Sexual Behavior Patterns of Methamphetamine-Using Gay and Bisexual Men

We assessed the sexual behaviors of 49 gay and bisexual methamphetamine users in New York City and the relationship between their use of the substance and their sexual practices as part of a larger investigation of the behavioral aspects of methamphetamine use. Participants were assessed on their use of methamphetamine and their sexual behaviors in conjunction with use of the substance. Participants reported equivalent rates of unprotected anal insertive and receptive behaviors when comparing their sexual acts while high on methamphetamine, high on other drugs, and sober. In addition, equivalent rates of “extreme” sex acts were found for 10 of the 12 behaviors examined while high on methamphetamine and while sober. While we found few differences in terms of rates of sexual behaviors, our analysis revealed more frequent risky sexual behaviors among HIV positive men when compared with HIV negative men. Our results suggest that methamphetamine attracts a hypersexual risk-taking group of men who engage in unprotected sexual behaviors regardless of their methamphetamine use. Treatment implications are discussed.     

Sexual behavior patterns of methamphetamine-using gay and bisexual men

We assessed the sexual behaviors of 49 gay and bisexual methamphetamine users in New York City and the relationship between their use of the substance and their sexual practices as part of a larger investigation of the behavioral aspects of methamphetamine use. Participants were assessed on their use of methamphetamine and their sexual behaviors in conjunction with use of the substance. Participants reported equivalent rates of unprotected anal insertive and receptive behaviors when comparing their sexual acts while high on methamphetamine, high on other drugs, and sober. In addition, equivalent rates of "extreme" sex acts were found for 10 of the 12 behaviors examined while high on methamphetamine and while sober. While wefound few differences in terms of rates of sexual behaviors, our analysis revealed more frequent risky sexual behaviors among HIV positive men when compared with HIV negative men. Our results suggest that methamphetamine attracts a hypersexual risk-taking group of men who engage in unprotected sexual behaviors regardless of their methamphetamine use. Treatment implications are discussed.     

A comparative analysis of methamphetamine use: black gay and bisexual men in relation to men of other races

We investigated the patterns and correlates of methamphetamine use among Black gay and bisexual men who participated in a large-scale study of club drug use, and sexual behavior in combination with club drug use in New York City. Almost half of the Black men (49%) in the sample indicated use of methamphetamine in the 4 months prior to assessment, a proportion somewhat lower than their White counterparts. In terms of the overall sample, the proportion of the Black men in the study was equivalent to the proportion of methamphetamine users who identified as Black. Black methamphetamine users tended not to reside in neighborhoods considered traditionally gay, were more likely to be HIV-positive, have lower educational attainment, and have lower levels of income than other methamphetamine users. In terms of frequency and reasons for use, Black methamphetamine users did not differ in any substantive way compared to other races and ethnicities. In addition, they did not differ along any key demographic lines from Black non-methamphetamine users. Poly-drug use was common among all Black men in the sample, with almost all methamphetamine users also reporting use of cocaine, but cocaine users not necessarily reporting methamphetamine use. Once a drug that was considered popular only among White gay men, methamphetamine use has been shown to transcend racial and ethnic lines. Because of the synergy that exists between use of the drug, the concentrated levels of HIV in the Black gay population, and the sexual disinhibition engendered with methamphetamine use, this drug presents a potentially mounting public health challenge.     

Initiation into methamphetamine use for young gay and bisexual men

Research over the past 10 years has suggested that methamphetamine use has become a significant problem and is associated with risky sexual behaviors among gay and bisexual men. In order to better understand initiation into methamphetamine use among gay and bisexual men, qualitative analyses were performed on a sample of young gay and bisexual men (ages 18–29) in New York City. Participants were recruited as part of a larger study which used time–space sampling to enroll club-going young adults who indicated recent club drug (ecstasy, ketamine, GHB, methamphetamine, cocaine, and/or LSD) use. The data for this paper are derived from the qualitative interviews of 54 gay and bisexual male methamphetamine users. At initiation (1) methamphetamine was used in a social, non-sexual setting for a majority of the participants; (2) participants expressed limited knowledge of methamphetamine; and (3) many participants used cocaine as a basis for comparison when describing various effects of the drug. The understanding that at initiation methamphetamine was not solely used as a sexual enhancement for members of this community may enable health workers to more accurately target potential users when putting forth intervention efforts. Future research should aim to gain a better understanding into the role that methamphetamine plays in non-sexual contexts, particularly among gay and bisexual men who may not be part of the club “scene.” The relationship between attitudes towards methamphetamine and other drugs, particularly cocaine, among gay and bisexual men should be explored.     

