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Multivariable Models Examining Associations between Program Design Preferences and SOCRATES Subscale Scores.
Source publication
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...
Contexts in source publication
Context 1
... 2 shows participant's ratings of potential program characteristics and Table 2 shows results from multivariable regression models examining the relationship between program preferences and each of the SOCRATES subscales. Among included 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. ...Context 2
... included 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. The median values for the contemplativeness, readiness, and action taking subscales were 12 ( Table 2 also includes the average rating for each of the characteristics that were assessed in terms of importance. Overall, most program characteristics explored were rated as important or somewhat important by at least one-in-five participants. ...Citations
... Treatment available has also overseen specific needs related to sexualized substance use (known as chemsex in some settings) [17,18], which include coping strategies for unpleasant emotions, depressive symptoms, and traumatic events [19,20]. Furthermore, as with the general population, it has been reported that gbMSM may be more interested in engaging in strategies that go beyond abstinence-based programs [21,22], such as harm reduction strategies. Although its origins were focused on HIV prevention, currently harm reduction strategies encompass strategies that protect and improve the health of persons who use drugs. ...
Background
The use of stimulants and other substances with the purpose of enhancing, maintaining, and prolonging sexual activity is known as sexualized substance use. Also known as chemsex, this pattern of use has been mainly explored in high-income countries. The aim of this article was to assess the feasibility, acceptability, and usefulness of a community- evidence-based harm reduction intervention among Mexican gay, bisexual, and other men who have sex with men (gbMSM) adults who reported sexualized stimulant use in the past 6 months and who were not enrolled in any psychosocial treatment.
Methods
The in-person intervention was designed in partnership with gbMSM who used substances. It consisted of 39 harm reduction strategies before, during, and after episodes of use. The components of the intervention were health and self-care, safety, and psychopharmacology. The intervention was delivered at a university campus, a public recreational space, and an HIV public clinic. Feasibility to deliver the intervention was assessed based on enrolment and completion rates; acceptability through a 28-item, 5-point Likert scale (140 max.) constructed and validated for the Mexican population with good reliability coefficients; usefulness through a 5-point Likert scale (“not useful”-“very useful”) for each of the 39 strategies; and potential behavioral change by subtracting the likelihood of implementing each strategy minus the frequency of use of the technique before the intervention.
Results
Participants (n = 19; recruitment rate = 35.2%; completion rate = 84.2%) rated the intervention as acceptable with a mean score of 121.6 (SD = 7.5). The highest potential for behavioral change was regarding the use of information about the half-life of stimulants, polysubstance use, and overdose prevention.
Conclusions
This intervention is feasible when provided within public health services where potential participants are already in contact. Harm reduction strategies need to surpass sexually transmitted infections prevention and HIV care and focus on substance use and mental health strategies.
... As a result, there is a lack of information on the priorities of gbMSM in this body of work, particularly their perspectives on existing services and their views regarding potential service improvements. Given the interrelatedness of sexual activity, sociality, and identity with methamphetamine use among gbMSM (Card et al., 2022), understanding this population's experiences with substance use services is critical. Characteristics of treatment programs that may be appropriate for individuals who use substances in general-such as a requirement of abstinence-may be a barrier to care for gbMSM, whose patterns of substance use are often strongly influenced by their sexual and social interactions (Hawkins et al., 2019). ...
... The existence of gbMSM-specific services may also help to assuage fears of discrimination in a service environment. Although stigma and discrimination can be barriers to care for any individual who uses methamphetamine, gbMSM face the potential for additional stigma from providers or other patients based on their sexuality, and gbMSM-specific services could help to remove that barrier (Card et al., 2022). While the long-term effectiveness of such services has not been demonstrated, participants in some short-term evaluations have decreased their methamphetamine use and reported improved psychological well-being (Lea et al., 2017;Tomkins et al., 2018). ...
Gay, bisexual, and other men who have sex with men (gbMSM) use crystal methamphetamine at higher rates than the general population, often in a sexual context. Some require support for problematic methamphetamine use. Health services are available for this population, but little information is available on how gbMSM who use methamphetamine view these supports. We explored the perspectives of gbMSM who used methamphetamine regarding available and desired treatment, support services, and resources to inform improvements to these services in British Columbia, Canada. We conducted semi-structured interviews with 33 participants and used thematic analysis to identify participants’ needs and preferences regarding treatment and services. Participants desired services that incorporated peers and providers with similar lived experience, tailored to their specific needs, including addressing overall mental health. The findings indicate that making culturally competent adjustments related to sexuality to provide gbMSM-specific treatment and integrating peer support would better serve gbMSM who use methamphetamine. Mental health and substance use should be addressed simultaneously.
Background:
Since 2005, Japan has incrementally banned a range of new psychoactive substances (NPS), including 5-MeO-DIPT (5MO; foxy) and alkyl nitrites (AN; rush, poppers) that have commonly been used among men who have sex with men (MSM). After the largest ban in 2014, these drugs were reported to have disappeared from the domestic market. Given that 5MO/AN/NPS use has been prevalent among men living with HIV in Japan, a population largely comprised of MSM, we sought to characterize changes in their drug use behavior following the supply shortages.
Methods:
Using data from two waves of a nationwide survey of people living with HIV in Japan in 2013 and 2019-20 (n = 1042), we employed multivariable modified Poisson regression to identify correlates of self-reported reactions to the 5MO/AN/NPS shortages and changes in drug use behavior in 2019-20 vs. 2013.
Results:
Among 391 men (96.7% MSM) surveyed in 2019-20, following the supply shortages, 234 (59.8%) stopped using 5MO/AN/NPS, 52 (13.3%) retained access to the supply, and 117 (29.9%) used substitute drugs: most commonly, methamphetamine (60.7%). Individuals who used substitutes were more likely to report unprotected sex (adjusted relative risk [ARR]=1.67; 95% confidence interval [CI]: 1.13-2.47) as well as low (ARR=2.35; 95% CI: 1.46-3.79) and lower middle (vs. upper middle to high) socioeconomic status (ARR=1.55; 95% CI: 1.00-2.41). The prevalence of past-year methamphetamine use (ARR=1.93; 95% CI: 1.11-3.35) and self-reported uncontrollable drug use (ARR=1.62; 95% CI: 1.07-2.53) were significantly higher in 2019-20 compared to 2013.
Conclusion:
Following the supply shortages, approximately one-fifth of our participants used methamphetamine as a substitute for 5MO/AN/NPS. Methamphetamine use and perceived uncontrollable drug use also appeared to have increased at the population level after the supply shortages. These findings suggest a potentially harmful substance displacement effect of the aggressive ban. Harm reduction interventions are needed in this population.
