Crossing the chemsex divide: Using avatars for inclusive research on sensitive topics.

Ethical decision-making in sensitive research domains significantly influences data integrity and participant representation. Individuals with past trauma, cultural divergence or acute social stigma may feel excluded from studies with common recruitment and data collection methods (Edelman, 2023). Therefore, sexual health research risks yielding an incomplete, heteronormative perspective that fails to capture the experiences of the most marginalized. This is a problem for Chemsex research where sexualised drug use presents a challenge for research recruitment and engagement. We propose a solution: an inclusive research methodology utilizing synchronous avatar-masked online conversations. Providing a virtual mask for both service-user and practitioner via a digital platform can mitigate inhibitory effects of shame and stigma experienced within the Chemsex community and provides benefits for both parties; an avatar 'masked' practitioner will not display emotional cues indicating judgement, while an avatar 'masked' participant may become more immersed as they personalise their avatar and ensure their anonymity. A digital avatar format enhances participant openness, ensures ethical robustness through trauma-informed design, and offers a scalable vehicle for both qualitative inquiry and the delivery of addiction and sexual health interventions. We provide a checklist to help researchers and supporters develop anonymous avatar-masked interactions, and a checklist for reporting research on sensitive subjects (CRoSS) to help compare studies.