Abstract
Introduction Synthetic stimulants such as mephedrone and MDMA are increasingly used to enhance sexual experiences. While this phenomenon is documented in several regions, it remains underexplored in Central Asia, where stigma and limited harm reduction infrastructure pose additional challenges. Methods A qualitative exploratory study was conducted using semi-structured interviews with six participants (aged 22–37) in Kazakhstan who reported using synthetic stimulants in sexual contexts. Participants were recruited via peer referrals. Thematic analysis was used to examine motivations, perceived effects, consent dynamics, sexual health behaviors, and access to support. Results Participants described stimulant use as a means to intensify intimacy, prolong sexual encounters, and reduce emotional barriers. However, risks included unprotected sex, prolonged sessions leading to physical exhaustion, and difficulties in navigating consent. None of the participants had received targeted harm reduction information or services. Stigma and fear of being judged were cited as major barriers to seeking help. Conclusions Sexualized stimulant use is present but largely hidden in Kazakhstan. Culturally sensitive, nonjudgmental harm reduction and sexual health services are urgently needed to address this intersection. Programs should integrate substance use and sexual health support, and actively work to reduce stigma around these practices.