{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T05:15:14Z","timestamp":1783574114976,"version":"3.55.0"},"reference-count":28,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:00:00Z","timestamp":1782777600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002322","name":"Coordena\u00e7\u00e3o de Aperfei\u00e7oamento de Pessoal de N\u00edvel Superior\u2014Brasil","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100002322","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nursing Reports"],"abstract":"<jats:p>Background: Chemsex, or sexualized drug use, exists along a continuum ranging from non-problematic, consensual recreational practice across diverse populations to problematic behaviors linked with clinical vulnerabilities, substance dependence, or compulsive disorders. Within nursing practice, understanding this spectrum is essential to mitigate healthcare-related stigma. Objective: To map and synthesize evidence on stigma and attitudes among nurses regarding chemsex, identifying implications for practice and research. Methods: A scoping review was conducted following the Joanna Briggs Institute methodology and PRISMA-ScR guidelines. Searches were performed across PubMed\/MEDLINE, Scopus, Web of Science, CINAHL, EMBASE, and LILACS. Studies involving nurses or healthcare teams focused on stigma, attitudes, or related constructs in chemsex care were included. Data underwent descriptive and thematic synthesis. Results: Six studies met the inclusion criteria, showing substantial heterogeneity. Only one focused exclusively on nurses. Stigma and attitudes were rarely assessed explicitly, emerging instead as underlying factors influencing clinical practice, communication, and patient engagement. Key themes included the necessity for non-judgmental care, significant gaps in knowledge and training, variability in clinical practice, and the impact of organizational barriers. A schematic representation was developed to illustrate the interrelationships between stigma, knowledge, professional attitudes, and structural factors influencing healthcare practice. Conclusions: This review positions stigma as a central mechanism influencing nursing care in chemsex contexts. The findings underscore critical gaps in nursing-specific evidence and emphasize the need for targeted training, validated measurement tools, and integrated care models. Strengthening stigma-informed, patient-centered approaches is essential to improve care delivery and health outcomes for this population.<\/jats:p>","DOI":"10.3390\/nursrep16070227","type":"journal-article","created":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T16:56:55Z","timestamp":1782838615000},"page":"227","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Invisible Barrier: A Scoping Review of Stigma and Nursing Attitudes in Chemsex Care"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6119-5193","authenticated-orcid":false,"given":"Emerson Lucas Junio Silva","family":"Camargo","sequence":"first","affiliation":[{"name":"Ribeir\u00e3o Preto School of Nursing, University of S\u00e3o Paulo, Ribeir\u00e3o Preto 14040-902, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2710-2122","authenticated-orcid":false,"given":"\u00c1lvaro Francisco Lopes de","family":"Sousa","sequence":"additional","affiliation":[{"name":"Campus de Tr\u00eas Lagoas, Federal University of Mato Grosso do Sul, Tr\u00eas Lagoas 79070-900, MS, Brazil"},{"name":"NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center (CHRC), REAL, NOVA University of Lisbon, 1050-091 Lisbon, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice Silva","family":"Costa","sequence":"additional","affiliation":[{"name":"Multiprofessional Program in Family Health, Federal University of Alfenas\u2013UNIFAL, Alfenas 37130-001, MG, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anderson Reis de","family":"Sousa","sequence":"additional","affiliation":[{"name":"School of Nursing, Federal University of Bahia, Salvador 40170-110, BA, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9066-2160","authenticated-orcid":false,"given":"Vinicius de Lima","family":"Lovadini","sequence":"additional","affiliation":[{"name":"School of Medicine, Universidade Brasil, Fernand\u00f3polis 15600-000, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"In\u00eas","family":"Fronteira","sequence":"additional","affiliation":[{"name":"NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center (CHRC), REAL, NOVA University of Lisbon, 1050-091 Lisbon, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5913-8886","authenticated-orcid":false,"given":"Herica Emilia Felix