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Substance Use and Sexual Health in Marginalized Populations

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Public Health Statistics and Risk Assessment".

Deadline for manuscript submissions: closed (15 June 2022) | Viewed by 22919

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Special Issue Editors

Dr. Heather Armstrong

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Guest Editor

School of Psychology, University of Southampton, Southampton SO17 1BJ, UK
Interests: sexual health; sexual and gender minority health; mental health; substance use

Dr. Kiffer Card

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Guest Editor

Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
Interests: substance use; health equity; health systems; drug policy; youth who use drugs; sexual and gender minorities; infectious disease

Special Issue Information

Dear Colleagues,

Historically, substance use and sexual health have been considered as separate domains, both academically and clinically. However, as research and theoretical models such as minority stress and syndemic theories have demonstrated, substance use and sexual health can be inextricably linked and can have significant cumulative effects on health, well-being, and pleasure. This is especially true for vulnerable and marginalized populations, including sexual and gender minority (SGM) individuals and racial and ethnic minority individuals. These communities are often disproportionately affected by higher levels of substance use, community transmission of HIV, sexually transmitted infections, and other sexual health conditions. Additionally, these communities may face greater structural barriers when accessing, or trying to access, substance use and sexual health services, such as access to contraception and safer sex provision. New approaches which consider the combined effects of substance use and sexual health within marginalized populations are necessary. Papers, including empirical research and reviews, are invited for this Special Issue. Community-based participatory research and studies adopting an intersectional approach to analyses are particularly welcome.

Dr. Heather Armstrong
Dr. Kiffer Card
Guest Editors

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Keywords

substance use
sexual health
sexualized substance use
sexual minority
gender minority
racial and ethnic minority
minority stress
syndemic theory
holistic treatment approaches

Published Papers (10 papers)

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Research

16 pages, 389 KiB

Open AccessArticle

Chemsex, Identity and Sexual Health among Gay and Bisexual Men

by Rusi Jaspal

Int. J. Environ. Res. Public Health 2022, 19(19), 12124; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph191912124 - 25 Sep 2022

Cited by 10 | Viewed by 3113

Abstract

This article focuses on some of the social, cultural and psychological aspects of drug use in sexualized settings in gay and bisexual men (referred to as “chemsex”). Using a narrative review approach, the article examines previous empirical research in this area and presents a novel theoretical approach for understanding and predicting chemsex behavior. Tenets of identity process theory from social psychology are drawn upon to offer an integrative theoretical framework within which the social, cultural and psychological underpinnings of chemsex can be collectively examined. Existing empirical research suggests that gay and bisexual men may experience sexuality-related stressors that can undermine feelings of self-esteem, self-efficacy, continuity and positive distinctiveness. Identity process theory examines how individuals react to threats to identity brought about by these stressors. In response to identity threat, gay and bisexual men may engage in chemsex as a coping response that encompasses and facilitates various, largely maladaptive, coping strategies and tactics. The more chemsex is perceived as enhancing identity processes and as averting identity threat, the more central it is likely to be to the identities of participants. The centrality of chemsex to one’s identity may preclude self-withdrawal from the practice. Several directions for future research are presented based on existing work on chemsex viewed through the lens of identity process theory. These should form the basis of future empirical research in the sphere of sexual health among gay and bisexual men and the outcomes of this research should inform policy and practice in this area. Full article

(This article belongs to the Special Issue Substance Use and Sexual Health in Marginalized Populations)

12 pages, 571 KiB

Open AccessArticle

Latent Class Analysis of Polysubstance Use and Sexual Risk Behaviors among Men Who Have Sex with Men Attending Sexual Health Clinics in Mexico City

by Rosibel Rodríguez-Bolaños, Ricardo Baruch-Dominguez, Edna Arillo-Santillán, Elsa Yunes-Díaz, Leonor Rivera-Rivera, Lizeth Cruz-Jiménez, James F. Thrasher, Alan G. Nyitray and Eduardo Lazcano-Ponce

Int. J. Environ. Res. Public Health 2022, 19(14), 8847; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19148847 - 21 Jul 2022

