From potential to pause – missed opportunities in harm reduction: lessons learned and perspectives from a discontinued implementation study among young men who have sex with men in Thailand

Information from the abstract

Harm reduction remains underutilized in Thailand, despite the increasing visibility of people engaging in chemsex—the use of substances during sex associated with complex health and sociolegal challenges. The CLYMAX study, a two-phase implementation project, was launched to explore the chemsex landscape among young men who have sex with men (MSM) aged 16–35 (CLYMAX-1) and to pilot a community-informed harm reduction model (CLYMAX-2). Although CLYMAX-2, an intended twenty-four-month prospective cohort, was prematurely terminated due to the cessation of U.S. funding, it yielded valuable, on-the-ground insights. Here, we distil lessons learned and perspectives from the six-month implementation period. While several studies reported that sexual health clinics could be potential gateways for MSM who engage in chemsex to seek healthcare services without bearing the burden of stigma, CLYMAX-2 found various barriers in achieving this goal. The lack of context-specific, scientifically proven, and practical harm reduction strategies disrupted chemsex-focused integration into sexual health services. Peer-led STI treatment models may effectively help address mistrust in the healthcare system and weave sexual health awareness into the fabric of chemsex culture. Moreover, the current definition of problematic substance use is unable to fully capture the nuances of how chemsex interacts with an individual beyond a biomedical viewpoint. These proved to be hidden challenges for providers and those engaging in chemsex to set a pragmatic goal for their harm reduction journey. We also emphasized the importance of integrating funding diversification into program designs to ensure sustained support for priority agendas. These perspectives inform the need for context-specific, practical harm reduction strategies tailored to MSM engaging in chemsex in Thailand. Further research is required to support the integration of chemsex-related services into sexual health services and to evaluate the effectiveness and feasibility of peer-led interventions. The waning international funding to support chemsex-related research highlights the need to diversify funding sources to ensure sustainable progress in the field.

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Related topics: HIV, Drug Use, Sexual Risk · HIV/AIDS Research and Interventions · Substance Abuse Treatment and Outcomes