Chemsex in South Africa

By Cornelius (Niel) Victor

Chemsex refers to the intentional use of specific psychoactive substances—typically crystal methamphetamine, mephedrone, GHB/GBL, and ketamine—to facilitate, enhance and prolong sexual experiences, usually among men who have sex with men (MSM). It is a subset of sexualised drug use (SDU), which includes any drug or alcohol use to initiate or intensify sex. While all chemsex is SDU, not all SDU qualifies as chemsex; the latter usually involves high-risk substances and sex practices such as group sex, kink-play and extended sessions (Bolmont, 2022; United Nations Office on Drugs and Crime, 2019).

Although not fully quantified in South Africa, chemsex appears most prevalent among urban MSM communities (including townships), with higher usage reported in cities like Cape Town and Johannesburg. A seven-city survey found that 11% of MSM in Cape Town, and 4% of MSM in Johannesburg, recently used crystal meth. There is a significant overlap between drug use and sexual risk-taking, with a high prevalence of injecting drug use. HIV prevalence among MSM engaged in chemsex are high—up to nearly 40% in some samples—and care retention is poor (exacerbated by lack of services in some areas). Furthermore, widespread experience of sexual and physical violence is reported in some studies, driven in part by the impact of stigma and strained relationships due to sexual-substance use. MSM in urban area’s often arrange to meet in private parties or sex-on-site venues primarily using digital networks. MSM in townships are likely to meet offline in chemsex-houses where substances are exchanged often for sex, money or both for extended periods (days/weeks) (De Barros, 2024; Mainline, n.d.; Scheibe et al., 2020, Slabbert et al., 2024).

As South Africa finds rising substance-use especially in sexual circumstances, mental health professionals are vital to addressing this shift. Psychologists can support individuals with problematic chemsex use through affirmative, culturally informed, non-judgmental, and integrated care. This can include engaging in evidence-based policy advocacy, contribute to inclusive education and training, participate in harm reduction research, and offer sex-positive psychotherapy. Trauma-informed approaches are essential, as many users have histories of stigma, abuse, or mental illness. Psychotherapy can assist with coping and behaviour change, including developing intimacy strategies for sober sex. Pharmacotherapy can be a consideration in dealing with dependence and mood disorders. Harm reduction strategies include providing chemsex kits, sterile injecting equipment, and safer sex education. Community engagement—through peer support, LGBTQIA+ organisations, and digital outreach—enhances trust and access to services (Pozo-Herce et al., 2024).