Cited by 3 | Viewed by 1691

Abstract

Men who have sex with men (MSM) are more likely to use drugs and other substances compared to their heterosexual peers. No studies have evaluated patterns of substance use among MSM adults in Mexico. We used latent class analysis (LCA) to identify MSM subgroups with specific substance use patterns and their associations with sexual behaviors. Methods: Data from 1850 adult MSM were collected at HIV clinics in Mexico City between September 2018 and December 2019. The structural equation modeling approach was used to estimate a LC model to identify patterns of substance use by self-report of substance use (i.e., cigarette smoking, alcohol, and drugs). To evaluate LC membership, we included HIV status, condomless anal sex (CAS), and serosorting, while controlling for demographic variables. Results: 30.3% were under the age of 22. Alcohol use in last 30 days (76.2%), binge drinking (29.2%), marijuana (29.4%), sex-drugs (23.9%), stimulants (13.7%), and depressants (6.3%). MSM reported engaging in CAS (55.9%) and serosorting (13.5%) behaviors, and 40% reported being HIV positive. LCA indicated three general categories of MSM substance users: Class 1 (49.0%), Class 2 (29.8%), and Class 3 (20.4%). Members of Class 3 were younger: 23–28 age years (aOR = 1.86) and 29–33 age years (aOR = 1.86), more educated: completed graduate studies (aOR = 1.60), had a high probability of polysubstance use and were more likely to engage in CAS and serosorting. Conclusions: Attempts to detect alcohol and problematic use of substances are needed for MSM followed by culturally competent approaches that address alcohol and drug use disorders. Full article

(This article belongs to the Special Issue Substance Use and Sexual Health in Marginalized Populations)

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13 pages, 349 KiB

Open AccessArticle

Sexual Orientation Discrimination and Exclusive, Dual, and Polytobacco Use among Sexual Minority Adults in the United States

by Delvon T. Mattingly, Andrea R. Titus, Jana L. Hirschtick and Nancy L. Fleischer

Int. J. Environ. Res. Public Health 2022, 19(10), 6305; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19106305 - 23 May 2022

Cited by 3 | Viewed by 1991

Abstract

Research on whether sexual orientation discrimination is associated with multiple tobacco product use among sexual minority (SM) adults is limited. Thus, we explored the associations between sexual orientation discrimination and exclusive, dual, and polyuse among a subset of SM adults (18+) (n = 3453) using the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions-III. We evaluated six indicators of prior-to-past-year sexual orientation discrimination separately and as a summary scale and defined past-year exclusive, dual, and polyuse based on cigarette, electronic nicotine delivery systems, other combustible (cigars and traditional pipe), and smokeless tobacco products. Using multinomial logistic regression, we estimated adjusted associations between sexual orientation discrimination and exclusive, dual, and polyuse. Experiencing discrimination in public places, being called names, and being bullied, assaulted, or threatened were associated with dual use, while experiencing discrimination when obtaining health care or insurance and when receiving health care were associated with polyuse. Each one-unit increase in the sexual orientation discrimination summary scale was associated with 5% and 10% higher odds of dual (95% CI: 1.01–1.10) and polyuse (95% CI: 1.02–1.18), respectively. To conclude, we advise health professionals to consider the salience of discrimination against SM adults and how these experiences lead to dual/polyuse. Full article

(This article belongs to the Special Issue Substance Use and Sexual Health in Marginalized Populations)

11 pages, 340 KiB

Open AccessArticle

Empowering Our People: Syndemic Moderators and Effects of a Culturally Adapted, Evidence-Based Intervention for Sexual Risk Reduction among Native Americans with Binge Substance Use

by Christopher G. Kemp, Rachel Chambers, Francene Larzelere, Angelita Lee, Laura C. Pinal, Anna M. Slimp and Lauren Tingey

Int. J. Environ. Res. Public Health 2022, 19(7), 4283; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19074283 - 03 Apr 2022

