Sexualised drug use among LGBT people : a mixed methods study of reasons for engagement and associations with physical and psychological wellbeing

Background Sexualised drug use has previously been researched among men who have sex with men (MSM) in relation to sexual health and sexual risk behaviours. The topic has received more attention due to the emergence of chemsex as a public health issue, which is a particular form of sexualised drug use, but little research has been conducted to understand any possible relationship with psychological health. Additionally, motivations suggested for engaging in sexualised drug use and chemsex among MSM also apply to women who have sex with women (WSW) and trans people, but these groups have been under-researched comparatively. Aim The aim of this programme of research was to investigate sexualised drug use among all LGBT people, reasons for engagement, as well as associations with physical and psychological health. Methodology A sequential mixed methods design was used across three studies. For Study 1, a systematic review investigating sexualised drug use among LGBT people within the recent context of chemsex was conducted, and how this behaviour is associated with sexual health and health behaviours. In Study 2, a cross-sectional online survey was used (The LGBT+ Sex and Lifestyles Survey) that recruited 3,507 LGBT people (1,663 MSM, 1,152 WSW, and 500 trans people; groups not mutually exclusive). Multivariable logistic regression analyses were conducted to explore associations with drug use, sexualised drug use, and chemsex. In Study 3, semi-structured interviews were conducted with 13 MSM service users and 16 sexual health service providers to further explore how engaging in sexualised drug use can impact physical and psychological health, as well as the standard of care received by people engaging in sexualised drug use. Interviews were analysed using thematic analysis. Findings from all three studies were triangulated and discussed in relation to the research objectives. Results The findings showed that LGBT people beyond MSM do engage in sexualised drug use, but chemsex was observed mostly among MSM. Engaging in chemsex among MSM appeared to be associated with greater sexual risk compared to other sexualised drug use. There was some evidence that drug use and sexualised drug use may be associated with physical and 2 psychological problems such as lower satisfaction with life and sexual assault, but not all of those engaging in sexualised drug use were experiencing negative associations with physical and psychological health. Sexual health services appeared to provide an adequate level of care for MSM engaging in sexualised drug use, but barriers to care existed within sexual health services (e.g. funding, access) and when engaging in other types of healthcare (e.g. mental health services). Discussion Overall, a harm reduction approach to sexualised drug use is needed to help those who engage in sexualised drug use reduce potential for physical and psychological harms, and support services should be available for those who need help managing or stopping their use. Additionally, LGBT people more broadly than MSM should be included in sexual health and drug research where appropriate.