The rate of substance use amongst LGBTIQ+ and MSM (men who have sex with men) communities around the world are reported to be higher than in other groups. This is believed to be in part due to the impact of the stigma and discrimination faced by these communities. These factors can also lead to internalised homophobia and an unconscious sense of shame and anxiety.
So-called Chemsex has become increasingly common, especially among gay, bisexual and other men who have sex with men. This involves using substances to enhance sex, increase desire and reduce inhibitions. Chemsex often leads to riskier sexual behaviours and an increase in HIV and STI infections.
So what is harm reduction?
When it comes to recreational substance use, the traditional approach is to label it as entirely unacceptable and criminal. Therefore, people who use are often stigmatised as criminals and the only option presented is complete abstinence.
However, many experts and some governments are starting to take the approach that substance use is a health and not a criminal or moral matter. There is an acknowledgement that all people – regardless of their substance use – are entitled to dignity and health care and services.
It’s also been increasingly recognised that forced quitting or abstinence is not always a realistic goal. In addition, those individuals who are interested in reducing their use, but not stopping completely, have been excluded from programs that required abstinence.
The harm reduction model thus includes a focus on the prevention of harm, rather than only on the prevention of substance use itself.
Harm reduction initiatives can encompass a range of strategies. These can include safer use, managed use, abstinence, providing services to users “where they are at”, and linkage to addiction treatment.
Harm reduction tips and advice
- Empower yourself with knowledge about the substances you use and the safest way to use them. Don’t only rely on others to tell you; do your own research.
- Use in safe environments and with people you trust; avoid placing yourself in danger.
- Avoid combining multiple substances as this could have unpredictable effects and/or increase the risk of overdosing.
- Buy less so you’re likely to use less.
- Lower your dosage and frequency of use.
- Set a time limit before you start and stick to it.
- Set aside some days in the week in which you don’t use.
- Make sure you have condoms and water-based lube with you.
- If you are HIV positive, get on and stay on treatment (ART); especially if you bareback.
- If you are HIV negative, get onto PrEP (HIV prevention pill); especially if you bareback.
- If you’re not on PrEP and you had an unprotected sexual encounter with high-risk HIV exposure, contact EMH or any other healthcare provider within 72 hours to get PEP.
- Use clean equipment to reduce the spread of infection, including pipes, straws/notes, spoons and filters.
- If you inject, ensure you also have clean needles, tourniquets and sterile water. Do not share needles and always inject yourself.
- Remember to eat, sleep and drink water. You may not always feel like doing these, but they are vital to staying healthy and assists with recovery. Consider meal replacement drinks or smoothies if a meal seems too daunting.
- If you decide that you need help, don’t be afraid to ask. You’ll be surprised how much help and support is out there.
How we can help?
- Should you wish to talk to a peer harm reduction counsellor (someone who understands what you may be experiencing), call or WhatsApp Engage Men’s Health on 082 607 1686. We can arrange a free and anonymous session for you (subject to availability).
- Engage Men’s Health offers free and professional HIV and STI services in Johannesburg, Pretoria, Nelson Mandela Bay and Buffalo City. This includes free HIV treatment, PrEP and PEP. Call or WhatsApp Engage Men’s Health on 082 607 1686.