Rehabilitating Our Approach to Gay Men Who Use Drugs

Much of the writing on HIV prevention is loaded with punitive clichés about gay men that highlight psychological deficits, lack of self control, and prevention fatigue. Perhaps the most repeated one since the onset of the epidemic suggests that the majority of gay men are into drugs and couldn’t care less about becoming infected while enjoying their substances.

While these clichés have persisted throughout the epidemic, a closer look at statistics shows a more nuanced portrait of gay men. The Sex Now survey (Canada’s largest survey of gay and bisexual men) showed that the vast majority of gay men report no risk for HIV in the previous year (70 percent) nor did most report any use of party drugs over the same time period (85 percent), not even once.

One issue of concern emerging from the Sex Now survey, however, is that gay men who do use drugs are nearly twice as likely to report HIV risk. Other researchers have also demonstrated this relationship. But concluding that “drugs = uncontrolled gay men = risky sex ”, and that health professionals should focus their efforts on eradicating drug use among gay men to prevent HIV, ignores the complexity of gay men’s lives and the reasons they engage in both risky sex and substance use. For example, a recent UK study looking into the narratives of gay men who use drugs suggests that only a small minority were unable to control their behaviour when doing drugs. For others, risky sex was a decision made independently of drug use, while others enjoyed their sex lives and substances without any HIV risk.

Moreover, the explanation for higher sexual risk among drug using gay men may not actually reside in drug use itself. In Sex Now, gay men who reported drug use were also likely to report an array of other psychosocial difficulties such as depression, anxiety, suicidality, experiences of violence and homophobia and episodes of binge drinking. All these factors are known in the HIV literature to increase one’s vulnerability to HIV.

Finally, it is important to consider how public health and community agencies have generally responded to the prevention needs of drug using gay men. A recent review of prevention activities in BC demonstrated that the gay drug-using population is largely ignored by prevention. Initiatives that have been implemented have tended to focus on warning gay men against the danger of mixing drugs and sex, while doing very little to empower more informed decisions. Again, this strategy does not attend to gay men’s needs – most men are familiar with the danger of drugs with sex. Fear-based campaigns ignore the co-occurring factors and health problems gay men may be experiencing in conjunction with drug use. A strategy that focuses on educating solely on the risks of drugs reinforces the cliché that gay men cannot make rational decisions.

Rather than blaming gay men, we need a more positive approach to sex and drug research that examines gay men’s experiences with substances beyond a statistical correlation with risky sex. This research needs to take into account the burden of other health issues in this sub-population. We should demand targeted health promotion initiatives that reflect gay men’s real needs and work to reduce the bias of the public health field which appears to have issues with both gay sex and substance use.

olivier ferlatte

Author: Olivier Ferlatte, Research Education Director at the Community-Based Research Centre for Gay Men’s Health, Vancouver.

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

Straight to Work

Canada is a country of labourers; a nation of hard working loggers, fishermen, farmers, and miners, toiling away in remote rural environments. To Canadians, these men are deemed rugged, resourceful, and above all heterosexual. However there is something we tend to overlook: some of these heterosexual men are having sex with one another.

These men are working in majority male-only environments remotely perched in the corners of our most rural landscapes, and on Vancouver Island such men have existed for a long time according to the anecdotal evidence available. Some might suggest that anecdotes are little to go on as evidence, but I disagree. Sometimes, these narratives of lived human experience are all we have in the face of a research void. Through these narratives we are learning that there are men having sex with men in a “MSM Vacuum;” a sex space that exists in isolation from and without connection to the social and cultural norms and expectations of men’s sexuality. Studies have explored this idea of a stand-alone MSM vacuum, such as research around rural gay experiences, incarcerated men and their sex practices, and the sex practices of men in the military. However, no research seems to have been done about specific rural work-based male-dominated labour environments.

Instead, these moments exist in a vacuum where the activities taking place within it are not connected to the outside world, and therefore divided from social expectations on sexuality, gender roles, and societal norms. For many of these men the key to entering into this vacuum is through the use of substances, such as alcohol, marijuana, or other harder drugs. If consequence-free MSM sex is the box, then the use of substance is the key to unlocking it.

This substance use could be interpreted in many ways. Does intoxication provide freedom from consequences in the decision making process? Does it lower a guard around secret sexual preferences, or create a heightened state where impulse control decreases? Or is it the absence of available female partners? Without more formidable research into the topic, this might be something we are left wondering over for a long time. The two consistent pieces of this MSM vacuum that have been shared with me thus far are a) this vacuum occurs often after substance use, and b) the use of condoms or other prevention barriers are virtually non-existent within these spaces.

With that in mind, how do we in turn create approachable HIV/STI prevention programming for MSM when some of these men identify as straight, and the prevention messages are directed toward gay/bisexual identified men? Accessing and engaging the varied MSM populations has always been a challenge in HIV work, and looking at men in this MSM vacuum might offer some further insights into how we can implement sexual health programming that is approachable to any and all men that engage sexually with other men. Perhaps HIV/STI prevention work will go further if we explore how sexuality is something more internal and experiential than longitudinal; perhaps straight men having sex with other men are simply straight men having sex with men.

samuel salvati

Author: Samuel Salvati, Men’s Wellness Program Coordinator, AIDS Vancouver Island

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