“Protective, Private, Proud”: Identity Matters for Gay and Bisexual Men Who Inject Drugs in Australia

Author: Sophia E Schroeder Bourne Adam Carla Treloar Mark Stoove Joseph Doyle Margaret Hellard

Theme: Social Science & Policy Research Year: 2022

Gay and bisexual men (GBM) report higher rates of sexualised and injecting drug use compared to
heterosexual men. Stigmatisation of people who inject drugs is linked to negative health outcomes,
but sexual minority perspectives remain underrepresented. We explored injecting drug use among
GBM in Melbourne, Australia, to elucidate identity and stigma processes at the intersection of drug
use and sexualities.
In-depth qualitative interviews were conducted with GBM who inject drugs between June-October
2020. Interviews explored participants’ experiences and concerns related to drug use, pleasure, risk,
and relationality in drug using contexts and beyond. Data were analysed using grounded theory
Interviewees (n=19) were between 24 and 60 years of age. Injecting histories ranged from two to 32
years; most injected methamphetamine (n=18) in sexual settings.
Four themes were identified:
(1) Fear of stigmatisation was mirrored in “othering discourses”, suggesting a hierarchical
organisation of local gay communities by drug practices, HIV status, and masculine ideals.
(2) “Group membership” was facilitated through sexualised/injecting drug use, enabling sexual
identities to be self-actualised.
(3) “Dynamic self-hood” distinguished narratives of men who self-identified as ‘drug addicts’ from
those rejecting such labels and who experienced holistic wellbeing regardless of drug use and/or HIV
(4) Emotional pain resulting from internalised stigma was seen to feed negative outcomes, but
“understanding who I was, was curative”.
Findings revealed that social exclusion processes resurface within gay communities through intrasex
competition and hegemonic masculinities; influencing GBM’s sense of self and drug use careers.
Inhabiting a positive self-concept appears critical to holistic wellbeing beyond the benefits
experienced from sexualised drug use. Further de-stigmatisation of drug use and HIV-acquisition
could support fostering the “dynamic self-hood” underlying such positive self-concepts. Findings
highlight the broader societal dynamics of status and power as feeding into any health disparities
experienced by GBM.
Disclosure of Interest Statement:
MH and AP receive investigator-initiated research funding support from Gilead Sciences, Abbvie and
Merck. JD’s institution has received investigator-initiated research funding from Gilead and AbbVie
and consultancies from Gilead and AbbVie. AP and their institution have received consultancies and
travel honoraria from Gilead. AB’s institution has received investigator-initiated research funding
from ViiV. CT has received speakers’ fees from Abbvie and Gilead and research funding from Merck
for research unrelated to this work. SS is supported by an Australian Government RTP Stipend and
Monash University International Tuition Fees Scholarship. The Burnet Institute is supported by the
Victorian Operational Infrastructure Support Program.

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