Substance Use Among Gay Men in Mexico: Perceptions of Well Being and Implications for Health

Background. Substance use among gay men is an ongoing public health issue with implications for education and prevention strategies due to the many risks which include sexually transmitted infections such as HIV and forms of trauma and/or violence due to the sociopolitical climate as well as societal, institutional, and community-based discrimination. Research often focuses on the harmful effects of substance use related to sexual risk (e.g., HIV, STIs, unprotected anal sex) and adverse outcomes associated with psycho-emotional health due to sexualized drug use, including depression, anxiety, substance use dependence, and suicide ideation. Such studies on substance use among gay men across the globe are often analyzed from the framework of risk and harm, disregarding the user’s perspective about various reasons for use, which for some may not be perceived as potentially harmful. The current study examines substance use among gay men and perceived benefits and adverse effects on their well-being from three unique geographical areas across Mexico.

Methods. A mixed-method study utilizing an online survey and focus groups examined substance use among gay men living in Mexico to understand their lived experiences and perceptions of well-being. Inclusion criteria included identification as a cisgender gay man, 18+, having used a substance (apart from tobacco and alcohol) in the past month, and residing in one of three Mexican geographic regions. Nineteen gay men (average age 32 years) from northern, central, and southern Mexico participated in the study. Data was interpreted utilizing a content analysis. From the perspective of social constructionism, this study sought to understand the meanings associated with substance use as a result of social interactions and communication between gay men living in Mexico, impacted by a number of factors including peer and societal beliefs, personal values, and knowledge about substance use.

Results. Study results describe participants responses related to the types of substances used and prevalence for lifetime use and over the past month. Poppers, crystal meth, and marijuana were the most recently consumed substances, with frequent use reported during sex. These results are followed by perceived adverse effects and benefits of substance use within four unique substance use environments (initiation drug environment; recreational drug environment; sexual drug environment without crystal meth; and sexual drug environment with crystal meth). Qualitative results underscore perceived adverse effects or benefits of substance use. First-contact drug use and recreational drug use showed greater perceived social and mental health benefits. In contrast, drugs used during sex had greater perceived adverse effects on overall well-being, primarily with the use of crystal meth.

Conclusions. There is an apparent ambivalence with using drugs based on the experiences of Mexican gay men participating in this study. Some participants reported an improvement in mental health and emotional well-being, sexual experiences, and increased socialization. Other participants reported harmful effects upon their health, mental health, and social well-being based on decisions to use substances. Implementing a gay-affirming harm reduction model may improve overall health outcomes for this minority population, as well as their mental health, overall well-being, and care needs.