Sexualized drug use is both culturally prevalent and under-acknowledged within Colombian HIV care for gay and bisexual men, with stigma and silence underscoring the need for community-driven, non-judgmental harm-reduction strategies.
Key Findings
Results
Sexualized drug use remained largely absent from HIV services in Colombia, where stigma and fear of judgment constrained disclosure and hindered harm-reduction counseling.
This pattern was identified as a core theme labeled 'Silences in care'
Participants reported that sexualized drug use topics were not routinely raised in HIV care settings
Fear of judgment from healthcare providers was identified as a key barrier to disclosure
The absence of these conversations directly impeded access to harm-reduction counseling
Results
Participants expressed ambivalence about sexualized drug use, acknowledging its role in enhancing sexual pleasure while also expressing concerns about risks, dependence, and lack of credible health information.
This pattern was identified as a core theme labeled 'Ambivalence and health concerns'
Participants recognized both perceived benefits (enhanced sexual pleasure) and perceived harms (risks and dependence)
Lack of credible health information was specifically identified as a concern
This ambivalence reflects unmet needs for balanced, evidence-based information on sexualized drug use
Results
Venezuelan migrants described limited visibility of sexualized drug use in Venezuela compared to its greater reported normalization in Colombia, creating new vulnerabilities and challenges.
Over one-third of the 66 participants were Venezuelan migrants (n = 26)
This cross-national contrast was identified as a distinct theme labeled 'Cross-national contrasts'
Migrants encountered a context where sexualized drug use was more normalized than in their country of origin
This exposure generated new vulnerabilities and challenges specific to the migrant experience
Methods
The study sample consisted of 66 gay, bisexual, and other men who have sex with men living with HIV across Colombia, with a median age of 31 years and a median year of HIV diagnosis of 2021.
Data were collected between October 2024 and April 2025 using semi-structured interviews
Median age of participants was 31 years
Median year of HIV diagnosis was 2021
26 of 66 participants (over one-third) were Venezuelan migrants
Thematic analysis was employed to identify patterns related to practices, meanings, and perceived health system responses
Background
Sexualized drug use among gay and bisexual men remains underexplored in Latin America, representing a gap in the regional research literature.
The study framed this as a background motivation for the research
The study employed a harm-reduction lens to investigate perspectives
The study is among the first to systematically examine this phenomenon in Colombia, including among Venezuelan migrant populations
The Colombian context was specifically chosen as a site where this phenomenon was reported to be prevalent but under-acknowledged
Conclusions
The authors identified community-driven, non-judgmental harm-reduction strategies such as peer education as needed responses to the documented gaps in care.
Peer education was specifically cited as an example of an appropriate intervention modality
Strategies should 'better reflect GBM's lived realities while supporting safer, more affirming approaches to health'
The call for action was grounded in the reported cultural prevalence of sexualized drug use alongside its under-acknowledgment in care settings
The recommendations were framed as responses to stigma and silence identified across all three themes
What This Means
This research suggests that gay and bisexual men living with HIV in Colombia commonly engage in 'chemsex' or sexualized drug use — combining drugs with sexual activity — but this topic is rarely discussed in HIV healthcare settings. Through interviews with 66 men (including 26 Venezuelan migrants) conducted between late 2024 and early 2025, the researchers found that men felt unable to speak openly with their doctors or nurses about drug use during sex, primarily because they feared being judged or stigmatized. As a result, they received little to no guidance on how to reduce the health risks associated with these practices.
The study also found that men held mixed feelings about sexualized drug use: they recognized that substances could enhance sexual experiences, but they also worried about health risks, potential dependence, and the lack of reliable information to help them make informed decisions. A particularly notable finding involved Venezuelan migrants, who reported that sexualized drug use was less visible or openly discussed in Venezuela, meaning that arriving in Colombia — where these practices appear more normalized — created new and unexpected health challenges for this already vulnerable population.
This research suggests that HIV care programs in Colombia and potentially across Latin America are missing important opportunities to support the health of gay and bisexual men. By not addressing sexualized drug use openly and without judgment, health systems may be leaving people without the information and support they need. The researchers suggest that peer-led education programs — where community members with similar lived experiences provide information and support — could be a more effective and culturally appropriate approach to filling these gaps.
Julien Brisson, Aarti S. Doshi, Mariangela Castro-Arteaga, Aarón Zea, A. Perez‐brumer. (2026). Harm reduction gaps in sexualized drug use among gay and bisexual men living with HIV in Colombia.. The International journal on drug policy. https://doi.org/10.1016/j.drugpo.2026.105331