Elsevier

Drug and Alcohol Dependence

Volume 187, 1 June 2018, Pages 292-295
Drug and Alcohol Dependence

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Correlates and subgroups of injecting drug use in UK gay and bisexual men: Findings from the 2014 Gay Men’s Sex Survey

https://doi.org/10.1016/j.drugalcdep.2018.03.014Get rights and content

Highlights

  • Patterns of drug injecting in UK gay and bisexual men are poorly understood.

  • We examined correlates and subgroups of injecting drug use among GBM.

  • HIV positive, middle-aged, or London-resident GBM most often reported injecting.

  • GBM with sexual risk with multiple partners were most likely to report injecting.

  • We found evidence for three types of injection drug use (chemsex, opiate, eclectic).

Abstract

Background

Evidence to understand which gay and bisexual men (GBM) inject drugs remains scant, especially in the UK. We describe correlates of last-year injecting in UK GBM, and characterise subgroups of GBM who inject drugs by types of drugs used.

Methods

Using data from the 2014 Gay Men’s Sex Survey, an opportunistic internet-based survey conducted of GBM living in the UK, we examined via logistic regression correlates with any injecting of six drugs (amphetamine/speed, crystal methamphetamine, heroin, mephedrone, GHB/GBL, and ketamine) in the last year. We estimated latent class models to understand underlying subgroups of injecting drug use among GBM reporting injecting drug use in the last year.

Results

Injecting was most common in GBM who were of middle age, who were HIV seropositive, and who lived in London, and was significantly associated with sexual risk with multiple partners in the last year, whether steady or non-steady. Most GBM who engaged in injecting either injected crystal methamphetamine, mephedrone or both (class 1, chemsex, 88.6% of injectors), whereas a smaller group had a focus on opiates (class 2, opiate, 7.9%). A small but identifiable subgroup (class 3, eclectic, 3.5%) engaged in injecting across the range of drugs examined.

Conclusions

This is the first epidemiological analysis to describe subgroups of injecting, and to describe correlates of injecting drug use, in UK GBM. Implications for design of harm reduction services include a need to focus on injecting drug use beyond opiates, currently the focus of most harm reduction services.

Introduction

While drug use in gay and bisexual men (GBM) is consistently higher than in the general population (Lea et al., 2013; Melendez-Torres et al., 2016), injection drug use by GBM remains sparsely documented and poorly understood in the UK (Public Health England, 2016). This is despite increasing media attention from 2013 onwards (Kirby and Thornber-Dunwell, 2013; Shaw, 2017). Recent evidence from Australian GBM indicates a prevalence of drug injecting of 4.7% in the last six months, with lifetime prevalence of 10.6% (Bui et al., 2018), but epidemiological description of injecting drugs among UK GBM remains scant. While previous surveys document low levels of injection drug use among GBM in Europe (The EMIS Network, 2013), the emergence of ‘chemsex’, or the sexualised use of crystal methamphetamine, GHB, mephedrone and ketamine (Bourne et al., 2015a), has sparked concern about the current extent of injection drug use in this population. Injecting use of chemsex drugs may be a particularly salient feature of high-risk sexual practices, given the use of these drugs to enhance sexual performance and increase the number of partners in a coital session (Bourne et al., 2015b), and we have previously described the relationship between chemsex drug use before sex and sexual risk at the level of the sexual encounter (Melendez-Torres et al., 2017). Major cross-sectional surveys of drug use by GBM have not been able to recruit enough GBM who inject drugs for comparison (Sewell et al., 2017). Data from the Unlinked and Anonymous Monitoring survey of people who inject drugs compared GBM and non-GBM among men who inject drugs and found that GBM were more likely to have recently begun injecting and to engage in high-risk sexual practices; however, this survey was unable to describe patterns within GBM who inject drugs (Glass et al., 2017). Not all injection drug use may be related to sex, and different profiles of injection drug use may exist among GBM. We present an observational epidemiological study based on cross-sectional survey data from a large number of GBM across the UK, in which we describe demographic and socio-sexual correlates of drug injecting and characterise subgroups of GBM injectors by types of drugs used.

Section snippets

Methods

We used data from the Gay Men’s Sex Survey, a convenience sample survey of GBM living in the UK, and the longest-running community-based survey of GBM in the UK. GBM were recruited to an internet-based survey in late summer 2014 via dating websites, Facebook advertisements and geosocial networking apps. Because of the recruitment methods used, a response rate is not available. We included in this analysis GBM over the age of 16 who identified as gay, bisexual or with another non-heterosexual

Results

Of the 16,464 GBM in our sample, 303 (1.81%) reported injecting in the last year. An additional 176 GBM (1.05%) reported ever injecting, but more than 12 months ago. In total, 16,288 GBM (97.14%) reported never injecting drugs. More than half of the sample (52.97%) was between the ages of 30 and 59, and nearly a quarter (24.10%) of the sample was from the London integrated region. More than two-thirds (67.20%) reported that their last HIV test was negative (see Table 1).

Discussion

This is the first epidemiological analysis describing subgroups of injectors among GBM living in the UK, and the first to describe correlates of injecting drug use in UK GBM. We were able to describe subgroups within the sample of GBM reporting injecting drugs in the last year. Most GBM who engaged in injecting either injected crystal methamphetamine, mephedrone or both, whereas a smaller group described engaging in generic injecting practices with a focus on opiates. A small but identifiable

Role of funding source

Nothing declared.

Contributors

GJMT conceived and carried out the analysis and led drafting of the paper. AB helped in developing the analysis and contributed to drafting of the paper. FH, DR and PW created and managed the survey on which this analysis is based and contributed to drafting of the paper. All authors approved the final manuscript.

Conflict of interest

No conflict declared.

Acknowledgements

The survey was commissioned by Terrence Higgins Trust on behalf of HIV Prevention England, a national HIV prevention initiative funded by Public Health England.

The work was undertaken with the support of The Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), a UKCRC Public Health Research Centre of Excellence. Joint funding (MR/KO232331/1) from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council,

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