Social Space, Sexual Identity and Substance Use

In many big cities, the main social scenes of lesbian, gay, bisexual, transgender and questioning (LGBTQ) communities centre on gay clubs and bars. These spaces allow individuals, who may feel socially isolated, a safe venue to express themselves outside the heteronormative (heterosexuality as the perceived norm) spaces of daily living.  In recent years, the selection of safe social spaces for LGBTQ has increased, but clubs and bars still remain a cornerstone. As such, many LGBTQ people see going to these bars and clubs as a cultural norm. Unfortunately in many cases, social spaces such as these may foster and incorporate the use of alcohol and recreational drugs into that cultural norm.

Research shows sexual minorities have greater substance use rates than the general population. Since 2008, we have coordinated the Centre for Addictions Research of BC’s High Risk Population Surveys, a project interviewing active drug users in Victoria and Vancouver.  Last year we published a paper based on this data in the journal Culture, Health & Sexuality examining substance use and sexual identity. Would sexual identity signal increased substance use in a group of active users, or would the fact they were already using drugs cancel out sexual identity’s predictive effect?

What we found was that even among active substance users, sexual identity was still a strong predictor for certain types of drugs. Mainly, the social drugs of alcohol, ecstasy and ketamine were found to be more likely used by lesbian, gay and bisexual (LGB)-identified than straight-identified participants. In addition, LGBs reported greater negative impacts to areas such as finances, health, and social lives from ecstasy and ketamine than straight participants. The social nature of these substances leads one to think back to the social spaces that dominate the LGBTQ communities and how many revolve around the use of alcohol and associated substances. Even among active users, the resilient effect of sexual identity remains.

Tremendous strides are continually being made in expanding the options for LGBTQ to meet and socialize in venues that are welcoming and safe outside of the club and bar scene.  Success has been experienced by Vancouver Coastal Health through their ‘CALL Out!’ project as well as the Trans Youth Drop-in, strengthening socialization and engagement in these communities.  As well, local queer resource centres such as QMUNITY in Vancouver continue to foster social connections for all ages through a variety of groups and activities. As the focus on bars and clubs as the main spaces for socialization continues to diffuse, along with the increasing social acceptance of LGBTQ individuals, it will be interesting to see whether sexual identity remains a predictor for substance use in the future.

clifton chow Vallance Kate-

Authors: Clifton Chow, Research Affiliate, Centre for Addictions Research of BC; Kate Vallance, Research Associate, Centre for Addictions Research of BC

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

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

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.

eric roth

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