REGIONAL October 16, 2019

Taiwan Symposium Puts Spotlight on MSM Chemsex

A recent ground-breaking symposium in Taiwan was the first meeting of its kind to explore the issue and health impacts of chemsex among men who have sex with men (MSM) in the Asia Pacific region.

Chemsex – combing sex with the use of recreational drugs such as crystal meth and GHB/GBL – is an emerging issue with growing concerns among MSM communities in Asia. However, health advocates believe awareness of the possible harms caused by certain substances is not as high in Asia as in Europe or America. They also believe there has been a lack of engagement around the issue between the MSM community in Asia and relevant local health sectors. 

In response to this, the 1st Asia-Pacific Chemsex Symposium (APCS) was recently held in Taiwan. It was organised by Taoyuan City Government, Taoyuan City Hospital, and HIV Education and Research Taiwan (HEART), and was supported by the Ministry of Health and Welfare. More than 200 public health advocates, NGO workers, policymakers, healthcare providers, and community members from seven countries joined together to discuss and share their knowledge and experiences. We asked INSET JOB TITLE HERE Stephane Ku to provide an overview of chemsex as an MSM health issue as well as the key content which emerged from the symposium.

How prevalent is chemsex among gay men across Asia?

In Asia-Pacific region, the prevalence of chemsex ranges differently according to countries, from 5% in Japan, 7% in Malaysia, 11-14% in Australia to nearly 18% in Thailand. In Taiwan, a recent online survey using Hornet showed nearly one in ten (9.3%) of MSM reported engagement in chemsex within the previous 3 months, a figure three times higher among men living with diagnosed HIV (30.5%).

Does the practice vary from country to country?

Although there are variances in substances and cultural context in different countries, amphetamine-type stimulants (ATS), primarily crystal methamphetamine, being inhaled or injected, are the most common substances used during sex across the region.

What are the physical and mental health implications of chemsex for gay men across Asia?

In the COMeT study presented by Taiwanese investigators during the symposium, more than 40% of crystal meth users reported to have problematic use, i.e. with a Severity of Dependence Scale score greater than four. Sleeping and eating problems, along with anxiety and emotional swings were the most experienced physical and mental health issues in general. More than 30% of the crystal meth and GHB/GBL users had overdose events, among which very few sought medical help.  

What kind of treatment is available for gay men in Asia who are experiencing negative health effects due to the practice of chemsex?

So far there is no replacement therapy for crystal meth or other ATS. There are outpatient-based, multidisciplinary interventions which include cognitive behavioural therapy, family therapies, motivational interviewing, contingency management, and 12-step facilitation.  Acute intoxication or withdrawal syndrome are mostly managed as inpatient. 

What can people do to help friends who are experiencing negative health effects due to the practice of chemsex?

People who practice chemsex can feel lonely from time to time, and it’s very crucial to have constant social support from their partner and friends in order to overcome substance problems. More often it’s other people rather than the users that first notice problematic substance use. In addition to bringing them to counsellors or doctors for professional help, it’s also important to listen to their issues and keep the dialogue open with a non-judgemental attitude. As quoted from the Japanese speaker Dr Yamaguchi, “the opposite of addiction is connection.”  

What are governments and community organisations across the region doing to address the issue?

Whilst some countries such as the Philippines have a punitive, zero-tolerance stance towards substance users, some countries have adopted a medicalisation approach in our region. In Taiwan, LGBTQ-friendly community health centres supported by CDC are ideal, one-stop venues to address sexual health issues including HIV, STI and harm reduction regarding chemsex. On the other hand, self-funded, non-governmental community-based organisations remain crucial in response to chemsex issue in most countries. For example, Narcotic Anonymous (NA), Drug Addiction Rehabilitation Centre (DARC), Asia Pacific Addiction Research Institute (APARI) and PLACE TOKYO based in Japan as well as the Greenhouse, LifeLine and LGBT Narcotic Anonymous in Singapore have provided support resources for recovery and linkage to other supportive services. 

What kind of topics were discussed at the chemsex symposium in Taiwan?

The topics in the symposium explored intoxication and acute withdrawal syndrome of GHB/GBL, novel intervention models for chemsex users, trends of chemsex in Taiwan and in Asia-Pacific region, panel discussions on unmet needs in the region. Foreign speakers included Dr Masazumi Yamaguchi from Japan, Dr Adam Bourne from Australia, Rod Olete from the Philippines Dr. Howie Lim from Malaysia, Mr Bryan Choong from Singapore, and Dr. Thomas Guadamuz from Thailand who delivered speeches regarding the trend of chemsex as well as substance and LGBT-related stigma encountered in each country. 

What impact will the symposium have on the health of gay men across Asia?

The 1st APCS served as a unique platform for open dialogue, bringing together different stakeholders including community members, health professionals, researchers and policymakers around the Asia-Pacific region. With regional collaboration, we hope it can help to improve drug services in our region, bring in effective, scientific, novel, and culturally-competent interventions and harm reduction strategies to problematic substance use, realize humanitarianism, and create a more friendly, supportive environment for recovery in the near future.