Viewed by 1204

Abstract

Native American (NA) communities are disproportionately affected by the intersecting, synergistic epidemics of sexually transmitted infections (STIs) and substance use. Targeted approaches to addressing these syndemics are critical given the relative scarcity of mental health and behavioral specialists in NA communities. We conducted a series of moderation analyses using data from a randomized controlled trial of the EMPWR (Educate, Motivate, Protect, Wellness, Respect) intervention for reducing sexual risk behaviors, culturally adapted for NA adults with recent binge substance use living on rural reservations. We considered several potential moderators and substance use and sexual risk outcomes at 6- and 12-months post-baseline. Three hundred and one people participated in the study. Age, marital status, educational attainment, employment, and depressive symptoms were differentially associated with intervention effects. EMPWR could be strengthened with the incorporation of additional skills-building related to condom use negotiation with casual partners. For individuals with lower educational attainment or without employment, additional supports and approaches to intervention may be needed. Importantly, this study did not identify intersecting sexual risk and substance use behaviors as moderators of EMPWR effectiveness, suggesting that NA adults with varying levels of risk behavior may be equally likely to benefit from this intervention. Full article

(This article belongs to the Special Issue Substance Use and Sexual Health in Marginalized Populations)

17 pages, 704 KiB

Open AccessArticle

Does Treatment Readiness Shape Service-Design Preferences of Gay, Bisexual, and Other Men Who Have Sex with Men Who Use Crystal Methamphetamine? A Cross Sectional Study

by Kiffer G. Card, Madison McGuire, Graham W. Berlin, Gordon A. Wells, Karyn Fulcher, Tribesty Nguyen, Trevor A. Hart, Shayna Skakoon Sparling and Nathan J. Lachowsky

Int. J. Environ. Res. Public Health 2022, 19(6), 3458; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19063458 - 15 Mar 2022

Cited by 2 | Viewed by 2426

Abstract

Crystal methamphetamine (CM) disproportionately impacts gay, bisexual, and other men who have sex with men (gbMSM). However, not all gbMSM are interested in changing their substance use. The present study aimed to examine whether participant-preferred service characteristics were associated with their readiness to change. We surveyed gbMSM who used CM in the past six months, aged 18 plus years, on dating platforms. Participants rated service-design characteristics from “very unimportant” to “very important”. Multivariable regression tested service preference ratings across levels of the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES-8D). Among 291 participants, 38.7% reported their CM use was not problematic, 19.5% were not ready to take any action to reduce or stop using CM, and 41.7% were ready to take action. On average, participants rated inclusive, culturally-appropriate, out-patient counselling-based interventions as most important. Participants with greater readiness-to-change scores rated characteristics higher than gbMSM with lesser readiness. Contingency management and non-abstinence programming were identified as characteristics that might engage those with lesser readiness. Services should account for differences in readiness-to-change. Programs that provide incentives and employ harm reduction principles are needed for individuals who may not be seeking to reduce or change their CM use. Full article

(This article belongs to the Special Issue Substance Use and Sexual Health in Marginalized Populations)

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16 pages, 525 KiB

Open AccessArticle

Alcohol and Cannabis Use Trajectories and Outcomes in a Sample of Hispanic, White, and Asian Sexual and Gender Minority Emerging Adults

by Michael S. Dunbar, Daniel Siconolfi, Anthony Rodriguez, Rachana Seelam, Jordan P. Davis, Joan S. Tucker and Elizabeth J. D’Amico

Int. J. Environ. Res. Public Health 2022, 19(4), 2059; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19042059 - 12 Feb 2022

