Research paper
Following Lives Undergoing Change (Flux) study: Implementation and baseline prevalence of drug use in an online cohort study of gay and bisexual men in Australia

https://doi.org/10.1016/j.drugpo.2016.11.012Get rights and content

Abstract

Background

Drug use among gay and bisexual men (GBM) is higher than most populations. The use of crystal methamphetamine, erectile dysfunction medication (EDM), and amyl nitrite have been associated with sexual risk behaviour and HIV infection among gay and bisexual men (GBM).

Objective

This paper describes an online prospective observational study of licit and illicit drug use among GBM and explores baseline prevalence of drug use in this sample. Capturing these data poses challenges as participants are required to disclose potentially illegal behaviours in a geographically dispersed country. To address this issue, an entirely online and study specific methodology was chosen.

Methods

Men living in Australia, aged 16.5 years of age or older, who identified as homosexual or bisexual or had sex with at least one man in the preceding 12 months were eligible to enrol.

Results

Between September 2014 and July 2015, a total of 2250 participants completed the baseline questionnaire, of whom, 1710 (76.0%) consented to six-monthly follow-up. The majority (65.7%) were recruited through Facebook targeted advertising. At baseline, over half (50.5%) the men reported the use of any illicit drug in the previous six months, and 28.0% had used party drugs. In the six months prior to enrolment, 12.0% had used crystal methamphetamine, 21.8% had used EDM, and 32.1% had used amyl nitrite. Among the 1710 men enrolled into the cohort, 790 men had used none of these drugs.

Conclusion

Ease of entry and minimal research burden on participants helped ensure successful recruitment into this online cohort study. Study outcomes will include the initiation and cessation of drug use, associated risk behaviours, and health consequences, over time. Results will provide insights into the role gay community plays in patterns of drug use among GBM.

Section snippets

Background

The prevalence of licit and illicit drug use among gay and bisexual men (GBM) is higher than in other population groups (Bolding, Hart, Sherr, & Elford, 2006; Cochran, Ackerman, Mays, & Ross, 2004; Hickson, Bonell, Weatherburn, & Reid, 2010; Lea et al., 2013b; Newcomb, Ryan, Greene, Garofalo, & Mustanski, 2014; Roxburgh, Lea, De Wit, & Degenhardt, 2015). In Australia, more than half of GBM reported recent (previous six months) illicit drug use (Lea et al., 2013b). One in twenty (5.6%) reported

Methods

The Flux study is being conducted nationally in Australia using online survey techniques. We systematically enrol and follow-up individual GBM to collect information about drug use, risk behaviour and associated harms, and gay community engagement. We obtained additional optional consent at enrolment for linkage to hospitalisation datasets to identify drug-related presentations and to the national HIV registry to confirm prevalent and incident HIV infections. The Flux protocol and all

Procedures for streamlined digital processing and data protection—FAME

The FAME process was designed to enable maximum digital management of the study and to ensure a simple, straightforward experience for participants. Each participant was digitally assigned a unique study identifier (USID) through the survey platform upon entry to the consent form. The USID was used to link to their unique records on all study data sources. It will remain the participants’ unique identifier throughout the study and is central to the implementation of FAME. All communications

Results

In total, 21,014 clicks were received on the studys website, and 6810 clicked through to the consent form. Of these, 4306 clicks were received past the first page of the consent form where they indicated their level of consent (six-monthly follow-up or baseline only). A total of 2943 people completed the consent form (six-monthly follow-up or baseline only), and 2705 men commenced survey responses, of whom 2250 (83.2%) provided sufficiently complete baseline data for tracking trends in drug use

Discussion

We have established an entirely online cohort study of incidence and risk factors for initiation, cessation, and changes in drug use over time among Australian GBM. The characteristics of both the enrolled and the anonymous participants in the Flux sample, while somewhat younger, are otherwise comparable to those of other samples of Australian GBM (Lea et al., 2013b, Prestage et al., 2009a; Zablotska, Holt, & Prestage, 2012). We have demonstrated the ability to collect sensitive information

Conclusions

Having successfully implemented FAME to establish the first entirely online cohort study of drug use among Australian GBM, the Flux study will be able to provide data on incidence and factors associated with initiation and cessation, and changes in patterns of drug use and related harms over time. The high rates of illicit drug use in this sample indicate the need for longitudinal enquiry and follow up to assess continuing and changing patterns of drug use over time within this population.

Funding source declaration

This study was funded by the Australian Research Council (ARC). ARC grant number: RG132750. The Kirby Institute and Centre for Social Research in Health receive funding from the Australian Government Department of Health. The National Drug and Alcohol Research Centre, UNSW is supported by funding from the Australian Government under the Substance Misuse Prevention and Service Improvements Grants Fund. Lisa Maher is supported by a National Health and Medical Research Council Senior Research

Author agreement/declaration

All authors certify that they have seen and approved the final version of the manuscript being submitted. All authors warrant that the article is the authors’ original work, has not received prior publication and is not under consideration for publication elsewhere.

References (44)

  • R.E. Davis et al.

    Interviewer effects in public health surveys

    Health Education Research

    (2010)
  • D. De Vaus

    Surveys in social research

    (2013)
  • W. DiFranceisco et al.

    Sexual adventurism, high-risk behavior, and human immunodeficiency virus-1 seroconversion among the Chicago MACS-CCS cohort, 1984 to 1992: A case‐control study

    Sexually Transmitted Diseases

    (1996)
  • J. Elford

    Changing patterns of sexual behaviour in the era of highly active antiretroviral therapy

    Current Opinion in Infectious Diseases

    (2006)
  • R.J. Engel et al.

    The practice of research in social work

    (2016)
  • D.G. Fisher et al.

    Use of crystal meth, Viagra and sexual behaviour

    Current Opinion in Infectious Diseases

    (2010)
  • P.N. Halkitis et al.

    Explanations for methamphetamine use among gay and bisexual men in New York City

    Substance Use & Misuse

    (2005)
  • P.N. Halkitis et al.

    Multivariate modeling of club drug use initiation among gay and bisexual men

    Substance Use & Misuse

    (2008)
  • M.L. Hatzenbuehler

    How does sexual minority stigma get under the skin? A psychological mediation framework

    Psychological Bulletin

    (2009)
  • F. Hickson et al.

    Illicit drug use among men who have sex with men in England and Wales

    Addiction Research & Theory

    (2010)
  • M. Hurley et al.

    Intensive sex partying amongst gay men in Sydney

    Culture, Health & Sexuality

    (2009)
  • R.C. Jerome et al.

    Club drug use, sexual behavior, and HIV seroconversion: A qualitative study of motivations

    Substance Use & Misuse

    (2009)
  • Cited by (0)

    View full text