LGBTQ, Subastance Abuse, and HIV

October 1, 2018


For years the LGBT community has been plagued with substance abuse issues. Studies have shown that, when compared with the general population, gay and bisexual men, lesbian, and transgender individuals are more likely to use alcohol and drugs at much higher rates than the general population. For many individuals in the community alcohol and substance use are reactions to the homophobia, discrimination, and violence some have experienced due to their sexual orientation. For others, substance use is a way of community acceptance and trying to fit in. Either way, substance abuse is a problem within the community disrupting relationships, employment, and financial stability for many people and also contributing to other mental health and physical problems.

Substance abuse research within the LGBT community isn’t well known but is a common problem within the community according to the substance abuse and mental health services administration. Some studies indicate that substance abuse disorders may be 20%-30% among the LGBT population which is 9% higher that than the general population. National research done in 2009 showed that substance abuse is twice a prevalent in LGBT youths compared to their peers, noted Jeremy Goldbach, an assistant professor at the University Of Southern California School Of Social Work. However, he adds, “82% of funding for LGBT people were focused on sexual risk and HIV. So if it’s not about sexual risk or HIV, primarily in adult gay men ... we basically have no idea about the true statistics of substance abuse within the LGBT community.” Some studies dispute these high number due to lack of defining, identifying and locating LGBT participants who willing to talk about their substance abuse problems
But I being a willing participant within the LGBT community and knowing the lifestyle of the LGBT people primarily gay and bisexual men youth, elders, and those in between know that substance abuse is an issue that has been plaguing the community for many years. So, why are substance abuse rates so much higher within the LGBT community than the general population? One major factor is stress from facing obstacles such as discrimination, stigma, and family rejection. “When you are a person who is under chronic stress, that chronic stress results in negative health outcomes,” Goldbach says. “The mind and body may react in multiple ways, and substance abuse is one of those ways.” Another major factor is lifestyle changes such as gender identity or being diagnosed with HIV/AIDS a common factor found with gay and bisexual men within the community.

Cultivated in an unsupportive culture, nurtured by homophobia and bullying, and no real family support; the stressors for a person who identifies as LGBT, especially youth, gay and bisexual men, add up. For people living within the LGBT community especially young gay and bisexual men, they have often escaped into substances such as methamphetamines, cocaine, crack cocaine, ketamine, and other illicit drugs as a way to cope with the stressor. Bars and clubs have a history of being a central meeting place for the LGBT community and a safe haven for impressionable youth, in addition, they have been a safe haven for illicit drug use creating easy access and providing a fertile ground for substance abuse.

My personal experience with this nurturing playground for sex, alcohol, and substance abuse started when around 15 years old. Some say marijuana is the gateway drug my first time using a drug was when I experimented with methamphetamine. I began sneaking out and would go to parties, clubs, and social event almost every night. I became somewhat of a socialite within the Houston LGBT community. I had finally found the illusion of family acceptance. Everybody knew me and if you didn’t know me I made sure that you did. I fell into the party life and I fell in hard and fast. I learned early that my youth was everything and I use it to get what I want and my youth also is what also lead to my first boyfriend and my drug of choice cocaine. It made me feel pretty like there was not a care in the world. I was introduced to the drug when I was 19 years old by my former lover and from the very first snort, I was hooked. Cocaine started to rule my life not only did I want it, but I needed it and like many users within the LGBT community I began to use the drug in both powdered and rocked formed long-term socially and privately. For 7 years the drug ruled my life, I am only 28 years old so you do the math. I began my recovery a year ago when I moved to Shreveport, Louisiana. My life had become completely consumed by the drug and after almost dying I had to take a hiatus from life in the big city, so I packed up and moved to the country and it was there that I saw the effects the drug had my health physically and mentally.