Cited by 6 | Viewed by 1789

Abstract

Substance use disproportionately affects health and psychosocial outcomes for some racial/ethnic groups, but few longitudinal studies examine the extent to which sexual and gender minority (SGM) emerging adults of different racial/ethnic groups may experience disparities in outcomes at similar levels of alcohol or cannabis use. This study used five waves of annual survey data (spanning 2015 (average age 18) to 2020 (average age 23)) from an ongoing longitudinal cohort study of emerging adults. In the subset of 359 SGM emerging adults, separate sequelae of change models assessed differences in trajectories of alcohol or cannabis use (past 30-day frequency) and multiple health and psychosocial outcomes across Hispanic, Asian, and White individuals. White SGM emerging adults showed higher baseline levels of alcohol and cannabis frequency compared to Hispanic and Asian peers, but all groups showed similar rates of change (slope) over time. We observed few racial/ethnic differences in SGM emerging adult outcomes at the same levels of alcohol or cannabis use; that is, racial/ethnic groups showed similar patterns on most health and psychosocial outcomes; however, some differences emerged. For example, Asian respondents reported less engagement in sex with casual partners after using alcohol, marijuana, or other drugs compared to their White peers, at the same levels of alcohol use (β = −0.579, p = 0.03) or cannabis use (β = −0.737, p = 0.007). Findings underscore a need to consider multiple outcome domains and factors beyond additive stress in examining the effects of substance use across different groups of SGM individuals. More longitudinal studies with large, contemporary, and diverse samples of SGM emerging adults are needed to better characterize similarities and differences in patterns of substance use and use-related consequences in relation to intersecting SGM, racial/ethnic, and other identities. Full article

(This article belongs to the Special Issue Substance Use and Sexual Health in Marginalized Populations)

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13 pages, 292 KiB

Open AccessArticle

Vulnerability, Risk and Harm for People Who Use Drugs and Are Engaged in Transactional Sex: Learning for Service Delivery

by Catriona Matheson, Lesley Bon, Louise Bowman, Adrienne Hannah and Katy MacLeod

Int. J. Environ. Res. Public Health 2022, 19(3), 1840; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19031840 - 06 Feb 2022

Cited by 5 | Viewed by 2739

Abstract

Against a backdrop of high levels of drug related harms in Scotland, this research aimed to inform training development to aid the upskilling of the workforce to support people who use drugs and are involved in transactional sex. Sixteen qualitative interviews were conducted with participants recruited across four health board areas and a range of services covering sexual health and/or harm reduction. Interviews explored initiation, frequency, and the nature of transactional sex; drug use, and experience of services. A thematic analysis was undertaken. Vulnerability was a key emerging theme when discussing drug use, sexual behavior, and service use. Vulnerability increased risk of a range of harms from sexual assault to injecting harms and overdose. Participants were often, but not always, introduced to drugs and transactional sex by someone who had power over them or was more experienced in drug use and/or sex. High risk drug use was evident in terms of polydrug use, consuming large quantities of drugs, sharing crack pipes/injecting equipment. There is a need for information and services to reduce the risk of harm from drugs, sexual violence, and unprotected sex as well as non-judgmental, trauma aware services. The workforce needs to be skilled to recognize and manage these potentially complex syndemics. Full article

(This article belongs to the Special Issue Substance Use and Sexual Health in Marginalized Populations)

16 pages, 1207 KiB

Open AccessArticle

Navigating the LGB Data Landscape: A Review of Appropriate Secondary Data Sources for Sexuality and Substance Use Research in the UK

by Megan Davies, Graham Moon and Clive E. Sabel

Int. J. Environ. Res. Public Health 2022, 19(3), 1329; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19031329 - 25 Jan 2022

Viewed by 2492

Abstract

Research has found that sexual minority individuals are more likely to experience health inequalities and have higher rates of substance use compared with their heterosexual counterparts. This association between sexuality and health outcomes is increasingly being explored using quantitative methodologies within the context of public health, psychology and health geography. Much of this research, however, has relied on primary data, despite the wide availability of secondary sources, mainly survey data, collecting information on sexuality and different types of health outcomes and health risk behaviours, such as substance use. This study reviewed recent surveys in the UK that are appropriate for exploring topics related to LGB populations and substance use behaviours. We carried out a narrative review of secondary data sources in the UK to assess the accessibility and suitability of secondary sources for sexuality and substance use research. We identified eight cross-sectional and two longitudinal surveys that contained both sexuality and substance use data. We summarised the possible applications of each survey and the scope of questions within sexuality and substance use research that could be addressed by each survey. The identification of appropriate surveys in this review can allow researchers to extend the use of secondary data sources in the UK to examine substance use inequalities between sexuality groups, further advancing this key topic. Full article

