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Paper short abstract

Chemsex users in their efforts to access healthcare negotiate the definition of health with healthcare personnel, highlighting a controversy: how to understand health in practices involving the sexualised use of drugs, where boundaries define the concept itself

Paper long abstract

Healthcare for chemsex users is structured around different boundaries and limits that arise from the relationships that develop between objects, chemsex users, healthcare personnel, and public institutions. Formally, there is an epistemic differentiation between chemsex users and healthcare personnel. However, based on research involving the tracking of objects and personal interviews, these formal boundaries lose their rigidity and we find hybrid entities, such as healthcare personnel who practise chemsex and use healthcare services.

These boundaries become more apparent when we consider how stigma manifests itself in the lives of chemsex users in a healthcare system weakened by the neoliberal offensive of recent decades. PrEP and antiretroviral treatment are presented as guarantors of the health of chemsex users because of the benefits they obtain by adhering to them. This formal equality, which is based on the affirmation of health as a universal right, is called into question when migrants try to access these treatments without a health card. They are faced with expensive bills and healthcare that is far from this universal formulation of health as a right.

This research seeks to unravel how these boundaries and limits are reified or contradicted by following objects such as mephedrone, PrEP, or antiretroviral treatments. In addition, we must recognise the intimate entanglements that enable the agency of pivotal health professionals, who are health workers committed to care of the communities that are excluded form healthcare system, and chemsex users and their capacity to produce scientific knowledge in an impure way with health workers.