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Background/Objectives: Sexualized drug use (SDU) and chemsex have emerged as a growing public health concern globally, reflecting complex intersections between sexual practices, psychoactive substance use, and structural vulnerabilities. In Brazil, however, evidence on healthcare access among individuals who engage in SDU/chemsex remains limited and fragmented. This scoping review aimed to map and analyze the available literature on healthcare access in this population, identifying barriers, facilitators, and gaps in care. Methods: The review followed the Arksey and O'Malley framework and Joanna Briggs Institute recommendations, with searches conducted in six databases (MEDLINE/PubMed, Embase, Scopus, SciELO, LILACS, and PsycINFO) for studies published between 2014 and 2025. Results: Eleven studies met the inclusion criteria, predominantly quantitative and concentrated in large urban centers. Findings indicate that healthcare access is shaped by persistent structural and symbolic barriers, including stigma, discrimination, fear of disclosure, and limited professional preparedness. Care remains largely centered on human immunodeficiency virus (HIV) and sexually transmitted infections (STIs) services, with insufficient integration of primary care, mental health, and substance use services, contributing to fragmented care. Significant gaps were identified, including the underrepresentation of women, transgender, and non-binary populations, and the absence of studies focusing on healthcare professionals. Conclusions: Substance use patterns reflect both global trends and local specificities, particularly the prominence of alcohol and cocaine in Brazil. This review provides the first synthesis of Brazilian evidence on chemsex from a healthcare access perspective. The findings highlight critical inequities and support the need for integrated, stigma-free, and context-sensitive care within the Brazilian Unified Health System. Based on these findings, the VIP-SDU/Chemsex Model is proposed as a multilevel framework to explain how structural, symbolic, and programmatic factors shape access and health outcomes.