de","family":"Carvalho","sequence":"additional","affiliation":[{"name":"Department of Nursing, State University of Maranh\u00e3o, Coroat\u00e1 65055-310, MA, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3195-8767","authenticated-orcid":false,"given":"Liliane Moretti","family":"Carneiro","sequence":"additional","affiliation":[{"name":"Campus de Tr\u00eas Lagoas, Federal University of Mato Grosso do Sul, Tr\u00eas Lagoas 79070-900, MS, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0379-913X","authenticated-orcid":false,"given":"Carla Aparecida Arena","family":"Ventura","sequence":"additional","affiliation":[{"name":"Ribeir\u00e3o Preto School of Nursing, University of S\u00e3o Paulo, Ribeir\u00e3o Preto 14040-902, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1108\/DAT-10-2018-0058","article-title":"Chemsex: Origins of the word, a history of the phenomenon and a respect to the culture","volume":"19","author":"Stuart","year":"2019","journal-title":"Drugs Alcohol Today"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.drugpo.2018.11.014","article-title":"Chemsex behaviours among men who have sex with men: A systematic review of the literature","volume":"63","author":"Maxwell","year":"2019","journal-title":"Int. J. Drug Policy"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"\u015aniadach, J., Orlof, W., So\u0142owiej-Chmiel, J., Kicman, A., Szymkowiak, S., and Waszkiewicz, N. (2025). Chemsex as a Diagnostic Challenge: Toward Recognition in ICD-12 and Integrated Treatment Approaches\u2014A Narrative Review. J. Clin. Med., 14.","DOI":"10.3390\/jcm14176275"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Ramazanova, M., Turdaliyeva, B., Igissenova, A.I., Zhakupova, M., Izbassarova, A.S., Seifuldinova, M., Nurlybaeva, G., Yergeshbayeva, R., and Karibayeva, I. (2025). Prevalence of Sexualized Substance Use and Chemsex in the General Population and Among Women: A Systematic Review and Meta-Analysis of Cross-Sectional Studies. Healthcare, 13.","DOI":"10.3390\/healthcare13080899"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Carvalho, I.S., Cepas, L.A., de Sousa, \u00c1.F.L., Fernandes, T.M., Luz, T.G., da Silva, J.C.S., da Silva Marques, A., Ribeiro, C.J.N., Lima, S.V.M.A., and de Sousa, A.R. (2025). Healthcare Access Among Individuals Who Practice Chemsex in Brazil: A Scoping Review Protocol. Nurs. Rep., 15.","DOI":"10.3390\/nursrep15100353"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e84068","DOI":"10.2196\/84068","article-title":"Development of a Line of Care for the Health of People Who Engage in Chemsex: Protocol for a Multimethod Study","volume":"15","author":"Cepas","year":"2026","journal-title":"JMIR Res. Protoc."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1136\/sextrans-2015-052052","article-title":"Illicit drug use in sexual settings (\u2018chemsex\u2019) and HIV\/STI transmission risk behaviour among gay men in South London: Findings from a qualitative study","volume":"91","author":"Bourne","year":"2014","journal-title":"Sex. Transm. Infect."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1136\/sextrans-2018-053933","article-title":"Psychosocial and sexual characteristics associated with sexualised drug use and chemsex among men who have sex with men (MSM) in the UK","volume":"95","author":"Hibbert","year":"2019","journal-title":"Sex. Transm. Infect."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1108\/DAT-11-2018-0066","article-title":"The problematic chemsex journey: A resource for prevention and harm reduction","volume":"19","author":"Platteau","year":"2019","journal-title":"Drugs Alcohol Today"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"940","DOI":"10.1177\/09564624231188752","article-title":"Harm reduction services for people engaging in chemsex in Brighton, UK: A pilot qualitative study","volume":"34","author":"McGaughey","year":"2023","journal-title":"Int. J. STD AIDS"},{"key":"ref_11","first-page":"e20230004","article-title":"Chemsex and its repercussions on the health of men who have sex with men (MSM): A global health perspective","volume":"76","author":"Sousa","year":"2023","journal-title":"Rev. Bras. Enferm."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.drugalcdep.2013.02.018","article-title":"Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: Systematic review","volume":"131","author":"Brouwers","year":"2013","journal-title":"Drug Alcohol Depend."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1146\/annurev.soc.27.1.363","article-title":"Conceptualizing stigma","volume":"27","author":"Link","year":"2001","journal-title":"Annu. Rev. Sociol."