“The thrill of having sex while using [recreational drugs] is just out of this world. You feel confident, invincible and, of course, very sexy. Since I started experimenting with drugs three years ago I can’t imagine having sex without it. I’m not addicted, I just prefer using the stuff when I’m out for a good time…” – Nick (26 years old)

The use of recreational drugs while having sex is not a new phenomenon. Powders, liquids and pills, whether snorted, inhaled or ingested, have been used to attain and sustain sexual pleasure for centuries.

For many, recreational drugs can become more than just a means to heighten sexual response and are also a quick-fix way to deal with issues related to their sexuality, sexual inadequacy and self-esteem.

Recreational drugs have become so commonplace that very few people are consciously aware of the direct and indirect risks, especially when it comes to HIV/AIDS.

Perhaps it would be fair to argue that for many there is an awareness of the associated risks but they choose to not allow these risks to deter them (also known as denial) from attaining the pleasure or escapism they so desire.

Research has shown that substance use (and abuse) is associated with:

  • impairment of judgement,
  • a decrease in inhibitions,
  • an increase in sexual risk-taking,
  • an increase in number of sexual partners, and
  • an increase in the odds of engaging in unprotected sex.

According to research conducted by OUT LGBT Well-being (a non-profit organisation based in Pretoria), in collaboration with the Centre for the Study of AIDS and Mambaonline in 2004/5:

  • 35% of gay men between the ages of 16 and 35 indicated that they sometimes used condoms, and 19% never or almost never used condoms, especially after consuming alcohol/drugs;

  • 17% indicated that they enjoyed the moment and did not worry about safer sex after consuming alcohol/drugs; and

  • 5% could not recall what they did, and 15% could mostly not recall what they did, after consuming large quantities of alcohol/drugs.

Professor Charles Parry, from the Medical Research Council, indicates that results from an assessment of drug-related HIV risk among men who have sex with men (MSM) suggests that drugs such as crack cocaine, cannabis and methamphetamine (such as Crystal Meth or Tik) were used specifically to facilitate sexual encounters.

Despite knowledge of HIV and safe sexual practices, many reported risky sexual behaviour, such as inconsistent condom use while having sex with strangers, participating in group sex or having multiple concurrent partners. One third of MSM participants, who agreed to HIV testing, tested positive.

Time Lane’s behavioural survey of MSM in peri-urban “township” communities in Gauteng found that an increase of unprotected anal intercourse was also associated with both regular drinking and regular drinking to intoxication.

Some drugs such as Methamphetamine and Methcathinone can be dehydrating which can lead to tears in the anus and mouth that increase the chances of becoming infected when exposed to HIV during sex.

Why are recreational drugs used during sex?

Recreational drugs can be used during sex for any number of reasons. For some individuals their reasons for using substances are quite clear, but for others it is less so. It just depends on the level of insight and denial present in the individual. Reasons may include any of the following functional, psychosocial and cultural aspects:

  • Coping with everyday professional and private stresses and pressures;
  • Peer pressure and associated need to be liked or belong;
  • Need for excitement, pleasure and/or escapism;
  • An inability to delay gratification or curb impulsivity;
  • Low self-esteem and/or low self-confidence;
  • Making sex more pleasurable, prolonged, or creating the proper mood for sex;
  • To offset fears of sexual inadequacy or other sexual problems.
  • To offset the after-effects of other drugs (which may for example reduce erections) when using a combination of substances;
  • To offset feelings of guilt and shame associated with sexual orientation or a particular sexual activity;
  • To experience some heightened emotion especially in cases of feeling numb or emotionally dead.

For people that regularly use recreational drugs during sex, there is the possibility that they come to feel that they cannot have sex without them, which can lead to an ongoing cycle of dependence.

What are the risks associated with recreational drug use

In addition to the HIV-related risks mentioned briefly above, recreational drug use, if used frequently, in large quantities, and over a prolonged period of time, can have severe consequences:

  • Alcohol: blackouts, impaired memory, impaired thinking, poor nutritional habits, physical deterioration, cirrhosis of the liver, heart failure, haemorrhages of capillaries, gastritis, and cancers of the mouth and throat.

  • Cocaine: Weight loss, paranoia, nervousness, fatigue, hallucinations, premature ventricular heartbeats, mania, depression and gloom when high wears off, and if overdose, possibly death.

  • Cannabis: Respiratory problems, cancer, mental confusion, flashbacks, psychotic-like reactions, and apathy.

  • Acid: Fear and panic, severe depression, marked confusion and disorientation, delusions, and psychotic-like reactions.

  • Poppers: Nausea, vomiting, headaches, hypotension, drowsiness, irritation of the respiratory tract, and death if used in combination with Viagra.

  • Methamphetamine (Crystal Meth / Tik): High blood pressure, twitching, seizures, increase in hostility, increase in homicidal and suicidal tendencies, weight loss, dermatological problems, restlessness, insomnia, delusions, brain damage, and if overdose, possibly death.

  • Methcathinone (Cat): weight loss, restlessness, insomnia, paranoia, delusions, heart palpitations, mood swings, panic attacks, high blood pressure, depression and gloom when high wears off.

How to minimise your risks

Here are a few suggestions on how to reduce the risks attached to recreational drug use:

  • Reduce intake;
  • Go out with friends who will look after you and ensure that you don’t place yourself in dangerous situations;
  • Avoid or minimise drug mixing (i.e., using more than one substance at the same time) as far as possible;
  • Whether you are planning (or not planning) to have sex while using a drug, be sure to carry condoms with you just in case.
  • Don’t share needles and sterilise between uses.
  • Know the facts.

Useful to know

According to Charles Parry, ‘Given increasing rates of substance use among MSM, which facilitates high-risk behaviour, it is imperative that we address drug-taking among MSM as part of broader HIV prevention initiatives.’ OUT is currently running a campaign that attempts to address the links between substance use and HIV transmission.

The campaign takes the form of HIV testing and risk reduction counselling at clubs, and at facilities in Pretoria, Mamelodi and Johannesburg. The aim of the campaign is not to take the moral high ground and preach to vulnerable men but to help them accurately assess their risk profile and assist them with harm reduction strategies. To enquire about this campaign, either as a part

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