Abstract / Summary
Abstract Introduction Chemsex, the use of substances during sex, is increasingly prevalent among young men who have sex with men (YMSM) and is linked to multiple harms. A comprehensive harm reduction service (HRS) is needed to address these issues. The CLYMAX-2 study evaluated outcomes of a four-pronged HRS that tackles chemsex-specific sexual health, mental health, and socio-legal harms. Methods CLYMAX-2 was a 6-month prospective cohort study enrolling YMSM aged 16–35 who engaged in chemsex between September 2024 and April 2025. Participants were recruited through three settings: sexual health, “on-the-spot” at a gay sauna, and a legal and rights-focused model. Study visits occurred at baseline, Month 3, and Month 6. At each visit, participants completed questionnaires assessing behavior, substance use, mental health, quality of life, and legal issues. HIV/sexually transmitted infection (STI) screening (lab-based or self-testing) was done at baseline and Month 6. Those who screened positive for harms in any component were offered domain-specific interventions to address the identified harms. Here, we report the baseline findings. Results Among 123 participants, over 90% were Thai and resided in Bangkok. The most commonly used substances were crystal methamphetamine (61.8%) and poppers (48.8%), and 53.7% reported injection drug use. Physical (61.8%) and social (66.7%) harms were most prevalent, and 97 (78.9%) participants had attempted to stop chemsex. When asked about the most important component of the HRS, 50.4% participants ranked chemsex-specific service as their top priority, followed by the sexual health component (38.2%). Among those who screened positive for each harm, the chemsex-specific intervention had the highest acceptance rate (61.6%; 61/99), followed by sexual health (34.5%; 39/113), socio-legal (29.7%; 27/91), and mental health services (24.0%; 23/96). Significant differences in intervention acceptance rates were observed across the three models for all four prongs. Conclusions CLYMAX-2 identified the multifaceted harms of chemsex among YMSM. Participants prioritized chemsex-specific services, underscoring their potential as a key entry point for integrated care. Despite substantial needs, mental health and socio-legal services were less accepted. The differences in service uptake across models underscore the importance of delivering person-centered HRS that are responsive to the diverse needs of YMSM.