The Netherlands

Strong connections between use of drugs and unsafe sex work

On the initiative of Mainline, Prostitutie & Gezondheidscentrum 292 / Prostitution & Health Centre 292, P&G292 carried out a survey of male and transgender sex workers between November 2013 and February 2014 in close cooperation with the Public Health Service of Amsterdam (GGD).

The goal was to gain more insight into the type and function of drug use during the sex work and the influence of drug use on sexual behaviour.

The results showed that the group targeted by the monitoring report uses drugs relatively frequently during their work. While under the influence of drugs they engage in riskier sexual behaviour. P&G292 finds the information provided by Mainline so relevant that they are carrying out an in-depth study among this group.

Mainline and P&G292 see it as important that male and transgender sex workers who use drugs be informed about conscious use. Such information is expected both to have a positive effect on damage to health due to drug use (harm reduction) and to help to prevent sexually risky behaviour under the influence of drugs.

Most important signals from the monitoring report

• Twenty-five of the thirty respondents used drugs while working
The assortment of drugs used is broad. Poppers, sniffing cocaine, alcohol, Viagra/Kamagra, and cannabis were used most frequently. The frequency with which drugs are taken during sex work varies. More than half of the respondents indicated that they regularly, usually, or always used drugs while they were working.

• More than half of the respondents who use drugs engaged in riskier sexual behaviour when they were under the influence of drugs
It is striking that the group of seropositive men engages in riskier sexual behaviour and more often uses a variety of different drugs. Unprotected anal contact occurs frequently in this connection. Half of the respondents had experienced negative effects as a result of their drug use.

• Under the influence: Consistently safe or more risky
More than half of the respondents who use drugs said that they engaged in riskier sexual behaviour when they were under the influence of drugs. According to their own statements, the respondents are either very consistent with regard to practising safe sex during their work when they are under an influence or regularly take sexual risks.

• Unprotected oral contact more often seen as a given
The fact that this is the case could be interpreted as indicating that men do not see such contact as risky sexual behaviour, but no specific questions were asked in this regard.

• The reason for drug use during sex work is mainly commercial in nature

Use is frequently a tool for delivering ‘better sex’ (read: earning more money). For the most part, the sex workersdo not use drugs because they are dependent; rather, the quality and quantity of their work are both reasons for them to use drugs.

• Use of uppers (crack cocaine, sniffing cocaine, speed, crystal meth)
Strikingly often, the use of uppers is said to have the function of prolonging sex (which results in more money being earned). In this connection, there may be a risk that condoms can tear due to insufficient lubricant (for longer-lasting sex) or that mucous membranes can dry out, leading to the development of sores. In connection with unprotected anal contact there is a significantly greater risk of transmission of STDs, HIV, and hepatitis C.

• There is a need for nuanced information regarding drug use, specifically in relation to sex work
The provision of individualized information and the provision of information via a website for sex workers are highly desirable. The existing websites provide good information about the various drugs, but clear, nuanced information on combination use (which combinations are good and which are not) cannot be found online.

• New online information
In cooperation with Mainline, P&G292 has developed a new site for this specific target group (male sex workers) with clear information.


Contactperson: Renate van Bodegom

Our current projects


Women who use drugs


Mainline was asked to review the current harm reduction programmes in Nepal from the perspective of women who inject drugs. Based on interviews with women we formulated recommendations to improve service delivery. 

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Services for Vulnerable Migrants who use Drugs in the EU

Netherlands, Belgium, Spain, Greece, Germany, France

Several risk factors increase the vulnerability of (new) groups of migrants to engage in problematic drug use. These risk factors include traumatic experiences, disengagement with society, unemployment and poverty. Services and municipalities throughout the European Union are faced with the urgent challenge to address these migrants’ needs. 

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Love Alliance

Burkina Faso, Burundi, Egypt, Kenya, Marocco, Mozambique, Nigeria, South Africa, Uganda, Zimbabwe

Mainline is a partner in the Love Alliance programme. The Love Alliance brings together organisations led by communities most affected by HIV and AIDS.

