The chaotic intersection of pleasure, chemistry, and connection reveals a public health challenge demanding compassion and evidence.
Imagine a health challenge so complex it involves the powerful neurochemistry of pleasure, the profound human need for connection, and the shadow of stigma that keeps those affected from seeking help. This is the reality of chemsex—the intentional use of specific drugs before or during sexual activity—a phenomenon that has gained increasing attention in public health circles, particularly among men who have sex with men (MSM).
But a groundbreaking systematic review published in 2025 shifts the conversation toward solutions, analyzing whether interventions actually work to reduce harm. The review examined twelve studies involving over 1,700 participants to answer a critical question: Can we effectively help those engaged in chemsex lead healthier lives? 1 2
Increase in people treated for chemsex addiction in the Community of Madrid from 2017-2018 to 2021-2022 9
This article goes beyond the sensational headlines to explore the science of chemsex interventions, examining what works, why it matters, and how a new generation of approaches is offering hope to those caught at the intersection of pleasure and risk.
Chemsex refers specifically to the use of psychoactive drugs before or during planned sexual activity to facilitate, enhance, prolong, or intensify the experience 6 . Unlike general substance use that might coincidentally overlap with sex, chemsex is intentional—the drugs are taken with the explicit purpose of changing the sexual experience.
"A particular type of sexualized substance use practice among gay and bisexual men, trans and non-binary individuals, and MSM who engage in casual or uncommitted sexual encounters." 9
"Tina", "Crystal Meth"
Provides energy, euphoria, and enables prolonged sexual sessions
"Meph", "Drone"
Enhances sensation and empathy
"G", "Gina"
Lowers inhibitions and intensifies physical sensations
"K", "Special K"
Creates dissociative effects that some users find enhances experience
The latest research has expanded to recognize a broader range of substances used in these contexts, leading to the development of specialized tools like the Pharmacosex Wheel—a visual classification system that categorizes drugs based on their pharmacological properties and sexual effects .
The practice must be understood within broader social contexts, including the impact of discrimination, minority stress, and for some, the navigation of newly accessible sexual networks through dating apps 8 .
The 2025 systematic review and meta-analysis published in Cureus represents the most comprehensive evaluation to date of chemsex interventions. The researchers analyzed twelve studies involving 1,711 participants, with nine studies (1,145 participants) providing sufficient data for meta-analysis—a statistical technique that combines results from multiple studies to draw more powerful conclusions 1 2 .
Studies Analyzed
Total Participants
Studies in Meta-Analysis
Interventions decreased episodes of unprotected anal intercourse (UAI) with serodiscordant partners by an average of -1.30 episodes (95% CI: -1.58 to -1.03; p<0.001)—a statistically significant reduction that translates to meaningful HIV risk reduction 1
Interventions also decreased the total number of sexual partners and the number of partners where UAI occurred, though these reductions didn't reach statistical significance 1
Several studies showed interventions significantly increased HIV testing uptake, a crucial component of prevention 6
Perhaps surprisingly, the use of psychoactive substances during sexual activities wasn't significantly reduced among intervention participants 1 2
While specific risky sexual behaviors decreased, broader patterns of substance use proved more resistant to change
This nuanced picture suggests that successful interventions don't necessarily need to eliminate chemsex entirely to provide significant public health benefits. Even modest reductions in specific high-risk behaviors can substantially decrease HIV transmission risk while respecting individual autonomy.
| Outcome Measure | Effect of Interventions | Statistical Significance |
|---|---|---|
| Unprotected anal intercourse with serodiscordant partners | Significant reduction | p < 0.001 |
| Total number of sexual partners | Reduction (not significant) | Not significant |
| Number of partners with UAI | Reduction (not significant) | Not significant |
| Use of psychoactive substances during sex | No significant reduction | Not significant |
To understand what effective interventions look like in practice, let's examine a specific study highlighted in the systematic review—a 2023 randomized controlled trial published in JMIR Public Health and Surveillance that tested a web-based harm reduction intervention for MSM in Hong Kong 6 .
