Dr. Nathan Lachowsky
University of VictoriaView Bio
As a pilot trial, CTNPT 030 had several aims: (1) to determine the feasibility and acceptability of interventions to reduce crystal methamphetamine use; (2) to design community-informed study outcomes and questionnaires for a larger trial; and (3) to determine the feasibility of conducting a larger trial. This trial was guided by Community Advisors who were gay, bisexual, and queer men of mixed HIV status who have used crystal methamphetamine.
The use of crystal methamphetamine has been associated with negative psychological and medical consequences. In gay, bisexual, and other men who have sex with men, crystal methamphetamine use may increase the chance of acquiring HIV due to an increase in sexual risk-taking behaviour. In gay, bisexual, and other men who have sex with men living with HIV, crystal methamphetamine use has been associated with lower engagement in care and poor treatment adherence, leading to a decreased likelihood of viral load suppression and an increased potential chance of transmitting HIV.
A total of 33 community members completed in-depth interviews, which were used to identify relevant topics and experiences with existing crystal methamphetamine interventions; this information was used to design an online survey. Then, a total of 803 community members provided informed consent to complete the new online survey. Information collected in the survey focused on willingness to participate in a larger intervention trial and on the characteristics of acceptable interventions, study design, and measurement of problematic crystal methamphetamine use, as well as the psychosocial factors underlying their substance use.
A mixed methods report based off of initial findings is available via the Community-Based Research Centre (CRBC). In this report, the researchers provide ten recommendations to improve support for gbMSM who use meth.
Using a feminist trauma framework to analyze the qualitative interview data, two overarching themes were identified: developmental and insidious trauma and coping with trauma-related stressors. gbMSMs’ methamphetamine use co-occurred with childhood experiences of family- and peer-perpetrated heterosexism, childhood sexual abuse, and intersecting forms of oppression/marginalization. These experiences manifested as internalized shame, interpersonal anxiety, and low self-esteem. In adulthood, participants reported difficulty managing emotions, low self-confidence, and loneliness. gbMSM reported using methamphetamine to manage negative emotions, life stressors, and overcome barriers to interpersonal connection. Findings indicate a need for trauma-informed interventions that address underlying issues and help gbMSM cultivate supportive relationships.
As aforementioned, the researchers also conducted an online survey with gbMSM to understand how they felt about their substance use and interventions, in addition to what barriers they faced when seeking help during the COVID-19 pandemic. The results showed that 38.7 per cent of participants did not think their crystal methamphetamine usage was problematic, 19.5 per cent were not ready to change their usage of crystal methamphetamine, and 41.7 per cent were ready to take action to address their use of crystal methamphetamine. In addition, getting help with substance use during the early COVID-19 period was more difficult for people on a lower income, who sometimes used methamphetamine before or during sex, or had a greater perceived need for help.
This study highlights the need for inclusive, low-barrier, culturally appropriate, counselling-based interventions that are readily available when gbMSM who use meth are ready to change their substance use patterns.