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Community consultations in Nepal

A round of community consultations by and for people who use drugs is currently being organised in Nepal. The goal is to identify key priorities that need to be taken up in the next Global Fund grant. Mainline offers technical support for this initiative.

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Stimulant Harm Reduction - Field Lab


In 2021 and 2022, SCDI in Vietnam and Mainline can continue to strengthen and expand the available harm reduction offer for people who use meth-amphetamines. After establishing the regional field lab in 2019 and 2020 we now have the opportunity to push this innovative initiative to the next level. One important element: to improve and expand the community mental health response. Moreover, the skills that were built in Hanoi's field lab are ready to be further disseminated across the South East Asian Region.

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Mindful Muscles

United Kingdom, Finland, Greece, Estonia, Serbia, Portugal, the Netherlands

Harm reduction approaches are rarely applied in a recreational sports setting. And why would we - sport equals health, right? Not always. Research shows that the use of performance and image-enhancing drugs (PIEDs) is quite common in various recreational sport scenes. And for those people who use frequently and in high doses, harm reduction can make a big difference.

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harm reduction for people who use crack cocaine


Mainline is starting a two-year project in Recife, Brazil, together with LANPUD, and the Free School for Harm Reduction (ELRD). The project aims to expand harm reduction and HIV care and support for young people who use crack cocaine.

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Mainline - Technical Advice

Did Mainline become a supplier? Yes: a supplier of technical advice for the Global Fund. Harm reduction organisations and networks of people who use drugs across the world can now request a Mainline training or capacity building. Read more about how this works.

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The use of drugs during sex is a growing worldwide phenomenon among men who have sex with men (MSM). Mainline has built a unique track record while working in the frontline of the Dutch 'chemsex' scene. Now, we also apply this expertise in an international context.

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Our finished projects


Assessing the drug scene


Mainline have been asked to assess the drug scene in five provinces in Zimbabwe. A team of three researchers worked in close collaboration with the Zimbabwe Civil Liberties Drug Network throughout 2022. The goal: to gain an insight into which drugs are commonly used and to recommend health interventions.

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Gender-based violence


Women who use drugs in Kenya face violence every day: At home. On the streets. By the police. In their communities. A unique study - conducted in Mombasa, Kenya - sheds light on the tough realities these women encounter. Urgent action is needed.

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Size estimation and service mapping: introducing harm reduction


Harm reduction is new in Zambia. Mainline was asked to estimate how many people inject drugs in the country and to map the already existing harm reduction and HIV services for people who use drugs. Based on this information, we drafted practical service guidelines. In doing so, Mainline hopes to have contributed to the introduction of harm reduction in Zambia.  

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Prison Health


Prisons in Indonesia are overcrowded and health services are limited. Is quality prison health too expensive? Not according to findings from Atma Jaya University, who applied the method of 'economic modelling' to prison health services, including drug dependency programmes. The findings fed important advocacy messages to improve the prison system in 2021. Moreover, Atma Jaya - via a 2021 implementation study - succesfully introduced motivational interviewing into the prison setting: an evidence-based method to assist people who are dependent on drugs and would like to reduce or quit their drug use.

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Quality Harm Reduction


Iran is renowned for its harm reduction programme. It was one of the first countries in this geographical region to adopt a harm reduction approach. Government supports and funds the programme. But the drug scene in Iran has changed over the past 20 years. More people are using stimulant drugs and, due to economic circumstances, more people who use drugs have become homeless. Mainline sets out to see whether the current programme in Tehran still fits the needs of the local people who use drugs.

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Women Who Use Drugs & Peer Workers

South Africa

Women Who Use Drugs face additional problems compared to their male counterparts. The harm reduction field far too often neglects the needs of women. To some extent, the same is true for peer workers: incredibly valuable staff in any impactful service. How can local services make sure that peer workers are valued, supported and living up to their full potential? And how can access for women who use drugs be improved?

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