The Impact of Stigma on the Substance Use Outcomes of Male Sex Workers

Background/Purpose:

Male sex workers face numerous adverse health outcomes, including mental health disorders, increased feelings of shame, and lack of social support. While more is known about the economies of male sex work, there is little research about the complex effects of the sex trade on the health outcomes of male sex workers, particularly the effects of stigma on substance use.

The current study examines the relationship between stigma and substance use in the lives of male sex workers. The study also analyzes the impact of social identity and social support on the relationship between stigma and substance use. The researcher hypothesized that higher levels of internalized and experienced stigma would be associated with higher frequencies of drug use within a twelve-month period. The researcher also hypothesized that social identity and social support would moderate the relationship between stigma and substance use and serve as buffers or protective factors.

Methods:

The study used purposive and snowball sampling to explore data from 250 male sex workers who had sex with men and participated in a web-based questionnaire. Of the sample, most participants (nearly 45%) were ages 26-30. Most of the participants were from New York City (21.2%), Los Angeles (11.6%), and Chicago (10.8%). Most of the sample (55.6%) was homosexual/gay although 29.6% identified as heterosexual/straight. Most participants were white (66.8%) while 26% of the sample were black. Most participants made $35,000-$74,999 (46.8%) in total income including sex work. Multiple linear regression was used to assess the ability of internalized and experienced stigma to predict substance use after controlling for age, sexual orientation, income, race, and nationality.

Results:

No significant associations were found between the stigma variables and frequency of alcohol and cannabis use (all p-values>0.05). However, significant associations were found between the stigma variables and stimulant, sedative, and opioid (hard drug) use (p<0.001). Higher levels of internalized and experienced stigma predicted higher levels of hard drug use. In addition, the association between internalized stigma and frequency of stimulant use was moderated by social support (p<.05). When social support was low, there was a strong positive relationship between internalized stigma and frequency of stimulant use (p<0.001). Lastly, the association between experienced stigma and frequency of hard drug use was moderated by social identity (p<.001). When social identity was low, there was a strong positive relationship between experienced stigma and frequency of hard drug use (p<0.001).

Conclusions/Implications:

The study’s findings highlight the importance of social identity and social support in serving as protective factors against the harmful effects of stigma on levels of substance use. Findings from this study may demonstrate a need to create more culturally aware and inclusive substance abuse prevention strategies and interventions for male sex workers. Moreover, social and behavioral scientists, including social workers, may be able to develop improved methods for increasing access to stigma-reducing services and programs for male sex workers, such as counseling and primary medical care. Community health agencies may potentially provide more accessible and equitable forms of healthcare to decrease rates of substance use.