Kanak (they/them) is a young Queer health advocate from Nepal. Their work focuses on HIV prevention, harm reduction, mental health, sexual and reproductive health and rights, and human rights advocacy. Kanak has a Bachelor in Public Health degree and they are currently affiliated to Blue Diamond Society, Nepal.

Background: Sexualized drug use (SDU) has gained increasing attention globally due to its strong association with high-risk sexual behaviors, particularly among MSM and TG population. Studies suggest that individuals who engage in SDU tend to exhibit lower negotiation power during sex causing a higher risk of violence. This scoping study aimed to assess the situation of SDU and associated violence among these key populations in Nepal.

Methodology: A nation-wide cross-sectional quantitative study was done using standard tools among MSM and TG population using a two-stage cluster random sampling technique. A sample size of 400 was determined, allowing for a 5% margin of error.

Results: Out of 393 respondents, 36.12% (n=142) reported engaging in SDU, while 4.07% (n=16) were chemsex users. Poly-drug use was prevalent, with individuals reporting use of up to six different drugs. Cannabinoids were the most used drug (n=71), while use of cocaine (n=21), heroin (n=20) and amphetamine derivatives (n=13) were also concerning. Among those reporting SDU, the vast majority (91.55%, n=130) first used drugs for sexual purposes at or before the age of 25 and MSM were the larger subgroup of users (65.49%, n=93). Un-consensual sexual activities was alarming among individuals reporting SDU as 40.14% (n=57) reported forceful sexual engagement without condom while under the influence of drugs, while 36.62% (n=52) were drugged by their partner(s) without consent. Regarding violence associated to SDU, 45.07% (n=64) reported experience of violence; verbal (78.00%, n=47), physical (71.88%, n=46) and sexual (17.19%, n=11), while 26.76% (n=38) reported perpetrating violence in the setting of SDU.

Conclusion: The study findings suggest SDU in Nepal is a public health concern among MSM and TG population. There is a need for comprehensive harm reduction program on SDU including information/education, commodities and services linking to safer sex practices including condom negotiation and protection from facing/perpetrating violence.