Remaking Chemsex Event Networks in the Age of HIV Pre-exposure Prophylaxis (PrEP)

Abstract

‘Let’s be honest: it’s a party drug’, declared the president of the AIDS Healthcare Foundation of Los Angeles, following the approval of Truvada for HIV pre-exposure prophylaxis (PrEP). Drawing on the accounts of gay and queer-identifying men, we explore the ways in which PrEP has not only made chemsex possible for a new group of people, but has also changed what chemsex is. If the association with HIV infection has helped render chemsex an object of sexual health concern, PrEP can be understood to interfere with the very ontology of chemsex, and the human and more-than-human bodies imbricated in it. This rethinking invites us to consider antiretrovirals as part of the infrastructure, or event network, of chemsex, in turn producing new kinds of embodied sexual subjects. In doing so, we argue for a more expansive account of chemsex that troubles the binaries of licit and illicit drugs, therapeutic and recreational use, and normal/deviant bodies.

Introduction

Following the US Food and Drug Administration’s (FDA) approval of the combination antiretroviral drug, Truvada (tenofovir disoproxil and emtricitabine), for HIV pre-exposure prophylaxis (PrEP), a number of commentators sought to call into question the value of PrEP on the basis of its ascribed association with sexual pleasure and uninhibited ‘hedonism’. ‘Let’s be honest: it’s a party drug’, Michael Weinstein, President of the AIDS Healthcare Foundation of Los Angeles, (in)famously declared (Associated Press, 2014). This figuration of PrEP can be read against a backdrop where the historical associations between gay sex, pleasure, drugs, and death are simultaneously highlighted and (re)problematised (Bersani, 1987). If the association of PrEP with sexual pleasure (that is, as ‘a party drug’) was intended as a kind of deterrent device – or indeed deployed in order to produce inhibitions around PrEP’s use – in this article we propose to take Weinstein’s claim seriously and explore the possibility that PrEP’s framing as a party drug may in fact be analytically useful. Drawing on the accounts of participants taking PrEP as part of a broader study of LGBTQ drug use, we argue that the sexual and corporeal possibilities afforded by PrEP provide pragmatic insights about its use, meanings, and effects. If the effects of drugs are understood to emerge in the context of the networks in which they are embedded (Fraser and Moore, 2011), then situating PrEP in relation to ‘party’ drugs and sex partying might provide greater clarity on how this drug variously materialises in situated, embodied practices. We focus in particular on tracing the figurations of PrEP in participants’ accounts of sexualised drug use (or ‘chemsex’), and how it emerges through encounters of sex, bodies and drugs, generating new affective, bodily capacities to participate in chemsex without fear of HIV infection. In doing so, we identify PrEP as part of the assemblage of chemsex, and argue for a more capacious account of chemsex that disrupts the dualisms of licit/illicit drugs, therapeutic/recreational use, and normalcy/pathology. The account we elaborate resonates with the ‘affective turn’ in body studies insofar as it centres the intensities of embodied sensations and emotions – or ‘bodily affectivities’ (Blackman, 2021: 48) – produced through the encounters of bodies, drugs, sex and partying. In this respect, our analysis articulates a processual view of the body as a porous, permeable assemblage of human and more-than-human phenomena (Blackman, 2021: 27; Latour, 2004). Consistent with our concern to interrogate the binary distinctions drawn in relation to drugs, such a view also challenges the long-standing Cartesian dualisms of nature/culture, reason/emotion, mind/body and self/other, bridging their ontological separability and treating them as co-constituted phenomena which rely on each other for meaning. Doing so allows us to trace the entanglements of bodies-in-the-making, as they materialise in concert with ‘other similarly contingent and ephemeral bodies, things and ideas’ (Alldred and Fox, 2017: 3), including antiretroviral drugs, pleasure, sexual practices and changing conceptions of HIV risk.

