{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,3,29]],"date-time":"2026-03-29T17:47:50Z","timestamp":1774806470757,"version":"3.50.1"},"posted":{"date-parts":[[2026,3,23]]},"group-title":"Public and Global Health","reference-count":43,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T00:00:00Z","timestamp":1774224000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,3,23]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>\n                    <jats:italic>Hi-fun<\/jats:italic>\n                    among gay, bisexual and other men who have sex with men (GBMSM) is increasing across Southeast Asia. Yet research remains focused on epidemiological trends and health risks, with limited qualitative work capturing lived experiences, motivations and support needs. These gaps are pronounced in Thailand, where social, legal and cultural structures emphasise control and enforced abstinence over harm reduction and holistic support.\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>\n                    This qualitative study drew on five FGDs and six IDIs with 30 Thai and non-Thai GBMSM in Bangkok, Khon Kaen and Pattaya. Data explored contexts, experiences, strengths, challenges and support needs related to\n                    <jats:italic>hi-fun<\/jats:italic>\n                    . Thematic analysis was conducted, and findings were reviewed with a community advisory board and partner NGOs.\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>\n                    Participants described\n                    <jats:italic>hi-fun<\/jats:italic>\n                    as a distinct world enabling self-expression, pleasure, intimacy and a sense of being valued and accepted beyond what everyday life affords. This world was shaped through equipment preparation, participant screening and unwritten rules promoting trust and safety.\n                    <jats:italic>Hi-fun<\/jats:italic>\n                    offered emotional and social benefits, including connection and belonging. However, participants also reported risks, including mental health challenges, dependence, sexual performance difficulties, violence, non-consensual recording, financial strain and legal consequences.\n                    <jats:italic>Hi-fun<\/jats:italic>\n                    became problematic when individuals lost control, encountered police or mandatory rehabilitation, experienced health decline or struggled with daily functioning. Participants emphasised needs for sterile equipment, post-use care, accurate information, stigma-free environments and legal reforms aligned with lived realities.\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>\n                    Supporting GBMSM engaged in\n                    <jats:italic>hi-fun<\/jats:italic>\n                    in Thailand requires moving beyond abstinence-focused approaches toward flexible harm reduction and structural reforms that uphold dignity, safety and equity.\n                  <\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.03.19.26348853","type":"posted-content","created":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T12:10:13Z","timestamp":1774440613000},"source":"Crossref","is-referenced-by-count":0,"title":["Living\n                  <i>hi<\/i>\n                  : GBMSM narratives of pleasure, risk, and everyday\n                  <i>hi-fun<\/i>\n                  (chemsex) navigation in Thailand"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8300-9892","authenticated-orcid":false,"given":"Worawalan","family":"Waratworawan","sequence":"first","affiliation":[{"name":"Mahidol Center for Health, Behavior and Society, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nattharat","family":"Samoh","sequence":"additional","affiliation":[{"name":"Mahidol Center for Health, Behavior and Society, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alison J","family":"Rodger","sequence":"additional","affiliation":[{"name":"Institute for Global Health, University College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harry","family":"Prabowo","sequence":"additional","affiliation":[{"name":"Asia Pacific Network of People Living with HIV\/AIDS, Bangkok, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gloria","family":"Lai","sequence":"additional","affiliation":[{"name":"International Drug Policy Consortium, Bangkok, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nittaya","family":"Phanuphak","sequence":"additional","affiliation":[{"name":"Institute for HIV Research and Innovation, Bangkok, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Siripong","family":"Srichau","sequence":"additional","affiliation":[{"name":"APCOM Foundation, Bangkok, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Verapun","family":"Ngamee","sequence":"additional","affiliation":[{"name":"Ozone Foundation, Bangkok, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam","family":"Bourne","sequence":"additional","affiliation":[{"name":"Australian Research Centre in Sex, Health and Society, La Trobe University Melbourne, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas E.","family":"Guadamuz","sequence":"additional","affiliation":[{"name":"Mahidol Center for Health, Behavior and Society, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T Charles","family":"Witzel","sequence":"additional","affiliation":[{"name":"Mahidol Center for Health, Behavior and Society, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand"},{"name":"Institute for Global Health, University College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"54368","reference":[{"key":"2026032910422186000_2026.03.19.26348853v1.1","unstructured":"APCOM. 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