An Outreach-based Harm Reduction Model Addressing Stimulant Use and Chemsex among Key Populations in Indonesia: Development, Piloting, and Lesson Learned
E-poster submission to AIDS 2026, the 26th International AIDS Conference at Rio de Janeiro, Brazil on 26-31 July 2026. PPH UAJ participated virtually.
Social and behavioural aspects and approaches to HIV prevention and living with HIV.
Yohannes Gentar, Eric Sindunata, Fikri Haidar, Dian Retno, Bayu Lesmana, Maradona, Paldi, Gracia Valeska Simanullang, Ignatius Praptoraharjo
Background
Patterns of drug use among key populations in Indonesia have shifted from predominantly opioid use to amphetamine-type stimulants (ATS), often in sexualized contexts known as chemsex. This shift is associated with heightened risks of HIV transmission, mental health problems, and other comorbidities.
Meanwhile, existing harm reduction programs remain largely focused on people who inject drugs and HIV prevention, with limited responsiveness to stimulant use and chemsex practices.
Therefore, strengthening outreach workers’ capacity to address these emerging risks is therefore critical to ensure a relevant and comprehensive harm reduction response.
Description
This project aimed to develop, pilot, and disseminate an outreach-based harm reduction intervention module focused on ATS use in sexual contexts among key populations, including men who have sex with men, sex workers, transgender people, and the general population.
The program employed a multi-stage, participatory approach encompassing literature review, stakeholder consultations, focus group discussions with communities, outreach workers, and health facilities, module development, training, piloting, and dissemination.
This module integrates harm reduction principles, mental health screening, risk assessment, referral pathways, and community engagement strategies, and is designed to complement existing HIV and Point of Care (PoC) services. A six-week pilot and multiple training modalities (face-to-face and virtual) were implemented to assess feasibility and acceptance.
Lessons learned
The project demonstrated that indirect, trust-based engagement is more effective than direct conversations about drug use.
Outreach workers require sustained capacity building, particularly in communication skills related to stimulant use and chemsex. Short, flexible assessment tools were more feasible than lengthy instruments, and peer-led approaches proved highly effective in expanding reach.
Persistent stigma and limited mental health service readiness remain key barriers to effective referral.
Next steps
The intervention module is feasible, acceptable, and responsive to current drug use patterns among key populations in Indonesia.
Embedding harm reduction for stimulant use within outreach systems, strengthening outreach worker capacity, and improving service readiness—especially for mental health—are essential for scaling up comprehensive, community-centered harm reduction responses.
Key outreach strategies should tailor approaches to the unique dynamics of each population, setting, and immediate conditions.