Regional Studies

Sexualized drug use, often called Chemsex, is the intentional use of psychoactive drugs to increase sexual pleasure, usually by men who have sex with men (MSM) and transgender women (TGW). Chemsex drugs are used before and during sex by MSM/TGW to facilitate long-lasting sexual intercourse, usually (but not always) with multiple consecutive sexual partners or during group sex [1, 2]. In Southeast Asia, the drug of choice in Chemsex is hydrochloride crystallized methamphetamine (Crystal Meth or Ice) usually in combination with erectile dysfunction drugs (ED), such as Viagra, Cialis, and their generic equivalents. Other substances that may be used during Chemsex are tablets of amphetamine (Yaa Baa or Yaa Maa), methamphetamine (Meth or Tina) and 3,4-methylenedioxy-N-methamphetamine (MDMA) (Ecstasy or E). Because of similarities in their chemical structure and stimulant effects on the brain and nerve system, these latter drugs are commonly grouped as amphetamine-type substances or ATS. Another Chemsex stimulant drug is mephedrone and its congeners (M-cat, Salts, or Meow) [3]. Reportedly, this drug is commonly used in the West, but little is known about its use in Southeast Asia. Gamma hydroxybutyrate (GHB) or its pre-cursor gamma butyrolactone ((GBL) (G) and ketamine (K) are also used during Chemsex, but these agents are classified as anesthetics rather than stimulant drugs. Finally, smoked marijuana, inhaled nitrites (Poppers) and alcohol can be taken during Chemsex to extend or temporarily increase feelings of euphoria and excitement. However, by themselves these latter substances do not qualify as Chemsex drugs. Because of the central role of crystal methamphetamine in Chemsex, the remainder of this introduction will focus on the routes of administration, effects, epidemiology, and HIV transmission risk of the use of this drug.