Research paper
Methamphetamine use among gay and bisexual men in Australia: Trends in recent and regular use from the Gay Community Periodic Surveys

https://doi.org/10.1016/j.drugpo.2016.01.003Get rights and content

Highlights

  • We examined trends in methamphetamine use among gay and bisexual men in Australia.

  • Rates of crystal use have increased in recent years, after several years of decline.

  • Injecting was reported by half of HIV-positive and one-fifth of HIV-negative men who used crystal.

  • Qualitative research is needed to guide culturally appropriate harm reduction responses.

Abstract

Background

Gay and bisexual men typically report high rates of illicit drug use, including methamphetamine use. This paper aimed to analyse trends in crystal methamphetamine (‘crystal’) and powder methamphetamine (‘speed’) use among gay and bisexual men in Australia, and characterise the sociodemographic, drug use, and sexual risk practices of men who reported crystal use.

Methods

The Gay Community Periodic Surveys, routinely conducted behavioural surveillance surveys of gay men in Australia, were analysed to examine trends in recent crystal and speed use during 2005–14 (any use in the previous 6 months), and trends in regular crystal and speed use during 2007–14 (at least monthly use in the previous 6 months). Covariates of recent and regular crystal use were analysed using 2014 data.

Results

Speed use declined from 25.0% to 10.2% during 2005–14 (p-trend <.001), while regular speed use declined from 7.0% to 2.3% during 2007–14 (p-trend <.001). Any crystal use declined from 15.6% to 11.4% during 2005–14 (p-trend <.001) and increased during 2010–14 (from 9.6% in 2010; p-trend <.001). Regular crystal use declined from 6.1% to 4.0% during 2007–14 (p-trend <.001) and remained stable during 2010–14 (3.9% in 2010; p-trend = .64). Participants who reported regular crystal use were more likely than men who used crystal less frequently to have used gamma-hydroxybutyrate, used party drugs for sex, and to have injected drugs in the previous 6 months. High rates of crystal use and injecting were reported among HIV-positive participants.

Conclusion

Rates of both crystal and speed use, despite fluctuations, were consistently high throughout the study period. The high rates of crystal use and associations with potentially risky sexual practices indicate that gay and bisexual men should be a particular focus for targeted harm reduction and combined harm reduction and sexual health services.

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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