Background: The increasing prevalence of sexualized drug use among gay, bisexual and other men-who-have-sex-with-men (GBMSM) is causing concern globally, as it poses multiple risks for their psycho-social-sexual health. This study aimed to describe the sexualized use of recreational drugs, and to characterize users among Latin American GBMSM.
Methods: The Latin American MSM Internet Survey was an online questionnaire, available in three languages across 18 Latin American countries. From January-May 2018, it collected information on sexual behavior, drug use, psychosocial health, HIV/STI testing, self-reported HIV/STI diagnosis, and preventive strategies. Participants were mainly recruited through gay apps/web-pages. The Chi-square test was used to compare proportions.
Results: Of the 64,655 participants, 45.8% had used drugs (excluding alcohol, tobacco, and sedatives) in the last 12 months (Brazil and Southern Cone countries had the highest proportions). Cannabis (29%), poppers (18%), erection-enhancing medications (15%), cocaine (9.5%) and ecstasy (7.3%) were the most commonly used substances. Injection drug use was reported by 0.3%. Among those who had sex with a man in the last 12 months (n=60,985), 49% had sex under the influence of alcohol or other drugs, 9.9% never had sober sex, and 24% used some recreational drug before/during sex with their last non-steady partner(s). Overall, 8,690 men (13.6%) reported using drugs to enhance or prolong sex during the last 12 months and 6.6% used drugs in a group sex setting. The using drugs to enhance their sexual experience was significantly more likely among men who reported the following characteristics: living in a Southern Cone country, residence in a city of more than one million inhabitants, aged 25-40, born abroad, higher education, employment, gay identity, engaging in transactional sex, and diagnosed with HIV. Also among these men, 72% reported condomless anal sex with non-steady partners in the last 12 months, 53% had been diagnosed with a previous STI; and, among those with no prior HIV-diagnosis, 2.6% were taking PrEP.
Conclusions: The sexualized use of drugs among Latin-American GBMSM is noticeable, particularly in big cities and Southern Cone countries. This pattern should be taken into account in public health programs and harm-reduction interventions included as part of the combined prevention approach.