Generative tension and social risk management surrounding sexualised drug use practice among men who have sex with men in highly stigmatised environments: A qualitative study from Jakarta, Indonesia.

Background: Global policies emphasise the need for tailored interventions to reduce the harms of sexualised drug use (SDU) among men who have sex with men (MSM), including taking account of local risk environments and the influence of social norms, drug and sexual minority stigma, and cultural and political conditions. To help guide the production of local SDU harm reduction interventions, this study aimed to explore the social and structural conditions that shape the practice of, and response to, SDU by MSM in Jakarta, Indonesia.

Methods: Informed by an interactionism theoretical perspective and socioecological frameworks, a reflexive thematic approach was used to analyse in-depth qualitative interview data from 20 MSM who practised SDU in Jakarta. To recruit the participants, the study was promoted through local organisations providing HIV services for MSM, as well as snowball recruitment.

Results: To protect their SDU practice, MSM in Jakarta developed a set of social risk management strategies designed to reduce the generative tension between enabling and disabling forces caused by local social and structural environments. Enabling forces emerged primarily from within MSM networks, were extended through the interpersonal dynamics of sexual partner relationships to peer influence and reinforced by product branding and marketing on both offline and online platforms. The disabling forces, which were introduced primarily from outside the network, manifested in stigmatising social norms, politics and religious beliefs towards homosexuality and drug use, and forced MSM who practised SDU to relocate to virtual environments.

Conclusion: Programmatic responses seeking to mitigate the risks associated with SDU practice among sexual minority men should incorporate established mechanisms of peer networks and virtual spaces into their design to maximise reach and intervention acceptability and effectiveness.