---
title: "Chemsex among MSM in Yangon: prevalence, substances, behaviors, and risk factors"
id: "plos-one-13-chemsex-among-men-who-have-sex-with-men-msm-in-yangon-myanmar-prevalence"
canonical_url: "https://medichelpline.com/clinical-feed/plos-one-13-chemsex-among-men-who-have-sex-with-men-msm-in-yangon-myanmar-prevalence"
content_type: "clinical_feed_article"
specialty: "Infectious Disease"
source_name: "PLOS ONE (Medicine)"
source_url: "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0353993"
published_at: "2026-07-17T14:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Chemsex among MSM in Yangon: prevalence, substances, behaviors, and risk factors
## Provenance & Clinical Metadata
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- **Specialty:** [Infectious Disease](https://medichelpline.com/clinical-feed/infectious-disease.md)
- **Primary Source:** PLOS ONE (Medicine)
- **Source URL:** [Original Journal Publication](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0353993)
- **Published At:** 2026-07-17T14:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- This cross-sectional online survey of 415 men who have sex with men (**MSM**) in Yangon (Dec 2024–Jan 2025) measured prevalence, practices, and correlates of **chemsex**. The mean participant age was 30.1 years; 71.3% were aged 18–34. - Overall lifetime chemsex prevalence was 26.0%; 20.7% reported chemsex within the prior six months. Mean age at first chemsex was 26.7 years. - The most commonly used substance was **methamphetamine** (69.8%), followed by poppers (33.7%) and cannabis (19.8%). Injection and inhalation were primary routes; injection occurred in 67.4% of chemsex users. - Chemsex most frequently occurred in hotels (76.7%) and private homes (54.7%); session length was commonly 4–12 hours (46.5%). Many participants engaged in group sex: threesomes (57.1%) and groups of 4–5 (40%). - Condom use during chemsex was low: only 10.5% always used condoms in the past six months; 52.3% sometimes and 24.4% never. Condom use in group sex was similarly inconsistent. - Adverse outcomes reported included unpleasant physical sensations (52.3%), anxiety/panic attacks (38.4%), paranoia (22.1%), irritability/aggression (19.8%), overdose with loss of consciousness (3.5%), suicidal thoughts or attempts (2.3% each). Missed medications due to chemsex occurred in 10.5%. - HIV-related characteristics: 14.2% self-reported living with HIV; 96.6% of those were on ART. Current PrEP use was 29.1%. - Multivariable analysis identified independent associations with chemsex: identifying as gay (aOR 3.0), current smoking (aOR 2.8), participation in group sex (aOR 4.0), and having multiple partners (aOR 3.3). - The authors conclude that chemsex prevalence among MSM in Yangon is high and linked to risky sexual and drug-related behaviors, underscoring the urgent need for targeted education, harm reduction, and MSM-specific health services.
