“It’s how we get to know each other”: Substance use, connectedness, and sexual activity among men who have sex with men who are living with HIV

Abstract

Background Among MSM, substance use increases risk for acquiring HIV and is associated with sub-optimal engagement in HIV-related care. Most research related to substance use and sexual activity among MSM focuses on identifying and reducing risk of HIV acquisition and transmission rather than pleasure and agency. However, substance use may also facilitate sexual pleasure and build community, which could be particularly meaningful for individuals who cope with intersecting stigmas related to the disease, sexual identity, and drug use. Methods To explore the ways in which substance use both promotes and hinders positive sexual expression and healthy sexual relationships, we conducted a secondary analysis of 33 semi-structured qualitative interviews with MSM living with HIV who were poorly engaged in care and reported recent substance use. Results Thematic analysis revealed that substance use was perceived as: (1) a potential pathway to intimacy and enhanced sexual experiences; (2) a tool to help access partners and gain entry to a community; and (3) a source of empowerment, though some noted that it sometimes came at the cost of sexual disempowerment and unbalanced relationships. Conclusions Clinically, our results suggest that the complex motivations for substance use during sexual activity need to be carefully considered and discussed with patients, especially when attempting to decrease problematic use as a pathway to improved HIV self-care.

Substance use and sexual risk behaviour among HIV-infected men who have sex with men

“…People living with stigmatized identities (e.g., sexual orientation -men who has sex with men, HIV diagnosis, socioeconomic status) may also use substances during sexual intercourse to build intimacy or strengthen connections that they struggle to find elsewhere. Individuals also used substance to decrease painful emotions, relieve psychological suffering, and maintain emotional stability and control [13]. These findings suggest that a comprehensive, interdisciplinary approach is obligatory to enable the attainment of a healthy approach to sexual life and there is a need for mental health support which should be among the interventions offered to MSM engaging in chemsex.…”

Effects of Methamphetamine and Narcotics on Sexual High-Risk Behaviors

“…However, drug use motivations are complex and might vary by population. Following a thematic analysis approach, Stanton et al showed that substance use was considered (1) a way to increase intimacy and have better sexual intercourse; (2) a pathway to improve access to partners and gain entry to a community; and (3) a potential way for empowerment (27). is a stimulant that powerfully activates brain chemicals linked to feelings of reward and pleasure.…”

“The familiar taste of poison”: a qualitative study of multi-level motivations for stimulant use in sexual minority men living in South Florida

“…Stimulant use (referred to here as usage of methamphetamine, crack-cocaine and/or powder cocaine) among sexual minority men who have sex with men (SMM) is up to 20 times more prevalent than in the general population [ 1 ]. Stimulants, especially methamphetamine (meth), can be used by SMM for increased energy and for sexual pleasure, reducing inhibitions, prolonging sexual encounters and has been associated with HIV-vulnerability through related risk behaviors [ 2 , 3 ]. Miami-Dade, Broward and Palm Beach counties (South Florida) ranked first in US HIV incidence from 2015 to 2019, is consistently in the top five metropolitan statistical areas in the US [ 4 ] and is a priority jurisdiction in the Ending the HIV Epidemic (EHE) plan [ 5 , 6 ].…”

“…Previous findings have highlighted the role of stimulants in sexualized drug use for SMM, such as “party and play (PnP)” or “parTy” in North America [ 3 , 7 , 8 ]. Combining stimulant such as meth with amyl nitrites (i.e., poppers) and erectile dysfunction drugs (PnP) can be used to increase libido, social connectedness and enhance sexual experiences[ 3 , 7 , 8 ].…”

“…Previous findings have highlighted the role of stimulants in sexualized drug use for SMM, such as “party and play (PnP)” or “parTy” in North America [ 3 , 7 , 8 ]. Combining stimulant such as meth with amyl nitrites (i.e., poppers) and erectile dysfunction drugs (PnP) can be used to increase libido, social connectedness and enhance sexual experiences[ 3 , 7 , 8 ]. As such, stimulant use is also associated with increased HIV-related risk behaviors, including condomless anal sex, multiple sexual partners, and sex with partners of an unknown HIV serostatus [ 1 , 2 ].…”