A Qualitative Study of Stimulant-Using Men Who Have Sex with Men

Drug use during sexual encounters has become a growing concern globally among men who have sex with men (MSM)¹, including in Southeast Asia.² Stimulant drugs (crystal methamphetamine, ecstasy) and gamma-hydroxybutyrate are used by some MSM to facilitate and enhance sexual pleasure, a phenomenon known as "chemsex." During chemsex, sexual disinhibition and hypersexuality often lead to reduced condom use, sex with multiple partners, and other high-risk sexual behaviors, increasing the likelihood of HIV and Sexually Transmitted Infection (STI) transmission.³

MSM who participate in chemsex experience a range of physical, mental, and social harms associated with stimulant use and often have minimal access to HIV testing, prevention, and treatment services. As such, late HIV diagnosis is common in this high-risk population. Despite strict drug laws in Southeast Asia, stimulant use among MSM living in urban areas is on the rise, evident in gay dating apps and social media where stimulant-using MSM seek chemsex partners and share stimulant drugs.

After consulting MSM-serving nongovernment organisations for input on recruitment and data collection, a research team designed a qualitative study in a Southeast Asian country to explore the mental health needs of stimulant-using MSM, to increase HIV testing, and to link them to treatment. The researchers sought to recruit participants through targeted outreach via a social media app frequently used by MSM. A researcher set up a profile on the app to converse with men whose profiles suggested stimulant use. The researchers recruited individuals who were biological males aged 18 years or older who used stimulant drugs and had condomless anal intercourse in the past 3 months. Individual, in-depth interviews were conducted at mutually agreed locations, some at private residences.

Due to societal norms in this country and suspicion among stimulant-using MSM, recruitment was very difficult. To accommodate this challenge, the researcher became well-versed in the world of chemsex by learning the language and approaches used for sexual encounters and sharing drugs. Over time, this researcher gained the trust of the community, and recruitment went smoothly. The researcher obtained verbal consent after contacting individuals via phone screening and explaining the study procedure, risks, and benefits, then arranged face-to-face interviews. Upon meeting a participant at his home, the researcher discovered him unclothed and using crystal methamphetamine. Under the influence, the participant attempted to engage in sexual intercourse with the researcher. Shocked, the researcher abruptly left and conducted all remaining interviews at a research center.

Some participants remained in contact with this researcher after completion of the study, seeking social support in coping with their drug use problems. The researcher also interacted socially with some participants and encouraged the use of HIV prevention services.