NEW DELHI: Community health workers, who counsel men having sex with men, transgenders and commercial sex workers, lack knowledge and are ignorant of identifying designer drugs commonly used by this population as a source of enhancing sexual pleasure, reveals a study conducted by the Indian Council of Medical Research (ICMR).
The study shows community health mobilisers (CHM), drawn from the above-mentioned category and who work with NGOs lack proper knowledge about diseases caused by high-risk sexual behaviours such as sexually transmitted infections (STIs) and other health and psychological illness associated with the daily usage of not only designer drugs but also of sexualised substance use (SSU).
They also lack knowledge about the impact of these substances in spreading HIV or about prophylactic medications to prevent getting HIV/AIDS.
A study by HIV Alliance, a Chennai-based non-profit organisation, under the aegis of ICMR, in five states found that these community health workers were also unaware of how these drug users – in the age group of 16 and 40 – were procuring these designer drugs and SSU.
“We found that there was lack of awareness about various drugs used for chemsex – using drugs as part of your sex life - like ketamine, erectile dysfunction drugs, etc. and latest substance of abuse such as designer drugs,” said Dr Sumit Aggarwal, Scientist and Program Officer at ICMR, who is also one of the authors of the study.
He said these CHMs were also not aware of the complex health issues associated with SSU, as its daily use leads to violent behaviour, paranoia, hallucinations and confusion.
“Drug users combine two-three drugs not only to get high but to increase their sexual capacity,” Dr Aggarwal told The New Indian Express.
He added that erectile dysfunction drugs, ketamine, and gamma-butyrolactone (GBL) are commonly used during chemsex.
It was found that there was a lack of knowledge among CHMs – working in community-led developmental programmes in Punjab, Gujarat, West Bengal, Delhi and Hyderabad - about online sources for SSU.
Chemsex is considered a subset of SSU, commonly defined as the use of specific drugs (methamphetamine, mephedrone, gamma-hydroxybutyrate (GHB/GBL), ketamine and cocaine) before or during sexual intercourse, said the study.
Dr Aggarwal said many drug users – who procured these drugs from medical shops and other places, including at sex parties - turned to SSU because of peer pressure.
Many also took it to relieve stress, anxiety, and grief, for sexual pleasure, to counteract any guilt, to increase the emotional bond with sex partners, or even to overcome a lack of confidence and even to overcome inhibition for sex work.
Not only that, craving and dependence on substance abuse caused most users to lose their jobs, leading to financial problems, which further pushed them to illegal activities, including smuggling, theft, and sex work, for quick cash to buy drugs, Dr Aggarwal added.
The study, published in Brain Sciences, an international, peer-reviewed, open-access journal on neuroscience, was conducted with the aim to assess the knowledge gaps regarding SSU among CHMs. For that, in-depth interviews were conducted with 19 CHMs, the majority being men, followed by transgender.
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They were also assessed for their knowledge of HIV, infection prevention, and complex health issues associated with SSU.
It has been found that chemsex is common among homosexuals, bisexuals, and MSM, who frequently engage in SSU/chemsex because they believe that psychoactive chemicals may boost arousal and stamina, enabling prolonged sex sessions with one or multiple partners.
Apart from financial problems, these drug users’ relationships with their parents, spouses, and friends suffered due to a lack of concentration. Many users who took it by injecting, sniffing, sublingual and smoking accepted they tried to get rid of the problem and even visited ‘ojhas,' (a charmer or a wizard).
Additionally, SSU is also known to have a role in survival sex practices, which includes the selling of sex for subsistence needs such as shelter, food, drugs, or money.