Background

HIV Pre-exposure Prophylaxis

The use of HIV antiretrovirals as pre-exposure prophylaxis (PrEP) among gay, bisexual and queer-identifying men has dramatically increased since 2012. In Australia, this increase has been particularly noticeable since 2018 when it was approved for listing on the country’s Pharmaceutical Benefits Scheme, meaning it would henceforth be subsidised through the national health insurance programme. By 2019, PrEP had become the most common HIV prevention strategy (Holt et al., 2021). The experience of men in Australia therefore provides a lens through which to analyse cultural changes emerging from the widescale consumption of antiretrovirals. However, the use of antiretrovirals as PrEP has a complicated history in gay community discourse. As Race (2016) notes, PrEP initially emerged as a ‘reluctant object’ due to its association with condomless (and unrestrained) sex. PrEP asksed gay men ‘to preempt a possibility that [they] have become accustomed to accounting for after the event’ (Race, 2016: 23, emphasis added). The temporal reversal highlighted by Race draws attention to the paradoxical relationship between antiretrovirals and HIV risk. Antiretrovirals are often deemed to be associated with increases in ‘risky’ behaviour, including initiation or intensification of sexualised drug use (Zimmermann et al., 2021), however they also guard against the possible negative outcomes of these actions, that is, HIV transmission (Race et al., 2017), thereby simultaneously changing the nature of risk (Holt and Murphy, 2017).

From the late 1990s to the first decade of the 2000s, the ‘optimism’ attributed to antiretrovirals was often problematised through psychological framings such as ‘risk compensation’ (Holt and Murphy, 2017). However, there has since been a shift with more recent research highlighting the ‘unanticipated’ (Quinn et al., 2020) benefits of taking PrEP, including reduced anxiety about HIV and sex (Keen et al., 2020), and increased levels of sexual comfort, freedom and pleasure (Curley et al., 2022). Behavioural research has also acknowledged, albeit implicitly, the importance of antiretrovirals in relation to sexualised drug use, or ‘chemsex’, via discussions of different dosing strategies (‘event-based dosing’ or ‘on-demand’ strategies) (Closson et al., 2018; Roux et al., 2018).

In addition to the abovementioned work of Race (2016), a body of critical literature has explored the biopolitical (Atuk, 2020) and ontological (Holt, 2021; Rosengarten and Michael, 2010) dimensions of PrEP. Other research has analysed PrEP’s temporalities (Florêncio, 2020; Rosengarten and Murphy, 2020; Sandset et al., 2023), its spatial dimensions (Brown and Di Feliciantonio, 2021), and the historical conditions through which it emerged (Hakim, 2019). This article extends this critical literature by exploring the relationship between PrEP, sexualised drug use, and the bodily capacities that these phenomena generate in their encounters – that is, what they allow bodies to do and feel (Alldred and Fox, 2017; Blackman, 2021: 131).

Chemsex

The consumption of illicit drugs has long been a mainstay of urban gay cultures, as has the consumption of these drugs during sexual encounters. In recent decades, the latter has been increasingly referred to by the neologism ‘chemsex’, most commonly in the United Kingdom (Bourne et al., 2015). While other terms such as ‘PnP’ (Party ‘n’ Play) and ‘wired play’ are more common in the United States and Australia (Race, 2009), a significant body of literature has emerged on ‘chemsex’. We recognise that this literature is not without problems in that it has reified a particular object of sexualised drug use among gay, bisexual and queer men, associated with consuming the drugs crystal methamphetamine, mephedrone and gamma-hydroxybutyric acid (GHB)/gamma-butyrolactone (GBL) (Edmundson et al., 2018). However, for our purposes, the term ‘chemsex’ offers potential as a term with widespread currency in popular culture, and one that is sufficiently capacious to include other drugs used to enhance or transform experiences of sex.

Although the relationship between illicit drugs (especially crystal methamphetamine) and sex has been an enduring area of research interest, the emergence and reification of the term, ‘chemsex’, has increased scholarly and popular cultural interest in this phenomenon (Møller and Hakim, 2021). Much of the behavioural research on chemsex has been concerned with negative outcomes, such as HIV transmission (Jennings et al., 2021), sexually transmissible infections (Achterbergh et al., 2020), sexual violence (Wilkerson et al., 2021), and poorer mental health and quality of life (Bohn et al., 2020; Ruiz-Robledillo et al., 2021). In recent times, epidemiologists and public health researchers have explored the association between PrEP and chemsex, identifying those men engaging in chemsex as more likely to use biomedical HIV prevention such as PrEP, thereby implicitly reinforcing the normative assumption that they are more responsible than their non-PrEP-using counterparts (Hammoud et al., 2020; Rollet et al., 2022) against expectations to the contrary. A critical literature on chemsex has also emerged, which explores its meanings and how it is constituted (Hickson, 2018; Santoro et al., 2020), its settings, relations and practices (Drysdale et al., 2020), and the concerns it indexes in relation to contemporary gay cultures (Kagan, 2018; Møller and Hakim, 2021; Race, 2018).

