UC Berkeley

Sexualized drug use (SDU) involves using drugs to enhance sexual activity with chemsex or party and play being prevalent among gay and bisexual men and men who have sex with men. This practice is linked to significant health risks, including mental health problems and HIV/STI transmission. Despite extensive research, traditional public health approaches often focus on the pathological aspects of SDU, ignoring broader social and cultural contexts. Particularly for harm reduction, lived experiences and personal strategies practiced by people who use drugs also tend to be excluded from intervention conceptualization. This dissertation addresses these gaps by adopting a counterpublic health (CPH) perspective, focusing on the health of sexual and gender diverse (SGD) people. This research is presented in three papers. Paper 1 is a narrative review of CPH literature focused on subaltern counterpublics, defining its tenets and identifying contexts where CPH is relevant. This review highlights the need for inclusive, context-sensitive public health approaches, proposing an emergent framework to enhance the understanding and application of CPH principles. Paper 2 critiques the assumption that all individuals conform to mainstream public health discourses, using harm reduction to explore how SGD individuals engaging in SDU navigate HIV/STI prevention and drug use risk reduction strategies. Through interviews with users of sexual networking apps, it captures their experiences, informing more nuanced harm reduction interventions. Paper 3 examines the interplay of moral agency, empathy, and stigma among SGD individuals in SDU contexts within a CPH framework. It investigates how participants perceive and exercise moral action and empathy while navigating stigma, emphasizing collective responsibility and inclusivity in harm reduction strategies. This dissertation advocates for reimagining public health through CPH, promoting inclusive and contextually-aware health interventions. By centering marginalized voices and valuing local knowledge, it aims to improve health outcomes and reduce disparities among marginalized communities.