OFFERING CHOICES TO YOUNG MEN WHO HAVE SEX WITH MEN ENGAGING IN CHEMSEX: A VARIETY OF COMMUNITY-LED COMPREHENSIVE CHEMSEX SERVICE MODELS IN BANGKOK

Methods: We implemented 3 community-led chemsex service models between September 2024-February 2025. The “Sexual health-focused model (Rainbow Sky clinic)” added substance use (SU), mental health (MH) and socio-legal/rights services to a community-led sexual health (SH) clinic. The “Legal-focused model (FAIR clinic)” had SH and MH services added to existing SU and socio-legal/rights services. The “Sauna model” offered SU, SH, MH and socio-legal/rights services in a chemsex venue. Lay staff at each site were trained and coached to offer basic screening/testing, primary treatment/prevention, and referral to specialists.

Rapid HIV/HCV/syphilis tests and molecular chlamydia/gonorrhoea (CT/NG) testing were available at Rainbow Sky clinic. Only HIV self-test and oro-genital self-sampling kits for CT/NG were available at the other sites.

Effectiveness: We enrolled 77 MSM using chemsex in past 6 months. Majority (79.1%) used chemsex >1/month and 4.3% shared needles. Half (49.4%) engaged in polydrug use. Crystal methamphetamine was mostly used (67.1%), followed by weed (15.2%), and GHB (8.9%). Sex was neither protected by condom nor PrEP among 21.5%.
Popular services accessed were SH (63.3%) and SU (40.0%) at Rainbow Sky clinic (n=30), SU (66.7%) and SH (27.8%) at Sauna (n=18), and SH (24.1%) and MH (20.7%) at FAIR clinic (n=29). HIV was identified in 9.1% at Rainbow Sky clinic, 40.0% at Sauna, and 11.1% at FAIR clinic. CT/NG was detected in 0%, 57.1%, and 55.6%. At Rainbow Sky clinic, syphilis was found in 14.3%.

Conclusion and next steps: Various models offered choices to MSM. The lack of self-test kits caused missed opportunities for lay providers to identify syphilis and HCV. We must advocate for multiplex self-testing and increase awareness of MH and socio-legal/rights services as part of chemsex services.