Recreational Drug Use Abstinence among Young Men who Have Sex with Men Living with HIV in Bangkok: A Qualitative Study

Abstract

Introduction

Thailand has the highest HIV prevalence in the Asia–Pacific region (~9%), with young men who have sex with men (YMSM) disproportionately affected. Recreational drug use intensifies risks of transmission and undermines adherence to antiretroviral therapy (ART). While prior research has explored patterns of drug use, little is known about the motivations behind abstinence among HIV-positive YMSM in Bangkok.

Objective

To explore the lived experiences and reasons for recreational drug use abstinence among HIV-positive YMSM in Bangkok.

Method

A one-year, cross-sectional, qualitative study was conducted with 62 HIV-positive YMSM aged 15 – 29 years. Participants were recruited through community-based organisations with oversight from a Community Advisory Board comprising civil society representatives and YMSM. In-depth interviews explored education, employment, health, relationships, and substance use. Interviews were transcribed and coded using a structured codebook, with data managed in NVivo 10 and analysed thematically.

Results

Three post-diagnosis trajectories emerged: complete abstinence, partial abstinence, and continued use. Abstinence was commonly motivated by fear of death, reduced sexual activity, and feelings of responsibility towards partners. Partial abstinence reflected hope derived from ART, financial or access constraints, and episodic peer influence. Continued use, though rare, was associated with denial and fatalism. Across trajectories, stigma, discrimination, misinformation, and judgemental clinical interactions reinforced fatalistic beliefs and suppressed disclosure, whereas affirming communication and trust in ART fostered resilience and engagement.

Conclusion

Abstinence among HIV-positive YMSM is shaped by both personal motivations and structural forces. Programmes should move beyond abstinence-only messaging towards harm-reduction and status-neutral approaches, integrating non-judgemental communication, safer-use planning, and consistent U=U messaging. Implementation research is needed to test these strategies in improving disclosure, adherence, and quality of life.