{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T07:20:09Z","timestamp":1790580009067,"version":"4.1.0"},"reference-count":56,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2023,11,2]],"date-time":"2023-11-02T00:00:00Z","timestamp":1698883200000},"content-version":"unspecified","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Department of Foreign Affairs, Trade and Development","award":["P007358"],"award-info":[{"award-number":["P007358"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2023,10,6]]},"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>\n                      Chemsex is defined as drug use to enhance sexual pleasure. Global literature illustrated the pervasiveness of chemsex among men who have sex with men (MSM) and transgender women (\n                      <jats:italic>hijra<\/jats:italic>\n                      ) for prolonging anal intercourse, reducing pain and intensifying pleasure, oftentimes without condoms. Global literature highlighted the association between chemsex and unsafe sexual behaviours. These circumstances warrant targeted chemsex research to explore the chemsex situation. The study aims to explore the overall dynamics of chemsex among MSM, male sex workers (MSW) and\n                      <jats:italic>hijra<\/jats:italic>\n                      in Dhaka, Bangladesh and formulate culturally relevant, context-specific, gender-sensitive and evidence-based recommendations for chemsex interventions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>\n                      This will be a sequential, exploratory, mixed-methods study. Data will be collected at four drop-in centres in Dhaka in three phases. To explore issues related to chemsex, the formative phase (phase 1) will generate evidence on the overall dynamics of chemsex through a literature review and qualitative interviews. Qualitative data will be manually analysed using thematic analysis. In phase 2, a cross-sectional survey will be conducted among 458 MSM, male sex workers and\n                      <jats:italic>hijra<\/jats:italic>\n                      to measure the prevalence, reasons and sexual risk behaviour associated with chemsex. In phase 3, qualitative interviews will be conducted with the participants involved in chemsex, service providers and relevant stakeholders to add qualitative depth to survey responses. In this phase, service provision will also be investigated for people engaging in chemsex. Moreover, based on the findings of phases 1 and 2, and qualitative interviews of phase 3, a preliminary chemsex intervention model will be developed through a series of intervention design workshops.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Ethical approval has been attained from the Ethical Review Committee of icddr,b. Informed consent will be obtained from the participants, and confidentiality will be maintained during data collection and storage. Findings will be disseminated via several platforms including dissemination seminars, scientific articles and study report.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-073976","type":"journal-article","created":{"date-parts":[[2023,11,2]],"date-time":"2023-11-02T13:30:32Z","timestamp":1698931832000},"page":"e073976","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Understanding the dynamics of chemsex among men who have sex with men, male sex workers and transgender women in Dhaka, Bangladesh: a multiphase sequential mixed-method research protocol"],"prefix":"10.1136","volume":"13","author":[{"given":"Golam","family":"Sarwar","sequence":"first","affiliation":[{"name":"Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samira Dishti","family":"Irfan","sequence":"additional","affiliation":[{"name":"Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masud","family":"Reza","sequence":"additional","affiliation":[{"name":"Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad Niaz Morshed","family":"Khan","sequence":"additional","affiliation":[{"name":"Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7319-1333","authenticated-orcid":false,"given":"Sharful Islam","family":"Khan","sequence":"additional","affiliation":[{"name":"Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,11,2]]},"reference":[{"key":"2025121221274999000_13.11.e073976.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2018.11.014"},{"key":"2025121221274999000_13.11.e073976.2","unstructured":"UNODC . 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Mapping study and size estimation of key populations in Bangladesh for HIV programs 2015-2016; 2016."},{"key":"2025121221274999000_13.11.e073976.38","unstructured":"Patton MQ . Qualitative research & evaluation methods: Integrating theory and practice. Sage publications, 2014."},{"key":"2025121221274999000_13.11.e073976.39","unstructured":"Patton M . Qualitative research & evaluation methods. Thousand Oaks (CA): Sage Publication, 2002."},{"key":"2025121221274999000_13.11.e073976.40","unstructured":"Ezzy D . Qualitative analysis: Practice and innovation. London: Routledge Google Scholar, 2002."},{"key":"2025121221274999000_13.11.e073976.41","doi-asserted-by":"publisher","DOI":"10.1191\/1478088706qp063oa"},{"key":"2025121221274999000_13.11.e073976.42","unstructured":"Salda\u00f1a J . The coding manual for qualitative researchers. 2021: 1\u2013440."},{"key":"2025121221274999000_13.11.e073976.43","unstructured":"Patton MQ . Qualitative research & evaluation methods. Thousand Oaks: Sage Publications, 2002."},{"key":"2025121221274999000_13.11.e073976.44","unstructured":"Catherine Pope NM . Qualitative Research in Health Care. 2013."},{"key":"2025121221274999000_13.11.e073976.45","doi-asserted-by":"publisher","DOI":"10.1177\/00380385030373002"},{"key":"2025121221274999000_13.11.e073976.46","doi-asserted-by":"crossref","unstructured":"Ezzy D . Qualitative analysis. Routledge, doi:10.4324\/9781315015484","DOI":"10.4324\/9781315015484"},{"key":"2025121221274999000_13.11.e073976.47","unstructured":"Lemeshow S , Hosmer DW , Klar J , et al . Adequacy of sample size in health studies. Chichester: Wiley, 1990."},{"key":"2025121221274999000_13.11.e073976.48","unstructured":"Kish L . Survey sampling. New York: John Willey and Sons Inc, 1965: 643."},{"key":"2025121221274999000_13.11.e073976.49","unstructured":"NASP . Behavioural and serological surveillance on males having sex with males, male sex workers and Hijra; 2016."},{"key":"2025121221274999000_13.11.e073976.50","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1007\/s10508-016-0886-0","article-title":"The sexual orientation and gender presentation of Hijra, Kothi, and Panthi in Mumbai, India","volume":"46","author":"Stief","year":"2017","journal-title":"Arch Sex Behav"},{"key":"2025121221274999000_13.11.e073976.51","unstructured":"NASC . National guidelines for management of sexually transmitted infections. In: National AIDS\/STD Program (NASP). 2020: 37."},{"key":"2025121221274999000_13.11.e073976.52","unstructured":"NASC . National HIV testing services (HTS) guideline. 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