Leveraging mHealth interventions to reduce sex-and drug-related risk behaviors among chemsex-involved men who have sex with men: evidence from a qualitative study

Background: Chemsex, a form of sexualized drug use, is a growing public health concern among men who have sex with men (MSM) in Malaysia. It is associated with an increased likelihood of HIV transmission and other adverse health outcomes, such as overdose. Although harm-reduction services are proven to be efficacious in mitigating these outcomes, they often remain inaccessible because of stigma, criminalization, and limited availability of the service. This study examines the barriers MSM face in such services and explores how a mobile smartphone app with tailored features could help overcome these barriers. Methods: From February to August 2022, six virtual focus groups were conducted with 22 MSM participants who had engaged in chemsex in the past six months. Participants were recruited through geosocial networking (GSN) applications and Facebook advertisements. The focus group sessions were recorded, transcribed, translated into English, and analyzed using thematic analysis. Results: Participants described multiple barriers to practicing chemsex harm reduction, including limited knowledge of safer drug use, peer pressure, fear of legal consequences, and stigma from healthcare providers. They emphasized the need for a mobile app that provides reliable educational resources, peer support groups, discreet ordering of harm-reduction supplies (e.g., condoms, lubricants, sterile injection equipment), and access to emergency assistance during adverse events. Privacy protection and a simple, familiar user interface were identified as essential for building trust and encouraging sustained use of the mobile app and uptake of harm reduction services among MSM. Conclusions: This study underscores the persistent structural and social barriers to harm reduction among MSM who engage in chemsex in Malaysia. A mobile app tailored to their lived experiences and privacy needs may offer a confidential pathway to harm-reduction information, community support, and linkage to services that MSM trust.