Support for ChemSex users

ChemSex is the deliberate use by MSM of certain drugs in the context of sexual activity or to influence sexual experiences. ChemSex use has (sub)cultural as well as individual aspects and can impact on users’ physical, mental, emotional and social health and wellbeing. Surveys show that ChemSex is a practice concentrated in large city populations, but also occurs elsewhere. ChemSex users may experience multiple levels of stigma based on sexuality, sexual practices and drug use. ChemSex use, similar to other types of drug use, may or may not be problematic. This also depends on the perspective (e.g. of the user himself or others). Because of their peer-to-peer experience, community-based services for MSM can offer support for ChemSex users who express their need in some way.

Item Does your CBCVT have this in place? Is there a documented standard, guideline, plan, policy, procedure, contract or agreement? Is it adapted to local needs and conditions? Is it working as intended? Action
Knowledge about ChemSex
Description

Description

This includes knowledge about the substances MSM currently use, but, more importantly, about all aspects of this phenomenon. In fact, knowledge about ChemSexculture and individual practice is more important than detailed knowledge about the substances themselves, which are also subject to local differences and frequent change. 

 

Guidance

Guidance

An example of ChemSexsupport can be found on the Dean Street Clinic’s website (http://dean.st/ChemSex-support/). Guidance for professionals is available at http://dean.st/tools/. Organising some staff training on the topic is a useful way to ensure that everyone has the necessary knowledge. It is important to combine several information sources, i.e. scientific information with knowledge and experience from within the team, as well as through invited experts. This will ensure you get an accurate picture of ChemSex culture, practices and impact.

 

Adaptation

Adaptation

While ChemSexhas broad common characteristics, it is strongly influenced by local factors. They include the availability of different types of drugs, subculture networks and preferred communication channels. In some cases this may also mean that, while the ChemSexusers are local, the ChemSexactually happens somewhere else, such as a metropolitan city or even another country. It is therefore very useful to include ChemSexusers as key informants when developing local responses. They can build on existing information resources and services available in large cities (e.g. http://dean.st/ChemSex-support/). Needs and preferred modes of accessing support services can then be adapted accordingly. 

The participatory needs assessment tools contained in the PQD (Participatory Quality Development) toolkit, available at www.qualityaction.eu–e.g. a (online) focus group or rapid assessment–can assist in this process. (See also the next topic in this checklist: Access to and participation of ChemSexusers in developing/providing services). 

 

Quality improvement

Quality improvement

Because the facts about ChemSex culture and practice –as well as the substances used – change rapidly, it is important that all personnel contributing to ChemSex support services have regular opportunities to update their knowledge. Knowledge can come from research and monitoring reports (e.g. http://dean.st/research/), participating in email groups to network and exchange information (https://ChemSex.groups.io/g/main) and from international organisations working on MSM issues (e.g. COBATEST, AIDSAction Europe – links?).

However, the most important information potentially comes from local ChemSex users (see also ‘Adaptation’ on this topic and the next topic in this checklist: Access to and participation of ChemSex users in developing/ providing services). 

Regular open discussion forums among staff and volunteers can support the exchange of information and ideas for improving ChemSexsupport services. Structured quality improvement tools can serve as discussion guides (e.g. selecting appropriate sections from the Succeedand PIQA tools available at www.qualityaction.eu).

 


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Access to and participation of ChemSex users in developing/providing services
Description

Description

ChemSexis a complex cultural and personal sexual practice.Not all ChemSex use is problematic. It differs from a behaviour choice influenced mainly by infection risk, e.g. ‘anal sex with a condom/without a condom’. It has evolved in informal MSM social and sexual networks, mainly in large cities. ChemSextherefore ‘belongs’ to the groups and individuals who engage in it. 

On the other hand, support provided by community health workers can clearly be of benefit to ChemSexusers. Some ChemSexusers have a greater need for support than others. The only way to ensure that such services are culturally appropriate and tailored to actual needs is to involve ChemSexusers in service design, delivery and evaluation. This is the key to making support accessible and useful to ChemSex users and maximise its potential for improving health outcomes.

