When substance use meets sexuality: perspectives of gays, bisexuals and men having sex with men (gbMSM) regarding their sexualized drug use

Background: Sexualized drug use (SDU) among gbMSM is a phenomenon of particular concern regarding addiction, physical and mental health risks. Few studies document how sexuality and drug use intertwine over time which is essential to implement prevention and treatment strategies addressing SDU. This study aims to explore the interrelations between substance use trajectories and various dimensions of sexuality from the perspectives of gbMSM.

Methods: Twenty adults gbMSM who reported problematic substance use over their lifecourse (CAGE/DAST measures) and that had at least one SDU episode within the last year were recruited in Quebec (Canada) by community organizations, publicities on social media, and network sampling to participate in a one-on-one semi-structured interview. A thematic analysis was performed on the interview transcriptions, guided by a syndemic and a sexual theoretical perspective.

Results: The interrelation between substance use and sexuality seems to follow a trajectory where the turning point is when the gbMSM are first introduced to methamphetamine in a sexual setting. Many factors influence, over time, the interrelation between substance use and sexuality, such as the need for socialization and performance on a sexual level leading to sexuality is a cornerstone of maintenance of substance use and relapses. These factors are shaped by the affective, psychological, and sociocultural dimensions of sexuality embedded in their substance use. SDU cessation is influenced by the desire to regain/gain a satisfactory sexual life and the rediscovery of themself.

Conclusion: This study suggests that the interrelation between substance use and sexuality is influenced by time and varies across sexuality dimensions. Understanding the SDU trajectory, transitions, and turning points will help clinicians better assess and address the factors strengthening SDU. In addition, these results could inform new informational, educational, environmental prevention, and treatment strategies by addressing specific characteristics influencing the development of a problematic SDU.