HERO——為從事藥愛 (chemsex) 的人提供支持
資料來源：http://www.thelancet.com/hiv第9卷/2022年10月 / 財團法人台灣紅絲帶基金會編譯
在 LGBTQ+ 人群的權利方面，台灣被譽為亞洲最進步的地區；然而，在性愛使用藥物方面仍然存在挑戰。復原、賦權，從藥愛中恢復 (Healing, Empowerment, Recovery of Chemsex ) HERO中心是解決這一問題的組織，並力求成為其他國家的榜樣。
HERO位於台灣南部，是一個綜合性的一站式中心。它由台灣台南市國立成功大學的柯乃熒教授於 2017 年在「遭受藥愛困擾的人們的需求」的推動下創立，旨在提供社會服務和能夠賦予社區權力的有利環境。柯告訴《刺胳針愛滋病毒期刊》，HERO 是台灣第一個關注藥愛議題並將藥愛作為全國性問題的組織。 HERO 活動負責人 Daniel Chung 解釋說，雖然台灣對 LGBTQ+ 友好，但圍繞藥物使用的問題並不那麼開放：「性別是可以的，但藥物使用問題很難」。
根據柯和 Chung 的說法，採取行動的催化劑是觀看了 2015 年關於性愛藥物使用的紀錄片 ChemSex，其中講述了 LGBTQ+ 活動家和健康專家大衛.斯圖爾特 (David Stuart) 的見解，並一致同意「我們需要邀請大衛」。不久之後，Stuart 多次訪問台灣並「啟發我們在台灣複製一個類似的中心」，柯補充說，當時人們根本沒有能力管理性愛藥物使用問題。
今年，HERO 進行了自我改造並搬進了新的辦公場所，「我們演變成 2.0 版的 HÉROS，結合了社區藥局、診所和非政府組織，以促進我們與藥愛相關的服務」，國立成功大學參與 HERO 的研究員Carol Strong解釋說。「[之前]我們嚴重依賴醫院，因為我們需要傳染病專家和檢驗，這實際上非常困難，我們想，要是我們能擁有自己的大樓、自己的診所就好了，因此，他們完全脫離了醫院。我們將一切都轉移到了完全基於社區的地方」。
一樓是藥店，二樓是診所，三樓是藥愛諮詢師，真正的整合空間。提供的服務包括愛滋病毒預防和治療（包括暴露前預防）、性傳播感染檢測和治療以及與藥物使用有關的康復小組（包括精神科醫師和社會工作者）。空間的分配反映在服務的凝聚力和全面性上。「我們可以在2小時內進行暴露前或暴露後預防，提供心理諮詢，精神科醫生提供焦慮症藥物，並提供愛滋病毒醫療服務」，柯熱情地說。
該中心贏得了許多忠實的支持者，包括肯特（為保密起見，化名Kent），他認為 HERO 幫助他克服了長達十年藥物使用上的奮鬥。「HERO 幫助我回到現實和康復」，Kent 解釋說，他幾乎失去了工作、家庭和家人。肯特說：「台灣的文化對 LGBT 友好，但用藥在社會中是隱藏的。你用藥所以你是壞人；我們不談論它，如果我想尋求幫助，我必須做出進入大樓的決定」。肯特生動地回憶起他對該中心的第一印象是一位熱情的社工握著他的手。然而在其他用藥者之康復模式，係將顧客視為患者，而在「HERO，感覺就像朋友，就像家人一樣，在東方文化中，家庭非常重要。對於康復小組來說，這是一個成功的策略」。
幾年前，英國倫敦衛生與熱帶醫學學院的福特.希克森(Ford Hickson) 訪問該中心時，正是這種熱情的態度引起了他的共鳴。「這令人印象深刻」，希克森說。「HERO 是台灣第一個為男男性行為者提供的綜合性健康和藥物使用服務，儘管台灣在 LGBT 平等方面取得了長足進步……藥物使用仍然受到嚴重的污名化，包括在同性戀社區中。藥愛場景是隱藏的，面臨物質使用的人很難獲得幫助。經營 HERO 的人明白這一點——該服務基於為這一亞群提供服務所需的保密、非評判性的方法」。
柯說，除了贏得國際仰慕者之外，HERO 還獲得了多項國家獎項。「這意味著他們認可 HERO 對 LGBT 的特殊照顧。高品質醫療保健的獎項意義重大，因為這顯示他們的工作得到了公認、授權、可見和認可」。柯渴望他們積累的知識的影響遠遠超出台灣的範圍，並與其他涉及性愛藥物使用的醫療保健專業人員分享該模型。「對我來說，我相信如果我們成功了，那將是一個全新的模式，一個社會企業。每個人都有與生俱來的治癒能力； 有了合適的環境，我們就能創造美好的未來」。
司馬.巴馬尼亞報導
HERO—providing support for those engaged in chemsex
http://www.thelancet.com/hiv 第 9 卷 / 2022 年 10 月
Taiwan is hailed as the most progressive region in Asia with respect to the rights of LGBTQ+ people; however, challenges remain with regards to sexualised drug use. The centre of Healing, Empowerment, Recovery of Chemsex (HERO) is one organisation addressing this issue and seeks to become a model for other countries.
