Chemsex in South Africa: Health, Harm Reduction & Support

Chemsex can carry serious physical, sexual and mental-health risks. This guide is for people who are already using substances during sex, are worried about their own use or are concerned about someone else. It explains the main risks, what to do in an emergency and where to find confidential support in South Africa. Chemsex generally refers to intentionally using psychoactive substances before or during sex. It is one form of sexualised substance use. It is most often discussed in relation to gay and bisexual men and other men who have sex with men, although other people may also be affected. South Africa has a dedicated Harm Reduction Guideline for Chemsex https://sajhivmed.org.za/index.php/hivmed/article/view/1763/3705 , developed for the local context. This guide gives an overview of the most important information. It does not replace medical advice or the detailed clinical guidance. What are the main risks? The risks depend on the substance being used, how much is taken, whether substances are combined, how they are taken and how long a session lasts. South African guidance identifies crystal methamphetamine, often called Tik or Crystal, as one of the substances commonly associated with chemsex locally. Other substances may also be involved. Long sessions, lack of sleep, dehydration, mixing substances, impaired judgement or sharing injecting equipment can increase the risk of overdose, injury, HIV and other sexually transmitted infections, mental-health problems or sexual violence. GHB or GBL can be particularly dangerous because the difference between an intended effect and a medical emergency can be small. It can cause sudden unconsciousness and breathing problems. Mixing it with alcohol, sedatives or other depressant substances can increase the danger. Know when it is an emergency Call for urgent medical help if someone: - cannot be woken or is having difficulty breathing - has a seizure, severe chest pain or severe shortness of breath - is extremely confused, agitated or hallucinating - has blue lips or appears seriously unwell - has collapsed or lost consciousness From a mobile phone in South Africa call 112 . For an ambulance you can also call 10177 . Stay with the person while help is coming. If they are unconscious but breathing normally, place them in the recovery position. Do not leave them alone. If you know what substances may have been taken, tell the healthcare team. Severe withdrawal from some substances can also become a medical emergency. If stopping a substance causes shaking, confusion, hallucinations, seizures or severe physical symptoms, seek medical help rather than trying to manage it alone. Looking after your sexual health Regular sexual-health care matters if chemsex is part of your sex life. PrEP can protect against HIV when used correctly. If you think you may have been exposed to HIV and were not protected by effective PrEP, PEP must be started within 72 hours . South African health guidance recommends a 28-day course after assessment by a healthcare provider. Regular HIV and STI testing is important because infections do not always cause symptoms. Condoms and compatible lubricant can reduce the risk of HIV and other STIs. If you live with HIV, staying on treatment and maintaining an undetectable viral load protects your health and means HIV is not sexually transmitted. A healthcare provider can also advise you about vaccinations that may be relevant to your circumstances. Find Sexual Health & HIV support /south-africa/support?category=sexual-health-hiv Consent still applies Using substances does not remove anyone's right to decide what happens to their body. Consent must be voluntary and ongoing. A person who is unconscious, asleep or so affected by substances that they cannot make or communicate decisions cannot meaningfully consent. A person can change their mind at any point. Consent also applies to photographs and videos. If you think something sexual may have happened without your consent, you can seek medical and counselling support even if you are unsure whether you want to report it to police. Thuthuzela Care Centres /south-africa/support/thuthuzela-care-centres are National Prosecuting Authority-led one-stop services based at hospitals and clinics across South Africa for survivors of rape and sexual offences. They can arrange medical care, counselling, assistance with reporting if you choose, follow-up STI and HIV care and court preparation. For immediate counselling and referrals, the national Gender-Based Violence Command Centre is available 24 hours on 0800 428 428 . For Thuthuzela enquiries, email thuthuzela@npa.gov.za . You can also use the official NPA list of Thuthuzela Care Centres https://www.npa.gov.za/thuthuzela-care-centres to find a centre. When to ask for help You do not need to wait for an emergency or describe yourself as addicted before asking for support. It may be time to speak to someone if chemsex is happening more often than you want, is affecting your health, work, finances or relationships, if sex without substances has become difficult, or if you are experiencing blackouts, overdoses, unwanted sexual experiences, strong cravings or withdrawal symptoms. Changes in mood also matter. Anxiety, depression, paranoia, persistent sleep problems or suicidal thoughts are reasons to seek help. Support can include medical assessment, sexual-health care, mental-health care, substance-use treatment, safe withdrawal management or help stopping. Find Mental Health support /south-africa/support?category=mental-health Find Healthcare support /south-africa/support?category=healthcare Chemsex support in South Africa OUT LGBT Well-being /south-africa/support/out-lgbt-well-being provides dedicated Chemsex, Health and Well-being support. Its programme includes harm-reduction information, social-worker support and links with the University of Pretoria's Community Oriented Substance Use Programme. OUT's +Dr practice in Pretoria also provides clinical chemsex harm-reduction care alongside HIV, STI and general health services. The national Substance Abuse Helpline is 0800 12 13 14 and can provide counselling and referrals. The AIDS Helpline is 0800 012 322 for HIV-related information and support. If there is an immediate medical emergency, call 112 from a mobile phone or 10177 for an ambulance. Find out more For detailed clinical information, read the South African Harm Reduction Guideline for Chemsex https://sajhivmed.org.za/index.php/hivmed/article/view/1763/3705 . Healthcare information and service availability can change. Check service details directly before relying on them. This guide provides general health and support information. It does not replace individual medical advice or emergency care.