Sex under substances: why it has become the norm and why it is dangerous

Have you noticed that conversations about sex have become more candid? But there is a topic that is whispered about — sex under the influence of substances. This is no longer a marginal story from old movies. New research by Italian doctors has shown that among men who have sex with men, this behavior has become several times more popular in just a few years. And this is not just a trend, but a serious health risk factor.

We are talking about so-called "chemsex" — sex under the influence of certain drugs. Doctors from the Rome center for the treatment of STIs and HIV compared data from two surveys: one conducted in 2018, the other in 2024–2025. 354 men participated in the first, and 331 in the second. And the numbers are impressive: in 2018, 5% of respondents practiced such sex, and in 2024–2025 — already 19%. That is, almost one in five.

What exactly has changed

Not only chemsex itself has increased. The "assortment" of substances has also expanded. The classic trio — crystal meth, mephedrone, and GHB/GBL (the so-called "liquid ecstasy") — is now used more often. Meth use rose from 2% to 8%, mephedrone from 4% to 9%, and GHB/GBL from 3% to 17%.

But the main thing is that new substances have appeared. In the 2024–2025 survey, men mentioned cocaine, amphetamines, ketamine, and even cannabinoids. Previously, these weren't mentioned at all. It turns out that every year the choice becomes wider, and the threshold for entry lower.

Why this matters not only for gay men

It would seem, what does this have to do with you if you are not in that environment? Here's what: any mind-altering substance dulls caution. Under the influence, people forget about condoms and make risky decisions they later regret. And this is a direct path to infection with HIV and other infections.

The authors of the study directly state that such behavior can increase the spread of STIs. This concerns not only the men themselves but also their partners. Therefore, doctors urge updating prevention programs: offering tests more often, talking more about harm reduction, not lecturing, but helping.

What to do if this concerns you

If you practice sex under substances, don't panic and don't deny it. It is important to be honest with yourself and your doctor. Tell your doctor directly: "I sometimes have sex under the influence." This is not shameful; it is information that will help choose the right examinations and protection. Regular tests for HIV and other STIs are not a punishment but a way of caring for yourself and your partner.

And if you don't use, but recognize yourself in the description of a friend or acquaintance, don't judge. Better support and remind them of simple rules: condoms, tests, conversations with partners.

The study is small and local, so it shouldn't be extrapolated to the whole world. But the trend is obvious: sex under substances is becoming more common. Ignoring this is turning a blind eye to a growing threat. And knowledge, as always, is the first step to protection.