From potential to pause - missed opportunities in harm reduction: lessons learned and perspectives from a discontinued implementation study among young men who have sex with men in Thailand.
4 affiliations
- 1Institute of HIV Research and Innovation (IHRI), 319 Chamchuri Square Phyathai Road, Pathum Wan Bangkok, Bangkok, 10330, Thailand. [email protected].
- 2Institute of HIV Research and Innovation (IHRI), 319 Chamchuri Square Phyathai Road, Pathum Wan Bangkok, Bangkok, 10330, Thailand.
- 3Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
- 4Foundation for Action on Inclusion Rights (FAIR), Bangkok, Thailand. [email protected].
Abstract
Introduction
Harm reduction remains underutilized in Thailand, despite the increasing visibility of people engaging in chemsex-the use of substances during sex associated with complex health and sociolegal challenges. The CLYMAX study, a two-phase implementation project, was launched to explore the chemsex landscape among young men who have sex with men (MSM) aged 16-35 (CLYMAX-1) and to pilot a community-informed harm reduction model (CLYMAX-2). Although CLYMAX-2, an intended twenty-four-month prospective cohort, was prematurely terminated due to the cessation of U.S. funding, it yielded valuable, on-the-ground insights. Here, we distil lessons learned and perspectives from the six-month implementation period.Discussion
While several studies reported that sexual health clinics could be potential gateways for MSM who engage in chemsex to seek healthcare services without bearing the burden of stigma, CLYMAX-2 found various barriers in achieving this goal. The lack of context-specific, scientifically proven, and practical harm reduction strategies disrupted chemsex-focused integration into sexual health services. Peer-led STI treatment models may effectively help address mistrust in the healthcare system and weave sexual health awareness into the fabric of chemsex culture. Moreover, the current definition of problematic substance use is unable to fully capture the nuances of how chemsex interacts with an individual beyond a biomedical viewpoint. These proved to be hidden challenges for providers and those engaging in chemsex to set a pragmatic goal for their harm reduction journey. We also emphasized the importance of integrating funding diversification into program designs to ensure sustained support for priority agendas.Conclusions
These perspectives inform the need for context-specific, practical harm reduction strategies tailored to MSM engaging in chemsex in Thailand. Further research is required to support the integration of chemsex-related services into sexual health services and to evaluate the effectiveness and feasibility of peer-led interventions. The waning international funding to support chemsex-related research highlights the need to diversify funding sources to ensure sustainable progress in the field.
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BibTeX
@article{boonruang2026from,
title = {{From potential to pause - missed opportunities in harm reduction: lessons learned and perspectives from a discontinued implementation study among young men who have sex with men in Thailand.}},
author = {Jakkrapatara Boonruang and Akarin Hiransuthikul and Jarunee Siriphan and Siriporn Nonenoy and Sudarat Thongsuksangcharoen and Piengfa Kamolrath and Piranun Hongchookiat and Jittraphon Chaejaew and Thitipun Sripitathanasakul and Nittaya Phanuphak and the CLYMAX-2 study team},
journal = {Harm reduction journal},
year = {2026},
month = jul,
doi = {10.1186/s12954-026-01507-w},
url = {https://europepmc.org/article/MED/42928285},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - From potential to pause - missed opportunities in harm reduction: lessons learned and perspectives from a discontinued implementation study among young men who have sex with men in Thailand.
AU - Jakkrapatara Boonruang
AU - Akarin Hiransuthikul
AU - Jarunee Siriphan
AU - Siriporn Nonenoy
AU - Sudarat Thongsuksangcharoen
AU - Piengfa Kamolrath
AU - Piranun Hongchookiat
AU - Jittraphon Chaejaew
AU - Thitipun Sripitathanasakul
AU - Nittaya Phanuphak
AU - the CLYMAX-2 study team
PY - 2026
DA - 2026/07/29
JO - Harm reduction journal
DO - 10.1186/s12954-026-01507-w
UR - https://europepmc.org/article/MED/42928285
AB - Introduction Harm reduction remains underutilized in Thailand, despite the increasing visibility of people engaging in chemsex-the use of substances during sex associated with complex health and sociolegal challenges. The CLYMAX study, a two-phase implementation project, was launched to explore the chemsex landscape among young men who have sex with men (MSM) aged 16-35 (CLYMAX-1) and to pilot a community-informed harm reduction model (CLYMAX-2). Although CLYMAX-2, an intended twenty-four-month prospective cohort, was prematurely terminated due to the cessation of U.S. funding, it yielded valuable, on-the-ground insights. Here, we distil lessons learned and perspectives from the six-month implementation period.Discussion While several studies reported that sexual health clinics could be potential gateways for MSM who engage in chemsex to seek healthcare services without bearing the burden of stigma, CLYMAX-2 found various barriers in achieving this goal. The lack of context-specific, scientifically proven, and practical harm reduction strategies disrupted chemsex-focused integration into sexual health services. Peer-led STI treatment models may effectively help address mistrust in the healthcare system and weave sexual health awareness into the fabric of chemsex culture. Moreover, the current definition of problematic substance use is unable to fully capture the nuances of how chemsex interacts with an individual beyond a biomedical viewpoint. These proved to be hidden challenges for providers and those engaging in chemsex to set a pragmatic goal for their harm reduction journey. We also emphasized the importance of integrating funding diversification into program designs to ensure sustained support for priority agendas.Conclusions These perspectives inform the need for context-specific, practical harm reduction strategies tailored to MSM engaging in chemsex in Thailand. Further research is required to support the integration of chemsex-related services into sexual health services and to evaluate the effectiveness and feasibility of peer-led interventions. The waning international funding to support chemsex-related research highlights the need to diversify funding sources to ensure sustainable progress in the field.
SN - 1477-7517
ER -