Supporting Safer Choices: Tackling Chemsex Risks Through Community Health Outreach

In the bustling street of Ho Chi Minh City (HCMC), Lay (not his real name), an experienced HIV community health worker (CHW), had become a quiet hero in promoting harm reduction services for emerging public health concerns: chemsex.

Chemsex is also known as sexualized drug use, a combination of stimulant drug use and sexual activity, predominantly among men who have sex with men (MSM) and transgender people. The risk of chemsex heightens risks such as immediate effects of the substance, unprotected sex, HIV, STIs, and mental health issues[1].

Minh’s Journey Toward Support and Awareness

Lay first encountered Minh through a message on his social media account, which he uses to reach at-risk MSM and transgender individuals. Minh, a college freshman from a southern province, was visibly anxious during their conversation.

"I think I’ve been exposed to HIV and need help with testing," Minh confessed.

Minh recounted how financial struggles had led him to engage in commercial sex, where he was introduced to chemsex. Under the influence of multiple substances, Minh felt powerless, unable to assert boundaries, and increasingly at risk. Although he knew the importance of condoms, the use of substances often blurred his judgment, leaving him vulnerable to potential harm.

Equipped with training and field expertise in HIV and chemsex harm reduction counseling, Lay prioritized providing an HIV test for Minh. When the results confirmed a non-reactive status, Lay initiated a conversation about sexual health and harm reduction strategies, including the risks of chemsex. With Minh’s consent, Lay swiftly facilitated Minh’s access to pre-exposure prophylaxis (PrEP) and accompanied him for clinical testing, ensuring Minh was enrolled in this high-impact HIV preventive treatment.

Three months later, Minh had adhered to his PrEP regimen, remained HIV free and reported feeling more in control of his life. Lay’s consistent support not only protected Minh’s health but also restored his confidence and agency.

The Role of Community Health Workers

Minh’s case is far from unique. Chemsex is becoming a growing trend in Viet Nam as well as in other countries of the Asia Pacific Region. UNODC data shows a surge in crystal methamphetamine seizures in Viet Nam[2], and VAAC reports that MSM engaging in chemsex are 6-8 times more likely to contract HIV. Increased use of stimulant drugs during sexual activity creates conditions ripe for the spread of HIV and STIs, threatening the well-being of individuals and the broader community. In response, The Ministry of Health, UNAIDS, and UNODC have worked in closed partnership with community organizations and the academia to provide evidence-based crucial HIV prevention and healthcare services for these at-risk populations.

Community health workers (CHWs) like Lay play a critical role in addressing the risks associated with chemsex on the frontlines, addressing the intersection of stimulant drug use, sexual health, and HIV prevention with compassion and expertise. They serve as vital intermediaries for marginalized populations. Chemsex users, often hidden due to stigma, rely on CHWs for harm reduction guidance, counseling, and referrals to appropriate healthcare services.

Lay’s impact stems from his participation in a pilot training program led by the Ministry of Health (MoH) and the Vietnam Administration for HIV/AIDS Control (VAAC), supported by UNAIDS and UNODC and Ho Chi Minh City University of Medicine and Pharmacy as a technical partner. This initiative empowered community health workers (CHWs) with correct and comprehensive knowledge as well as hands-on skills to tackle chemsex-related challenges, including overdose prevention, harm reduction strategies, and mental health support.

The pilot program’s people-and-community-centered approach fosters collaboration with CHWs like Lay and other community members at every stage, from designing the training curriculum to implementing and conducting real-world trials of its components. Feedback from community members with lived experience is pivotal in creating a training curriculum that genuinely addresses the needs of those impacted by chemsex. This collaborative process ensures a more inclusive and impactful response to HIV and other health risks associated with chemsex.

A Public Health Priority: Building Capacity and Support

“Drawing on decades of HIV outreach experience, we’re proving that even the most hidden battles can be fought—and won,” Lay said. “To address chemsex-related risks, an enabling environment supported by the government and public is crucial for us to access resources and deliver services. CHWs also need continuous and updated capacity training to understand the complexities of chemsex and provide appropriate responses.”

Creating an enabling environment is equally crucial. This means reducing stigma, ensuring non-discriminatory service delivery, and protecting the rights of CHWs to perform their roles effectively. Government leadership, public support, ongoing capacity-building initiatives and investments in public health infrastructure are vital to these efforts.

“A measure of harm reduction for people using stimulant drugs, which is psychotherapy, has been included in a 2024 Government Decree guiding implementation of the Law on HIV/AIDS Prevention and Control,” said Dr. Nguyen Thi Minh Tam, Head of Prevention Department, Viet Nam Administration of HIV/AIDS Control. “This is our latest move in creating an enabling environment to protect the health of this key population, following the issuance of a National Guidelines on HIV Prevention Interventions for MSM Engaged in Sexualized Drug Use.”

“We are committed to continue supporting national efforts to prevent HIV infection and address other healthcare needs of people engaged in sexualized drug use,” said Mr. Raman Hailevich, Country Director of UNAIDS, “In 2025, we will support the finalization of this training curriculum for CHWs and subsequently training of trainers, in collaboration with UNODC.”

Community health workers like Lay are beacons of hope for individuals navigating the risks of chemsex. Their dedication and community-centred interventions are critical in protecting vulnerable populations and underscoring a shared commitment to public health.

[1] UNAIDS and UNDOC (2024). Toolkit on chemsex for Asia Pacific clinical service providers. Accessed from https://unaids-ap.org/wp-content/uploads/2024/11/chemsex-toolkit-for-clinical-service-providers-in-the-asia-pacific-region_05112024.pdf 

[2] UNODC (2024). Synthetic Drugs in East and Southeast Asia: Latest developments and challenges. Accessed from https://www.unodc.org/roseap/uploads/documents/Publications/2024/Synthetic_Drugs_in_East_and_Southeast_Asia_2024.pdf