"A way to liberate myself": A qualitative study of perceived benefits and risks of chemsex among gay, bisexual, and other men who have sex with men in Almaty, Kazakhstan

Abstract

Background: In Kazakhstan, the HIV epidemic has a significant impact on marginalized groups such as gay, bisexual and other men who have sex with men (GBMSM), exacerbated by homophobic attitudes (in society) and (resulting) minority stress. This stress often leads to coping behaviors such as chemsex - the use of synthetic stimulants to enhance sexual experiences. Our study explores the motivations and perceived risks associated with chemsex among GBMSM in Almaty. Methods: We conducted semi-structured in-depth interviews with 21 chemsex participants self-identified as GBMSM in Almaty, Kazakhstan. Participants were recruited through community-based organizations to ensure a diverse sample in terms of age and ethnicity. Thematic analysis was used to identify key themes related to motivations and risks. Results: Participants practiced chemsex to seek liberation from societal norms and personal inhibitions, increase sexual pleasure, and escape daily stressors. Chemsex sessions provided intensified sexual experiences, emotional comfort, and social connections, challenging constraints on sexual behavior. Participants recognized significant risks, including mental and physical health issues, social stigma, and violence victimisation. Despite these risks, the desire for the perceived benefits of chemsex, particularly feelings of freedom and happiness, underscored its appeal. Conclusions: The study reveals a complex dynamic in which chemsex serves as a coping mechanism for minority stress, a source of sexual liberation, and a social connector for GBMSM in Kazakhstan, while also posing significant health risks. These findings emphasize the need for targeted harm reduction strategies, mental health support, and community-building efforts that are responsive to the experiences and needs of GBMSM who engage in chemsex.