 

Guidance

Guidance

General guidance on participatory models of developing services for MSM can be found in the Participatory Quality Development (PQD) toolkit available at www.qualityaction.eu

Moreover, several community-based service providers across Europe and further afield have already developed models of support for ChemSexusers that involve the target group. These examples are highly recommended as guidance for checkpoints aiming to extend their services to include support forChemSexusers. Some relevant examples are:

(link)

(link) 

Ich ergänze (THT, Mainline ….)

 

Adaptation

Adaptation

To be effective but feasible, participation of ChemSexusers can be adapted to local circumstances. Not all CBVCTs have the capacity to actively recruit local ChemSexusers to become volunteers or contribute in an advisory capacity. While it is always preferable to actively involve members of the local target group, this is not always achievable. In this case it is recommended to use the expertise and experience of other CBVCTs who have already developed services with the participation of ChemSex users. Asking clients for detailed feedback, especially in the initial phase of piloting new services, can help adapt them even better to the needs and preferences of the local target group.

 

Quality improvement

Quality improvement

If, as is recommended, ChemSexusers are participating in the development and delivery of services for this target group, it is also important to reflect on the quality of the collaborative relationship. This can be done as part of the regular quality improvement process used by the CBVCT. 

If a structured quality improvement tool is used, you can ensure that the role and participation of the target group as stakeholders is also discussed: How satisfied are you with the input/contribution from ChemSexusers? How could their participation be improved? Could the CBVCT use their expertise more? How satisfied are ChemSexusers with their involvement? 

The quality improvement tools available on www.qualityaction.euall contain relevant sections. In the Succeedtool, for example, the sections ‘Structure of the Project/Key Populations’, ‘Structure of the Project/Resources’and ‘Project Process/Support and Participation’contain relevant questions. 

 


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Targeted harm reduction, counselling and support for ChemSex users
Description

Description

Targeted harm reduction may include: information on safer drug use, drug interactions and safer sex, STI screening and treatment, providing clean injecting equipment and condoms.

Counselling may include: discussing personal attitudes and values towards ChemSex, discussion and self-help groups, linkage to drug detoxification and drug rehabilitation services, and follow-up counselling after rehabilitation.

Support may include: advocacy to support ChemSexusers, e.g. when using other health and social services, ensuring the continuum of care for ChemSexusers and assistance with managing daily life (e.g. through referral to social support services and financial counselling, but also through services such as yoga or other body awareness methods).

 

Guidance

Guidance

The skills required to provide harm reduction, counselling and support in the area of drug use are distinct from those required to conduct testing only. However, most CBVCTs already deal with drug use issues in their service provision or have links to experienced providers. 

Depending on the level of counselling and support already provided by the CBVCT, it will be necessary to conduct additional staff training and/or introduce additional policies and procedures. Guidance on harm reduction, counselling and support for ChemSexusers, to inform professionals and volunteers working with ChemSex, can be found at

https://www.davidstuart.org/care-plan

 

Adaptation

Adaptation

When adapting service provision models for harm reduction, counselling and support for ChemSexusers, the following questions should be discussed first:

  • What are the needs of the ChemSexusers among the local MSM target group?
  • Which of these needs are already well provided for by other service providers, and are they accessible to MSM who practice ChemSex?
  • Given its capacity and the available resources, which gaps in service provision for ChemSexusers should the CBVCT fill?
  • Which collaborations and referral networks will the CBVCT need to pursue in order to provide adequate harm reduction, counselling and support options for ChemSexusers? 

 

Quality improvement

Quality improvement

Harm reduction, counselling and support methods are already part of CBVCT services. They should therefore also be subjectto regular quality improvement. 

See also the ‘quality improvement’ sections in the checklist for the ‘Counselling’ and ‘Linkage to care’ topics in this toolkit. 

Structured quality improvement questions for harm reduction and other drug-related services can be found in the ‘PIQA’ tool available on www.qualityaction.eu.

 

Targeted promotion or collaboration with other providers
Description

Description

Providing culturally appropriate and effective support for ChemSexusers requires additional effort by the CBVCT. To ensure that this subpopulation of MSM knows about and has access to these services, they must be promoted in a targeted manner. The CBVCT may either conduct its own information campaign or collaborate with other providers who are well placed to reach the target group (e.g. GLBTIQ* organisations). 

Collaborating with drug service providers can assist both sides with a lot of useful additional knowledge and experience.

