Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, Tahir Foundation Building #10-01, 117549, Singapore.
FHI 360, 359 Blackwell St #200, Durham, North Carolina 27701, USA.
Int J Drug Policy. 2018 Nov;61:31-37. doi: 10.1016/j.drugpo.2018.10.002. Epub 2018 Oct 26.
BACKGROUND: Sexualised substance use, or 'chemsex' has been shown to be a major factor driving the syndemic of HIV/AIDS in communities of gay, bisexual, and other men who have sex with men (GBMSM) around the world. However, there is a paucity of research on chemsex among GBMSM in Singapore due to punitive drug laws and the criminalisation of sexual behaviour between men. This qualitative descriptive study is the first to explore perceptions towards, motivators to engaging in, and the barriers to addressing the harms associated with chemsex among GBMSM in Singapore. METHODS: We conducted 30 semi-structured in-depth interviews with self-identifying GBMSM between the ages of 18-39 in Singapore following a purposive sampling strategy. Interview topics included participants' perceptions of drug use among GBMSM in Singapore, perceptions towards chemsex, reasons for drug use and chemsex, and recommendations to address the harms associated with chemsex in Singapore. Interviews were audio-recorded, transcribed, coded, and analysed using thematic analysis. RESULTS: Participants reported that it was common to encounter chemsex among GBMSM in Singapore as it could be easily accessed or initiated using social networking phone apps. Enhancement and prolongation of sexual experiences, fear of rejection from sexual partners and peers, and its use as a means of coping with societal rejection were three main reasons cited for engaging in chemsex. The impact of punitive drug laws on disclosure and stigmatisation of GBMSM who use drugs were reported to be key barriers towards addressing chemsex. Participants suggested using gay-specific commercial venues as avenues for awareness and educational campaigns, and social media to reach out to younger GBMSM. CONCLUSIONS: This study highlights the complexities behind chemsex use among GBMSM in Singapore, and the range of individual to institutional factors to be addressed. We recommend that community-based organisations and policy-makers find ways to destigmatise discussion of chemsex and provide safe spaces to seek help for drug use.
背景：性化物质使用，或“嗑药性行为”，已被证明是导致全球男同性恋、双性恋和其他与男性发生性关系的男性（MSM）社区艾滋病毒/艾滋病综合征的一个主要因素。然而，由于惩罚性的毒品法和对男性之间性行为的刑事定罪，新加坡对 MSM 中嗑药性行为的研究很少。这项定性描述性研究是首次探索新加坡 MSM 对与嗑药性行为相关的看法、参与嗑药性行为的动机，以及解决与嗑药性行为相关危害的障碍。
方法：我们采用目的抽样策略，对新加坡年龄在 18-39 岁之间的自我认同的 MSM 进行了 30 次半结构式深入访谈。访谈主题包括参与者对新加坡 MSM 中药物使用的看法、对嗑药性行为的看法、药物使用和嗑药性行为的原因，以及在新加坡解决与嗑药性行为相关危害的建议。访谈进行了录音、转录、编码和主题分析。
结果：参与者报告说，在新加坡，嗑药性行为在 MSM 中很常见，因为它可以通过社交网络电话应用程序轻松接触或启动。参与者报告说，增强和延长性体验、害怕被性伴侣和同龄人拒绝，以及将其作为应对社会排斥的一种手段，是参与嗑药性行为的三个主要原因。惩罚性毒品法对披露和污名化使用毒品的 MSM 的影响，被报告为解决嗑药性行为的关键障碍。参与者建议利用特定于同性恋者的商业场所作为宣传和教育活动的途径，并利用社交媒体接触年轻的 MSM。
结论：这项研究强调了新加坡 MSM 中嗑药性行为背后的复杂性，以及需要解决的个人和机构因素的范围。我们建议社区组织和政策制定者找到方法来消除对嗑药性行为的讨论污名化，并提供寻求药物使用帮助的安全空间。
Sex Transm Infect. 2016-12
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