Explanations for Methamphetamine Use Among Gay and Bisexual Men in New York City

Qualitative interview data from Project Tina, a formative investigation of methamphetamine use among gay and bisexual men in New York City, were used to explore the reasons men use methamphetamine. Interviews were conducted with 48 active methamphetamine users, and coding revealed that a majority of the men used the substance to enhance sexual experiences. However, usage was also related to physical needs, emotional needs, and socialization. Differential explanations were noted across participant HIV serostatus, age, and race/ethnicity. HIV seropositive men indicated significantly greater use of methamphetamine for sexual reasons, as did older respondents. HIV seronegative participants reported significantly greater use of the drug for social reasons, as did younger men. White participants were significantly more likely to use the drug for physical reasons compared to other men. These data suggest that methamphetamine use is multifaceted. Treatment programs should consider individual differences and motivations for drug use in tailoring programs.     

Explanations for methamphetamine use among gay and bisexual men in New York City

Qualitative interview data from Project Tina, a formative investigation of methamphetamine use among gay and bisexual men in New York City, were used to explore the reasons men use methamphetamine. Interviews were conducted with 48 active methamphetamine users, and coding revealed that a majority of the men used the substance to enhance sexual experiences. However, usage was also related to physical needs, emotional needs, and socialization. Differential explanations were noted across participant HIV serostatus, age, and race/ethnicity. HIV seropositive men indicated significantly greater use of methamphetamine for sexual reasons, as did older respondents. HIV seronegative participants reported significantly greater use of the drug for social reasons, as did younger men. White participants were significantly more likely to use the drug for physical reasons compared to other men. These data suggest that methamphetamine use is multifaceted. Treatment programs should consider individual differences and motivations for drug use in tailoring programs.     

Differences in club drug use between heterosexual and lesbian/bisexual females

Although there has been much empirical research documenting current trends in club drug use among gay and bisexual men, little research has addressed the variance among lesbian, bisexual, or heterosexual women. Using data collected through time-space sampling from dance clubs in New York City during 2005 (N=1104), this study explored sexual identity variance among women in the reported use of six club drugs: methamphetamine, cocaine, MDMA, ketamine, GHB, and LSD. Significant differences were found in that younger women were more likely to be active club drug users. Lesbian and bisexual women reported significantly higher lifetime rates of ecstasy, cocaine, methamphetamine, and LSD use compared to heterosexual women. These data suggest a need to better understand the influence of sexual orientation and sexual culture in relation to club drug use and to tailor health promotion efforts to meet the needs of various groups of club drug using women.     

Sexual Risk and HIV Infection Among Drug Users in New York City: A Pilot Study

Measures of sexual health were assessed during 2008–2009 in a New York City sample of 102 injection and noninjection users of heroin, cocaine, or crack. There was considerable overlap and transitioning between crack smoking and injecting. Crack users were also significantly more likely to be gay, lesbian, or bisexual than other drug users. In multivariate analysis, HIV infection was independently associated with crack use and with being gay or bisexual. In New York City, HIV prevention for drug users has focused on syringe access, safe injection, and drug user treatment, but further progress in HIV control will require strategies to address sexual health among people who use drugs. The study's limitations are noted.     

Poly-club-drug use among gay and bisexual men: a longitudinal analysis

OBJECTIVE: We sought to delineate patterns of poly-club-drug use among gay and bisexual men. Data were drawn from a large-scale 12-month longitudinal investigation of club drug use and sexual behavior among 450 racially, ethnically, and geographically diverse sample of gay and bisexual men in New York City. METHODS: Using community-based sampling, we recruited the sample from numerous venues and assessed the self-reported use of five drugs and their relation to one another: cocaine, ecstasy, GHB, ketamine, and methamphetamine. Multivariate hierarchical linear modeling (HLM) was utilized to examine associations of usage over the 12-month data collection period. RESULTS: Use of the five club drugs was highly related as noted by both parametric and non-parametric analyses of the cross-sectional data. Patterns of use over time also indicated significant longitudinal associations. Specifically, the use of methamphetamine over time was related to both the use of ecstasy and GHB. CONCLUSIONS: The analyses suggest that usage patterns of individual club drugs such as methamphetamine, ecstasy, and GHB among gay and bisexual men are highly related across time. These findings hold implications for the treatment approaches that are utilized to address substance abuse in this segment of the population, and suggest that practitioners focus on the totality of the substance abuse behaviors and not necessarily individual drugs which are administered.     

