When the first forum took place two years ago in London, most of the discussion was about the drugs that gay men were taking, the impact of potent drug combinations on the body and the brain, and whether a harm reduction approach is even possible when the drug is crystal meth. But there had been almost no discussion of sex, sexual addiction or sexual compulsion, Ben Collins, the organiser of the meeting, said.

In Berlin, loneliness and boredom were recurring themes. “Is the focus shifting from the shock of chemsex to looking at the environment in which chemsex is becoming commonplace?” he asked. Chemsex – the use of certain drugs to enhance or facilitate sex – is seen as a specific problem that has emerged on the gay scene, linked to the way gay men interact with each other and treat each other.

Leon Knoops of the Dutch harm reduction organisation Mainline asked what the underlying issues were for different men involved in chemsex. “Do they use because everyone seems to do it? Call it peer pressure. Is it the role of a lack of confidence, because they’re out of shape, or think they are too old? Call it body shaming. Or is it the struggle with their HIV status? What if they miss profound connections or steady partners?” he asked.

Ben Collins outlined a typical process that some gay men go through in relation to chemsex. At some point, a man is feeling lonely or bored. He is looking for connection and intimacy, and tries to meet some of those needs using dating apps and social media. He gets introduced to drugs in a sexual context and gets more involved in the chemsex scene. For some men, this becomes problematic.

Eventually he may withdraw from chemsex, at which point he becomes lonely again, as Leon Knoops explained. “Sex buddies talk amongst each other about how horny, extreme or extended the chemsex sessions are. As long as it’s fun, they’ve got a lot of friends. But once they start questioning the fun, or when they admit having lost control, these sex buddies often disappear into thin air.”

The focus of the forum was on chemsex that has become problematic. There are many gay men who use drugs without having difficulties, but the meeting was not about these ‘happy users’, Knoops said.

The forum opened with a minute of silence for those men who have died of drug overdoses and drug-related suicides. Many of the activists present had got involved in this work because of these cases. “In the eighties and nineties I saw too many gay men dying of AIDS and I don’t want to see this happen again,” said Arnd Bächler of the counselling organisation Schwulenberatung Berlin.

Leon Knoops said that Mainline’s peer support meetings on chemsex are often attended by men who seem to have lost control. They often participate in sex marathons which go on for days. They experience physical issues like sleeping problems, losing weight, dental problems and dehydration.

“Mental issues such as depression, psychotic episodes and suicidal tendencies are also frequently occurring problems,” he said. “Men have shared stories about losing jobs, houses and partners due to their drug use.”

The response to problematic chemsex should come from within the gay scene itself, but will require gay men to acknowledge the issue. Jan Großer of Schwulenberatung Berlin said that gay men had a long history of defending their sexual culture and shared sexual spaces. As gay sex tends to be seen as an “uninhibited, horny, fun party where everyone looks hot”, it can be difficult to accept that people are coming to harm in these sexual spaces, he said.

We need to create new narratives of gay sexuality which encourage men to accept and express their emotions as they arise, he suggested. Many men use drugs to overcome their inhibitions, but many of these inhibitions relate to very ‘normal’ concerns such as having a less than perfect body. “At the moment it feels like a lot of gay men feel obliged to censor and suppress some of their emotions in order to have sex,” he said.

Gay men should change their sexual culture so as to have better sex, with richer emotional experiences and deeper personal connections. “Sleazy pigs can be emotionally aware too,” he said.

Adam Schultz, an activist from London, said that when he withdrew from chemsex, he had to reconstruct his entire social network and social life. An important part of his recovery was to find ‘safe spaces’ where he could reconnect with gay men on a social, rather than sexual level. He joined running clubs, pole dancing classes and social groups. He particularly appreciated the frank discussions he could have at the open mic night ‘Let’s Talk About Gay Sex and Drugs’. He needed a safe space to think about and talk about his experience: “I finally gave meaning to what happened to me.”

While the largest groups of delegates came from ‘hot spot’ cities in Germany, the United Kingdom, the Netherlands and France, the forum also drew attention to chemsex issues in a wide range of countries in central Europe, the Balkans and eastern Europe. Andrii Chernyshev of Alliance Global said that his survey of 100 chemsex users in Ukraine showed that almost half had experience of overdose. There was a need for information on mixing drugs, alcohol and erectile dysfunction drugs and safer dosages, he said.

Viken Darakjian said that as Armenia is a highly pressurised environment for men who have sex with men, those who have the income travel to major western European cities in order to have sex. It was common for travellers to find that the majority of their potential partners on dating apps were only interested in having sex if drugs were involved. As men tend not to know anything about chemsex before these encounters, he is running workshops for men in Armenia to provide basic factual information.

The forum also highlighted chemsex amongst migrants, sex workers and trans people, with an acknowledgement that people often belong to more than one group. Sex workers may use drugs while working because many clients request it, it makes it easier to keep going for longer and it allows them to disengage. However migrant gay men may be less likely to access support services, due to linguistic and administrative barriers, as well as gaps in their knowledge of how the health system works. Trajche Janushev, a migrant sex worker from Macedonia working in Vienna, said that he was working to develop outreach work on chemsex for his peers in Austria.

Many of the delegates are working in contexts where they know anecdotally about chemsex problems, but there is no local research data. They were urged not to be held back by this, but to take the first steps from the position they are currently at.

What should the response to chemsex be? “Anything,” said Robert Fletcher of the UK drugs organisation Turning Point. “Just doing something is better than not doing anything.”