Chemsex entre gays e outros HSHs: uma investigação analítico-comportamental

Abstract

Chemsex—defined as the use of psychoactive substances such as methamphetamine, GHB, ecstasy, ketamine and cocaine to intensify sexual pleasure—has been associated with sexually transmitted infections (STIs) and other health outcomes among gay and bisexual men. However, few studies have approached this phenomenon from a behaviour-analytic perspective in Brazil. This thesis presents two studies aimed at (a) identifying possible antecedent and consequent variables of chemsex and (b) proposing communication and support strategies for the affected population. In Study 1 (qualitative), seven gay and bisexual men (aged 31–44) who were current or former chemsex participants were interviewed using a semi-structured protocol. The interviews were transcribed and analysed through indirect functional assessment procedures and the 5W framework (when, where, why, with whom, and what happened). Findings revealed complex contingencies involving combined positive and negative reinforcement, aversive events, peer and partner influence, previous substance use history, multiple sexual partnerships, and practices mediated by geosocial networking apps as key antecedent variables. In Study 2 (mixed-methods), an online questionnaire with 37 items derived from Study 1 was administered to 62 gay and bisexual men (aged 25–58) recruited via social media and geosocial apps. A cross-checked indirect functional assessment was conducted to examine the strength of the identified correlations. Results indicate that chemsex is maintained by positive reinforcers related to sexual activity (sexual pleasure, expansion of sexual repertoire, and prolongation of sexual encounters) as well as social reinforcers (group use and social validation). Statistically significant associations were observed between a negative evaluation of the overall impact of substance use and both the intention to stop or reduce use (χ² = 16.73, p = 0.00023) and the seeking of professional help (χ² = 12.11, p = 0.0024). Additional findings included negatively reinforced variables (e.g., relief from anxiety and social isolation), the formation of social exchange networks around chemsex, and participants’ difficulties in exhibiting self-control behaviours. Multiple sexual partnerships, non-monogamous relationships, and high rates of STIs—particularly syphilis—were also reported, with cocaine being the most frequently cited substance. Based on these findings, a representative persona of the sample was developed and a set of guidelines was proposed, recommending non-punitive environments, contextualised language (including slang), recognition of perceived positive aspects, multidisciplinary teams, flexible access (e.g., anonymity and online support), continuous support even in cases of relapse, peer support, and targeted outreach through geosocial apps and social media platforms. The main limitations of this research include the use of a convenience sample (Study 1), reliance on self-reported data, and the predominance of participants from the Southeast region of Brazil. Future research should aim to include more diverse samples, focus on self-control, and incorporate direct observation measures