(This article belongs to the Special Issue Substance Use and Sexual Health in Marginalized Populations)

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0 pages, 348 KiB

Open AccessArticle

Post-Exposure Prophylaxis and Methamphetamine Use among Young Sexual Minority Men: The P18 Cohort Study

by Elizabeth Kaplun, Richard J. Martino, Kristen D. Krause, Michael Briganti, Paul A. D’Avanzo and Perry N. Halkitis

Int. J. Environ. Res. Public Health 2022, 19(2), 712; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19020712 - 09 Jan 2022

Cited by 1 | Viewed by 1615

Abstract

Methamphetamine use is associated with increased risk of HIV infection among young sexual minority men (SMM). Post-exposure prophylaxis (PEP) is an effective strategy for individuals who are exposed to HIV, but there is limited research about PEP use among young SMM and its relationship with methamphetamine use. This study analyzes the association between ever PEP use and recent methamphetamine use among young SMM in New York City, using cross-sectional data from the P18 Cohort Study (n = 429). Multivariable logistic regression models were used to assess the association between methamphetamine use and ever PEP use. Compared with those who had not used methamphetamine in the last 6 months, young SMM who did use methamphetamine were significantly more likely to have ever used PEP (AOR = 6.07, 95% CI: 2.10–16.86). Young SMM who had ever used PrEP had 16 times higher odds of ever using PEP (AOR = 16, 95% CI: 7.41–35.95). Those who completed bachelor’s degrees were 61% less likely to have ever used PEP (AOR = 0.39, 95% CI: 0.17–0.88). These data suggest that methamphetamine use could increase the risk of HIV infection, highlighting the critical need to target interventions for young SMM who use methamphetamine and are more likely to engage in unprotected intercourse. Full article

(This article belongs to the Special Issue Substance Use and Sexual Health in Marginalized Populations)

14 pages, 1046 KiB

Open AccessArticle

Longitudinal Event-Level Sexual Risk and Substance Use among Gay, Bisexual, and Other Men Who Have Sex with Men

by Jordan M. Sang, Zishan Cui, Paul Sereda, Heather L. Armstrong, Gbolahan Olarewaju, Allan Lal, Kiffer G. Card, Eric A. Roth, Robert S. Hogg, David M. Moore and Nathan J. Lachowsky

Int. J. Environ. Res. Public Health 2021, 18(6), 3183; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18063183 - 19 Mar 2021

Cited by 6 | Viewed by 2422

Abstract

(1) Background: Condomless anal sex and substance use are associated with STI risk among gay, bisexual, and other men who have sex with men (gbMSM). Our first study objective was to describe event-level sexual risk and substance use trends among gbMSM. Our second study objective was to describe substances associated with event-level sexual risk. (2) Methods: Data come from the Momentum Health Study in Vancouver, British Columbia and participants were recruited from 2012–2015, with follow-up until 2018. Stratified by self-reported HIV status, we used generalized estimating equations to assess trends of sexual event-level substance use and assessed interactions between substance use and time period on event-level higher risk sex defined as condomless anal sex with an HIV serodifferent or unknown status partner. (3) Results: Event-level higher risk anal sex increased across the study period among HIV-negative/unknown (baseline prevalence: 13% vs. study end prevalence: 29%) and HIV-positive gbMSM (baseline prevalence: 16% vs. study end prevalence: 38%). Among HIV-negative/unknown gbMSM, event-level erectile drug use increased, while alcohol use decreased over the study period. Overall, interactions between substance use and time on higher risk anal sex were not statistically significant, regardless of serostatus. However, we found a number of time-specific significant interactions for erectile drugs, poppers, Gamma-hydroxybutyrate (GHB), crystal methamphetamine and ecstasy/MDMA use among HIV-negative/unknown gbMSM. (4) Conclusion: Significant differences in substance use trends and associated risks exist and are varied among gbMSM by serostatus. These findings provide a more comprehensive understanding of the effects of event-level substance use on sexual risk through longitudinal follow-up of nearly six years. Full article

(This article belongs to the Special Issue Substance Use and Sexual Health in Marginalized Populations)

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