Needle exchange and harm reduction programs in the UK provide a range of interventions which could be effective in reducing the risk of physical and psychological harm and minimizing the spread of blood-borne viruses for men who have sex with men (MSM) who engage in chemsex. To understand the existing practice, this qualitative study was undertaken using semi-structured interviews with 17 harm reduction practitioners working in needle exchange services in two UK cities. The following four themes were identified during data analysis: chemsex understanding and existing practice; drugs, sex, and pleasure; visibility; and inclusivity. Findings indicate that these harm reduction and needle exchange services are not equipped to meet the needs of MSM who inject drugs associated with chemsex. The heteronormative perceptions of needle exchange programs, coupled with the uncomfortableness of exploring pleasure, challenge the inclusive environment and universal offer these services promote. Practitioner perceptions of sexualized drug use and pleasure may be a barrier to reducing harm to MSM who engage in chemsex. Further research into interventions for chemsex is needed to inform a best practice model to be used across all drug and alcohol provisions in the UK.