Maxi Gaudette is a genderqueer PhD candidate in public health at Université de Montréal, interested in LGBTQI+ health and drug use intersections. Maxi’s work and activism are grounded in critical thinking and harm reduction principles, where they advocate for safer, inclusive spaces and address community health challenges through participatory approaches.

Despite disproportionately high rates of sexual assault in chemsex settings, the limited understanding of how consent operates during chemsex hinders efforts to prevent this violence. We conducted a photovoice study, informed by a queer transformative framework, to advance understandings of consent during chemsex. Photovoice is a participatory research method that combines photography and narration, enabling participants to creatively reflect on and document their experiences. In collaboration with a Community Advisory Board, we recruited 20 individuals engaging in chemsex. They participated in an initial meeting to discuss the photo assignment, reflect on related ethical issues, address potential concerns, and cultivate reflections about consent, boundaries, and sexual harm reduction. Participants were then invited to take photos representing their experiences of consent in chemsex contexts. This was followed by an in-depth 90-minute interview where participants described their photographs and the meanings behind them. Both photographs and transcripts were analyzed thematically which yielded three themes. First, chemsex often involved the intentional loss of control and the eroticization of risk-taking, complicating consent negotiations. Second, sexual boundaries were frequently discovered through their transgression, with participants struggling to understand or articulate limits while under the influence. Consent was often retroactively constructed as participants made sense of their experience, as (self-)violation or not, exposing gaps in real-time harm reduction practices. Third, despite these challenges, participants emphasized the importance of knowledge-sharing, pleasure, and care within chemsex communities, which fostered ways to negotiate consent adapted to their realities. Photovoice helped participants document and reflect on their experiences, providing critical insights into the complexities of consent, boundaries, and agency in chemsex settings. The intentional loss of control and blurred boundaries challenge conventional consent understandings, which underscore the need for more context-specific sexual harm reduction strategies. Communities’ strengths, specifically knowledge-sharing and caretaking, offer a valuable starting point for developing culturally sensitive strategies.