Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden.
Department of Social Work, Stockholm University, Sveavägen 160, 113 46, Stockholm, Sweden.
BMC Public Health. 2021 May 5;21(1):863. doi: 10.1186/s12889-021-10906-6.
Recreational and sexual drug use among men who have sex with men may result in increased risk of poor health. The aim of this study was to better understand drug use and harm reduction techniques among Swedish men who have sex with men traveling to Berlin in order to improve the health of this population and inform public health strategies.
A qualitative study based on semi-structured interviews with 15 Swedish men aged 23-44 with experience of drug use were recruited through network sampling. Interviews were conducted in Stockholm and Berlin and analysed using content analysis. The interview guide included questions on drug use, context, health and safety.
The participants engaged in drug use in both settings and in various contexts. Participants saw themselves as capable of finding a balance between pleasure, safety and risk with the aim to maximize positive effects while minimizing negative ones. The different risks of drug use were known, and participants relied on knowledge, harm reduction strategies and self-defined rules of intake to stay safe and healthy in a broad sense, both short term (i.e. during each session) and long term. Choice of drug and, frequency of intake, multi-use, risk of overdose, risk of HIV, purpose and context of use, how often, etc. were all part of the overall strategy. Knowledge of these methods was spread within the community and on-line rather than from counsellors or other health care providers. However, it did not always translate perfectly into practice and some had experienced overdoses and problematic use.
The findings of this study point to the need for increased adoption of harm reduction techniques in this population focusing on mitigating harm and prevention of risk of problematic use or starting injection drugs. Existing traditional services require adaptations to become more accessible and acceptable to sub-groups of drug users, including low-threshold services providing non-judgemental, evidence-based information. This will require funding of alternative providers such as STI/HIV clinics, among others, and health care providers to increase adoption of prevention strategies, specifically pre-exposure prophylaxis for HIV.
男男性行为者（MSM）的娱乐性和性行为相关药物使用可能会增加不良健康风险。本研究旨在更好地了解前往柏林旅行的瑞典 MSM 的药物使用和减少伤害技术，以改善该人群的健康状况并为公共卫生策略提供信息。
本研究是一项基于半结构化访谈的定性研究，招募了 15 名年龄在 23-44 岁之间、有药物使用经验的瑞典 MSM。通过网络抽样招募参与者，访谈在斯德哥尔摩和柏林进行，并使用内容分析法进行分析。访谈指南包括药物使用、背景、健康和安全等方面的问题。
参与者在两个地方和不同背景下都有药物使用。参与者认为自己有能力在快乐、安全和风险之间找到平衡，目的是最大限度地提高积极影响，同时最大限度地降低负面影响。不同的药物使用风险是已知的，参与者依赖知识、减少伤害策略和自我定义的摄入规则来保持广义上的短期（即每次使用时）和长期（即每次使用时）的安全和健康。药物选择、摄入频率、多用途、过量风险、HIV 风险、使用目的和背景、使用频率等都是总体策略的一部分。这些方法的知识在社区和网络上传播，而不是来自顾问或其他卫生保健提供者。然而，这些知识并不总是完美地转化为实践，一些人经历过过量使用和问题性使用。
本研究结果表明，需要在该人群中更多地采用减少伤害技术，重点是减轻伤害和预防问题性使用或开始注射药物的风险。现有的传统服务需要进行调整，以便更能被药物使用者的亚群接受，包括提供无评判、基于证据的信息的低门槛服务。这将需要为包括性传播感染/艾滋病诊所在内的其他替代提供者提供资金，并需要卫生保健提供者增加预防策略的采用，特别是艾滋病毒的暴露前预防。
