Harm reduction gaps in sexualized drug use among gay and bisexual men living with HIV in Colombia

BACKGROUND: Sexualized drug use among gay, bisexual, and other men who have sex with men (GBM) remains underexplored in Latin America. This study investigated perspectives on sexualized drug use among GBM living with HIV in Colombia, including Venezuelan migrants, through a harm-reduction lens. METHODS: Between October 2024 and April 2025, we conducted semi-structured interviews with GBM living with HIV across Colombia. Thematic analysis was employed to identify patterns related to practices, meanings, and perceived health system responses to sexualized drug use among participants. RESULTS: The sample included 66 participants (median age: 31 years), with a median year of HIV diagnosis of 2021. Over one-third of participants were Venezuelan migrants (n = 26). Three themes were identified: (1) Silences in care: sexualized drug use remained largely absent from HIV services, where stigma and fear of judgment constrained disclosure and hindered harm-reduction counseling; (2) Ambivalence and health concerns: participants acknowledged the role of substances in enhancing sexual pleasure while also expressing concerns regarding risks, dependence, and lack of credible health information; and (3) Cross-national contrasts: Venezuelan migrants described limited visibility of sexualized drug use in Venezuela compared to its greater reported normalization in Colombia, generating new vulnerabilities and challenges for migrants. CONCLUSIONS: As reported by participants, sexualized drug use is both culturally prevalent and under-acknowledged within Colombian HIV care for GBM. Stigma and silence surrounding these practices underscore the need for community-driven, non-judgmental harm-reduction strategies (e.g., peer education) that better reflect GBM's lived realities while supporting safer, more affirming approaches to health.