst men who have sex with men but is also associated with high risk behaviours that can negatively impact on health and wellbeing in heterosexual, bisexual men and women, and in homosexual women too. This qualitative study investigated perceptions and experiences of chemsex, motivations, cisgender male sex work, consent, economic exploitation, and ways to address and reduce harms. We conducted semi-structured interviews with health care providers and their clients—including sex workers and their customers (n = 14) between the ages of 28 and 46 years following a purposive sampling strategy. Interview topics included perceptions and experiences of chemsex use, reasons for drug use and chemsex, and proposals to address harms associated with chemsex in the UK. Interviews were audio-recorded, transcribed, coded, and analysed using Grounded Theory. The findings revealed a stepwise process of chemsex use in a ‘ladder of consent’, whereby the process starts with willing participation that is both highly pleasurable and controllable. Sexual polydrug activity often descended in rungs so that lines of consent became blurred, and even broken, resulting in physical detriment and financial exploitation. Strategies for elevation back up the consent ladder also emerged. The findings clarify the conditions of willing participation, the stepwise relationship to exploitation, and the support strategies that help re-empower individuals whose lives get taken over by chemsex, including peer-to-peer support, poly-centres, and smartphone apps to climb back up the consent ladder to improve the health, safety, and social rights of sex workers.

Highlights

  • Male sex workers commonly use apps to recruit clients, and such e-commerce brings with it the ability to screen clients, organise payment, and state what they are willing to offer before meeting (McLean 2015)

  • Smartphone apps make it easy to invite people to come to the sex parties which usually take place in private residences (Ahmed et al 2016) and to purchase sex or drugs, so technology has had an integral role in the relationship between sex work and chemsex (Stuart 2019)

  • The analysis revealed a stepwise process in chemsex participation and exploitation that we have conceptualised as ‘the consent ladder’

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Summary

Introduction

Like so much other commerce, from print-based advertising onto smartphone apps, as well as website chatrooms and web-based geosocial networking apps (MacPhail et al 2015; Morris 2018). Male sex workers commonly use apps to recruit clients, and such e-commerce brings with it the ability to screen clients, organise payment, and state what they are willing to offer before meeting (McLean 2015). Smartphone apps make it easy to invite people to come to the sex parties which usually take place in private residences (Ahmed et al 2016) and to purchase sex or drugs, so technology has had an integral role in the relationship between sex work and chemsex (Stuart 2019). The high saturation of male sex workers (MSW) means that it is not unknown for MSW to offer services, such as chemsex, that are sexually risky owing to the level of competition (MacPhail et al 2015)

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