Rehabilitating our approach to gay men who use drugs

Much of the writing on HIV prevention is loaded with punitive clichés about gay men that highlight psychological deficits, lack of self control, and prevention fatigue. Perhaps the most repeated one since the onset of the epidemic suggests that the majority of gay men are into drugs and couldn’t care less about becoming infected while enjoying their substances.

While these clichés have persisted throughout the epidemic, a closer look at statistics shows a more nuanced portrait of gay men. The Sex Now survey (Canada’s largest survey of gay and bisexual men) showed that the vast majority of gay men report no risk for HIV in the previous year (70 percent) nor did most report any use of party drugs over the same time period (85 percent), not even once.

One issue of concern emerging from the Sex Now survey, however, is that gay men who do use drugs are nearly twice as likely to report HIV risk. Other researchers have also demonstrated this relationship. But concluding that “drugs = uncontrolled gay men = risky sex ”, and that health professionals should focus their efforts on eradicating drug use among gay men to prevent HIV, ignores the complexity of gay men’s lives and the reasons they engage in both risky sex and substance use.

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