Pathways to HIV Risk and Vulnerability Among Lesbian, Gay, Bisexual, and Transgendered Methamphetamine Users: a Multi-Cohort Gender-Based Analysis, Brandon D.L. Marshall et al., BMC Public Health (2011)

Using data from three ongoing cohort studies of drug users in Vancouver, Canada, this article relies on a "risk environment" framework—the theory that external factors intersect to produce and reproduce HIV risk and other drug-related harms—to examine the rate of methamphetamine (MA) use in sexual minorities and its relationship to individual, social, and structural HIV vulnerabilities. Sexual minorities were found not only to have higher risk of recent MA use, but were also associated with a set of HIV vulnerabilities, such as injection drug use and unprotected sexual intercourse.

The analysis of the data from each cohort study demonstrated that sexual minorities used MA at a significantly higher rate than heterosexual individuals. Of the males who were identified as sexual minorities, 62.1% reported MA use in the past six months, while 40.3% of the female sexual minorities reported similar use. For comparison, 3.74% of heterosexual males reported recent MA use and only 1.8% of heterosexual females.

Among the male sexual minorities, there was a higher risk of depression and behaviors, such as unprotected sexual intercourse, that have a higher risk of HIV transmission. In female sexual minorities engaged in sex work, MA use was similarly associated with a higher rate of unprotected intercourse with clients. For both males and females, movement restrictions (such as those pertaining to court orders and sentence requirements) influenced where drugs were consumed or purchased. Those facing some sort of movement restriction faced not only increased stigma, but increased risk of sexual vulnerability and HIV.

The authors conclude that because of the complexities in the relationship between MA use and sexual minorities, reducing MA-related harm and HIV risk will require more comprehensive interventions that involve sectors outside of health in addition to drug-specific approaches aimed at LGBT populations.