The Gay Men’s Health Collective on chemsex, harm reduction, and cultivating more LGBT+ inclusive drug services

In this Q&A, the SSA’s Natalie Davies asks Patriic Gayle about the mission of...
Created On: 24 June 2022   (Last updated: 13 July 2022)

In this Q&A, the SSA’s Natalie Davies asks Patriic Gayle about the mission of the Gay Men’s Health Collective, their innovative letterbox-sized ‘safer chemsex’ packs, and why some gay men are reluctant to access or return to mainstream drug services.

Natalie: Firstly, I’d love to know about the origins of the Gay Men’s Health Collective and what your organisation’s mission is today.

Patriic: “The mission of the Gay Men’s Health Collective (GMHC) is to promote the health and wellbeing of gay, bisexual, and other men who have sex with men (GBMSM). Our origins can be traced back to 2009, when a small group of gay men – affected by the emergence of three new(ish) drugs (GHB/GBL, crystal meth and mephedrone), a sharp rise in HIV and hepatitis C, and an absence of harm reduction – teamed up. We understood that our sex, life, and health issues were interconnected, so instinctively knew that our work would need to reflect this.”

We understood that our sex, life and health issues were interconnected, so instinctively knew that any website or harm reduction project would need to reflect this

MENRUS.CO.UK is our primary project, and is believed to be the first of its kind in the UK – approaching gay men’s health holistically rather than through the lens of single issues like HIV, ‘coming out’, or hate crimes. And we don’t try and keep visitors on the website, but encourage them to use the 15,000+ hyperlinks to access support, other organisations and groups, and further reading.”

“We also started making short films in 2010 under THREE FLYING PIGLETS, and have completed 100 film projects to date, and developed our PIP PAC safer chemsex packs, which first appeared in April 2014, but the demand for them now is greater than ever.”

One of your organisation’s areas of expertise is chemsex. How would you describe ‘chemsex’ to people who aren’t aware?

“GMHC volunteers prefer to think of themselves as informed GBMSM, not experts – some with decades of lived experience, with backgrounds in health promotion, sexual health and so on.”

“We would define chemsex as methamphetamine, GHB/GBL (‘G’), and mephedrone used in any combination to facilitate, enable and/or enhance sex. Sex can last from hours to days with little need for sleep or food, and the heightened sexual focus enables more extreme sex, including in group settings. However, definitions vary. Some GBMSM engage in chemsex occasionally while maintaining the ability to take a break or stop. And, not all GBMSM engage in chemsex. GBMSM are ‘not best served’ by the narrative that chemsex is universal, inevitable, or impossible to escape (1 2 3).”

We promote 12 tips on how to ‘hook-up’ safer, which include making GBMSM aware that some drugs are odourless and tasteless and have been used to spike drinks and lube

“It’s distressing to know that ‘G’ has been used with the intent of sexual assault and rape, coupled with increasing instances of burglary and murder. We promote 12 tips on how to ‘hook-up’ safer, which include making GBMSM aware that some drugs are odourless and tasteless and have been used to spike drinks and lube.”

“MENRUS.CO.UK launched the ‘G Aware: Our Lives Depend On It’ social media campaign on St Valentine’s Day 2020, spearheaded by four 30-second film messages. The campaign sought to clarify confusing information on notable websites, such as the difference between GBL and GHB, dose amounts, and how ‘G’ is used to spike both drinks and lubricant. In fact, at the time, we said ‘We actively encourage our colleagues and partners in the chemsex field to review and update their safer chemsex information, ensuring gay men are provided with consistent harm reduction, signposting, advice and support.’”

The Gay Men’s Health Collective has responded to chemsex-related harms in a number of ways. One of these is an innovative ‘safer chemsex’ pack (called PIP PAC), which can be ordered online and fits through the letterbox. How did you decide what should be in the packs? And would you be willing to share some examples of what is included, and how these items help to keep people safe?

A photograph of the PIC PAC ‘safer chemsex’ box

“My background is in gay men’s health and HIV prevention. I co-founded Rubber Stuffers (safer sex pack distribution across Greater London), which later morphed into Freedoms – so, it wasn’t a stretch to innovate a safer chemsex pack.”