Sexual risk and HIV infection among drug users in New York City: a pilot study

Measures of sexual health were assessed during 2008-2009 in a New York City sample of 102 injection and noninjection users of heroin, cocaine, or crack. There was considerable overlap and transitioning between crack smoking and injecting. Crack users were also significantly more likely to be gay, lesbian, or bisexual than other drug users. In multivariate analysis, HIV infection was independently associated with crack use and with being gay or bisexual. In New York City, HIV prevention for drug users has focused on syringe access, safe injection, and drug user treatment, but further progress in HIV control will require strategies to address sexual health among people who use drugs. The study's limitations are noted.     

Priorities and practices of risk reduction among gay and bisexual men in Australia who use crystal methamphetamine for sex

Crystal methamphetamine (hereafter crystal) is associated with deleterious health outcomes, such as drug dependence and physical and mental health disorders. While some harms from crystal use can affect all users, there may be additional risks for people who combine the use of drug with sex. Compared with the broader population, gay and bisexual men in Australia report a higher prevalence of methamphetamine use, and crystal is the most commonly injected illicit drug among this population. The Crystal, Pleasures and Sex between Men research project was conducted between 2017 and 2019 and examined gay and bisexual men's crystal use in four capital cities in Australia, with the aim of identifying how to best support men who use crystal for sex. In this article, we examine how risk is understood and prioritised by gay and bisexual men who combine crystal use and sex and identify the range of risk reduction practices that they used. We classified these risks as those associated with the transmission of HIV, HCV and STIs, and those associated with dependence on either crystal or the sex it facilitated. Gay and bisexual men overwhelmingly prioritised the risk of dependence over any other risks associated with crystal-enhanced sex, and this prioritization was reflected in the risk reduction practices they employed. While some of the strategies that gay and bisexual men have adopted may contradict anticipated public health principles, they derive from a carefully considered and shared approaches to the generation of pleasure, the maintenance of a controlled form of feeling “out of control”, and the negotiated reduction of risk. The consolidation of these strategies effectively constitutes a “counterpublic health” underpinned by forms of “sex-based sociality”, which gives primacy to the priorities and practices of gay and bisexual men in Australia who combine crystal and sex.     

Multivariate Modeling of Club Drug Use Initiation Among Gay and Bisexual Men

This paper documents patterns and sequence of initiation of club drug use in a sample of 450 gay and bisexual men in New York City. Quantitative and qualitative baseline data from a yearlong longitudinal investigation conducted between 2001 and 2005 were analyzed. The study focused on the use of five club drugs—cocaine, GHB, ketamine, ecstasy, and methamphetamine—using self-reported indications of use for a period of 4 months prior to assessment. Patterns of club drug use among gay and bisexual demonstrated that poly-club-drug use is common, and that patterns of use can be differentiated along the lines of age, race/ethnicity, and sexual orientation, with those who are older, Black, and bisexual, reporting less club drug use. The majority of the men initiated use of the five club drugs as follows: (a) cocaine, (b) ecstasy, (c) ketamine, (d) methamphetamine, and (e) GHB. Variations in patterns were related to both age and level of poly-club-drug use. The sequencing and/or patterns of club drug use may be better explained by socialization processes in the gay community than by Gateway Theory, which has been traditionally used to explain patterns of drug use in the population. Future research should more closely examine the synergy of drug use combinations with an emphasis on measuring the extent to which the drugs are taken in synchronicity.     

