Substance use and sexual risk between men in London: a critical exploration of social practices and health concerns

Abstract

Over the past two decades, men who have sex with men (MSM) have witnessed both the improvement of HIV living conditions and a certain relaxation of fears around safe sexual behaviour. Research has pointed to the use of drugs and alcohol as a causal factor leading more people to have unprotected sex, which would explain the rise of HIV diagnoses due to this mode of transmission. This project questioned the theoretical underpinnings for such a peculiar association and set out to explore the significance of alcohol and drugs among MSM in London, England. Engaging with a research field fragmented between epidemiological and cultural models of “risk”, two studies were devised addressing both social practices and health concerns. In the first study, participant observation was carried out in gay-friendly dance parties where drug use is prevalent. In the second study, a long-term psychotherapeutic group was established for nine men presenting as problem substance users seeking help. Data, in the form of fieldnotes and session transcripts, were analysed using Grounded Theory. Through their consumption substances functioned as relational commodities sometimes turning into overvalued objects of satisfaction. In gay-friendly environments the use of drugs and alcohol fostered the expression of same-sex sexual desire. This recurrently took up features of affirmation of the self, validation, and belonging. Rather than being associated to another person with whom enjoyment had been experienced, however, substances functioned as fetish for some men. Akin to abstract commodities, they became charged with expectations of everlasting and renewable gratification. Findings will be discussed around the conjoined pursuit of pleasure and pain in spite of the limits of enjoyment and around the interchangeable use of different objects, including health-preservative ones, for similar purposes. For those taking part in these practices, the findings give primacy to personal agency over subjectification through object-consumption; a neutral stance towards substances and gay sex might therefore be more authentic for educators and the effects of anxiety and shame in relation to personal distress, beyond HIV risk, might be addressed in future research. Value might be drawn, for harm prevention, from openly discussing the sexual and social disappointments associated with fetishistic object-consumption, whereas neutrality of outcome with regard to the consumption of individual substances by clients and their decisions to leave treatment might be useful for practitioners to consider. This project highlights accountability as central to personal satisfaction and social intercourse: policy makers might want to draw their attention to the direct pharmacological properties of each object at comparable levels of consumption when deciding upon the legal status and limits to their use.