The study evaluates the integration of a sexual pleasure-based approach into harm reduction services for MSM and transgender persons engaging in chemsex or substance use in Thailand, using the "Pleasuremeter" tool to improve sexual health and related outcomes.
MSM, transgender women, transgender men, or non-binary persons
Age ≥18 years
Engaged in chemsex or substance use within past 12 months
Able to provide informed consent
None
Parallel
Pleasuremeter-guided qualitative interview
BehavioralSemi-structured in-depth interviews guided by the Pleasuremeter framework, covering 7 domains of sexual pleasure: * Physical and psychological satisfaction * Self-determination * Consent * Safety * Privacy * Confidence * Communication/negotiation
Pleasuremeter-based sexual pleasure discussion integrated with harm reduction services
BehavioralParticipants will undergo: * Sexual pleasure assessment using Pleasuremeter (0-10 scale, 3-month recall) * Behavioral risk and substance use assessment * HIV/STI testing * Mental health screening using Electronic Mental Wellness Tool (e-mwTool) * Social and stigma assessment * Harm reduction services (drug literacy, counseling, referral, harm reduction kits) The intervention aims to facilitate structured discussions on sexual pleasure within harm reduction services.
Willingness to engage in sexual pleasure discussions assessed using the Pleasuremeter tool
The primary outcome is the proportion of participants who agree to engage in structured discussions on sexual pleasure using the Pleasuremeter, a structured assessment tool covering 7 domains: * Physical and psychological satisfaction * Self-determination * Consent * Safety * Privacy * Confidence * Communication/negotiation Willingness will be assessed at each study visit (baseline, month 3, month 6) based on participant acceptance or refusal to complete the Pleasuremeter assessment.
Sexual pleasure score assessed by the Pleasuremeter (0-10 scale)
Sexual pleasure will be measured using the Pleasuremeter, a composite self-reported scale assessing 7 domains of sexual experience. * Scale range: 0 to 10 * Minimum value: 0 (lowest level of sexual pleasure) * Maximum value: 10 (highest level of sexual pleasure) * Interpretation: Higher scores indicate better sexual pleasure and satisfaction Scores may be analyzed as: * Overall composite score * Domain-specific scores
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