MDMA ('ecstasy') use, and its association with high risk behaviors, mental health, and other factors among gay/bisexual men in New York City

This study assesses patterns of use of methylenedioxymethamphetamine (MDMA or 'ecstasy'), and the characteristics of users, in a sample of 733 men who have sex with men (MSM) in New York City. Among respondents, 13.7% reported using MDMA in the past 6 months, with mean frequency of use of 6.24 times in that period. MDMA users were found to be younger, less educated, to have had more male partners, more one night stands with men, more visits to bars or clubs and sex clubs or bathhouses, to have unprotected anal sex with a male, to be likely to have been the victim of physical domestic violence, to have more gay/bisexual friends, to have disclosed their sexual orientation to more friends, family members, and coworkers, and to have higher levels of gay community participation and affiliation. Among MDMA users, higher frequency of MDMA use was associated with being younger, having more visits to bars or clubs, more gay/bisexual friends, and having an HIV negative test result or never having been tested. MDMA users thus constitute a group at risk for sexually transmitted diseases, including HIV, and other problems. The data suggest that MDMA use is associated with being more 'out', which may be advantageous in helping gay men deal with harmful psychological effects of stigma, but may place individuals in settings that expose them to MDMA. These men have also presumably already been well exposed to safer sex messages within the gay community, thus raising challenges for interventions aimed at prevention, as well as opportunities (e.g. MSM and community specific interventions) that need to be further explored.     

Assessing Gay and Bisexual Men's Outcome Expectancies for Sexual Risk Under the Influence of Alcohol and Drugs

Alcohol and substance use plays a complex role in sexual behavior among gay and bisexual men. Data from 779 gay and bisexual men who reported sex with a casual partner in the past 3 months were collected in November 2002 at two large lesbian, gay, and bisexual community events in New York City. Participants reporting any unprotected anal receptive or insertive sex scored significantly higher in outcome expectancies for sexual risk taking while using drugs or alcohol, as did HIV-positive men and men with a higher rate of lifetime sexually transmitted infections. Sexual compulsivity, romantic obsessions, drug use, unprotected anal receptive sex, and HIV serostatus successfully predicted outcome expectancies for sexual risk while under the influence. Therapists and other health and social service providers working with gay and bisexual men should explore the connection between sexual risk and being under the influence to uncover psychosocial mechanisms related to this phenomenon.     

Assessing gay and bisexual men's outcome expectancies for sexual risk under the influence of alcohol and drugs

Alcohol and substance use plays a complex role in sexual behavior among gay and bisexual men. Data from 779 gay and bisexual men who reported sex with a casual partner in the past 3 months were collected in November 2002 at two large lesbian, gay, and bisexual community events in New York City. Participants reporting any unprotected anal receptive or insertive sex scored significantly higher in outcome expectancies for sexual risk taking while using drugs or alcohol, as did HIV-positive men and men with a higher rate of lifetime sexually transmitted infections. Sexual compulsivity, romantic obsessions, drug use, unprotected anal receptive sex, and HIV serostatus successfully predicted outcome expectancies for sexual risk while under the influence. Therapists and other health and social service providers working with gay and bisexual men should explore the connection between sexual risk and being under the influence to uncover psychosocial mechanisms related to this phenomenon.     

Alcohol use and stigmatized sexual practices of HIV seropositive gay and bisexual men

HIV seropositive (HIV+) gay and bisexual men continue to report unprotected sexual practices. Although numerous research studies have examined the relationship between alcohol use and unsafe sex, few have examined this from a qualitative perspective. In this paper, we examined the impact of alcohol use on stigmatized sexual practices among HIV+ gay and bisexual men with alcohol-use disorders. An ethnically diverse sample (81% men of color) from the New York City metropolitan area was recruited from a variety of settings frequented by gay and bisexual men. Using a qualitative interview, contextual issues regarding sexual activities under the influence of alcohol were examined. Qualitative analysis revealed that alcohol use facilitates engagement in sexual practices that are perceived as stigmatic while sober. Interventions targeting alcohol use and unsafe sex should be sensitive to the role which alcohol plays in the sexual practices among HIV+ gay and bisexual men.     

