Smith Vivienne, Tasker Fiona
Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London WC1E 6BT, UK.
Department of Psychological Sciences, Birkbeck University of London, Malet Street, Bloomsbury, London WC1E 7HX, UK.
Sex Health. 2018 Apr;15(2):116-122. doi: 10.1071/SH17122.
Background Chemsex (the combined use of drugs and sexual experiences) by men who have sex with men is associated with the transmission of sexually transmissible infections and blood-borne viruses, but psychosocial factors associated with chemsex engagement and remission remain unidentified. In the present study we considered how do gay men self-identify a chemsex problem and remain chemsex free?
Using a life course perspective, the present qualitative interview study examined participants' reflections to discern pathways in and out of chemsex engagement. Six participants (aged ≥18 years) were drawn from a cohort of men who had completed the tailored therapeutic Structured Weekend Antidote Program. Transcripts were analysed using a Labovian narrative analysis framework.
Each man identified a multiplicity of incidents and feelings that contributed to their engagement in chemsex, and engagement in chemsex was connected to participants' identity development and desire to belong to a gay community. Underlying individual accounts, a common narrative suggested a process through which chemsex journeys were perceived as spiralling from exciting and self-exploratory incidents into an out-of-control, high-risk activity that was isolating and prompted engagement with therapy. Despite seeking therapeutic engagement, participants expressed uncertainty about maintaining a gay future without chemsex.
Chemsex was associated with a positive gay identity gain, which explained the ambivalence participants expressed in maintaining a gay future without chemsex despite their awareness of negative consequences. This is significant for understanding both why chemsex pathways may prove attractive and why they may be so difficult to leave.
背景 男男性行为者的化学性行为（药物使用与性体验相结合）与性传播感染和血源病毒的传播有关，但与化学性行为参与和戒断相关的社会心理因素仍不明确。在本研究中，我们探讨了男同性恋者如何自我识别化学性行为问题并保持无化学性行为状态？
本定性访谈研究采用生命历程视角，考察参与者的反思，以辨别参与和脱离化学性行为的途径。六名参与者（年龄≥18岁）来自完成了量身定制的结构化周末解毒治疗项目的男性队列。使用拉波夫叙事分析框架对访谈记录进行分析。
每名男性都识别出了导致他们参与化学性行为的多种事件和感受，且参与化学性行为与参与者的身份发展以及归属同性恋社区的愿望相关。在个人叙述的背后，一个共同的叙事表明，化学性行为的过程被视为从令人兴奋的自我探索事件逐渐演变成一种失控的高风险活动，这种活动具有孤立性并促使他们寻求治疗。尽管寻求治疗，但参与者对于在没有化学性行为的情况下维持同性恋未来表示不确定。
化学性行为与积极的同性恋身份认同相关，这解释了参与者尽管意识到负面后果，但在没有化学性行为的情况下维持同性恋未来时所表达的矛盾心理。这对于理解化学性行为途径为何具有吸引力以及为何难以戒除都具有重要意义。
