^{Florent Jouinot from Swiss AIDS Federation reports on AFRAVIH 2026 in Lausanne.}

Chemsex: a real phenomenon, but one often subject to exaggeration

Chemsex refers to the use of psychoactive substances in a sexual context, generally to prolong intercourse, intensify sensations or facilitate certain relational and sexual experiences. The substances most frequently mentioned remain methamphetamine, GHB/GBL, cocaine and certain synthetic cathinones.

But as Annie Velter pointed out, the phenomenon is often portrayed in a caricatured manner in the media and public debates.

Chemsex exists, but it is not a homogeneous reality. The profiles, practices, contexts and experiences are extremely diverse. Some people describe positive, socially or sexually enriching experiences; others report significant complications related to their mental health, overdoses, infections or problematic use.

Reducing chemsex to a figure of absolute danger therefore prevents us from understanding what is really at stake.

Moving beyond a perspective focused solely on HIV risk

The research presented also highlights the limitations of certain indicators used in quantitative studies.

In the ERAS survey of MSM in France, those engaging in chemsex report more anal sex without a condom, more partners and more bacterial STIs. But they are also much more likely to be on PrEP or already living with HIV and receiving regular medical care.

In other words, certain indicators traditionally used to measure “risk” are becoming less relevant in an era of prophylactic and therapeutic treatments that prevent transmission.

Unprotected anal sex does not automatically equate to a risk of HIV infection if the person is taking antiretroviral treatment.

The speakers therefore emphasised the need to adapt questionnaires and statistical analyses to eliminate confounding factors:

• number of partners and diversity of sexual practices;
• sexual networks, particularly urban community networks;
• access to and use of testing and treatment, including PrEP;
• HIV status;

The question then becomes more precise: given comparable sexual practices, are people engaging in chemsex truly more exposed to certain specific risks? And if so, which ones exactly, from a holistic perspective of bio-psycho-social health?

Understanding trajectories rather than classifying practices

Several presentations also highlighted the limitations of purely quantitative approaches.

The sexualised use of substances cannot be understood solely through figures or behavioural categories. The motivations are manifold:

• the pursuit of pleasure;
• disinhibition;
• sexual exploration;
• socialising;
• anxiety management;
• a sense of belonging;
• combating isolation;
• psychological coping;
• affirmation of identity.

Future research will therefore need to incorporate more qualitative and longitudinal approaches.

The future Sex&Drugs community cohort in France is moving in this direction: understanding the life trajectories, subjective experiences and real needs of people who practise chemsex, beyond mere health indicators.

This shift appears essential for developing appropriate responses.

Conventional systems often remain ill-suited

Another key theme runs through the various presentations: many of those affected do not identify with either traditional HIV services or specialist addiction treatment centres.

The fear of stigmatisation remains widespread:

• moral judgement;
• confusion with addiction;
• discrimination based on gender, sexual orientation, sexuality and/or substance use, which often intersects;
• criminalisation of identity or sexual and substance-use behaviours;
• fear of being reduced to the identity of a “drug addict” or “person at risk”.

These tensions appear particularly acute in contexts where minority sexualities and substance use are criminalised.

In Morocco and Tunisia, the community-led project presented by Fatiha Rhoufrani highlights how chemsex remains largely invisible in the MENA region. Yet the communities concerned exist, are organising themselves and are already developing forms of self-regulation and harm reduction.

The participatory community assessment carried out in both countries has notably made it possible to document practices that had previously been little studied, as well as forms of collective organisation, supervision and mutual support among participants.

The direct participation of chemsex users was crucial in overcoming mistrust and producing genuinely useful data.

The community-based approach as a prerequisite for access

Projects developed in Cameroon, Senegal and the MENA region all point to the same conclusion: community-based approaches remain the most effective way of reaching the most marginalised people.

In Cameroon, programmes targeting MSM, transgender people and people who inject drugs have achieved high rates of testing and treatment uptake thanks to mechanisms built around:

• peers/siblings;
• digital tools;
• outreach interventions;
• flexible opening hours;
• community venues;
• self-testing;
• support from peer navigators.

In Senegal, women’s campaigns addressing substance use also highlight the importance of moving beyond rigid institutional categories inherited from the HIV response. Many of those affected reject the label “drug user”, even when they need support, information or harm reduction materials.

Community collectives therefore play an essential role:

• mediation;
• peer support;
• mental health;
• economic and material support;
• access to healthcare;
• harm reduction;
• individual and collective empowerment.

The African experiences presented during AFRAVIH thus demonstrate a particularly inspiring capacity for community-based social innovation.

Early detection, brief intervention and overall health

The presentations also emphasised the importance of opportunities for contact with health services and community organisations.

People who engage in chemsex are often more likely to be screened for HIV and other STIs, more frequently on preventive or therapeutic HIV treatment, and more connected to community networks. These points of contact can become valuable opportunities for:

• early detection;
• brief intervention;
• discussions about substances;
• mental health;
• reduce risks associated with sex and/or substance use;
• and social support.

But this requires non-judgemental services that are trained and able to address substance use without moralising.

An approach centred on people, not on panic

Ultimately, the various sessions demonstrated how chemsex acts as a barometer of current tensions in public health.

• Between a biomedical approach and lived experience.
• Between prevention and social control.
• Between sexual health, mental health and substance use.
• Between institutions and communities.

The speakers emphasised that an effective response cannot be built against the people concerned. It must be developed with them, based on their realities, their practices and their experiential knowledge.

Moving beyond moral panic does not mean denying the risks or the suffering. It means recognising that the people concerned also possess skills, coping strategies and organisational capacities.

And that the most effective responses often emerge where communities have the means to act for themselves.