## Clinical Analysis & Structured Key Points
SKIP TO MAIN CONTENT Advertisement plos.org Create account Sign in About Browse Publish advanced search 0 Save 0 Citation 117 View 0 Share OPEN ACCESS PEER-REVIEWED RESEARCH ARTICLE Chemsex among men who have sex with men (MSM) in Yangon, Myanmar: Prevalence, practices, and associated risk factors Naung Latt Htun , Myo-Myo Mon, Kyaw Soe Thant, Phyu Phyu Kyaw Published: July 17, 2026 https://doi.org/10.1371/journal.pone.0353993 Article Authors Metrics Comments Media Coverage Abstract Introduction Materials and methods Results Discussion Supporting information Acknowledgments References Reader Comments Figures Abstract Introduction Chemsex is the intentional use of psychoactive substances to facilitate, enhance, or prolong sexual encounters. It is notably common among men who have sex with men (MSM), contributing to high-risk sexual behaviors. However, limited research has focused on chemsex among MSM in Myanmar. This study aimed to assess the prevalence, practices, and associated risk factors of chemsex among MSM in Yangon, Myanmar. Materials and methods Between December 2024 and January 2025, a cross-sectional online survey was conducted among MSM aged 18 and older living in Yangon. Participants were recruited through social media platforms, including Facebook and Telegram, as well as dating apps. Data were collected using the KoboCollect platform and analyzed in SPSS. Descriptive statistics summarized demographic and behavioral data, and multivariate analyses identified factors associated with chemsex. Results The study included 415 MSM participants with a mean age of 30.1 years. The majority (71.3%) were between 18 and 34 years old. Most identified as gay (76%), had a university or postgraduate degree (62%), and 60% were employed. Approximately 26% reported engaging in chemsex at some point, with 20.7% having done so within the past six months. The most commonly reported substances were methamphetamine (69.8%), poppers (33.7%), and cannabis (19.8%). Injection and inhalation were the most common routes of administration. Chemsex sessions mostly took place in hotels (76.7%) and homes (54.7%), and for nearly half of participants, sessions lasted between 4 and 12 hours. Only 10% reported consistent condom use during chemsex, while group sex was frequent – about 40% engaged with 4–5 partners, and nearly 60% participated in threesomes. Chemsex within the last 14 days was reported by 46.5%. Factors significantly associated with chemsex included identifying as gay (aOR = 3.0, 95% CI:1.5–5.9, p = 0.001), smoking (aOR = 2.8, 95% CI:1.2–4.0, p = 0.006), participation in group sex (aOR = 4.0, 95% CI: 2.4–6.6, p < 0.001), and having multiple partners (aOR = 3.3, 95% CI:1.7–6.3, p < 0.001). Conclusion Chemsex prevalence among MSM in Yangon is alarmingly high and associated with risky behaviors. There is an urgent need for targeted interventions that focus on education, harm reduction, and improved access to MSM-specific health services. Figures Citation: Htun NL, Mon M-M, Thant KS, Kyaw PP (2026) Chemsex among men who have sex with men (MSM) in Yangon, Myanmar: Prevalence, practices, and associated risk factors. PLoS One 21(7): e0353993. https://doi.org/10.1371/journal.pone.0353993 Editor: Daniel Demant, University of Technology Sydney, AUSTRALIA Received: March 18, 2026; Accepted: July 1, 2026; Published: July 17, 2026 Copyright: © 2026 Htun et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability: All relevant data are within the manuscript and its Supporting Information files. Funding: The author(s) received no specific funding for this work. Competing interests: The authors have declared that no competing interests exist. Introduction Chemsex is the intentional use of psychoactive substances to facilitate, enhance, or prolong sexual encounters. It has become a public health concern in many countries over the past decade. It is common among men who have sex with men (MSM) and is linked to behaviors that increase the transmission of HIV and other sexually transmitted infections (STIs). The most commonly used substances are crystal methamphetamine, mephedrone, and gamma-hydroxybutyrate/gamma-butyrolactone (GHB/GBL) [1]. These substances are used alone or in combination and are taken orally, smoked, or injected. Injecting practices, referred to as “slamsex,” are especially concerning because they introduce additional risks of HIV and hepatitis C transmission through shared injection equipment [2]. Motivations for chemsex are varied. Studies describe its use to achieve disinhibition, escape stress, increase pleasure, and cope with stigma or negative emotions [3]. Chemsex differs from recreational drug use in that its primary goal is sexual enhancement. It often occurs in private settings and can last several days. Because chemsex sessions are often prolonged and involve multiple partners, they are frequently linked to condomless