Hi-fun among men who have sex with men in Bangkok: A scoping study exploring key informants’ perspectives on hi-fun contexts, harms and support strategies

Abstract

The use of specific drugs (e.g. methamphetamine, GHB/GBL and other stimulants) to enhance sex among men who have sex with men (MSM), is the focus of global public health concern because of links to social harms, poor mental and sexual health. Often called ‘chemsex’ in Western settings or ‘hi-fun’ in Southeast Asia, this type of sexualised drug use is increasingly visible in Thailand where the unique sociocultural and legislative environments shape sexual cultures and harms. This study aimed to develop an understanding of key informants’ perspectives onhi-funcontexts, harms and current responses in Bangkok. In-depth interviews were conducted with thirteen key informants from clinical, community, policy and development organisations. Four key informants had personal experience ofhi-fun. Interviews coveredhi-funcontexts, harms and support, were transcribed verbatim, translated to English (where necessary) and analysed using a thematic framework. MSMhi-fun‘influencers’ shape norms and provide support online, primarily through Twitter.Hi-funwas linked to Westernisation and wealth; complex hierarchies emerged from asymmetries in social/financial capital. Police coercion towards MSM engaged inhi-funwas a concern. Given the nature of their funding, HIV/HCV/STI transmission was the most pressing focus for many organisations, however key informants were concerned especially about drug overdoses and mental health/well-being impacts. The political and economic context means funding for MSM health in Thailand focuses primarily on HIV prevention/treatment; restrictions on development aid constrain holistichi-funfocused service development. Mosthi-funsupport was informally developed; successful strategies relied on partnership working and peer developed/delivered services, some of which were adapted from high-income settings. Despite substantial barriers, organisations developed services responding to the needs of MSM engaged inhi-fun. Given that many were informally developed or adapted from high-income settings, establishing a theoretical basis for further interventions that is grounded in this unique context is a priority.