Methamphetamine Use in the Context of Chemsex Among LGBTQIA+ Populations: A Multidimensional and Critical Synthesis of Epidemiology, Health Inequities, Policy Gaps, and Future Directions

Methamphetamine use within the context of chemsex has emerged as one of the most complex, contested, and insufficiently understood public health phenomena affecting LGBTQIA+ populations worldwide. Far from representing an isolated pattern of substance use, chemsex involving methamphetamine reflects a profound convergence of sexuality, desire, pleasure, vulnerability, stigma, structural inequality, criminalization, and systemic failures in health and social care. It is a phenomenon shaped not only by individual behavior, but by histories of exclusion, minority stress, biomedicalization of sexuality, and persistent gaps between public health discourse and lived experience. Despite its growing visibility in clinical settings, community narratives, and epidemiological surveillance, methamphetamine-related chemsex remains largely marginalized within mainstream health systems and policy frameworks. Its harms are frequently fragmented across disciplinary silos—HIV care separated from substance use treatment, mental health isolated from sexual health, and prevention strategies disconnected from social realities. As a result, many of the individuals most affected by chemsex navigate care pathways marked by stigma, moral judgment, professional unpreparedness, and institutional invisibility. This work arises from the recognition that addressing methamphetamine use in chemsex settings requires a comprehensive, critical, and interdisciplinary approach. Drawing on the global body of scientific literature, this work examines epidemiological patterns and disparities within LGBTQIA+ populations, intersectional and demographic correlates, pathways of initiation, social and sexual networks, modes of use, and patterns of polydrug consumption. Equally important, it explores the broader sociostructural determinants that shape these practices, including criminalization, digital sexual cultures, migration, racism, and economic precarity. The chapters that follow also examine the short- and long-term consequences associated with methamphetamine use in chemsex contexts, encompassing neuropsychiatric and cardiovascular effects, sexual and reproductive health outcomes, exposure to violence, and the syndemic interplay with HIV and other sexually transmitted infections. These clinical and public health impacts are analyzed alongside the pervasive stigma and secrecy that continue to obstruct timely access to prevention, harm reduction, and treatment services. Beyond documenting harms, this work critically assesses existing prevention strategies, harm reduction models, treatment approaches, and policy responses. Particular attention is given to gaps in surveillance systems, the absence of clear clinical guidelines, and the persistent lack of culturally competent, sexuality-affirming care. Ethical tensions, methodological challenges, and the limitations of current research paradigms are examined with the aim of advancing more nuanced and inclusive knowledge production. Ultimately, this work is grounded in a rights-based and evidence-informed perspective. It seeks not only to synthesize what is currently known, but to challenge dominant narratives, expose structural blind spots, and articulate future directions for research, practice, and policy. By doing so, it aims to serve clinicians, researchers, policymakers, and advocates committed to confronting the realities of methamphetamine-related chemsex with rigor, compassion, and accountability—and to supporting LGBTQIA+ communities in ways that are both scientifically sound and socially just.