 

Guidance

Guidance

The main steps are to articulate clear goals for communication (e.g. informing the target group about ChemSex, about the support offered by the CBVCT, or both), develop key messages and then select the most appropriate communication channels. Key guiding questions from the audience’s perspective are:

  • What does ChemSexmean?
  • Does what I do in my sex life count as ‘ChemSex’?
  • How can the support offered by the CBVCT be useful for me?
  • Will I be treated with respect? Will my choices be judged?
  • How and where can I access support?

See also the ‘guidance’ sections in the checklist for the ‘Communications’ topic in this toolkit.

 

Adaptation

Adaptation

Adapting campaigns to local conditions maximises their reach. This is especially relevant when the target group is a subgroup of MSM such as ChemSexusers. It is worth investigating how local ChemSexnetworks communicate and where MSM tend to look for information. The level of secrecy based on fear of law enforcement or drug use stigma (also inside the MSM community!) may vary locally. This can also inform how the messages are best communicated.

See also the ‘adaptation’ sections in the checklist for the ‘Communications’ topic in this toolkit.

 

Quality improvement

Quality improvement

Promoting ChemSexsupport to MSM requires reflecting on the effectiveness of the information campaign. Levels of use ofthe ChemSexsupport services offered are only one indicator. Many factors may influence how and when the target group will respond to the message. Actual access to support services may only occur after some time has passed. 

If you are unsure, some of the tools contained in the PQD (Participatory Quality Development) toolkit, available at www.qualityaction.eu,can be used to check if your campaign messages are reaching the target group and are understood as intended.  

See also the ‘quality improvement’ sections in the checklist for the ‘Communications’ topic in this toolkit. 

 

Collaboration and referral networks with relevant social and health service providers
Description

Description

Clients seeking support withtheir ChemSexuse are likely to have reached the point where their use is having a significant negative impact on their life. This means that not only their physical, mental and emotional health can be affected, but also their housing, work and financial situation, as well as their social and intimate relationships. 

The CBVCT may not be able to address all these issues. Collaborations and referrals, especially to housing support, social security, financial counselling and specialised detoxification/drug rehabilitation services will enable a holistic approach.

 

Guidance

Guidance

Collaborative and referral networks with additional service providers can be established and maintained using the same approaches and skills the CBVCT already uses in its relationships with other stakeholders. 

Referrals are more likely to be successful if the referral service is aware of the CBVCT, knows that clients may be referred from there, and is familiar with the range of issues these clients may be facing.

It is even better if the referring CBVCT staff know the staff at the referral service personally, can make appointments for their clients and/or even offer to accompany them to their first appointment.

Services may be unfamiliar with MSM or with ChemSex, or even have discriminatory attitudes and practices. To achieve this kind of collaboration, there may be a need for training and advocacy on topics such as homophobia, drug use and the experiences of disadvantaged groups before ChemSexusers can be referred. See also the training resources available at http://dean.st/tools/.

 

Adaptation

Adaptation

How local social and health service systems are organised and how they can be accessed depends on the legal and regulatory environment, funding mechanisms, balance between government and non-government actors and their historical development and relationships with one another. 

To adapt to these conditions, decisions on who to collaborate with and refer clients to must be strategic and deliberate. It is recommended to discuss one or more anonymous case studies of ChemSexusers seeking support in a team meeting to explore the opportunities and barriers to a holistic support service. Such anonymous case studies can also be used in negotiations and planning discussions with collaborating services. 

 

Quality improvement

Quality improvement

Collaborations and relationships with other stakeholders are an important part of regular team reflections on quality. Maintaining good relationships requires that all partners also pay attention to their relationship with each other, not only togetting the work done. 

Many structured quality improvement tools contain sections on stakeholder relationships. These may be based on written agreements (e.g. memoranda of understanding, letters of intent, letters of support etc.) or pastcollaborations. 

Apart from reviewing and maintaining existing relationships, it can also be useful to review stakeholder relations as a whole. The ‘Circles of Influence’ method in the Participatory Quality Development (PQD) toolkit, available at www.qualityaction.eu, can be used by the team to map the CBVCT’s stakeholders and their influence on decision making, discover gaps and support a more strategic approach to collaboration and referrals.

 

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Support for ChemSex users
Support for ChemSex users
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