Background This study examined the perceived difficulty of getting help with substance use among sexual and gender minorities who have sex with men (SGMSM) who use methamphetamine during the early COVID-19 period. Methods SGMSM, aged 18+, who reported sex with a man and methamphetamine use in the past 6 months were recruited to complete an online survey using online advertisements. Ordinal regression models examined predictors of greater perceived difficulty of getting help. Explanatory variables included participant characteristics (i.e., age, HIV status, ethnicity, sexuality, gender, region, income) and variables assessing patterns of methamphetamine use (i.e., frequency, % time methamphetamine is used alone and during sex; perceived need for help) and patterns of healthcare access (i.e., regular provider, past substance use service utilization). Results Of 376 participants, most were gay-identified (76.6%), white (72.3%), cisgender (93.6%), and had annual incomes of less than $60,000 CAD (68.9%). Greater perceived difficulty of getting help was associated with having lower income, sometimes using methamphetamine prior to or during sex, and greater perceived need for help. Conclusion Based on these results, we urge greater investments in one-stop, low-barrier, culturally-appropriate care for SGMSM who use methamphetamine. This is especially important given that participants who perceive themselves as needing help to reduce or abstain from substance use perceive the greatest difficulty of getting such help.

Sexualized drug use, also known as Party and Play (PnP, chemsex) is a phenomenon that is increasingly pervasive among 2SGBTQ+ communities in Canada and has been epidemiologically linked to increased risk of HIV and other sexually transmitted and blood‐borne illnesses (STBBI). The phenomenon is highly stigmatized even within 2SGBTQ+ communities, perpetuating discrimination against individuals who PnP. Consequently, such individuals often remain invisible to formal care systems. Even as public health efforts seek to reduce the harms associated with PnP, narrowly epidemiological understandings of the phenomenon without understanding it from the perspectives of those with living experience of it, and—without attention to how historical, socio‐structural, and cultural factors shape the phenomenon—contribute to the stigmatization, disempowerment, and marginalization of people who PnP from healthcare access. In this chapter, we describe how an evaluation‐driven program design process grounded in the transformative evaluation paradigm and the principles of LGBTQ+ evaluation supported a paradigm shift for one public health agency in how they re‐conceptualized a more empowering approach for engaging people who PnP in dignified, meaningful care.