Chemical Practices

Despite the myriad ways in which antiretrovirals and illicit drugs intersect in the consumption practices of gay men, there have been surprisingly few attempts to consider these drugs together analytically. Maintenance of this boundary between licit and illicit drugs – rigorously enforced by regulatory regimes – instantiates binary distinctions such as medications/drugs and therapeutic/recreational use (Malins, 2017: 129). Dedicated collections on sexualised drug use (Bourne et al., 2018; Desai et al., 2018) have generally maintained this heuristic boundary, presenting antiretrovirals as a decontextualised (and desexualised) HIV prevention tool, thereby overlooking their role in embodied chemsex practices. The designation of some drugs as sexualised, and others as not, is further complicated by the fact that certain drugs are still defined as ‘chemsex drugs’ even when consumed in non-sexual settings (see for example Frankis et al., 2018). However, some studies have intuited the importance of antiretrovirals in chemsex contexts, pointing to their role in enhancing sex, although primarily attributing this enhancement (of sex) to antiretrovirals’ instrumental role in HIV prevention (Hammoud et al., 2018). In addition, some of the early – albeit alarmist – descriptions of the sexualised use of antiretrovirals, alongside illicit drugs, documented the diversion of antiretrovirals from people living with HIV (PLHIV) to party packs of crystal methamphetamine, Truvada and Viagra, dubbed ‘MTV’ (Kurtz et al., 2014; Philpott, 2013).

The familiar, predictable narrative in which chemsex leads to HIV risk, which in turn demands an intervention in the form of PrEP, instantiates a particular chronology in which biomedicine solves a behavioural problem (Maxwell et al., 2019). However, this narrative overlooks the way in which chemsex and HIV risk are inextricably linked. Chemsex would never have emerged as an object of the sociomedical sciences were it not for the association with HIV infection (Race, 2018: 133–134), and when this association is removed, the ontology of chemsex is destabilised. What if we were to think about this risk narrative differently, with PrEP – as its name implies – preceding sex, or specifically chemsex, rather than solving the ‘problems’ these practices throw up? This rethinking, we suggest, invites us to consider PrEP (or rather, antiretrovirals) as part of chemsex. On this view, PrEP is producing new forms of chemsex. What is emerging is not simply more chemsex but ontologically different kinds of chemsex with significant implications for HIV and for the long-standing distinctions drawn between licit and illicit drugs, therapeutic and recreational use, and normal versus deviant bodies. These new enactments of chemsex reveal the empirical shakiness of these distinctions and invite us to reconsider familiar, overdetermined narratives of chemsex as inherently ‘risky’ and problematic, and to de-emphasise the association between chemsex and HIV infection – an association that paradoxically motivated the problematisation of chemsex in the first place (Race, 2018).

Approach: PrEP in the (Re)making of Chemsex

Our conception of drugs and their ‘effects’ is informed by work in Science and Technology Studies (STS), which challenges the commonplace view of drugs as stable entities with unique chemical properties that act to produce certain effects. We proceed on the understanding that the action of drugs and their purported effects are produced in relation to various other actors, contexts and practices (Race, 2014). On this view, drugs and their effects are brought into being and changed in their encounters with other phenomena including individual bodies, sexual practices, technological devices, other drugs, and concepts of pleasure, risk and play. This approach invites a shift in focus away from the human subject, the chemsex participant, as the orchestrator of action, and towards chemsex, conceived of as a conjunctural event, that is, a ‘concrete activity whose modes, practices and dispositifs can be described. . . [and] in which the relevant subjects, objects and social groupings are co-produced’ (Gomart and Hennion, 1999: 228). Our analysis draws on Gomart and Hennion’s (1999) conceptualisation of a subject-event network, which articulates the arrangements put in place to produce certain passionate attachments (to music and/or drugs). The concept of the subject-event network turns attention away from the source of action, and a subject ‘who acts’, and towards what occurs – and ‘the devices by which amateurs put their passion into practice’ (p. 221). This approach is consistent with the affective turn’s emphasis on the body’s capacities to affect and be affected, directing emphasis away from embodied selfhood and towards the relations that shape what bodies can do and feel (Alldred and Fox, 2017; Blackman, 2021).

Drawing on interviews with drug users and music enthusiasts, Gomart and Hennion (1999) note how being affected involves:

[E]ntering into a world of strong sensations; of accepting that ‘external’ forces take possession of the self; of being ‘under the influence’ of something else; of bracketing away one’s own control and will in order to be expelled or rendered ‘beside oneself’. (p. 221)

They go on to argue that participants in these scenes undertake specific forms of labour (or ‘meticulously establish conditions’) in order to be ‘moved’ (p. 227). In other words, ‘events are conditioned or prepared by skilled users’ and ‘there are techniques, settings, devices and collective carriers which make this active dis-possession possible’ (p. 221). A range of procedures and dispositifs (settings, devices) are employed ‘to make things happen’ (p. 232) and create the ‘condition[s] for the drug’s taking over’ (p. 236). This preparation includes timing, location, human company, drug combinations, and techniques of administration.

