FACILITATORS AND BARRIERS TO ACCESSING HEALTH SERVICES FOR CHEMSEX USERS: A SCOPING REVIEW

Abstract

Background: Chemsex, defined as the intentional use of psychoactive substances before or during sexual activity to enhance or prolong sexual experiences, has emerged as a public health concern, particularly among men who have sex with men (MSM). It is associated with high-risk sexual behaviors, increased transmission of HIV and other sexually transmitted infections (STIs), and adverse mental health outcomes. Individuals engaging in chemsex may face multiple challenges in accessing appropriate health and harm reduction services. Objectives: This scoping review aimed to describe the types of health services sought by individuals engaging in chemsex and to synthesize evidence on the facilitators and barriers they experience when accessing these services. Method: A scoping review was conducted using searches in PubMed and the Cochrane Library. Studies were screened in two stages (title/abstract and full text) based on predefined criteria. Data were extracted on study and participant characteristics, types of health services, and reported facilitators and barriers. Barriers and facilitators were mapped using Levesque’s Patient-Centered Access to Healthcare Framework and synthesized narratively. Results: Eight studies (2016–2025) were included. While a range of health services were identified - primarily HIV prevention (PrEP/PEP), HIV/STI screening, and psychosocial support - the synthesis emphasized factors influencing access to these services. Facilitators included LGBTQ+-affirming and chemsex-specialized care, integrated service delivery, proactive provider engagement, and streamlined referral pathways, which enhanced trust, service navigation, and continuity of care. In contrast, barriers were more consistently reported and operated across multiple levels, including provider stigma and misconceptions, a fear of criminalization, limited awareness of available services, and structural constraints such as long waiting times, limited clinic availability, and fragmented care systems. Financial barriers affecting sustained access to PrEP were also identified, though less frequently examined. Conclusion: Access to healthcare among individuals engaging in chemsex is primarily shaped by persistent barriers rather than service availability alone. Stigma, criminalization, and structural limitations within healthcare systems remain key impediments, often outweighing existing facilitators. Strengthening LGBTQ+-affirming, integrated, and chemsex-informed care - alongside addressing structural and policy-level barriers - is essential to improve equitable and sustained access to services for this population.