April 2014 – Matters of Substance

Research with gay and bisexual men (GBM) in North America shows two distinct substance-use patterns related to sexual behaviour: 1) recreational drugs like methamphetamines, ecstasy and ketamine used to increase sexual pleasure; and 2) drugs ingested to enhance sexual performance, including erectile dysfunction drugs (EDD) like Viagra® , as well as amyl nitrates, or poppers.

For the purpose of this blog, we will focus on the enhancement-drug pattern, as EDD and poppers are associated with anal intercourse among GBM. For example, in Vancouver’s Momentum Health Study for GBM, participants reported on substance use within two hours before or during sex for up to five of their last sexual partners. Initial analysis of this event-level data provides the clearest link between substance use and sexual behaviour. For example, insertive anal intercourse was almost three times more likely to occur with EDD relative to receptive anal intercourse. Poppers, which relax vascular smooth muscles, were almost two times more likely to accompany receptive anal intercourse than insertive intercourse.

Both drugs have a history in HIV studies. Pfizer, the pharmacological maker of Viagra®, successfully defended itself from lawsuits claiming that recreational use of Viagra® “caused” HIV/AIDS among San Francisco GBM. Poppers, originally developed as angina treatment, were so strongly associated with initial North American GBM HIV/AIDS cases that the disease was originally called GRID, standing for “Gay Related Immunodeficiency Disease”. Today, both drugs remain important factors in HIV epidemiological research, with analysis of the large US Multicenter AIDS Cohort showing EDD and popper use, singularly, or in conjunction, significantly increase the probability of HIV sero-conversion.

Despite these similarities, EDD and popper availability differs today. EDD are readily available and increasingly used recreationally by North American straight and GBM. In contrast, because of their psychoactive properties, poppers are increasingly restricted in North America.

Because Momentum is a longitudinal study taking place over a five-year period, we can look at patterns around EDD and popper use for Vancouver GBM. This blog invites discussion about their use and availability. For example, we know that some GBM regret recent Canadian restrictions on poppers, whose muscle relaxing properties may act as HIV harm reduction by reducing tearing of delicate rectal tissue, an event associated with HIV transmission.

We want to hear from you about these issues.

Author: Dr. Eric Roth, Scientist, Centre for Addictions Research of BC; Professor, Department of Anthropology, University of Victoria

**Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC

What do school-based drug educators and sex educators have to learn from one another? Perhaps a great deal, especially considering some of the historical parallels of the evolution of these subjects in the curriculum and the perennial challenges they have posed to parents, teachers, and school administrators.

In North America, school-based drug education first began with the efforts of “temperance” (i.e., anti-alcohol) campaigners, such as the Woman’s Christian Temperance Union (WCTU), in the 1880s. Relatively new institutions at the time, public schools were regarded by such moral reformers as ideal spaces to advance their progressive causes. By the turn of the 20th century, most students were exposed to some form of temperance instruction, urging them not only to abstain from alcohol drinking, but also to support the political cause of alcohol prohibition.

Sex education was an even more daunting subject for schools to embrace, due in part to lingering Victorian-era puritanical attitudes towards even talking about sexuality. However, by the end of the 1914-1918 Great War, concerns about sexually transmitted infections among returning soldiers and the perceived public health crisis of “self-abuse” (i.e. masturbation) eventually opened classroom doors to the taboo subject of sex education.

The similarities of early approaches to drug education and sex education are striking. They both adopted the rhetoric and practices of science to inculcate essentially moral attitudes about these behaviours. They also drew heavily on principles of social Darwinism, suggesting that behaviours as such autoerotic or pre-marital sexual activity, and psychoactive substance use (other than caffeinated drinks and tobacco), were atavistic and degenerate. By the mid-20th century, temperance and sex education efforts in many schools had waned, but where they were undertaken, it was with little evolution from the earlier inaugural “social hygiene” programs.

In the 1960s, however, as the baby boom generation came of age, both sexuality and drug use became renewed public, political, and thereby educational, concerns. The sexual revolution of this era led to previously unimaginable topics for discussion in school classrooms, including homosexuality, masturbation and birth control. As a result, secular sex education classes have evolved significantly from the morally charged didacticism of a century ago.

By contrast, the escalation of the war on (some) drugs in the 1970s and 1980s resulted in most schools embracing scare-tactic methods in drug “education,” with abstinence-based programs not greatly different in instructional method and philosophical content to the temperance instruction pioneered by WCTU. For example, in some popular programs, uniformed police officers visit school classrooms to deliver lessons about drugs, a role and exercise significantly comparable to celibate clergy providing sex education.

A common challenge to delivering both sex and drug education in schools is a latent concern about affording young people transgressive knowledge: that openly discussing these topics—especially their pleasurable or other appealing aspects—will inflame the desire to try them. Thus, many parents and educators have supposed that the prevention of knowledge—sometimes protective, even life-saving, knowledge—is a viable means to preventing undesirable behaviours. However, in the information-saturated 21st century, when youth are avidly online for learning and socializing, the impulse to preserve innocence and moral purity through deliberate ignorance is unfounded.

What is the take-home lesson for today’s sex and drug educators? The naïve “just say no” indoctrinatory approach of yesteryear must become the “just say know” educational imperative of tomorrow.

Author: Kenneth W. Tupper, Adjunct Professor, School of Population and Public Health, University of British Columbia.

This blog post is adapted from Kenneth’s article, “Sex, drugs and the honour roll: The perennial challenges of addressing moral purity issues in schools,” published in the journal Critical Public Health (2014, vol. 23, no. 2, pp. 115-141, doi:10.1080/09581596.2013.862517)

**Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC

Month: April 2014

A Tale of Two “Sex Drugs” among Gay and Bisexual Men

Sex and Drug Education in Schools: Are There Parallels?