Abstract
BACKGROUND: Gay, bisexual and other men who have sex with men's (GBMSM) sexualised drug use, defined as taking psychoactive drugs before or during sex, is the focus of public health concern globally. 'Hi-fun' in Thailand (similar to the practice of 'chemsex' in Western settings) is a subset of sexualised drug use. Much harm reduction programming relies on Western chemsex definitions, obscuring critical variation related to local cultures, drug markets and legislative contexts. We aimed to develop, informed by transnational queer sociology, a locally grounded definition of hi-fun compared to other sexualised drug use types practiced among GBMSM in Thailand. METHODS: To delineate sexualised drug use types and explore structural and social influences on how hi-fun is practiced and organised, focus groups and in-depth interviews (May-Sept 2024) were conducted with GBMSM (with sexualised drug use experience within prior 12-months) recruited from community organisations in Bangkok, Khon Kaen and Pattaya. Data were transcribed, translated where necessary and analysed with a thematic framework. RESULTS: Participants (n = 30) were aged 25-47 years, 25 gay, ten living with HIV, seven born outside Thailand. Most (n = 23) used crystal methamphetamine (ice) before/during sex in preceding 12-months, with fewer taking other drugs (ecstasy/MDMA= 14, ketamine = 12, cocaine = 10, GHB/GBL = 5). Participants' accounts coalesced around three main sexualised drug use types: hi-fun, sex at homepas (medium to large parties where men socialise, usually while wearing only underwear) and incidental sex with drugs (spontaneous and situational combining sex with drugs, often after a night out). Hi-fun was delineated from other sexualised drug use types based on participant motivations to increase wellbeing through pleasure and intimacy, in contrast to homepas and incidental sex with drugs which were linked more to socialising. Crystal methamphetamine (ice) was considered foundational to hi-fun, whereas other drugs (e.g. cocaine, ecstasy/MDMA, ketamine and GHB/GBL) were more common in homepas and incidental sex with drugs. Technology, especially geolocation social/sexual networking apps, were central to hi-fun organisation, but potentially less important for other sexualised drug use types. Both hi-fun and homepas primarily took place in private settings, whereas incidental sex with drugs happened in a wider range of venues. CONCLUSIONS: Hi-fun in Thailand can be defined as the intentional combination of sex and crystal methamphetamine (ice) to enhance intimacy and pleasure with one or more other man/men, facilitated by technology and usually in a private setting. This definition will be useful for those supporting GBMSM in Thailand through policy, research and service provision.