Access without speakability: rush use, chemsex boundaries, and sexual healthcare communication among MSM in China.

INTRODUCTION

Rush use has been increasingly discussed in relation to HIV/STI risk among men who have sex with men (MSM) in China, yet less is known about how users interpret rush in sexual contexts or whether it becomes discussable within sexual healthcare. This study examined how rush was understood, classified, and managed in relation to pleasure, risk, chemsex boundaries, and healthcare communication.

METHODS

Semi-structured interviews were conducted with 30 adult MSM in China who had used rush in a sexual context within the previous 12 months. Interviews explored participants' experiences of rush use, distinctions between rush, sexual enhancement, "drug use," and chemsex, risk perception and management, and experiences with sexual healthcare. Data were analyzed using reflexive thematic analysis.

RESULTS

Rush was frequently normalized as sexual facilitation, with participants describing it as a way to manage bodily readiness, sexual confidence, partner expectations, and app-mediated encounters. Its classification remained unstable: participants often distinguished rush from more stigmatized forms of "drug use," while recognizing that its meaning could shift in longer, group-based, or more substance-involved encounters. Risk perception was similarly selective. HIV/STI risk was more readily articulated through familiar prevention vocabularies, whereas rush-specific concerns were often treated as embodied, situational, and privately manageable. Even among participants who accessed testing, PrEP/PEP-related care, self-testing, or community-based services, disclosure could remain partial when discussing rush required making sexual circumstances, bodily after-effects, partner pressure, or substance use visible.

DISCUSSION: Access to sexual healthcare did not necessarily make rush-related concerns fully speakable. Sexual health services may therefore benefit from confidential, non-judgmental, and MSM-sensitive communication that allows rush to be discussed as part of sexual practice while addressing bodily effects, possible substance interactions, partner dynamics, and harm-reduction needs.