An intersectoral policy response to chemsex in Barcelona: governance and public health action

Issue

Chemsex is increasingly reported in major urban settings in Spain, particularly in Barcelona, and represents an emerging public health challenge within LGBTI health. It involves the intentional use of drugs in sexual contexts among gay, bisexual and other men who have sex with men

Problem

Chemsex is associated with increased risks of substance use disorders, mental health problems, HIV and other sexually transmitted infections (STIs), as well as broader physical, mental and social harms. Its complexity—linked to stigma, mental health and social vulnerability—requires a coordinated and rights-based response. However, the current response in Barcelona remains fragmented, limiting the effectiveness and accessibility of prevention, care and support services

Results

In 2025, the Public Health Agency of Barcelona established a city-level coordination platform bringing together healthcare, social services, community organisations, law enforcement and people with lived experience. This led to the Barcelona Chemsex Response Programme 2025–2028, structured around 12 strategic axes across the continuum of care and key system components, including training, research, surveillance and coordination. Equity and user participation are embedded as cross-cutting principles. The programme includes 41 actions, such as strengthening care pathways, referral protocols, harm reduction, social support and integration of sexual and mental health services

Lessons

This policy framework acknowledges the complexity of chemsex and highlights the importance of intersectoral coordination, community participation and rights-based approaches in policy design and implementation. The Barcelona experience provides a transferable model of collaborative public health governance to address emerging challenges in LGBTI health

Key messages

• City-level governance and intersectoral coordination are essential to address chemsex as a complex public health issue.

• Rights-based, co-produced policies improve effectiveness and equity in responses to chemsex and LGBTI health challenges.