anal intercourse (CAI), transactional sex, and group sex [4], all of which are high-risk sexual behaviors that increase HIV transmission risk. A pooled prevalence of chemsex among MSM was 19%, according to a systematic review of studies from Asian countries [5]. In the UK, nearly 30% of HIV-positive MSM reported participating in chemsex in the past year. Among this group, chemsex was strongly associated with unprotected anal sex, serodiscordant sex, bacterial STI diagnoses, and hepatitis C infection [6]. Bacterial STIs may increase susceptibility to HIV through mucosal inflammation, which further facilitates HIV transmission [7]. Clinic-based studies in London and Amsterdam also report higher rates of post-exposure prophylaxis use, HIV acquisition, and mental health issues among MSM who engage in chemsex [8]. Beyond increasing the risk of STIs, chemsex has been linked to adverse mental health outcomes. Anxiety, depression, psychosis, and cognitive impairment have been observed among men participating in extended sessions [8]. A meta-analysis of 23 Asian studies found that methamphetamine was the most commonly used substance during chemsex (pooled prevalence 16%), followed by GHB/GBL (15%) and ketamine (8%) [5]. These psychoactive substances may reduce inhibition and impair judgment, increasing engagement in behaviors associated with HIV acquisition and onward transmission [9]. Chemsex prevalence was significantly higher among MSM engaged in transactional sex and among those living with HIV [5]. These findings suggest that chemsex is an increasingly important HIV prevention challenge across Asia, particularly among populations already disproportionately affected by HIV infection. In response to these risks, comprehensive harm reduction strategies have become increasingly important for MSM who engage in chemsex. These approaches typically include access to pre-exposure prophylaxis (PrEP), regular HIV and STI screening, condom promotion, mental health support, and substance use services [1]. Although PrEP is highly effective in preventing HIV acquisition, it does not prevent other sexually transmitted infections or address harms associated with substance use [10]. In Malaysia, an online survey of 870 MSM found that 9% had engaged in chemsex in the past six months [11]. Participants who reported chemsex were more likely to have engaged in transactional sex, to know someone using PrEP, and to have been diagnosed with an STI in the past six months. Chemsex was also strongly associated with recent injection drug use [11]. In Vietnam, a socio-ecological study of MSM in Hanoi and Ho Chi Minh City found that 20% had used methamphetamine during sex, with 18% classified as engaging in high-risk use. Methamphetamine use was linked to selling sex behaviors, higher sexual sensation-seeking scores, and perceptions that chemsex was common within their networks [12]. These findings show how local social dynamics and drug availability can influence chemsex practices. Qualitative studies in Singapore reveal similar patterns but also highlight local barriers. Participants reported using drugs to overcome fear of rejection and to enhance sexual pleasure. However, they also expressed serious concerns about strict drug laws and the criminalization of same-sex behavior, which deterred them from seeking help or sharing their chemsex experiences [13]. These structural issues, together with cultural stigma, may lead to underreporting and limit access to harm reduction services. Although chemsex itself has not been studied in Myanmar, sexual risk behavior among MSM is well documented. A cross-sectional study of 256 MSM in Yangon and Mandalay found high rates of multiple partnerships and inconsistent condom use. More than 70% of participants reported having multiple partners in the past six months, and 56% of adult MSM and 61% of young MSM reported never or inconsistently using condoms with their permanent partners [14]. These findings indicate high-risk sexual behavior among MSM in Myanmar, which chemsex could amplify if present. Myanmar’s sociopolitical environment further complicates this issue. Same-sex sexual activity remains criminalized under colonial-era laws, and drug use is heavily penalized, creating structural barriers to health-seeking behaviors and harm-reduction services [15]. Following the 2021 Myanmar military coup, political instability and conflict have severely disrupted Myanmar’s health system and HIV programs, further limiting access to prevention and care services [16]. At the same time, the widespread availability of illicit drugs and weakened governance increase access to psychoactive substances [17]. Persistent stigma from both society and healthcare providers continues to discourage MSM from accessing testing and prevention services. In the context of the ongoing HIV epidemic among MSM, limited harm-reduction services, and disruptions to HIV prevention programs