This study evaluates the pre-implementation phase of a host-led harm reduction model for men who have sex with men (MSM) engaging in chemsex in Bangkok, Thailand, focusing on understanding harms, contexts, and needs to develop a tailored intervention.
MSM aged ≥18 years
Able to communicate in Thai
Chemsex hosts: hosted ≥2 times in past 6 months
Chemsex guests: attended ≥2 times in past 6 months
None
Recruit chemsex party hosts, chemsex party guests, representatives from the CSOs, government hospital, police organization G1: Chemsex party hosts 1. Have ever hosted a chemsex party at least 2 times in the past 6 months. G2: Chemsex party guests 1\. Have ever attended a chemsex party at least 2 times in the past 6 months. G3: CSOs 1. Currently working in a CSO 3. Hold a role or perform a duty related to chemsex-related incidents or drug use for more than 3 months. G4: Government hospitals 1. Currently working in a government hospital. 2. Hold a role or perform a duty related to chemsex-related incidents or drug use for more than 3 months. G5: Police officers 1\. Currently working in a police organization. 3. Hold a role or perform the duty related to chemsex-related incidents or drug use for more than 3 months.
Cohort
Other
Self-administered questionnaire assessment
BehavioralParticipants (chemsex party hosts and guests) will complete structured self-administered questionnaires to assess: * Substance use patterns and related harms * Sexual health risks (e.g., condom use, HIV/STI testing, PrEP/ART adherence) * Mental health status using validated tools: * Patient Health Questionnaire-9 (PHQ-9) * Generalized Anxiety Disorder-7 (GAD-7) * Socio-legal harms including stigma and discrimination
Semi-structured in-depth interviews (IDIs)
BehavioralAll stakeholders will participate in semi-structured in-depth interviews: * Exploration phase: guided by EPIS framework * Preparation phase: guided by * Theoretical Domains Framework (TDF) (hosts \& guests) * Consolidated Framework for Implementation Research (CFIR) (organizational stakeholders) The interviews aim to: * Identify harms associated with chemsex * Explore current practices and contexts * Identify barriers and facilitators * Inform development and refinement of a harm reduction model
Development and refinement of harm reduction model
BehavioralA novel four-pronged harm reduction model will be developed and refined based on quantitative and qualitative findings. Domains include: * Substance use harm reduction * Sexual health harm reduction * Mental health harm reduction * Socio-legal harm reduction
Substance use-related harm assessed by self-administered questionnaire
Substance-related harms will be assessed using a structured self-administered questionnaire. The assessment includes: * Patterns of substance use (snorting, injecting, ingesting, anal insertion) * Frequency of use * Physical harms (e.g., injection-related injuries, overdose) * Psychological harms (e.g., substance dependence) This is a descriptive assessment; no composite scale score is generated.
Sexual health risk behaviors assessed by self-administered questionnaire
Sexual health risks will be assessed using a structured questionnaire including: * Number of sexual partners * Condom use * HIV/STI testing history * Self-reported HIV status * Pre-exposure prophylaxis (PrEP) use and adherence * Antiretroviral therapy (ART) adherence among participants living with HIV This is a descriptive assessment; no composite scale score is generated.
Depression severity assessed by Patient Health Questionnaire-9 (PHQ-9)
Depression will be assessed using the Patient Health Questionnaire-9 (PHQ-9): * Score range: 0 to 27 * Interpretation: * 0-4: Minimal depression * 5-9: Mild * 10-14: Moderate * 15-19: Moderately severe * 20-27: Severe Higher scores indicate worse depression severity
Anxiety severity assessed by Generalized Anxiety Disorder-7 (GAD-7)
Anxiety will be measured using the Generalized Anxiety Disorder-7 (GAD-7): * Score range: 0 to 21 * Interpretation: * 0-4: Minimal * 5-9: Mild * 10-14: Moderate * 15-21: Severe Higher scores indicate worse anxiety
Perceived stigma and socio-legal harm assessed by structured questionnaire
Socio-legal harms will be assessed using a structured questionnaire adapted from the CLYMAX study, including: * Internalized stigma related to chemsex * Perceived discrimination (family, workplace, social) * Legal risks and experiences This is a descriptive assessment; no composite scale score is generated.
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Institute of HIV Research and Innovation Foundation, Thailand
Lead sponsor
International AIDS Society
Collaborator