In December 2012 I was infected with HIV virus and for almost two years I survive without antiretroviral treatment, but all the while I was abusing powder and crack cocaine. In October 2104 I was diagnosed with AIDS after having a CD4 count of 94. In course of two years, my condition worsened but not due to an undiagnosed virus. I believe my condition worsen faster due to drug abuse and addiction. Studies have shown that drug abuse and addiction can worsen the progression of HIV and its consequences. (Langford, 2003). One study shows that methamphetamine increased the amount of HIV virus present (Marcondes, 2010), while another show that substance abuse caused greater neuronal injury and cognitive impairment in methamphetamine abusers compared to non-drug users. (Rippeth, 2004). Once I started treatment my substance usage increased which lead to a poor adherence to my antiretroviral treatment and too afraid to seek help for substance abuse problem the HIV virus grew within me and became resistance to 21 out 30 medications in 2015.

Often, illicit drug use is viewed as a criminal activity rather than a medical issue that requires counseling and rehabilitation. This prevents people who use illicit drugs from seeking treatment services, which place them at a greater risk for HIV, in addition, people living with HIV who use substances are less likely to adhere to their antiretroviral treatment regimen as prescribed due to side effects from a drug interaction. Not taking your antiretrovirals as prescribed can worsen the effects of HIV and increase the likelihood of spreading HIV.

There fear of stigma, feelings of guilt, and low self-esteem prevented me from seeking help for my substance issues for a long time, well before I was diagnosed with HIV/AIDS. In fact, being diagnosed only gave me reasons to abuse substances even more and each downfall that I faced while being HIV positive only created excuses for me to continue to abuse substances. And even though help was always available to me but it was not until I ready to get the help that I was able to receive help, but not two addicts are the same. I had to find the strength within myself to say “I have a problem” which is not easy to do. Others who feel alone and misunderstood, which are also two major factors as to why LGBT youth begin to abuse substances, may need a little extra help such intervention and prevention program. By the time LGBT substance users reach adulthood, they become addicts that do not believe they have an addiction problem and as an adult it harder for them to receive treatment and might be discouraged from seeking treatment for substance abuse issues due to anticipating negative reactions from peers and/or providers.

The key to curbing substance abuse issues within the LGBT community is to isolate and target the initial problems by tailoring intervention methods and techniques. Prevention programs work, but they only really work if the participants feel it’s culturally relevant and it matches them, but as the old saying goes “birds of a feather flock together” many users within the LGBT community usually use substances in a peer group setting. So when we tailor an intervention, where participants see people and things in those programs that are similar to them, they’re more engaged, and the engagement leads to healing emotional/mental wounds and scars, which leads to less drug use, but in order to do this we must separation users from their peers in a way that may not increase the sense of isolation and differentness that LGBT people already feel.

Substance abuse is a topic that is rarely talked about within the LGBT and HIV community but is something that is so common amongst the two. For decade recreational drug use has been a way of celebration and community for many within the LGBT community, but also a way of escape and coping for those who have experienced the hardships of being LGBT. No longer must we make excuses for users to abuse substances such as “some gay and bisexual men use alcohol and illegal drugs, especially methamphetamines, amyl nitrates (poppers), to treat erectile dysfunction.” In a time where it seems as if being LGBT is socially acceptable, it is time for the issues that fell to the wayside of gay rights, trans rights, and marriage equality to have the attention put back on the concerns that continue plague the community such as substance abuse.

1. Langford, D., et al., Patterns of selective neuronal damage in methamphetamine-user AIDS patients. J Acquir Immune Defic Syndr, 2003. 34(5): p. 467-74.
2. Marcondes, M.C., et al., Methamphetamine increases brain viral load and activates natural killer cells in simian immunodeficiency virus-infected monkeys. Am J Pathol, 2010. 177(1): p. 355-61.
3. Marshal, M. P., Friedman, M. S., Stall, R., King, K. M., Miles, J., Gold, M. A., et al. (2008). Sexual orientation and adolescent substance use: A meta-analysis and methodological review. Addiction, 103(4), 546-556.
4. Rippeth, J.D., et al., Methamphetamine dependence increases the risk of neuropsychological impairment in HIV infected persons. J Int Neuropsychol Soc, 2004. 10(1): p. 1-14.