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Parker, R., and Aggleton, P. (2007). HIV-and AIDS-related stigma and discrimination: A conceptual framework and implications for action. Culture, Society and Sexuality, Routledge.","DOI":"10.4324\/9780203966105-42"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"105697","DOI":"10.1016\/j.nurpra.2026.105697","article-title":"Party and Play Meets Primary Care: Sexual Health Case Challenge","volume":"22","author":"Carney","year":"2026","journal-title":"J. Nurse Pract."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Nyblade, L., Stockton, M.A., Giger, K., Bond, V., Ekstrand, M.L., Lean, R.M., Mitchell, E.M.H., Nelson, R.E., Sapag, J.C., and Siraprapasiri, T. (2019). Stigma in health facilities: Why it matters and how we can change it. BMC Med., 17.","DOI":"10.1186\/s12916-019-1256-2"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"SH25109","DOI":"10.1071\/SH25109","article-title":"Comprehensive chemsex harm reduction services for young MSM in Thailand: A four-pronged approach informed by multi-stakeholder perspectives (CLYMAX-1)","volume":"22","author":"Hiransuthikul","year":"2025","journal-title":"Sex. Health"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"596","DOI":"10.1007\/s10900-025-01445-x","article-title":"Knowledge of PrEP Among Healthcare Workers in Substance Use Disorder Services: A Cross-Sectional Study in Italy","volume":"50","author":"Rosset","year":"2025","journal-title":"J. Community Health"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Schifano, F., Bonaccorso, S., Arillotta, D., Guirguis, A., Corkery, J.M., Floresta, G., Papanti Pelletier, G.D., Scherbaum, N., and Schifano, N. (2025). Drugs Used in \u201cChemsex\u201d\/Sexualized Drug Behaviour-Overview of the Related Clinical Psychopharmacological Issues. Brain Sci., 15.","DOI":"10.3390\/brainsci15050424"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Aromataris, E., and Munn, Z. (2020). Chapter 11: Scoping reviews. JBI Manual for Evidence Synthesis, JBI.","DOI":"10.46658\/JBIRM-20-02"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"467","DOI":"10.7326\/M18-0850","article-title":"PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and explanation","volume":"169","author":"Tricco","year":"2018","journal-title":"Ann. Intern. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1097\/OLQ.0000000000001209","article-title":"The Availability and Feasibility of Chemsex Services Within Sexually Transmitted Disease Clinics in the Netherlands: A Cross-Sectional Survey Among Sexually Transmitted Disease Nurses","volume":"47","author":"Evers","year":"2020","journal-title":"Sex. Transm. Dis."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"63","DOI":"10.29045\/14784726.2024.12.9.3.63","article-title":"Chemsex: Core knowledge for emergency medical service responders","volume":"9","author":"Kingsley","year":"2024","journal-title":"Br. Paramed. J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1111\/phn.13308","article-title":"Chemsex among men who have sex with men during the Mpox health crisis in Brazil: A nationwide web survey","volume":"41","author":"Santos","year":"2024","journal-title":"Public Health Nurs."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"477","DOI":"10.4103\/1995-7645.359791","article-title":"The triple stigma of HIV and chemsex among gays, bisexuals, and other men who have sex with men (GBMSM) in the Philippines","volume":"15","author":"Alibudbud","year":"2022","journal-title":"Asian Pac. J. Trop. Med."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Pozo-Herce, P.D., Mart\u00ednez-Sabater, A., Sanchez-Palomares, P., Garcia-Boaventura, P.C., Chover-Sierra, E., Mart\u00ednez-Pascual, R., Gea-Caballero, V., Saus-Ortega, C., Ballestar-Tar\u00edn, M.L., and Karniej, P. (2024). Effectiveness of Harm Reduction Interventions in Chemsex: A Systematic Review. Healthcare, 12.","DOI":"10.3390\/healthcare12141411"},{"key":"ref_28","unstructured":"United Nations Office on Drugs and Crime (2024). Asia-Pacific Chemsex Toolkit, UNODC Regional Office for Southeast Asia and the Pacific."}],"container-title":["Nursing Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2039-4403\/16\/7\/227\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T04:21:37Z","timestamp":1783570897000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2039-4403\/16\/7\/227"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,30]]},"references-count":28,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["nursrep16070227"],"URL":"https:\/\/doi.org\/10.3390\/nursrep16070227","relation":{},"ISSN":["2039-4403"],"issn-type":[{"value":"2039-4403","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,30]]}}}