From Liberal to Punitive: A Qualitative Meta-Synthesis of Multilevel Health Needs Among MSM Engaged in Chemsex

Chemsex among men who have sex with men (MSM) is a complex health issue shaped by individual, interpersonal, community, and structural factors. This systematic review aimed to synthesize the lived experiences and healthcare needs of MSM engaging in chemsex across diverse sociocultural and policy contexts using the Social Ecological Model (SEM) as an interpretive framework. A systematic search was conducted in PubMed, Web of Science, the Cochrane Library, Scopus, and CINAHL. Qualitative studies were synthesized using Thomas and Harden's thematic synthesis method. Study quality was assessed using the Joanna Briggs Institute Qualitative Assessment and Review Instrument, and confidence in findings was evaluated using the CERQual approach. Twenty-four qualitative studies from Asia, Europe, and North America were included. Five themes were identified across SEM levels, including pleasure-seeking and emotional escape at the individual level, tensions between connection and pseudo-intimacy at the interpersonal level, informal harm-reduction practices within communities, and stigma-related barriers at societal and policy levels. Participants emphasized the need for safe, anonymous, integrated, and non-judgmental healthcare services. Trauma-informed care, partner communication support, and community empowerment may guide nursing practice. Future research should develop culturally adapted multilevel interventions, particularly in punitive policy contexts.