Harm reduction for chemsex/sexualised drug use: a qualitative evaluation of London’s Sex, Drugs, and Care for All peer mobiliser programme

Abstract Background Sexualised drug use (SDU) in queer communities, including but not limited to ‘chemsex’, can be pleasurable and empowering, but carries risks related to sexual ill-health, sexual assault, overdosing and addiction. Yet, there is a dearth of accessible and inclusive SDU harm reduction advice and services in the United Kingdom. Recognising this gap, The Love Tank (a community interest organisation) and Antidote (a drug and alcohol service), with funding from a London borough, developed Sex, Drugs, and Care for All (SDC4A). SDC4A offers a harm reduction alternative to existing brick-and-mortar services and outreach efforts, as it trains diverse cohorts of ‘peer mobilisers’ to impart harm reduction advice in spaces where SDU takes place. This participatory evaluation aimed to: 1) explore the process and emergent impacts of establishing and running a harm reduction programme for SDU; 2) understand how community members trained through SDC4A enact their roles as peer mobilisers. Methods The participatory evaluation – rooted in critical approaches to evaluation that explore emergent impacts, process, and experiences – involved two focus groups with seven mobilisers, and eight interviews with personnel involved in designing and implementing SDC4A. Results The main themes that emerged from the focus groups and interviews were the importance of understanding SDU as a spectrum; that mobilisers are motivated by an ethics of care and that it feels empowering and prideful to be a mobiliser; that mobilisers impart advice on safer drug use as well as open up conversations about harmful use; that working across organisations creates new communities of practice and possibilities for doing harm reduction work; and that challenges relating to peer-led harm reduction work include reaching more marginalised populations or those whose SDU is at crisis level, and working in less permissive policy spaces. Conclusions Harm reduction programmes for SDU must be flexible and able to learn from the community they are developed with and for in order to address the spectrum of SDU. The value of co-developing programmes between organisations and with the community lies in the strengthening of a community of practice and an ethics of care.