Obituary: David Stuart

HIV activist and researcher who led global efforts to reduce the harms of chemsex. He was born on Jan 28, 1967 in Adelaide, SA, Australia, and died on Jan 10, 2022 in London, UK, aged 54 years.

Chemsex and HIV advocate David Stuart drew on his own past experiences of drug use and challenging early life experiences to help mostly men who have sex with men (MSM) reduce the harms of chemsex. Many peers have credited him with coining the term chemsex—the use of illicit drugs to enhance sexual experiences, which can be associated with increased risk behaviours and adverse health effects. In 2015, Stuart featured in the documentary Chemsex, a ruthless exposé of high-risk chemsex behaviour.

Stuart worked relentlessly to highlight the extent of chemsex and to support those affected. He spent more than a decade working in drug treatment services in a range of settings in London, UK—firstly, from 2007 to 2014, as a volunteer at the Antidote Substance Misuse Service, based at London Friend, an LGBTQI+ health and wellbeing charity. He then became the Substance Misuse Lead at the Dean Street Clinics in London, where he had worked for the past 8 years, including a period leading its CODE clinic, which provides harm reduction and chemsex support services, in partnership with Antidote. David Asboe is the Clinical Director of HIV, Sexual Health, and Dermatology at Chelsea and Westminster Hospital NHS Foundation Trust, of which the Dean Street Clinics are part, and worked extensively with Stuart at Dean Street. “David was a pioneer in his work and dedicated his time as an advocate, activist, support worker, campaigner, lecturer, and researcher”, said Asboe in a statement to The Lancet on behalf of all of Stuart’s colleagues at Dean Street. “He was a well known and respected colleague and friend to many of us, and highly recognised internationally for his tireless work with Gay, Bi, and Queer communities which he did with passion, empathy, and kindness. David’s work has undoubtedly saved the lives of many and his loss is immeasurable to all of us.”

During the second decade of the 2000s, the chemsex scene in London and other major global cities exploded, as did the demands on Stuart’s time. Yet he would always aim to make each patient leave his office in a better state than they entered. Early in 2013, he discussed with The Lancet in a World Report how illicit drugs such as methamphetamine were used by some MSM who were dealing with shame and vulnerability issues. Among his many talents was the ability to support those engaged in chemsex to find a way through addiction. He steadfastly focused on helping patients cope with the complex factors surrounding their drug use, and, in time, end their dependence on drugs for sex, if that was their goal. When this was not possible, he would advise them how to use drugs more safely and establish safety nets. The tributes to Stuart on social media after his death include many from individuals whose lives he helped turn around, and family members of those who were lost while he tried to help them. Stuart will be remembered for his compassion, never-ending availability, and understanding when supporting patients who were struggling with their own unique chemsex situation—each of them in desperate need of a helping hand, and always able to walk through Stuart’s open door.

Alongside the care and support he gave to so many people, Stuart became a global advocate for strategies to address the harms associated with chemsex and spoke at conferences, collaborated on research papers, and advised governments. His contributions included a guide for health-care providers on chemsex and hepatitis C, papers on the effect of polydrug use, chemsex, and HIV risk behaviour, and how HIV pre-exposure prophylaxis affected the dynamics of chemsex. “David Stuart’s visionary activism and research on chemsex was fundamental to understand and bring onto the public health and HIV agenda this phenomenon that, today, is increasingly affecting the life of gay, bisexual, trans and queer communities worldwide”, said Cleiton Euzebio de Lima, Senior Adviser for Civil Society Networking at UNAIDS, Geneva, Switzerland. “Through his work at the Dean Street Clinics, he definitively demonstrated the importance of peer-led, non-judgmental, and tailored services to the success of HIV prevention and harm reduction programmes. His legacy will live on through the HIV/AIDS response and in LGBTQI+ communities around the world.”

By Tony Kirby and Michelle Thornber-Dunwell