Research sheds new light on sexualized drug use factors among rural sexual minority men

Gay, bisexual and other sexual minority men in Southern U.S. states are more likely than their counterparts elsewhere to have HIV and other sexually transmitted infections. Additionally, those living in rural areas in the South face a higher likelihood of drug use disorders compared to heterosexual men in the region.

Both conditions share a common factor: sexualized drug use, which involves the use of recreational substances such as alcohol or other drugs immediately before and during sex with other men. Until now, however, little has been known about the factors associated with sexualized drug use by sexual minority men in the rural South.

A new study by Christopher Owens, PhD, and Benjamin Montemayor, PhD, both health behavior scientists with the Texas A&M University School of Public Health, gives insight into this phenomenon.

In their formative study, the researchers surveyed 345 sexual minority men living in rural areas across 14 southern states between Feb. 1 and March 23, 2024.

“Previous studies have found that sexual minority men believe that using substances before or during sex will heighten or prolong their sexual experience,” Owens said. “Our study sought to identify additional demographic, behavioral and minority stress factors behind this practice among rural men.”

The study was published in the Journal of Rural Health and was supported by an internal grant from the Texas A&M Health Science Center (Texas A&M Health).

A statistical analysis of the data found that nearly 80 percent of participants reported the use of substances immediately before or during sex in the past year. The most common substance was methamphetamines, followed by amyl nitrate (“poppers”), GHB/GBL, cannabis and alcohol. Among the sample, more than 82 percent were HIV-negative, and more than 75 percent had not been diagnosed with a sexually transmitted infection in the past year.

The study found associations between sexualized drug use in the past year and the experiences of microaggressions and stressors (such as discrimination, violence and rejection) faced by rural sexual minority men. The study also found a link between these factors and polysubstance use (taking two or more drugs at the same time). Finally, the study found associations for testing for sexually transmitted infection and having oral sex with a man.

“Sexual minority men in rural areas report more minority-related stressors than those in urban areas, so it could be the case that they use substances in both sexualized and non-sexualized situations to cope,” Montemayor said. “We know marginalized groups often use substances, such as smoking, vaping and alcohol, to cope with discrimination. These rural men might be doing the same thing. We also know that people who use more than one substance are more likely to hazardously use substances and experience the consequences.”

The researchers said some of these findings align with those of previous studies. This underscores the need for rural primary care clinics, HIV/AIDS organizations and substance use organizations to provide integrative sexual and substance use screening, counseling and referral services for their rural clients. Additionally, there is a need to develop cognitive behavior therapy to promote coping and resilience among rural sexual minority men.

“While more research is needed, this study adds to our understanding of the factors of rural sexual minority males who practice sexualized drug use, which will help address the epidemics of substance misuse, HIV and sexually transmitted infections,” Owens said.