HIV Prevention, Mental Health, Sexually Transmitted Infections (STIs), Substance Use
Conditions
Keywords
Chemsex, Harm reduction
Brief summary
This study evaluates the pre-implementation phase of a host-led harm reduction model for men who have sex with men (MSM) engaging in chemsex in Bangkok, Thailand, focusing on understanding harms, contexts, and needs to develop a tailored intervention.
Detailed description
HAMMOCK is a cross-sectional mixed-methods study designed to explore chemsex practices among MSM, including both hosts and guests, as well as key stakeholders such as CSOs, hospital staff, and police. The study aims to: * Explore substance-related, sexual health, mental health, and socio-legal harms * Understand the context and dynamics of private chemsex parties * Co-develop a novel host-led harm reduction model * Identify barriers and facilitators to implementation The study includes both quantitative (self-administered questionnaires) and qualitative (in-depth interviews) components and follows a two-phase approach: exploration and preparation phases under the EPIS framework.
Interventions
BEHAVIORALSelf-administered questionnaire assessment
Participants (chemsex party hosts and guests) will complete structured self-administered questionnaires to assess: * Substance use patterns and related harms * Sexual health risks (e.g., condom use, HIV/STI testing, PrEP/ART adherence) * Mental health status using validated tools: * Patient Health Questionnaire-9 (PHQ-9) * Generalized Anxiety Disorder-7 (GAD-7) * Socio-legal harms including stigma and discrimination
BEHAVIORALSemi-structured in-depth interviews (IDIs)
All stakeholders will participate in semi-structured in-depth interviews: * Exploration phase: guided by EPIS framework * Preparation phase: guided by * Theoretical Domains Framework (TDF) (hosts \& guests) * Consolidated Framework for Implementation Research (CFIR) (organizational stakeholders) The interviews aim to: * Identify harms associated with chemsex * Explore current practices and contexts * Identify barriers and facilitators * Inform development and refinement of a harm reduction model
BEHAVIORALDevelopment and refinement of harm reduction model
A novel four-pronged harm reduction model will be developed and refined based on quantitative and qualitative findings. Domains include: * Substance use harm reduction * Sexual health harm reduction * Mental health harm reduction * Socio-legal harm reduction
Sponsors
Institute of HIV Research and Innovation Foundation, Thailand
International AIDS Society
Study design
Observational model
COHORT
Time perspective
OTHER
Eligibility
Sex/Gender
MALE
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* MSM aged ≥18 years * Able to communicate in Thai * Specific by group: * Chemsex hosts: hosted ≥2 times in past 6 months * Chemsex guests: attended ≥2 times in past 6 months * CSO / hospital / police staff: working ≥3 months in related roles * Provide informed consent
Exclusion criteria
• Unable to provide informed consent (e.g., under substance influence at consent)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Substance use-related harm assessed by self-administered questionnaire | Baseline (during Exploration phase, prior to model development) | Substance-related harms will be assessed using a structured self-administered questionnaire. The assessment includes: * Patterns of substance use (snorting, injecting, ingesting, anal insertion) * Frequency of use * Physical harms (e.g., injection-related injuries, overdose) * Psychological harms (e.g., substance dependence) This is a descriptive assessment; no composite scale score is generated. |
| Sexual health risk behaviors assessed by self-administered questionnaire | Baseline (during Exploration phase, prior to model development) | Sexual health risks will be assessed using a structured questionnaire including: * Number of sexual partners * Condom use * HIV/STI testing history * Self-reported HIV status * Pre-exposure prophylaxis (PrEP) use and adherence * Antiretroviral therapy (ART) adherence among participants living with HIV This is a descriptive assessment; no composite scale score is generated. |
| Depression severity assessed by Patient Health Questionnaire-9 (PHQ-9) | Baseline (during Exploration phase, prior to model development) | Depression will be assessed using the Patient Health Questionnaire-9 (PHQ-9): * Score range: 0 to 27 * Interpretation: * 0-4: Minimal depression * 5-9: Mild * 10-14: Moderate * 15-19: Moderately severe * 20-27: Severe Higher scores indicate worse depression severity |
| Anxiety severity assessed by Generalized Anxiety Disorder-7 (GAD-7) | Baseline (during Exploration phase, prior to model development) | Anxiety will be measured using the Generalized Anxiety Disorder-7 (GAD-7): * Score range: 0 to 21 * Interpretation: * 0-4: Minimal * 5-9: Mild * 10-14: Moderate * 15-21: Severe Higher scores indicate worse anxiety |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Perceived stigma and socio-legal harm assessed by structured questionnaire | Baseline (during Exploration phase, prior to model development) | Socio-legal harms will be assessed using a structured questionnaire adapted from the CLYMAX study, including: * Internalized stigma related to chemsex * Perceived discrimination (family, workplace, social) * Legal risks and experiences This is a descriptive assessment; no composite scale score is generated. |
Countries
Thailand
Contacts
CONTACTNittaya Phanuphak, MD,PhD.
CONTACTJakkrapatara Boonruang, MD
PRINCIPAL_INVESTIGATORJakkrapatara Boonruang, MD
Institute of HIV Research and Innovation (IHRI)
Outcome results
None listed