# Healthcare Access Among Individuals Who Practice Chemsex in Brazil: A Scoping Review Protocol

## TL;DR

This study aims to understand how people who engage in chemsex in Brazil access healthcare, highlighting barriers and needs to improve public health strategies.

## Contribution

The study provides a novel scoping review protocol to synthesize fragmented evidence on healthcare access for chemsex participants in Brazil.

## Key findings

- Barriers like stigma and lack of specialized services hinder healthcare access for chemsex participants.
- The review will identify health needs and facilitators to improve care for this population.
- It will highlight knowledge gaps for underrepresented groups in the Brazilian context.

## Abstract

Background: Chemsex, the intentional use of psychoactive substances to enhance sexual experiences, is an emerging public health issue in Brazil, associated with increased risks of sexually transmitted infections and complex psychosocial vulnerabilities. Despite the universal coverage provided by the Unified Health System (SUS), individuals who practice chemsex often encounter barriers to healthcare, including stigma, discrimination, and a lack of specialized services. To date, no comprehensive reviews appear to synthesize evidence on how this population accesses healthcare in the Brazilian context; existing knowledge remains fragmented across individual studies. Objectives: The aim is to map and synthesize the available evidence regarding access to health services among people who engage in chemsex in Brazil, identifying health needs, professional demands, barriers, and facilitators. Methods: The protocol follows the Joanna Briggs Institute methodology for scoping reviews and PRISMA-ScR guidelines. A systematic search will be conducted in MEDLINE (PubMed), Embase, Scopus, SciELO, and LILACS for studies published between 2014 and 2024 in Portuguese, English, or Spanish. Data will be summarized using descriptive and narrative synthesis, presented in tables and thematic categories. Studies will be included if they address chemsex or sexualized drug use in Brazil and report on healthcare access, regardless of gender identity, sexual orientation, or drug type. Studies that do not address chemsex, focus on drug use outside a sexual context, or are unrelated to Brazil will be excluded. Expected results: The review is expected to identify key barriers and facilitators to healthcare access, highlight knowledge gaps for underrepresented groups, and support recommendations for research, policy, and practice to improve care for people engaging in chemsex in Brazil. By focusing on an underexplored intersection of drug use, sexuality, and healthcare access in Latin America, this study aims to provide an innovative contribution to public health literature.