Gomart and Hennion’s sociology of attachment has been productively applied to a range of sociotechnical assemblages (Gauci, 2021; Sattlegger, 2021). It has also been used in accounts of drug consumption (e.g. Dennis, 2017; Vitellone, 2017) and sexualised drug use (Race, 2019). Building on this literature, this article considers ‘chemsex’ as a kind of abandonment or dispossession, created through actions that are intricate and regularised enough to allow participants to ‘let themselves go’. Importantly, for our purposes, antiretroviral drugs are part of the subject-event network through which chemsex materialises. This rethinking invites us to consider PrEP (or antiretrovirals) as part of the infrastructure, or event network, that comprises chemsex, in turn producing new kinds of embodied sexual subjects.

Our approach also rests on contemporary understandings of the body. In line with the theoretical influences described above, we view bodies neither as stable entities, nor as ‘constant or fixed in their intensities, attachments and affectations’ (Paasonen, 2018: 39). Rather, as Bruno Latour (2004) argues, the body is an ‘interface’ in constant engagement with various devices, technologies, and environments through which it learns to be affected and acquire distinctive capacities (p. 206). As noted above, these sociotechnical arrangements have become central concerns within the field of critical drug studies (Dennis, 2019; Race et al., 2023).

Methods

Our analysis draws on interviews with 10 self-identified gay and queer participants from a larger qualitative study exploring LGBTQ Australians’ use of drugs to transform aspects of sexual and gender experience. The study was approved by the University of Sydney’s Human Research Ethics Committee (Approval number 2017/735). Participants were recruited through the networks of LGBTQ organisations, social media posts, chain referrals and flyers placed in LGBTQ health clinics and social venues. Prospective participants were screened for eligibility, based on identifying as LGBTQ, being aged over 18, and living in the states of New South Wales or Victoria. Participants included in this analysis were taking antiretrovirals as PrEP at the time of interview (2018–2019). They ranged in age from 25 to 52 years, with nine identifying as cis-men and one as non-binary. Most identified as gay, and one as queer. The majority had a western European background, with two from an East-Asian and one from a southern European background; six of the 10 were born in Australia. All described current use of one or more drugs including alcohol, cannabis, crystal methamphetamine, erection medications (e.g. Viagra), MDMA, GHB/GBL, and psychedelics (e.g. LSD). All participants provided informed written consent and chose a pseudonym for reporting purposes.

Interviews were conducted in person and comprised a dual-method approach involving a semi-structured interview and a mapping exercise where participants were asked to plot the substances they consume, based on the frequency of consumption. Interviews were recorded, transcribed verbatim and all identifying details were removed from the transcripts. The transcripts were coded using NVivo and followed an inductive approach (Boyatzis, 1998): conceptual and descriptive codes were developed after reading a sample of interviews and with reference to the empirical literature on HIV antiretrovirals and sexualised drug use. They were then tested on the remaining material, and supplementary codes were added in a systematic and reflexive way across the dataset. In the analysis that follows, we focus on two key themes that emerged:

1. The sexual possibilities that antiretrovirals materialise; and

2. The role of antiretrovirals in mediating sexualised drug use.

Antiretrovirals as ‘Chems’ for Sex

A striking feature of participants’ accounts was the way in which they described engaging in sexualised drug use after commencing PrEP. Avery (31, gay), for example, indicated that taking PrEP had created an opportunity to consume illicit drugs with casual sexual partners, which he had not ‘ever really thought about’ prior to taking antiretrovirals.

Avery:

I guess those experiences have probably opened up to me as possibilities since taking PrEP. I probably wouldn’t have entered those scenarios so freely before PrEP.

Interviewer:

What are those scenarios?

Avery:

Like going to someone’s house to take G [GHB] and fuck. [. . .] To go to someone’s house with the intention of taking drugs and having sex was not something I ever really thought about doing before PrEP. So, it’s hard to say if that’s because I was anxious about it because it wasn’t really something I even gave time to consider.

