The use of drugs in sexual settings among gay, bisexual or other men who have sex with men (MSM) is colloquially known as ‘chemsex’ or ‘party and play’. It has been documented in numerous countries around the world and is associated with a range of mental, physical and sexual health harms. This Special Issue of Sexual Health provides valuable data about the patterns and impacts of chemsex/party and play, as well as examining the healthcare and policy responses needed to reduce harm.

Combining sex and drugs shares many features with other voluntary high risk activities that involve specialist skills and intense sensations. This paper suggests some chemsex is a type of ‘edgework’, an exploration of personal limits when living under conditions of alienation. The consumptive nature of chemsex locates it as a quintessential activity in a sex and drugs ‘shopping culture’.

Existing health and drug programming exists within blinkered silos, inappropriate for delivering multifaceted interventions which chemsex urgently needs. This narrative review aims to draw international health and drug policies into existing chemsex dialogue,and encourage health programming to widen its focus. It calls upon countries to honour their international commitments to health and vulnerable populations; advocates for data disaggregation; and endorses recent progressive changes within international drug policies.

This study considered factors affecting chemsex (the combined use of drugs and sexual experiences) engagement and remission by gay men. Participants’ identified multiple incidents and feelings as contributing to chemsex engagement, and engagement was connected with participants’ gay identity development. Chemsex journeys were perceived to spiral from exciting and exploratory into high-risk activity, but the association of chemsex with a gay identity gain explained participants’ ambivalence to remaining chemsex free.

Gamma-hydroxybutyrate among gay and bisexual men has increased in recent years, and is accompanied by growing concerns about overdose and HIV risk behaviour. We examined factors associated with GHB use, its relationship to sexual risk behaviour, and the contexts, consequences, and motivations for its use. Use of gamma-hydroxybutyrate to enhance sexual experiences often occurred in the context of sexual risk behaviour and frequent use was associated with overdose.

This study considers whether use of ‘party drugs’, such as crystal methamphetamine, in a social or sex-based setting facilitates a sense of social connectedness for some men. A survey of Australian gay and bisexual men (GBM) living with HIV found that those who used party-and-play drugs reported greater connection with some social networks, which was associated with resilience and less concern about HIV-related stigma. While party drug use poses risks health risks, the social contexts in which these drugs by GBM) may provide wellbeing benefits linked to social connectedness.

‘Chemsex’ – using specific illicit drugs to enhance sex among men who have sex with men (MSM) – has recently received sustained attention. This survey found that while only 1 in 20 MSM report chemsex, those who do report high levels of HIV and sexual risk taking. Early identification of those most vulnerable to chemsex-related harm and the development of a specialised responsive patient pathway would help address their particularly acute needs.

ChemSex is a public health issue that is forcing stakeholders to improve care by addressing both sexual health and addiction in the gay, bisexual and trans men community. This article describes the development and foreseen use of the Links-SU Sex, a screening tool designed to assess sexual behaviours related to substance use among this population. The Link-SU Sex represents a crucial step in identifying at risk populations and in supporting clinical decision-making.

This case discusses a gay male participating in sexualised drug use. It raises several important issues which may not have been disclosed if the patient was not specifically asked about drug use during or before sex. It strengthens the case for routine screening for sexualised drug use in men who have sex with men so that better informed and higher quality health care can be provided.

This case review examines some of the steps that have helped formulate a policy response to chemsex in England. It highlights that although the evidence on chemsex and related harms for users is growing, there are still opportunities to improve drug treatment and other support for those negatively impacted by chemsex. It contributes to the literature on developing effective responses to problematic chemsex.

In response to the apparent rise in chemsex in the Netherlands, Mainline foundation has been offering harm-reduction intervention for MSM and promoting the development of a continuum of care by building networks, training professionals and investing in advocacy. This case study describes the various interventions of Mainline foundation, that make up their continuum of care approach concerning chemsex issues.

With illicit drug use among lesbian, gay and bisexual people higher than in the general Australian population, community organisations can support people to party and play safely. In Sydney, harm-reduction, pleasure-positive and peer-based responses have led to increased service uptake, strong community engagement and robust research relationships. Such targeted health promotion has been enabled by Australia’s strong partnership response to HIV.