Chemsex trajectories among gay, bisexual and other men who have sex with men with Nikolay Lunchenkov

Chemsex trajectories among gay, bisexual and other men who have sex with men with Nikolay Lunchenkov

How do different strategies aid in addiction recovery? This conversation between researcher and host digs into chemsex among gay, bisexual and other men who have sex with men in Almaty, Kazakhstan, and asks what kind of support genuinely helps. Dr Elle Wadsworth chats with Dr Nikolay Lunchenkov, a medical doctor and global health specialist focused on HIV prevention in Eastern Europe and Central Asia.

Together, they talk through his qualitative study on chemsex, defined here as the intentional use of stimulants such as mephedrone, GHB/GBL, crystal methamphetamine and other new psychoactive substances to enhance sex among specific communities. Rather than treating chemsex as automatically “the problem”, Nikolay explains why his team used a life course framework, organising people’s stories into five stages: initiation, maintenance, escalation, dependence and disengagement.

He notes that participants rarely went looking for drugs; instead, "they were introduced by their close friends or sexual partners" and often felt that chemsex finally gave them the kind of sex, intimacy and belonging they’d lacked.

One quote sums this up powerfully: after first trying chemsex, a man said "the huge emptiness that he experienced before was filled with absolute love." You’ll hear how chemsex sessions can shift from special-occasion events to multi-day “marathons”, how mental health, grief and isolation can drive escalation, and how stigma inside and outside the LGBTQ+ community can make dependence even harder to address.

The study also shows that many men do not want full abstinence – they want safer, more manageable use and support that doesn’t punish them. The episode is ideal for clinicians, researchers, harm reduction workers and anyone curious about how social context, drug policy and LGBT+ stigma shape chemsex and recovery options. It raises a simple but important question: how can services be reshaped so people get help without losing their dignity, livelihood or sense of community?