Similarly, Kylan (25, gay) credited PrEP with providing a sense of reassurance that he could engage in bareback (condomless) sex on crystal methamphetamine without the risk of contracting HIV:

I think being on PrEP kind of made it more okay to do it – to do bareback – really, and crystal, because you don’t really know what it [crystal methamphetamine] feels like the first time. But afterwards, yeah, it did feel like it’s okay, because you won’t get HIV.

Elsewhere in the interview Kylan shared his view that men who take crystal methamphetamine don’t ever use condoms, and that in such contexts he would not have been able to insist on them. This reference draws attention to the strong cultural connection between the consumption of crystal methamphetamine and condomless sex: starting PrEP for these men made both possible for the first time, highlighting the role of antiretrovirals in transforming bodily capacities and conceptions of HIV risk.

Kylan and Avery’s accounts reveal that, for them, sexualised drug use only became a practice – or even a possibility – as a result of starting PrEP. Prior to PrEP, the risks of engaging in condomless sex in chemsex scenes functioned as a prohibitive factor. The accounts of other participants indicate that while they had engaged in sexualised drug use – with varying degrees of frequency – prior to taking PrEP, doing so was associated with vigilance and apprehension. For example, Dane (30, gay) noted:

Dane:

Before I started taking PrEP I wasn’t taking all of these drugs as much as I am now. [. . .] I probably took them [less than once a month]. And [the risk of HIV infection] was a consideration. It was a thing [you had] to think about. When you are really fucked up and you are having sex with someone, all of a sudden you just think, ‘Shit, are they wearing a condom, did I check that?’ [. . .] I never, ever, have that thought anymore. And I definitely notice that I take these drugs more now in those situations. I don’t know if that is because of [PrEP] or if I take [PrEP] because I take these [drugs] more now. I don’t know, but [risk of HIV] is definitely not something I ever think about now.

Interviewer:

Are they linked, in a way?

Dane:

Totally. I guess taking [PrEP] now allows my experience on those drugs to just . . . like it’s pretty uninhibited in terms of what I have to think about . . . apart from, ‘Do I physically like how that feels?’, to whether I physically want to be around this person. I can just do whatever I want sexually, which is a really good feeling.

Here Dane suggests that antiretrovirals have changed his ‘experience on those [other] drugs’, invoking the notion of disinhibition to describe how antiretrovirals ‘allow’ more open-ended sexual encounters (in which attentiveness to HIV risk is no longer necessary), and which contrasts with the ‘sudden’ in situ jolts of concern he experienced when being ‘really fucked up’ – and being fucked – in the past. And while he highlights how antiretrovirals make a particular experience of chemsex possible for HIV-negative men – one less freighted with concerns about condom use and HIV infection – his account also draws attention to the way in which chemsex is experienced bodily, and in particular as a receptive partner in sexual encounters. The idea that PrEP affords particular kinds of embodied ‘physical’ pleasure is alluded to in the interplay between thinking and feeling in relation to sexual practices and specifically via the use of disinhibition as an organising concept.

Similar to Dane’s account, a sense of vigilance was also evident in the accounts of other participants such as Alejandro (28, gay) who described how, before starting PrEP, he had made an effort when using illicit drugs to maintain what he referred to as “that little nugget of consciousness [. . .], that was [. . .] stable enough to say, ‘Don’t forget to put a condom on.’” Another participant, Bertie (32, gay), vividly recounted the different experiences of sexualised drug use prior to, and since starting, PrEP. Reminiscent of Gomart and Hennion’s description of drug users and music amateurs surrendering themselves to their passion, Bertie reports allowing crystal methamphetamine to finally ‘take a hold of’ him after starting PrEP. He suggests that before commencing PrEP, the effects of consuming crystal methamphetamine in sexual settings had been moderated, so in this sense, antiretrovirals allowed the drug to work better:

When I first started using ice [crystal methamphetamine], I felt like I was more careful. [. . .] It took a hold of me, but it didn’t take a hold of me a lot, because when I started taking PrEP, that is when I knew that I could stop fighting it, if that makes sense, and just like let myself go with it. And I don’t need to worry so much anymore. But I mean chances are, you know, that I wouldn’t have been able to fight it for that much longer, and, yeah, like I would have been addicted to ice as I am already, but I would be HIV positive, I imagine.

