Comprehensive chemsex harm reduction services for young MSM in Thailand: a four-pronged approach informed by multi-stakeholder perspectives (CLYMAX-1)

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BACKGROUND: The lack of knowledge regarding the essential components of comprehensive chemsex services for men who have sex with men (MSM) in Thailand poses a substantial obstacle to the development of such services. We explored perspectives from various stakeholders on the necessary components of comprehensive chemsex services. METHODS: Semi-structured, in-depth interviews were conducted in-person with 60 key informants: 40 MSM who use chemsex, 10 peers/family members and 10 service providers. A codebook was developed based on a priori themes of the interview guide and emergent themes from transcripts. RESULTS: We identified four components that should be incorporated into comprehensive chemsex services. First, promoting substance use literacy is the top priority. In particular, people who use chemsex value a reliable source of information on chemsex-related harms and mitigating strategies. Second, mental health counseling from specialists, such as psychologists or psychiatrists, due to relationships between mental health and chemsex use. Third, sexual health services, including routine sexually transmitted infections screening, and the provision of preventive measures, such as PrEP and condoms. Fourth, legal and stigma consultation are crucial in the context of the country's punitive laws and common abusive practices toward people who use substances. Some MSM prefer onsite services for a more professional feel and effective communication, whereas others prefer online services due to experienced/anticipated stigma and discrimination. CONCLUSION: Chemsex-specific literacy, mental health services, sexual health services, and legal and stigma consultation were identified as key chemsex service components, and their inclusion in comprehensive chemsex services for MSM in Thailand should be further explored.

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