Sexualized drug use and high-risk behaviors among men who have sex with men, transgender women, and gender-diverse individuals in Andalusia

Background Sexualized drug is increasingly recognized as a health issue among gay, bisexual, and other men who have sex with men (GBMSM), transgender women and gender-diverse individuals. However, regional data remain scarce. This study aimed to characterize sexualized drug use in these populations in Andalusia, Spain, and explore associated sexual behaviors, outcomes, and professional perspectives relevant to healthcare organization. Methods A cross-sectional study was conducted in Andalusia between December 2024 and May 2025 using two anonymous, self-administered surveys: one targeting individuals who engage in sexualized drug use, and the other targeting professionals involved in its prevention and care. Descriptive analyses were performed. Results Of 159 completed and analyzed questionnaires, 148 participants reported drug use in a sexual context. Among participants reporting sexualized drug use (148/159), 65% reported a previous STI. In the chemsex subgroup ( n = 110), 78% reported long-lasting sexual episodes, 64% reported >25 sexual partners annually and 95% reported engaging in condomless sex. Among professionals ( n = 235), only 40% had received chemsex-specific training, and 94% reported insufficient multidisciplinary coordination. Conclusions Sexualized drug use is an important public health concern. These findings support integrated sexual health, mental health and substance-use services, alongside professional training and coordinated care pathways.