following the 2021 military coup, chemsex may represent an emerging but unrecognized challenge for HIV prevention in Myanmar. However, chemsex practices remain largely undocumented in Myanmar. Although international and regional research on chemsex is growing, no studies have specifically examined chemsex among MSM in Myanmar. Given the well-documented high-risk sexual behaviors, the widespread availability of psychoactive substances, and the structural vulnerabilities affecting MSM in Myanmar, understanding the extent and patterns of chemsex is important for HIV prevention and public health planning. Therefore, this study was conducted to assess the prevalence, practices, and factors associated with chemsex use among MSM in Yangon, Myanmar. Materials and methods Study design, area, and population A cross-sectional online assessment was conducted using a quantitative research design from December 1, 2024, to January 25, 2025. Inclusion criteria included MSM aged 18 or older who live in Yangon, can read Burmese, and have had sexual experiences (with men or women) in the past six months. Operational definitions Chemsex use (sexualized drug use) is defined as intentionally using psychoactive substances before or during sexual activity to prolong or intensify the experience, diversify sexual practices, or enhance sexual performance [18]. This study will focus on commonly used chemsex drugs in Myanmar, including cannabis, ecstasy, poppers, cocaine, and methamphetamine/ice. Men who have Sex with Men (MSM) in this study are men who engage in sexual activity with other men, regardless of sexual orientation [19]. This group includes gay and bisexual men in Yangon, Myanmar. High-risk sexual behaviors include unprotected sexual intercourse (oral or anal), multiple sexual partners, high-risk partners, and aggressive sexual acts such as fisting, which can cause abrasions and other physical injuries [20]. Sample size and sampling The sample size was calculated using a single-proportion formula. Because no prior studies on chemsex among MSM in Myanmar were available, a prevalence estimate of 19% from a recent systematic review and meta-analysis of studies among MSM in Asia was used [5]. Assuming a 95% confidence level, a 5% precision error, and a 10% allowance for missing data, the minimum required sample size was 261 participants. For estimating the infinite population proportion Proportion (p) = 0.19, Error (d) = 0.05 Alpha (α) = 0.05, Z (0.975) = 1.96 Recruitment Online recruitment was conducted through trusted, closed social networks within the population. Information about the study and its objectives was shared on social media platforms to encourage participation. Questionnaires were then distributed through common social media channels, including Facebook pages for Yangon-specific MSM dating groups, private Telegram groups, and dating and social networking apps such as Grindr and HeeSay. Recruitment took place from December 2024 to January 2025. Data collection A structured questionnaire was developed based on a literature review. Quantitative data were collected using this questionnaire, which was distributed online via the KoboCollect platform. The questionnaire included 45 questions across five sections: 1) Background characteristics of participants; 2) Lifestyle and sexual practices; 3) HIV related characteristics of participants; 4) Sexualized drug use (Chemsex) and associated sexual practices; and 5) Attitudes regarding chemsex. The developed questionnaire, excluding the sociodemographic section, was reviewed and validated for content validity by two experts. The overall content validity index (CVI) was 0.96, with individual CVI values of 1.00 for relevance and 0.94 for clarity and conciseness. A brief advertisement was created to explain the study’s goals, eligibility requirements, and the principles of anonymity and confidentiality. Eligible participants were directed to the questionnaire via a link or by scanning a QR code. At the start of the questionnaire, we informed participants that participation was voluntary, their responses would be kept confidential, and they could withdraw at any time. We also emphasized that they could stop the questionnaire at any time if they felt uncomfortable or did not want to continue. To prevent multiple submissions, the basic protection method in KoboCollect was used to block duplicate entries from the same user on the same browser and device. Data management and analysis Excel data files were exported from KoboCollect. Data management and analysis were conducted in SPSS. Descriptive statistics were reported using appropriate measures, including the mean, median, frequency, and percentage. Bivariate analyses were conducted using the chi-square test, and a p-value <0.05 was considered statistically significant. Logistic regression was performed to identify predictors of chemsex. Variables with a p-value <0.2 in the bivariate