The reigning Mr Gay World has spoken out about the "problematic" culture of drug use during sex among some gay and bisexual men, after suffering psychosis that triggered terrifying paranoid thoughts of people attempting to kill him during a prolonged period of substance abuse.Giulio Spatola, 41, who works in the cinema industry and originally hails from Palermo in Italy but is now based in London, revealed he first experimented with both mephedrone and γ-hydroxybutyrate (GHB) - an illicit recreational party drug - recreationally back in 2019. Initially, Giulio described his drug use during sex as "once in a while", but by 2021 he was engaging in chemsex — defined as sex under the influence of psychoactive drugs by the British Medical Journal — "almost every weekend".The consequences on his mental health were severe, leading to episodes of psychosis and depersonalisation, a dissociative condition in which a person feels detached from themselves. At his lowest point, Giulio was visiting a sexual health clinic for sexually-transmitted infections (STIs) "twice a month" and frequently calling in sick to work due to "bad downs" following weekend-long chemsex sessions.It was in the months leading up to receiving the call to compete in the prestigious Mr Gay World pageant on 1st December last year that Giulio began to take his sobriety seriously.‌READ MORE: Billie Eilish tells LGBTQ+ fans to 'stay strong' in heartfelt messageREAD MORE: 'I'm in a relationship with four men - we have sex and want kids but there's a major rule'Giulio told PA Real Life: "Mr Gay World saved me and gave me one more reason to stay sober. To my surprise, I was the only one who mentioned chemsex (during the competition) because it's a big thing to come out like this. But then when they later screamed, 'Let's welcome our new king' and I found out I won, I felt a rush. I did it, and it was a dream come true."Giulio's pageant journey began in 2010 when he claimed victory in both Mr Gay Street and Mr Gay Rome on the very same day, subsequently going on to triumph in Mr Gay Italy and Mr Gay Europe. Due to a scheduling conflict, Giulio's production team opted for him to enter Mr Gay Europe in Romania rather than Mr Gay World in the Philippines in 2011, before he "stepped down" from pageant competitions in 2012.Giulio relocated to London in 2013, completing a cinematography degree before embarking on a career in visual effects in 2017. By the summer of 2019, he was introduced to GHB and mephedrone "simply to fit in" and "because everyone was doing it" at a party he attended one evening.‌He added: "I just decided to let go, trust in the fact that most of the people that I knew there were all doing it, and they were fine." Giulio said he began using around "once a month", exclusively on Saturday nights, returning to bed by Sunday morning.In 2020, Giulio described having a "perfect life" — a partner, their own flat, and his "dreams" career in visual effects. Then the Covid-19 pandemic struck and Giulio said it "destroyed everything", compelling him to return to Italy for five months.By March 2021, Giulio's relationship had collapsed and, despite returning to London, he was forced to move in with friends. This was the point at which he became deeply entrenched in the chemsex scene — most prevalent among men who have sex with men, where drugs are used to facilitate, enhance and prolong sexual encounters.‌Giulio said: "I found myself emotionally weak, like I had never been in my whole life... I felt hurt by the break-up. So I decided to suffocate all the pain by just going out and partying. That's when (chemsex) started to become problematic."I started to use (drugs) way more and I was going to parties where I would have multiple partners – like in orgies and sex parties. I wanted to suffocate the part of me that wanted a partner."At the peak of his drug-fuelled sexual encounters in 2021 — which would frequently stretch across an entire weekend — Giulio's mental health deteriorated severely, with recurring episodes of psychosis and depersonalisation triggering paranoid panic attacks.On one occasion, he became convinced that people inside his friend's house had stolen his keys from his jacket, had copies made, and could enter his home to kill him at any moment.‌Regarding his sexual health, Giulio revealed he routinely took PrEP — a preventative HIV medication — yet this did not protect him from contracting other STIs. He said: "I was at the Dean Street (sexual health clinic) twice a month for STIs. To the point that I remember the nurse told me that if I continued at the rate I was going, the antibiotics that they injected me with were not going to do anything anymore," he added.He would also phone in sick to work "at least once a month", leading HR to question Giulio: "Is there something we should know about your health? You're constantly sick, especially at the beginning of the week."Giulio underwent an assessment and began an email programme which, he said, helped him recognise that he was "trapped in a loop" that he "couldn't escape".He believes a subsequent diagnosis of autism and ADHD at the age of 40 helped him understand the link between neurodivergence and addiction. By July 2025, Giulio received an unexpected Instagram message from Mr Gay World, revealing they'd spotted his background in gay pageants — including the fact he'd never actually competed at Mr Gay World level — and asked whether he'd like to represent Mr Gay Italy at the competition scheduled for December 1.‌Giulio said: "The very same moment that I accepted, I knew I wanted to bring the word 'chemsex' on that stage. It was my way of making the years of bad experiences that I had meaningful," he added.Throughout the pageant, Giulio explained that delegates are assessed across multiple themed costume rounds — including outfits representing their nation — alongside their understanding of global LGBTQ+ history, and their reasons for becoming the next Mr Gay World.Upon discovering he'd claimed victory, Giulio said he "felt a rush" before raising a photograph of David Stuart, described as a "pioneer of chemsex harm reduction" in London prior to his death in 2022, aged 54.‌Since his win, Giulio said he's been given a "bigger platform to talk about" chemsex, including involvement in a campaign titled Out In The Open — launched by LGBTQ+ dating app Grindr alongside not-for-profit organisation You Are Loved — which revealed 28% of LGBTQ+ people across the UK have engaged in sex while using drugs within the past year.Giulio said it's crucial for him to "respond directly" to individuals who contact him regarding their own chemsex struggles, enabling him to "offer that kind of empathic support" he desperately wished he'd received. He added: "I was scared that I had completely broken myself and there was no going back – but there is."For further details about Out in the Open, head to the Grindr for Equality website.If you would like to speak to an LGBT helpline please call Switchboard – they are open 7 days a week 10am – 10pm on 0800 0119 100. They also have an instant messaging service, which you can access through their website.‌If you have a query relating to drugs and alcohol you can contact the Antidote team at antidote@londonfriend.org.uk. You can also visit the Rehab 4 Addiction website, which is an advisory and referral service for people who suffer from alcohol, drug and behavioural addiction.