男同志藥愛行為與相關求助經驗之質性探究

Abstract

研究背景：在多元性別族群中，男同志性行為使用娛樂性藥物(chemsex)一直是受到關注的議題。藥愛行為不僅帶來性傳染病的傳遞，同時也會導致危險意外的發生。當娛樂性藥物轉變為成癮時，將對個人的生理和心理狀態造成危害，進而影響親密關係、社交關係及日常生活功能。另一方面，受到社會風氣的影響，多元性別族群主動尋求幫助的比例偏低，而男同志族群因其文化特殊性，無法以一般大眾價值觀或其他性向歷程經驗作為詮釋。因此，深入了解男同志性行為使用娛樂性藥物的經驗，以及他們在求助行為各方面所面臨的困境，將有助於理解此族群的經驗脈絡，提供更符合男同志藥愛需求的資源建議。 研究目的：本研究目的為探討男同志族群中藥愛行為的起始過程與歷程，及藥愛行為下的求助經驗，並分析男同志藥愛行為中娛樂性藥物暨性傳染病防治之主觀經驗與建議。 研究方法：本研究為現象學研究，分別透過「愛滋病匿名行動篩檢站」、「教學醫院精神科門診」及「非政府營利之同志聯盟組織」等管道，採用立意取樣與滾雪球方式招募受訪者，並以「暴露前預防性投藥(PrEP)」及「簡明心理健康量表九題版(The 9-item Concise Mental Health Checklist, CMHC-9)」分數作為參考，使用半結構式訪談大綱收集兩年內曾親身經歷藥愛的男同志經驗，以Colaizzi資料分析法進行資料分析。 研究結果：本研究共納入16名個案，平均年齡為33歲。經分析後歸納為「藥愛的起頭」、「沉浸階段」、「求助現象」與「建言與忠告」等四個藥愛行為轉變歷程下的主題，男同志初次接觸藥愛行為的原因出自於對親密與人際關係的嚮往，以及追求性行為的舒適感受。娛樂性藥物帶來立即性回饋使男同志願意持續選擇藥愛，並把娛樂性藥物拓展至日常生活，也隨之進入「沉浸階段」。隨著時間的推移，男同志逐漸感受到娛樂性藥物帶來的負面影響，在生活陷入困境與惡性循環後萌生戒除的想法，並受到不同的社會支持程度影響而採取不同的求助行為，然而研究發現男同志在求助過程中會面臨社會輿論、汙名、家人壓力與醫療負面經驗等阻礙。最後，男同志有感於國內現行藥愛的需求與用藥政策，提出了教育、行動、族群互助及政策回饋等四面向的建議。 結論與建議：從本研究個案所陳述的的經驗與脈絡中，發現男同志的藥愛行為起因於追求歡愉感及對人際與親密關係的渴望，隨著男同志將娛樂性藥物擴展到日常生活使用而走向沉浸的人生。在面臨到藥愛所帶來的困擾後，男同志可能嘗試以自我協助、非正式或正式的求助方式來擺脫娛樂性藥物。總結來說，研究發現社會支持對於藥愛男同志求助行為上的選擇具有重要影響，並以「情緒性支持」最為被男同志所需要。然而再經歷求助行為之後，藥愛男同志仍可能會反覆地復用，或是在求助過程遇到阻礙後放棄繼續尋求幫忙。因此，幫助藥愛男同志脫離娛樂性藥物，需要多管齊下的推廣與宣導求助資源，同時建立友善的求助環境，讓藥愛男同志從專業治療獲得成癮症狀的緩解後，學習自我覺察與建立自我認同，並且包容與陪伴他們在這過程中反覆復用的歷程。

Background: Chemsex, the use of recreational drugs by gay men who have sex with men (GMSM), has long been a concern among lesbian, gay, bisexual, transgender and queer (LGBTQ) populations. This behavior not only contributes to sexually transmitted infections but also poses risks of accidents. When recreational drug use escalates to addiction, it harms individuals' physical and psychological well-being, affecting intimate relationships, social connections, and daily functioning. However, due to social stigma and cultural factors, the proportion of the LGBTQ seeking help for drug use or chemsex is relatively low, particularly among gay men. Hence, through exploring the chemsex experience and help-seeking dilemma in gay men, the context of chemsex will be comprehended and disclosed via research evidence that provides more tailored resources to address their chemsex-related needs. Purpose: This study aims to explore the initiation and progression of chemsex behavior and help-seeking experiences among gay men. The researcher analyzed subjective experiences of chemsex among GMSM and came up with emerging themes concerning recreational drug use and its subsequent sexually transmitted infections during chemsex. Methods: This phenomenological study employed purposive and snowball sampling techniques to recruit participants from three sources of particpants, i.e., "Anonymous AIDS Screening Stations," "Psychiatric outpatient departments of two study hospitals," and "Non-governmental LGBTQ alliance organizations." Participants were selected based on Pre-Exposure Prophylaxis (PrEP) experience and the 9-item Concise Mental Health Checklist (CMHC-9) scores. Semi-structured interviews were conducted to collect the experiences of gay men who had personally engaged in chemsex within the past two years. Colaizzi's data analysis method was employed. Results: The study included 16 participants, with an average age of 33 years old. The findings were categorized into four themes describing the transformative features under the chemsex context: "The Beginning of Chemsex," "The Sinking Phase," " Help-seeking Phenomenon," and "Advice and Suggestions." Gay men were initially drawn to chemsex due to their desire for social connections and the pursuit of sexual comfort. The immediate feedback from recreational drug use led them to continue engaging in chemsex, eventually incorporating recreational drugs into their daily lives. As time goes on, gay men began to experience the negative effects of chemsex, prompting them to consider quitting and seeking help. However, the study revealed that gay men with chemsex encountered obstacles during the help-seeking process, including social stigma, family pressure, and negative healthcare experiences. Lastly, they offered four recommendations in terms of education, action, gay men community support, and policy based on existing chemsex-related demands and current regulations of drug use. Discussion & conclution: Based on the experiences and contexts elucidated by the participants in this study, it is found that gay men's chemsex behavior originates from the pursuit of pleasure and a yearning for interpersonal and intimate relationships. As gay men integrated recreational drug use into their daily lives, they sank into an indulgent lifestyle. When faced with chemsex challenges, gay men may turn to self-help, informal assistance, or formal services to help themselves. In summary, this study revealed that social support significantly shapes chemsex gay men's help-seeking behavior, with "emotional support" emerging as a paramount requirement. Nevertheless, even after assistance-seeking efforts, these individuals may still relapse into chemsex or even abandon seeking help when faced with obstacles. Consequently, aiding gay men with chemsex in disengaging from recreational drug use requires a comprehensive approach. This includes the dissemination and advocacy of help-seeking resources while cultivating a supportive help-seeking environment for GMSM. This will help gay men to learn self-awareness and develop self-identity after experiencing relief from addiction symptoms through professional treatment, and to create a climate of acceptance and companionship during the journey of relapse under chemsex experience.