analysis were included in the initial multivariable logistic regression model. Backward stepwise regression was then applied to obtain the final model. Ethical consideration The objectives of the assessment were clearly stated at the start of the form, and all participants provided informed consent. Participant information was kept strictly anonymous and confidential. It was also made clear that participation in the study posed minimal risk and involved minimal intrusion into personal information. We emphasized that participants could withdraw at any time for any reason, such as feeling uncomfortable with the questions. To protect privacy and confidentiality, we did not ask for any personal identifiers, including email addresses. Data collected through the KoboCollect platform is secured, encrypted, and protected against unauthorized access. Only authorized research team members could access the data, and strict data-handling procedures were followed to ensure confidentiality. Additionally, participants were informed of these procedures and provided consent prior to data collection. Ethical approval was secured from the Ethics Review Committee of the Ministry of Health, National Unity Government, Myanmar (Ethics/NUG-MOH/2024/06). Results Demographic characteristics of participants A total of 415 MSM were included in the study, with a mean age of 30.1 years (SD = 7.1; range 18–56 years). The majority (71.3%) were younger than 35 years. Most participants identified as gay (76.4%), and 23.6% identified as bisexual. Regarding education, over three-fifths of respondents (62.2%) had attained a bachelor’s degree or higher, 21.4% were current university students, and 16.4% had completed only basic education. Employment was common among participants: 59% were employed, 29.2% were engaged in freelance or business activities, and 11.8% were unemployed. Only a small proportion (4.3%) reported working in entertainment-related occupations. Monthly income varied, with 51.1% earning more than 600,001 MMK, 39.8% earning up to 600,000 MMK, and 9.2% reporting no income. Regarding living arrangements, 39.3% lived with their parents, 34.0% lived with others, and 26.7% lived alone. HIV related characteristics of participants At the time of the survey, 14.2% of participants self-reported living with HIV, 71.3% reported being HIV-negative, 10.1% were unsure of their HIV status, and 4.3% declined to disclose their HIV status. Among participants living with HIV, 96.6% were receiving antiretroviral therapy (ART). Current use of PrEP was reported by 29.1% of participants. Prevalence of chemsex Overall, 26.0% of participants reported engaging in chemsex at some point, while 74.0% had never participated. Among those who had, the mean age at first chemsex experience was 26.7 years (SD = 6.2; range 15–44 years). In the six months before the survey, 20.7% reported engaging in chemsex, whereas 5.3% reported prior experience but not within the past six months. Behaviors and sexual practices during chemsex Among the 108 participants who reported chemsex, methamphetamine was the most commonly used substance (69.8%). Drug use was predominantly via injection (67.4%) (Fig 1), with over half self-injecting (62.1%) or being injected by others (67.2%). Sharing injection equipment was relatively rare (8.6%). Chemsex most commonly occurred in hotels (76.7%) and private homes (54.7%). Nearly half (46.5%) of the sessions lasted between 4 and 12 hours, and 41.9% lasted less than 4 hours. Download: PNG larger image TIFF original image Fig 1. Types and routes of chemsex. https://doi.org/10.1371/journal.pone.0353993.g001 Condom use during chemsex in the past six months was inconsistent, with only 10.5% always using condoms, 52.3% sometimes, and 24.4% never. Group sex during chemsex was reported by 40.7%, usually involving threesomes (57.1%) or groups of 4–5 (40%). Condom use during group sex was also inconsistent, with only 11.4% always using condoms, 54.3% sometimes, and 22.9% never. Regarding the most recent chemsex, 46.5% reported chemsex within the past two weeks, 14.0% within the past month, and 23.3% within the past three months. Adverse outcomes linked to chemsex were common. Over half (52.3%) experienced unpleasant physical sensations, 38.4% experienced anxiety or panic attacks, 22.1% experienced paranoia, and 19.8% exhibited irritability or aggressiveness. A small portion reported overdose with loss of consciousness (3.5%), suicidal thoughts (2.3%), or suicide attempts (2.3%). One in ten (10.5%) missed regular medication because of chemsex, while 30.2% were unsure. Additionally, 30.2% used illicit drugs outside sexual contexts. Attitude regarding chemsex Participants held mixed views on chemsex, with a substantial proportion recognizing benefits alongside notable concerns. Nearly half reported that chemsex made sexual experiences more enjoyable (44%) a
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