Relational and Structural Factors Informing the Methamphetamine-Using Behaviors of Sexual Minority Men

Background: Sexual minority men (SMM) have historically been exposed to societal and structural stressors that translate into poor social and health outcomes. One of these negative health outcomes is substance abuse, which research has long documented as a site of disparities among SMM. Methamphetamine is a particularly deleterious substance for SMM because its use is framed within social and sexual contexts that are inextricably associated with the causes and coping strategies related to social and structural stressors. Sexual compulsivity (SC) has long been positioned at the center of research among SMM. However, SC’s role in the substance using behaviors of SMM remains underdeveloped and its framing has often been considered problematic due to its potential to further pathologize and stigmatize SSM. Guided by syndemics theory, intersectionality frameworks, and revised stress and coping theory, the purpose of this mixed methods study is to contextualize the role of SC in the methamphetamine-using behaviors of SMM living with HIV.

Methods: Data were collected from 2014-2019 as part of a randomized controlled trial testing a positive affect intervention in San Francisco, CA. The sequential mixed methods analysis consisted of narrative analysis and network analysis.

Findings: The quantitative sample was comprised of 129 methamphetamine-using SMM living with HIV were used for the quantitative analysis. Mean age was 43 and 56% self-identified as non-White. A sub-sample of 24 participants was purposively sampled for the qualitative arm of the study. The mean age of participants in the qualitative sub-sample was 47, and over half (54%) self-identified as non-White.

Based on the narrative analysis, two-thirds of participants reported experiencing adverse events related to their sexuality. Seventy-one percent reported that sexuality was related to methamphetamine initiation and over 80% reported sexuality as the reason for sustained methamphetamine use. Participants reported that methamphetamine use was disruptive to relationships during initiation (38%) and subsequent use (46%). Narrative analysis surfaced a sequential pattern of disconnection at foundational, relational, and recovery levels. This time-based, sequential analysis revealed that experiences of negative affect, isolation, SC, depression, and other mental health issues were present across the life-course and informed SMM’s methamphetamine use. Narrative analysis informed the network analysis, which included 12 psychosocial factors. Results of the network analysis suggest two significant bivariate associations. The first between depression and negative affect (b= 0.26, SD= 0.07, 95% CI [0.12, .038]) and the second between PTSD symptoms and depression (b=.37, SD=.07, 95% CI [0.23, 0.49]).

Conclusions: Findings highlight the influence of life-long experiences of psychosocial factors in the methamphetamine-using behaviors of SMM, which were informed by structural processes of stigma and victimization. Findings suggest that interventions focus on holistic, integrated approaches tending to SMM’s histories of adverse events and mental health issues that precipitated their methamphetamine-using behaviors. Additionally, findings suggest that peer-based approaches are imperative to reframe the ways in which SMM form and sustain relationships. Moreover, SC should be understood as a potential coping strategy developed by SMM as a response to societal, cultural, and institutional processes of stigmatization and discrimination.