“They had to be sent by post fitting through letter boxes so that was the starting point. Deciding what went inside was relatively intuitive. And, as injecting drugs was relatively new to GBMSM, we introduced colour-coding to reduce sharing of spoons and fixed needles and transmission of blood-borne infections. The nicest compliment we’ve received from a long-time friend/ally to GMHC was: ‘Trust the gays to colour code everything, but this is something mainstream harm reduction should have done years ago.’”

“We had a working prototype in 4 weeks, and an online shop in 12. Volunteers made 500 packs as a punt thinking that would be it. They were gone in 9 months and today PIP PAC produces 100–150/month, which are sold online and distributed to the NHS and drug services.”

“PIP PAC are packed up by volunteers and produced on a not-for-profit basis, and the small amount of money left over is invested in printed resources. Feedback has remained positive on the whole, but sadly, we have heard some criticism from colleagues in the drug treatment field that we’ve set the bar too high with these packs in terms of what they contain.”

“PIP PAC has evolved, but at its core includes safer drug-injecting paraphernalia, condoms and lubricant, and relatable harm reduction resources linked to MENRUS.CO.UK. We make improvements to ensure it meets need, validates GBMSM, doesn’t criminalise using drugs, and provides a springboard to further information and support.”

GMHC also produces a range of harm reduction and health promotion booklets, including on the topics of hepatitis C prevention and safer ‘hook-ups’. One of the booklets is about people’s rights on arrest. Your website says that “There’s a wealth of anecdotal evidence to say that when things go wrong gay men don’t know who to call or what to do”. Can you give us some insight into some of the issues around chemsex and the criminal justice system?

“In our experience, some GBMSM who engage in chemsex can oversimplify risks or be unaware of the implications should things go wrong. Others lack the necessary skills to navigate today’s 24/7 hook-up culture more safely. Others find themselves caught between a rock and hard place because they don’t understand the reach of police powers. It also feels like death by a thousand cuts as the media finds new ways to weave the next chemsex scandal ‘tastefully’ into the news cycle.”

“GMHC knows that when an ambulance is not called in a chemsex overdose situation, it may be because GBMSM are fearful the police will turn up as well, and if there has been a fatality, this could lead to arrest and investigation (see our survey from 2020).”

“GMHC has just produced a new ‘overdoses and calling 999’ leaflet which shows a flow diagram of what might/might not happen should you call/not call 999 in overdose situations. Granted, it’s a synthesis of a range of scenarios which can be complex with life-changing implications, but it’s our sincere hope that it will start to get GBMSM thinking about choices and decisions.”

When we spoke previously, you said that many men who have sex with men won’t access mainstream drug services. Why do you think this is, and what types of things can drug services do to be more inclusive of the LGBT+ community?

“I remember how everyone came together at the height of the HIV/AIDs epidemic, including drug services, but I’ve never truly comprehended why they drifted back to the hills and abandoned the LGBT+ community, rather than embed us into services. LGBT+ people are woven into the fabric of communities, yet meaningful provision is scant at best. Putting up rainbow bunting in June and saying ‘we’re inclusive’ on websites doesn’t cut it in the 21st century. Of course, there are pockets of excellence with incredibly driven staff providing a welcoming environment for the LGBT+ people, and I know some of them personally. But this is where the landscape is at the moment.”

LGBT+ people are woven into the fabric of the communities, yet meaningful provision is scant at best

“On a marginally brighter note, MENRUS.CO.UK noticed a sustained uptick in mainstream Greater London drug services stating that they offer support with chemsex support, and we undertook a survey in August 2021 to learn more. It was encouraging to note that some mainstream drug services are addressing their relationship with GBMSM and the wider LGBT+ community, which GMHC has been vocal about the need for, for several years. In the survey, responses to the statement ‘Some gay men say they do not access or return to mainstream drug services because they feel they are not understood’ yielded the most comments and provided invaluable insight.”

And finally, where can people find more information about your projects and services?

“Details of our projects can be found on the Gay Men’s Health Collective website. If you’re into newsletters, you can sign up at MENRUS.CO.UK – just scroll down to the bottom of our homepage.”

Patriic Gayle is Projects Lead for the Gay Men’s Health Collective. You can email the Gay Men’s Health Collective at admin@gmhc.co.uk.

Conversation edited and condensed for clarity by Natalie Davies.


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