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