Life became chaotic for Poon early. (Not his real name.)
As a gay teenager he was bullied at school by students and teachers. He moved in with his grandparents when his parents separated, but eventually left northern Thailand for Bangkok. There he survived through sex work.
Then Poon learned he was living with HIV. The weight of HIV prejudice merged with the stigma he already carried as a young gay man and sex worker. Some friends he made at a camp disclosed his HIV status online after an argument. He was diagnosed with major depressive disorder.
A partner introduced him to drug-use during sex. He went on to use multiple substances including methamphetamines and cocaine.
“Sex, drugs and alcohol are my escape,” he said.
This was one of the stories shared at the 6th Asia Pacific Chemsex Symposium (APCS). Held in Bangkok on November 6 and 7, the event brought together over 300 stakeholders from 27 countries. They shared their research and responses to a practice that remains largely hidden and not yet well understood. The event specifically explored pleasure as opposed to risk as an entry point for providing services.
Chemsex—also called High Fun in several Asian countries—refers to the use of stimulant drugs during sexual activity. It lowers inhibitions and may increase risk-taking. There are several public health implications including higher rates of HIV and sexually transmitted infections (STIs), lower adherence to treatment, overdose and the fallout linked with intoxication.
In Asia Pacific four of every five new HIV infections are among people from key population communities including men who have sex with men or MSM, people who use drugs, people in prisons or other closed settings, sex workers and transgender people. Young people make up a quarter of all new HIV infections and in some countries around half of new infections are among youth ages 15 to 24.
Several countries in the region are facing an HIV prevention crisis with new infections among MSM either increasing or decreasing far too slowly. In 2023, 43% of new infections in Asia-Pacific were among MSM. At the same time, there is evidence that the practice of chemsex in this community ranges from 3% to 31% depending on the country. But although chemsex is most visible in the MSM community, it is practiced by people from all populations.
“We are talking about sex and drugs—two topics that people call taboo,” said Brigitte Quenum, UNAIDS Regional Team Lead for Sciences, Systems and Services at the opening ceremony. “But as HIV has taught us, to reach people, we must confront the realities of their lives.”
Toolkit now available for Asia Pacific health workers
On day 2 of the symposium UNAIDS and UNODC launched the first-ever toolkit on chemsex for Asia Pacific clinical service providers. The toolkit was developed by the Australian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM). It is geared toward health workers in Asia and the Pacific working with men who have sex with men and transgender women.
"The increasing use of stimulant drugs in the region, including for ‘Chemsex’, poses significant health risks, including drug use disorders and various psychosocial challenges," said Masood Karimipour, Regional Representative of UNODC’s Office for Southeast Asia and the Pacific. "This UNAIDS-UNODC toolkit provides essential guidance for healthcare providers to address these challenges through evidence-based interventions. It emphasizes the importance of holistic, non-judgmental care that prioritizes the physical, psychological and social wellbeing of individuals, while ensuring access to harm reduction services and the prevention and treatment of drug use disorders within a comprehensive continuum of care."
The resource was created to support comprehensive clinical services in the region’s restrictive legal environments. Twenty-eight countries in Asia Pacific criminalise drug possession for personal use while 17 criminalise same-sex relations. Penalties for drug-related offences in the region are among the world’s harshest.
The toolkit was developed through consultation with clinicians, community representatives and government agencies. It covers chemsex basics as well as approaches to harm reduction, sexual health, and mental health services. It also covers different service delivery models including face-to-face, online and by communities. The toolkit offers guides and tools on topics such as initiating non-judgmental conversations and risk assessment.
“Stronger HIV prevention strategies tailored to chemsex are needed, along with expanded, inclusive services for sexual, physical and mental health,” said Suniya Taimour, UNAIDS’ Community-led Responses Advisor for Pakistan and Afghanistan.
Thia approach recognises that comprehensive health services can be lifesavers by using one point of contact to address multiple issues including physical, sexual and mental health as well as social issues. Poon is a living example. He has benefitted from a service package that has combined his HIV treatment with harm reduction interventions and psychiatric care. Today he is a 22-year-old university student with clear life goals who feels more empowered about his HIV status.