More likely to undergo HIV testing in intervention group
Reduction in chemsex engagement (OR=0.23)
| Outcome Measure | Intervention Effect | Statistical Significance |
|---|---|---|
| Condom-use self-efficacy (CSES) | β=4.52, 95% CI 2.03-7.02 | p < 0.001 |
| Sexual safety self-efficacy (SESS) | β=2.11, 95% CI 0.66-3.56 | p = 0.004 |
| Drug avoidance self-efficacy (DASES) | β=6.98, 95% CI 1.75-12.22 | p = 0.009 |
| Engagement in chemsex (past 3 months) | OR=0.23, 95% CI 0.10-0.53 | p = 0.001 |
| HIV testing (past 3 months) | OR=3.08, 95% CI 1.72-5.54 | p < 0.001 |
This study is particularly significant because it demonstrates that relatively low-cost, scalable digital interventions can effectively reduce harm even when delivered entirely online—an important consideration for reaching populations who may not access traditional health services due to stigma or privacy concerns.
Researchers and clinicians working in chemsex intervention employ a diverse set of tools and approaches. Here are some of the most important:
Minimizes negative health impacts without requiring abstinence
Example: Needle exchanges, overdose prevention education, sexual safety planning
Enhances intrinsic motivation for change
Example: Exploring ambivalence about chemsex, strengthening commitment to change
Identifies and modifies problematic thought patterns
Example: Addressing triggers for chemsex, developing coping strategies
Medications to manage dependence or mental health
Example: Naltrexone for craving reduction, antidepressants for co-occurring depression
The recent development of the Chem-Sex Inventory (CSI) is particularly noteworthy. This validated 42-item scale assesses four key dimensions of mental health risk associated with chemsex: emotional instability, risk of psychosis, altered body perception, and suicide risk 9 .
Such specialized tools allow clinicians to identify those at greatest risk and tailor interventions accordingly.
As research evolves, several promising developments are shaping the future of chemsex interventions:
A significant movement is emerging toward "pleasure-based approaches" that acknowledge the legitimate role of pleasure and sexual exploration in people's lives rather than focusing exclusively on risk. This approach, highlighted at the 2024 Asia Pacific Chemsex Symposium, recognizes that effective interventions must acknowledge why people engage in chemsex rather than simply telling them to stop 7 .
In November 2024, UNAIDS and UNODC launched the first regional Asia Pacific Chemsex Toolkit for healthcare providers. This resource offers guidance on harm reduction, sexual health, mental health services, and non-judgmental communication strategies tailored to the region's specific needs 5 7 .
Leading experts increasingly advocate for "one-stop shop" services that integrate substance support, sexual health, mental health, and social services. As Eamonn Murphy of UNAIDS Asia Pacific explains: "We need integrated sexual health and substance use services including access to HIV pre-exposure prophylaxis (PrEP), HIV testing, HIV treatment adherence support, regular screening for other STIs and harm reduction in a one-stop shop" 5 .
28 Asia Pacific countries criminalize drug possession while 17 criminalize same-sex relations, creating barriers to service access 7
Most studies focus on MSM, with limited research on other populations including women and transgender individuals 3
Current interventions primarily target those already engaged in chemsex, with few programs aimed at primary prevention 8
The evidence on chemsex interventions reveals a complex but hopeful picture. We now know that targeted interventions can significantly reduce high-risk sexual behaviors associated with chemsex, even if reducing substance use itself proves more challenging.
They recognize that people engage in chemsex for understandable reasons—pleasure, connection, coping—and that effective support must offer meaningful alternatives or safer approaches rather than simple prohibition.
As research continues to evolve, the field is moving toward more nuanced, person-centered approaches that respect individual autonomy while providing robust support for healthier choices. The goal isn't necessarily to eliminate chemsex entirely, but to ensure that whatever choices people make about their sexual lives and substance use, they can do so with accurate information, reduced risk, and adequate support for their overall wellbeing.
The science of chemsex interventions reminds us that public health challenges rarely have simple solutions—but with compassion, evidence, and innovation, we can find a path forward that honors both safety and human dignity.