Like Dane and Alejandro, Bertie indicates that taking antiretrovirals allowed him to participate more fully in sexual encounters involving other drugs. His account also suggests that certain arrangements need to be in place for drugs (in this case crystal methamphetamine) to produce maximal or desired effects in terms of what they allow the body to do and feel (Alldred and Fox, 2017). The notion of control is also referred to throughout this excerpt in expressions such as ‘took a hold of’, ‘stop fighting’, and ‘let myself go’. While one can read these references to loss of control as invoking ‘addiction’, Bertie is also talking about being affected in a different sense. His account suggests that, before commencing PrEP, his apprehension of HIV risk prevented him from enjoying the full effects of crystal methamphetamine – a drug that is culturally associated with ‘uninhibited sex’ (Race, 2009). It is also clear that control here is not attributed to an individual human subject, but rather circulates among the different human and more-than-human actors in this chemsex event network. This idea of control as distributed and diffuse fits with our analytic approach of de-centring the individual body and instead approaching it as both shaped by, and active in shaping, the effects of drugs (Pienaar, 2016; Race, 2014).

Letting ‘Chemsex’ Happen

In what follows we explore the mechanisms through which participants perform the kind of ‘active passion’ (Gomart and Hennion, 1999: 221) associated with chemsex, tracing the role of antiretrovirals in co-constituting sexualised drug use and the bodily capacities and intensities it makes possible. As indicated in the accounts of Dane, Alejandro, and Bertie, chemsex involves a degree of ‘consensual self-abandonment’ (Gomart and Hennion, 1999: 221). Bertie in particular clarified how he had experienced chemsex differently – and in his words, more fully – after starting PrEP. We could say, therefore, that for HIV-negative men, antiretrovirals mediate the effects of crystal methamphetamine and other drugs commonly used for chemsex. This conceptualisation of certain phenomena (in this case antiretrovirals) as mediators acknowledges that an event has occurred, but does not seek to circumscribe its boundaries in terms of origins or effects (Gomart and Hennion, 1999: 225–226). Something is happening through consuming antiretrovirals in chemsex contexts, however it cannot be attributed to the properties of either antiretrovirals or crystal methamphetamine alone. Rather bodily experiences in chemsex encounters are produced through the conjoining of human and non-human practices including drug consumption, self-abandonment and sexual pleasure (Fox, 2012; Guillaume and Hughes, 2011). Here the body is not a bounded, self-enclosed entity but an open, dynamic assemblage that emerges relationally, through its connections to other phenomena, techniques and practices, themselves relationally produced (Blackman, 2021).

In their ethnography of drug use, Gomart and Hennion (1999) note that various preparations are undertaken by drug users and music amateurs to create the conditions in which they are ‘moved’, their bodily capacities affected in heightened ways. Our participants also referred to some of the physical or mechanical aspects of preparing themselves to be affected. Although it may seem somewhat contradictory, it was the routinised, daily dosing practices of PrEP that were a crucial aspect of these preparations. For example, Alejandro’s account traces the relationship between antiretrovirals and chemsex by emphasising how the daily consumption of PrEP is separated temporally and (usually) spatially from the sexual contexts in which it comes to matter:

[Taking the pills] is so removed from the act itself. It’s something that I do every morning. I wake up and have coffee and have my PrEP, [which is] quite possibly the least sexy time of the day, you know? So, it’s just a constant, regular, part of my day. And, you know, I have sex with random guys.

This excerpt also highlights the interplay between the highly regularised consumption of antiretrovirals, and the pleasurable open-endedness and excitement of sexual play. (Alejandro refers to having ‘sex with random guys’ to denote both chemsex and group sex.) In this way, the disciplined and domestic act of adhering to PrEP’s daily dosing regimen renders this embodied subject (Alejandro) available for spontaneous chemsex encounters.

Dane (30, gay) offers a similar account of the role of antiretrovirals in mediating the transition to an impassioned chemsex participant: ‘I just take [concern about HIV] out of the equation, I just don’t have to think about that’. This transition from an active mode – ‘I [. . .] take’ – to an inactive mode – ‘I [. . .] don’t have to think’ – demonstrates how effects emerge through specific preparations, as theorised by Gomart and Hennion (1999). A similar shift from intentionality and agency to allowing things to happen is invoked by Dudley (38, gay): ‘I know it [HIV] is being managed, I know what I’m doing, and yeah, I actually really just enjoy and connect with that experience, connect with people’ (emphasis added). Crucial in these embodied moments of disinhibition is the knowledge that HIV risk ‘is being managed’ through a daily dosing regimen of PrEP that is temporally removed from the spontaneity of the sexual encounter. And while these accounts demonstrate how participants ‘meticulously establish conditions’ in order to be ‘moved’ (Gomart and Hennion, 1999: 227), they also draw attention to the specific forms of labour involved – including mental effort – and how the body is transported in a seemingly paradoxical way, which Gomart and Hennion refer to as an active dis-possession.