Multivariate modeling of club drug use initiation among gay and bisexual men

This paper documents patterns and sequence of initiation of club drug use in a sample of 450 gay and bisexual men in New York City. Quantitative and qualitative baseline data from a year-long longitudinal investigation conducted between 2001 and 2005 were analyzed. The study focused on the use of five club drugs-cocaine, GHB, ketamine, ecstasy, and methamphetamine-using self-reported indications of use for a period of 4 months prior to assessment. Patterns of club drug use among gay and bisexual demonstrated that poly-club-drug use is common, and that patterns of use can be differentiated along the lines of age, race/ethnicity, and sexual orientation, with those who are older, Black, and bisexual, reporting less club drug use. The majority of the men initiated use of the five club drugs as follows: (a) cocaine, (b) ecstasy, (c) ketamine, (d) methamphetamine, and (e) GHB. Variations in patterns were related to both age and level of poly-club-drug use. The sequencing and/or patterns of club drug use may be better explained by socialization processes in the gay community than by Gateway Theory, which has been traditionally used to explain patterns of drug use in the population. Future research should more closely examine the synergy of drug use combinations with an emphasis on measuring the extent to which the drugs are taken in synchronicity.     

GHB use among gay and bisexual men

The recreational use of gamma-hydroxybutyrate (GHB) has been relatively understudied, despite its popularity in gay communities. We examined the use of GHB in a sample of 450 club drug using gay and bisexual men. Of these, 29% indicated use of the substance in the recent past. GHB users were similar to those in the sample who reported no use along key demographic factors, although GHB users were more likely to identify as gay than bisexual and were slightly older. Poly-drug use was common, with close to half of GHB users combining with methamphetamine, MDMA, or ketamine; approximately one quarter also used GHB with alcohol. Participants reported that GHB was often used at nightclubs, circuit parties, sex parties, and sex clubs, with HIV-positive men more likely to use the substance in sexual contexts. Use of GHB is common among a certain subset of gay men despite warnings within the community about the potentially fatal effects of the substance, suggesting that more effort be given to educate drug using gay men about GHB.     

Destabilising the ‘problem’ of chemsex: Diversity in settings,relations and practices revealed in Australian gay and bisexual men's crystal methamphetamine use

In Australia, the crystalline form of methamphetamine (“crystal”) is a commonly used illicit substance associated with sexual activity among gay and bisexual men. Attention to psychoactive substance use among this population is the subject of increasing global concern regarding the intentional and simultaneous combination of sex and drugs, often referred to as “chemsex”. While not all gay and bisexual men who use psychoactive substances report problematic use, those who do often become representative of chemsex practices more generally, and the harms they experience become attributable to all men who use drugs for sex. The way in which these practices have been framed over the past few decades contributes to the rise of a narrow set of understandings of chemsex defined by the circumstances and behaviours presumed of drug-enhanced sexual activity. In effect, these understandings now align recognisable combinations of sexual and drug-using practices with assumed correlates of risk.The Crystal, Pleasures and Sex between Men study conducted 88 interviews with gay and bisexual men in four Australian cities between 2017 and 2018. Findings from the project revealed that men used crystal in a variety of settings and relations, which mediated their sexual practices and patterns of use. In looking at the wider context in which practices were associated with the combination of sex and drugs, we identified experiences that the contemporary discourse of chemsex—in its rhetorical proposition of at-risk behaviours and circumstances—may leave out of consideration. Our findings indicate that researchers should remain open to the variability and contingency of settings, relations and practices in gay and bisexual men's different networks when recommending public health responses to their engagement in drug-enhanced sexual activity. Accordingly, we seek to destabilise the definition of chemsex that precludes consideration of the influence of experiences beyond pre-determined risk parameters.     

Street careers: homelessness, drug use, and sex work among young men who have sex with men (YMSM)

"Hustling" or sex work is a common means of surviving on the streets and paying for drugs among homeless youth. In this article, we formulate the concepts of "street capital" and "street competencies" to describe how 10 young men who have sex with men (YMSM) in New York City accumulated various knowledge and skills throughout their childhood and adolescence, and later entered into homelessness and the street economy as sex workers. While half of these young men described themselves as gay or bisexual, sexual identity was not a primary consideration amongst these youth. All were homeless and/or users of illegal drugs, and all survived through intimate involvement in the "street economy"-an informal system of exchange that circulates drugs, sex, and money across a range of settings and participants. Based upon an analysis of life history accounts gained through ethnographic interviews, we describe common pathways into the street economy with an emphasis on understanding how these 10 young men of diverse backgrounds became involved in homelessness, drugs, and sex work. In doing this, we document the differential sources of knowledge and particular childhood experiences that launched these youth into coherent street careers.