Research paperMethamphetamine use among gay and bisexual men in Australia: Trends in recent and regular use from the Gay Community Periodic Surveys
Introduction
In 2015, the Australian Government established a National Ice Taskforce to develop law enforcement, health and education responses to what the then Prime Minister Tony Abbott described as an “epidemic” of crystal methamphetamine use in Australia (Australian Government Department of the Prime Minister and Cabinet, 2015, April 8). It is perhaps inaccurate to characterise crystal methamphetamine (hereafter “crystal”) use as at epidemic levels in the general community, as only 2% of Australian adults report any methamphetamine use in the previous 12 months, and rates have remained stable for over 10 years (Australian Institute of Health and Welfare, 2014). However, what has changed in recent years is a trend towards the use of crystal over the less potent powder form (“speed”), more people reporting regular crystal use (i.e., at least monthly), as well as an increase in the average purity of crystal, and a decline in the purity-adjusted cost (Australian Institute of Health and Welfare, 2014, Scott et al., 2015). It has been suggested that these changes are responsible for increases in methamphetamine-related harms and presentations to treatment services and emergency departments (Australian Institute of Health and Welfare, 2015, Roxburgh and Burns, 2015). While infrequent methamphetamine use is less likely to lead to health and social problems, regular use is associated with an elevated risk of dependence, mental health problems (e.g., depression, psychosis) and blood-borne virus risk (Darke et al., 2008, McKetin et al., 2006a). These problems are more likely to occur among people using crystal compared to less potent forms of methamphetamine, and among regular and heavier users (McKetin et al., 2006a, McKetin et al., 2006b).
Gay and bisexual men (hereafter “GBM”) are a population that typically reports high rates of methamphetamine use (Colfax et al., 2005, Lea et al., 2013b, Prestage et al., 2007a, Prestage et al., 2007b). In the 2013 Australian National Drug Strategy Household Survey, GBM were almost 4 times as likely to report any methamphetamine use in the previous 12 months compared to heterosexual men (9.7% vs. 2.5%) (Roxburgh, Lea, de Wit, & Degenhardt, 2015). Community-based surveys in Australia have shown that GBM more commonly report crystal use over speed (Lea, Prestage, et al., 2013).
Crystal is often used by GBM in sexual contexts, known colloquially as “chemsex” or “party and play”, and polydrug use with alcohol and other drugs such as amyl nitrite, erectile dysfunction medications (e.g., Viagra) and gamma-hydroxybutyrate (GHB) is common (Bourne, Reid, Hickson, Torres-Rueda, et al., 2015Hurley and Prestage, 2009, Rawstorne et al., 2007, Reback, 1997, Slavin, 2004). While crystal use is valued for its enhancement of sexual confidence, endurance and intimacy, the use of crystal and other drugs in sexual contexts is associated with an increased likelihood of engaging in high-risk sexual practices associated with HIV and hepatitis C virus (HCV) transmission, such as condomless anal intercourse with casual partners, multiple sex partners, group sex and brachiorectal insertion (‘fisting’) (Green and Halkitis, 2006, Halkitis et al., 2014, Prestage et al., 2007a, Prestage et al., 2009, Rawstorne et al., 2007, Vosburgh et al., 2012, Vu et al., 2015). GBM who use crystal also report high rates of injecting drug use, injecting in sexual contexts and sharing injecting equipment (Hopwood, Lea, & Aggleton, 2015). In a recent Australian study, 41% of GBM who injected drugs reported sharing any injecting equipment in the previous 6 months (Hopwood et al., 2015).
There is evidence that methamphetamine treatment services with a high caseload of gay male clients are currently operating at capacity in Australian capital cities (Findlay, 2015, 1 June; Scott & Branley, 2015, 13 August), mirroring national trends in increased methamphetamine-related treatment presentations (Australian Institute of Health and Welfare, 2015). There is thus a need to improve our understanding of methamphetamine use among GBM in Australia, in order to develop better harm reduction and treatment services for this population.
The Gay Community Periodic Surveys (GCPS) have been collecting annual or biennial data on methamphetamine use among GBM in Australia for more than a decade (Zablotska, Kippax, Grulich, Holt, & Prestage, 2011). To our knowledge, there are no other routine behavioural surveillance surveys among GBM internationally that include repeated questions on substance use that are conducted with the same regularity as the GCPS (MacKellar et al., 2007, Paquette and de Wit, 2010, Zablotska et al., 2011). Using GCPS data collected during 2005–14, this paper aims to (i) examine trends in recent and regular methamphetamine use (crystal and speed [methamphetamine powder]) among GBM in Australia; (ii) compare the sociodemographic characteristics and sexual and drug use practices of men who report crystal use with men who report no use; and (iii) determine whether men who report regular crystal use have a different sexual and drug use profile compared with men who report infrequent crystal use. Crystal was emphasised in these analyses because of the prominent role of crystal use in sexual contexts for many GBM, and the higher risk of blood-borne virus transmission and drug-related harms associated with the use of crystal compared to speed (Darke et al., 2008, McKetin et al., 2006a, McKetin et al., 2006b).