However, while the chemsex event network is tight enough to afford participants some sense of practical control (against unwanted outcomes such as HIV), it is also loose in other ways. It is not simply a case of putting in place arrangements that are predictable enough to know what is going to happen every time. Instead, possibilities are left open for unpredictable elements to unfold (such as the randomness valued by Alejandro). These unpredictable elements constitute desired effects as more than simply the operationalisation of pre-figured corporeal pleasures with different pleasures afforded when some novel or unanticipated experiences occur (Paasonen, 2018). The arrangement must be sufficiently flexible and capacious to move embodied subjects out of their habitual disposition, generating excitement and pleasure through the unknown possibilities of self-transformation. This notion of arrangements creating the conditions for unpredictability or openness is captured by Alejandro who characterises the preparations for a night out as a ‘reliable architecture’ upon which a range of possible experiences may be built:

It’s a pretty reliable architecture to a night, you know. We pretty much take drugs when we go out. So, you go out, go for a dance, stay there for a while, go to the sauna, hang out there for a while, and then, you know, [it could] go a few different ways from there. You can go home, or you can keep partying, or you can keep fucking, or you can go to somebody’s house. Yeah, but it always starts in that context of having a night out. So, it’s a Friday or Saturday that this is almost always happening.

Other objects and arrangements are also important in co-producing desired effects. In Alejandro’s account, these include specific times (during weekends, and at certain points in the evening), places (a dance club, sauna or ‘somebody’s house’), and the sequencing of activities. And although not explicitly mentioned in this excerpt, Alejandro refers elsewhere to the use of digital devices and apps for arranging further hook-ups, and other drugs, especially erection medications. And while informing partners – either explicitly or implicitly – about consuming PrEP was part of these arrangements for some participants (at least on some occasions), discussing HIV prevention with potential chemsex partners is by no means universal, and being freed from concerns about it – including the need to discuss it in situ – was highly valued by participants.

Participants who engaged in injecting placed even greater value on planning in terms of producing desired effects and heightening bodily capacities to do and feel in particular ways. For Sterling (52, gay), PrEP was ‘a fucking wonder drug’ (an apt double entendre in this context) as it had enabled injecting crystal methamphetamine with sexual partners. Similar to other participants, the quotidian consumption of PrEP was crucial in enabling the spontaneity – and in this case, intensity – of chemsex. In addition to PrEP, these preparations included taking erection medications, choosing the correct pornography, and the highly ritualised practices of mixing the ‘gear’, filling the syringes, and the act of injecting (which in Sterling’s case, also required an expert pair of hands, as he was always injected by someone else). Such preparations were important in producing the embodied effects of the ‘rush’ in particular, and sexualised drug use in general (Dennis, 2019; Vitellone, 2017). Moreover, part of the pleasure of the ‘rush’ derived from the transgressive, risky nature of injecting (Dwyer, 2008) and the intimacy of being injected by a sexual partner. In relation to the latter, we have analysed elsewhere the importance of techniques of drug administration such as ‘slamming’ in constituting chemsex events, arguing that these techniques can be understood as sexual practices insofar as they help to generate intimacy, eroticism and sexual desire (Race et al., 2023).

