Introduction: Chemsex is a relatively recent phenomenon, characterized by the intentional use of drugs to engage in sex for extended periods of time among gay, bisexual, and other men who have sex with men (GBMSM). Chemsex is a complex phenomenon that generally involves polydrug use, mixed addictions (to sex, to the sexualized use of drugs, to screen use, and to psychotropic substances), and is marked by its intersectionality, as it brings together psychological, cultural, relational, and sociocultural dimensions. Within this context, the search for pleasure and the need to belong are key elements sustaining the practice.
Method: This doctoral dissertation seeks to explain the lived experiences, perceptions, and constructions of GBMSM who engage in chemsex, as well as to explore factors such as motivations, associated sociocultural elements, and sex-affective meanings, among others. A dual methodological strategy was employed: a qualitative meta-synthesis of the available scientific literature and an empirical study based on in-depth interviews mainly conducted in Barcelona. The research was grounded in a constructivist epistemology, applying constructivist grounded theory. Analytic strategies included coding, constant comparisons, triangulation, and the construction of categories and a core category.
Results: The findings of the meta-synthesis reveal that chemsex is sustained by the wide availability of drugs and sex mediated by digital applications, as well as by a repertoire of beliefs and attitudes toward the practice, taking shape as a subculture that produces identity and belonging. The field study reinforces and nuances these dimensions, highlighting three major areas: the emotions, constructs, and beliefs that structure subjective experience; the tensions between masculinity, sexuality, and sexual performance shaped by stereotypes and stigma; and the community dimension, in which chemsex functions as a space of encounter and belonging, but also as a practice that can undermine health and relationships. From this analysis, the core category “You Belong” emerges, synthesizing the experience of feeling recognized and connected to others through chemsex, while constantly negotiating ambivalences between pleasure and risk, care and loss of control, intimacy and disconnection.
Discussion: The findings can be understood in dialogue with the social determinants of health, theories of gender and sexuality, and harm reduction approaches, showing that chemsex must be interpreted as a complex phenomenon where social, psychological, cultural, identity-related, and bodily dimensions converge. Ambivalences, cognitive dissonances and implicative dilemmas, as well as co-constructions, motivations, and the need to belong, appear as central elements in sustaining chemsex practices.
Conclusions: Sex-affective meanings and decision-making processes are key when addressing chemsex. Finally, this thesis emphasizes the need for non-pathologizing and culturally competent responses, integrating harm reduction, cognitive-social aspects and attention to the diversity of trajectories, while recognizing the role of community and spaces of belonging in health and wellbeing.
Keywords: chemsex; GBMSM; belonging; masculinity; ambivalence; sexual and mental health; harm reduction; grou