Section snippets
Method
The GCPS are repeated, cross-sectional surveillance surveys of gay, bisexual and other men who have sex with men in Australia. The surveys target men who are socially and sexually involved with gay men, and aim to monitor trends in sexual and drug use practices, and testing for HIV and other sexually transmissible infections (Zablotska et al., 2011). The surveys are conducted annually in Sydney, Melbourne and Queensland (Brisbane, Gold Coast and Cairns), and biennially in Adelaide, Perth and
Sample characteristics
Overall, 70,732 men completed questionnaires during 2005–14. The mean age of respondents at the time of completion was 35.8 years (SD = 11.8); 87.9% identified as gay, 6.9% as bisexual and 5.2% as heterosexual/unspecified. Most respondents identified as Anglo-Australian (66.6%) and were employed full-time (66.6%); half had completed a university degree (49.0%). Nine per cent of respondents reported being HIV-positive, 76.0% were HIV-negative, and 15.3% were untested or of unknown HIV status.
Discussion
Crystal use among GBM in Australia initially peaked in the mid-2000s, accompanied by high levels of community concern and the development of a range of harm reduction and education responses by HIV and LGBTI community organisations (ACON, 2006, Dennett, 2008, Worth and Rawstorne, 2005). The findings of this paper show that rates of crystal use have increased again, after several years of decline. While rates of crystal use among HIV-negative/unknown status men are still considerably lower than
Conclusions
In this study, we found high rates of methamphetamine use among GBM in Australia, which were consistently higher than reported among heterosexual men in national representative surveys (Roxburgh et al., 2015). The high rates of crystal use and injecting among HIV-positive men indicates that these men should be a particular focus for harm reduction services, as well as other GBM who report regular crystal use. Additional research, including the use of qualitative methods, is required to
Acknowledgements
We would like to thank the study participants for contributing their time to this study. We would also like to acknowledge the contributions of our community partners including the Australian Federation of AIDS Organisations and state- and territory-based community organisations supporting the health and wellbeing of GBM and people living with HIV.
The GCPS are funded by the health departments of each participating state or territory. The Centre for Social Research in Health and The Kirby
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2022, International Journal of Drug PolicyCitation Excerpt :The use of psychostimulants (such as crystal methamphetamine, gammahydroxybutyric acid (GHB), gamma-butyrolactone (GBL), mephedrone, ketamine and amyl nitrate) to facilitate and enhance sexual experiences has been described as particular to GBM (Maxwell et al., 2019; Tomkins et al., 2019). This practice is known as chemsex or – predominantly in Australia – party and play (PnP), and is a global phenomenon, reported by GBM in Western Europe (Berg et al., 2020; Bourne et al., 2015; Schmidt et al., 2016; Van Hout et al., 2019), South-East Asia (Guadamuz & Boonmongkon, 2018; Lim et al., 2015), North America (Donoso & Ávila, 2020; Mimiaga et al., 2010; Ristuccia et al., 2018; Souleymanov et al., 2020), Australia (Drysdale et al., 2020; Lea et al., 2016; Lea et al., 2013a) and New Zealand (Saxton et al., 2020). Among GBM who engage in sexualised drug use, a notable minority also engages in intravenous drug administration (hereafter: injecting) (Dowsett et al., 2005; Scheibein et al., 2020; Scheim et al., 2019; Schreck et al., 2021) – a practice which GBM sometimes refer to as ‘slamming’ or ‘blasting’ (Race et al., 2021).
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2022, Sexual Medicine ReviewsStigma as understood by key informants: A social ecological approach to gay and bisexual men's use of crystal methamphetamine for sex
2021, International Journal of Drug PolicyCitation Excerpt :HIV-positive GBM who use crystal are more likely to report recent injecting compared with HIV-negative and untested men (53.8% vs. 21.9%) (Lea et al., 2016). GBM who use crystal are more likely than men who did not use crystal to report practices that pose a risk of blood borne virus transmission, including condomless anal intercourse with casual partners, injecting drug use, and drug use in sexual contexts (Lea et al., 2016), and are more likely to use biomedical HIV prevention that mitigates against these risks (Hammoud et al., 2019). Findings such as these have driven reports in Australia and elsewhere of a ‘chemsex’ crisis (Bryant et al., 2018; Drysdale et al., 2020; Shoptaw & Reback, 2007).
Priorities and practices of risk reduction among gay and bisexual men in Australia who use crystal methamphetamine for sex
2021, International Journal of Drug PolicyCitation Excerpt :In particular, sexually transmissible hepatitis C (HCV) has been reported in Australia among gay and bisexual men who use crystal (Brener, Murphy, Cama & Ellard, 2015). Compared with the broader Australian population, gay and bisexual men report a higher prevalence of methamphetamine use (Lea et al., 2016; Roxburgh, Lea, de Wit & Degenhardt, 2016) and crystal has been previously found to be the most commonly injected illicit drug among this population (Lea et al., 2013). Moreover, HIV-positive gay and bisexual men are more likely to report crystal use compared with HIV-negative and untested men (Lea et al., 2016).