Concluding Remarks: PrEP in the Chemsex-Body Assemblage

In returning to our initial aim of addressing the provocation that PrEP is a ‘party drug’, our analysis reveals that PrEP does indeed play an important role in partying, and that a range of new insights could be gained if this role was more explicitly acknowledged in critical chemsex and health promotion literatures. In considering the role of antiretrovirals in the chemsex event network, it is clear they create a sense of control for participants. However, the control invoked by these PrEP users is not the same as neoliberal control (of the sovereign subject) (Race, 2017). Rather, we argue, control emerges from the event network, and it is this kind of control (over unwanted outcomes such as HIV infection) that paradoxically enables a valued loss of control: the surrendering of oneself to the diverse possibilities and passions of a sexual encounter (Measham, 2004; Murphy et al., 2016). In conceptualising control in this way, we follow Gomart and Hennion’s (1999) approach, which seeks to shift the analytic focus away from the source of action, and suggest instead that action is an unanticipated gift from the ‘dispositif’. As they argue, active work is undertaken, and particular arrangements are put in place, for participants to be ‘moved’ and give effect to their passions. Similarly, we found participants in our study put in place particular social and material arrangements that enabled them to be affected (and have their bodily capacities transformed) in particular, though not always predetermined, ways. Chemsex encounters can be approached, in other words, as entailing specific kinds of abandonment and dispossession, created through actions that are intricate and regularised enough to allow participants to ‘let themselves go’. What is emerging, we argue, is not simply ‘more chemsex’ but new ontologies of chemsex, which are themselves labile and in flux. This rethinking invites us to take seriously the contention that PrEP is a ‘party drug’ and to tease out its implications regarding dominant understandings of antiretrovirals as purely therapeutic agents. Implicit in such accounts are the dualisms of licit/illicit drugs, therapy/recreation, volition/addiction, mind/body and normalcy/deviance that work to problematise chemsex as a risky, aberrant phenomenon. Against these dualisms and the polarising accounts of chemsex that they reinforce, our analysis has sought to track the ontological multiplicity and instability of chemsex, highlighting how it is remade in its encounters with antiretrovirals and individual bodies in ways that queer normative binary distinctions. In addition, our analysis draws attention to the politics of sexuality by challenging some of the recent homonormative framings of gay men’s health that position PrEP as a private matter of individual responsibility (Mowlabocus, 2019).

While our analysis has drawn attention to the role of PrEP in the chemsex event network, it is worth briefly commenting on other discursive framings of ‘barebacking’ – that may involve chemsex – where PrEP and in fact any forms of biomedical HIV prevention are denounced (Dean, 2015). Within barebacking – or more specifically, ‘bugchasing’ – subcultures, PrEP is eschewed because it is precisely the eroticisation of risk that is valued (García-Iglesias, 2022). However, the extent to which such subcultures exist, beyond discussions in online fora, is unclear (García-Iglesias, 2022).

At the time of the interviews, all study participants were consuming antiretrovirals on a daily basis. Event-based dosing strategies have subsequently become more common. As the name suggests, event-based strategies are likely to further foreground the role of antiretrovirals in facilitating the ‘active dis-possession’ that practitioners are pursuing, and therefore also the emergence of the subject through the chemsex ‘dispositif’ (Gomart and Hennion, 1999: 221). Such a foregrounding has been explored to some extent in research on different dosing strategies for PrEP (‘event-based dosing’ or ‘on-demand’ strategies) (Closson et al., 2018; Roux et al., 2018). The emergence of event-based dosing arguably aligns with other preparatory practices that have become a feature of gay sexual cultures, such as the use of hook-up apps to arrange and schedule casual sex (Race, 2021). PrEP is one of a number of preparatory practices that gay men have installed to put their passion into practice. It not only makes chemsex possible for a group of people whose concerns about HIV had ruled out, or limited, their participation, but also changes what chemsex is – an embodied practice no longer associated with HIV risk. If we consider that the association with HIV infection is what produced chemsex as an object of sexual health concern (Race, 2018: 133–134), then PrEP can be understood to interfere with the very ontology of chemsex, and the human and more-than-human bodies entangled in it. Therefore, rather than diminishing the value of PrEP for its intended users, we have argued that framing PrEP as a party drug tallies with the desires of some gay men to participate in less ‘inhibited’ sex and drug practices.

‘Disinhibition’ has long been understood to mediate the relationship between illicit drugs and sexual behaviour (Edmundson et al., 2018; Melendez-Torres and Bourne, 2016). It has also been called upon as an explanatory framework for unplanned HIV risk, that is, as exceptional occasions during which the traditionally sovereign subject of HIV prevention and harm reduction is temporarily absent (Race, 2009: 167). This oscillation between the notion of the calculative sovereign subject and the disinhibited hedonist has led to a ‘drama of extremes’ in which any alternatives other than pure intention and total disinhibition are unavailable (Race, 2009: 167). However, our participants’ accounts suggest a need to interrogate this polarisation so that sex and drugs are not ‘entirely beyond the realm of care and attention’ (p. 167). Doing so opens up the possibility that drugs may actually provide a means by which gay men can have the sex they desire (Weatherburn et al., 2017), and may contribute to overcoming shame and relieving conflicting emotions associated with sex and sexuality (Pienaar et al., 2020). This is important because gay sex, party drug use, and even PrEP use are to some extent stigmatised practices, which in turn can produce disavowal, dissimulation, judgement and pathologisation. Countering their framing as disreputable activities is a necessary step in rendering these practices intelligible rather than a source of denial or moral opprobrium (Warner, 2000). In short, we need to consider these practices as worthy of close, careful attention without – or notwithstanding – moralism about drugs and sex.