Harm Reduction for Chemsex in Lisbon: community-based interventions for a hard-to-reach group, during the COVID-19 pandemic

Chemsex has proliferated in Lisbon in the last years, namely among men who have sex with men (MSM). Harm reduction (HR) and sexual health community-based teams become invaluable settings for counselling about both safer sex and safer drug use, when proximity and trust with MSM has been built. COVID-19 turned chemsex into an even more secluded practice, demanding our two HR organizations to adapt and implement individual videocall counselling, a fortnightly online peer group named ChemTalks, and on-site peer support. In order to map service users’ needs and to evaluate and adjust our intervention, we collected data from email and videocall contacts had from August 2020 to January 2022. Our sample comprises 33 MSM, aged from 21 to 53, of whom 16 are migrants and 17 are HIV-positive. Cathinones, methamphetamine and GHB explained two thirds of requests, the other third comprising these and other substances; 10 injected methamphetamine or cathinones. The men asked support to manage their practice, diminish or stop drug use, prevent a return to drug use, or prepare a first experience with a drug. Their main complaints included drug use frequency and duration, abstinence, craving, GHB blackouts, unprotected or unconsented sexual acts, sexually transmitted or blood borne infections, psychiatric symptoms, and interpersonal and work-related difficulties.

The men were counselled regarding safer drug use, safer sex, reducing drug use and reducing psychiatric symptoms, and informed of other community-based resources. They were referred to ChemTalks, collecting drug use and safer sex equipment in our center or through a peer, or other types of services (sexual health, mental health, victim support, addiction treatment).

HR in chemsex requires answering drug use and sexual health needs, articulating with different services, and outreach through online and peer-led interventions.