Abstract
Background: Chemsex is described as the intentional use of psychoactive substances to engage in sexual activity over prolonged periods, primarily among gay, bisexual, and other men who have sex with men. Despite its clinical and public health relevance, the available qualitative evidence is scattered and requires interpretive synthesis. Objective: To synthesize and interpret the qualitative evidence on chemsex among gay, bisexual, and other men who have sex with men, identifying the main experiential and sociocultural themes and their implications for clinical practice and public health. Methods: A qualitative meta-synthesis was conducted following the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Searches were carried out in PubMed, Dialnet, Scopus, CINAHL, and PubPsych, in Spanish and English, with no time restrictions. Qualitative studies, mixed-methods studies, and reviews reporting qualitative findings in English, Spanish, or Catalan were included, while quantitative, theoretical, or methodologically insufficient studies were excluded. Critical appraisal was conducted using the Critical Appraisal Skills Programme (CASPe) tool. Analysis was performed through inductive thematic analysis. Results: A search of electronic databases and grey literature yielded 4973 records. After removing duplicates and screening titles and abstracts, 174 full texts were assessed for eligibility. Following CASPe methodological appraisal, 31 studies met all criteria and were included in the final synthesis. The analysis produced 276 codes and was organized into six interpretive themes: (1) Access to drugs and sex: they are there when I want them; (2) Beliefs and attitudes toward chemsex: internalizing social constructions; (3) Chemsex practice as an identity-based subculture; (4) Patterns of use: of substances, relationships, and spaces; (5) Motivations surrounding chemsex: pleasures and emotions; and (6) Self-perceived risks in chemsex practice: beyond the biological. Conclusions: The meta-synthesis portrays chemsex as a sociocultural phenomenon mediated by technology, shared meanings, and relational dynamics, with perceived benefits and potential repercussions. Across studies, a stable tension emerges between psychosocial functions (e.g., pleasure, disinhibition, social connection, and belonging) and cumulative harms that include mental health and relational consequences. The findings support comprehensive and culturally competent interventions that move beyond an exclusively biomedical approach by integrating harm reduction, situational risk assessment, and mental health care, while avoiding moralizing framings that may reduce service acceptability.