HERO is situated in southern Taiwan and is an integrated one-stop centre. It was founded by Monica Nai-Ying Ko (National Cheng Kung University, Tainan City, Taiwan) in 2017 driven by “the needs of people who suffer from chemsex” to provide social services and an enabling environment that could empower the community. Ko told The Lancet HIV that HERO was the first organisation in Taiwan to focus on chemsex and to highlight chemsex as a problem nationwide. Head of HERO’s activities, Daniel Chung, explains that although Taiwan is LGBTQ+ friendly, issues around drugs use are not so open: “gender is OK, but drug issues are difficult”.
According to Ko and Chung, the catalyst to act was viewing the 2015 documentary film ChemSex about sexualised drug use featuring insights from David Stuart, an LGBTQ+ activist and health professional, and agreeing in unison that “we need to invite David”. Soon after, Stuart visited Taiwan several times and “inspired us to replicate a similar centre in Taiwan”, said Ko who added that at the time people simply were ill equipped to manage sexualised drug use.
This year, HERO reinvented itself and moved into new premises, “we evolved into HÉROS, a version 2.0, combining a community pharmacy store, a clinic and the NGO to facilitate our chemsex-related services”, explains Carol Strong (National Cheng Kung University) a researcher involved with HERO. “[Before] we heavily relied on the hospital because we needed the infectious disease specialists, the tests, and it was actually quite difficult, we thought, if only we could have our own building, our own clinic, and hence, they completely detached themselves from the hospital. We moved everything to fully community based.”
The first floor houses a pharmacy, the second floor a clinic, and the third floor has the chemsex counsellors, rendering it a truly integrated space. The services provided include HIV prevention and treatment (including pre-exposure prophylaxis), testing and treatment for sexually transmitted infections, and a drug-related recovery group (involving psychiatrists and social workers). The allocation of spaces is reflected in how cohesive and comprehensive the services are. “We can get pre-exposure or post-exposure prophylaxis within 2 h provide psychological counselling, a psychiatrist to provide medicine for anxiety, and provide medical care for HIV”, Ko said enthusiastically.
The centre has garnered many devoted supporters, including Kent (name changed for confidentiality), who credits HERO with helping him overcome a decade-long struggle with drug use. “HERO helped me to go back to reality and recovery”, states Kent, explaining that he almost lost his job, home, and family. According to Kent: “Taiwan’s culture is LGBT friendly, but drug use is hidden in society. You use drugs you are bad; we don’t talk about it, and if I want to find help, I have to make a decision to enter a building.” Kent vividly recalls how his first impression of the centre was of a welcoming social worker who held his hand. While other drug use recovery models, treat clients as patients, “HERO, felt like a friend, just like family and in eastern culture, family is very important. It’s a successful strategy for a recovery group.”
It was this welcoming approach that really resonated with Ford Hickson (London School of Hygiene and Tropical medicine, UK) when he visited the centre a few years ago. “It was impressive”, Hickson said. “HERO was Taiwan’s first integrated sexual health and drugs service for men who have sex with men, and although Taiwan has made great strides in LGBT equality…drug use is still very heavily stigmatised, including among the gay community. The chemsex scene is hidden and people facing substance use find it difficult getting help. The people running HERO understood this—the service is based on the confidential, non-judgemental approach needed to serve this subpopulation.”
Aside from garnering international admirers, HERO has received a number of national awards, says Ko. “It means they recognise HERO’s special care for LGBT. The awards for high quality health care were significant, as it showed that their work was recognised, authorised, visible, accredited.” Ko is keen that the effect of their accrued learning extends well beyond the remit of Taiwan and to share the model with other health-care professionals involved in sexualised drug use. “For me, I believe if we are successful, it will be a brand-new model, a social enterprise. Everyone has an innate healing power; with the right environment, we can create a bright future.”
Sima Barmania