The prevalence of licit and illicit drug use among gay and bisexual men (GBM) is higher than in other population groups. More than half of GBM reported recent illicit drug use. Few studies have reported on incidence or risk factors for, initiation and cessation of, or changes in, drug use over time, or on the harmful outcomes of such use. Condomless anal intercourse with casual male partners (CLAIC) is the primary risk factor for HIV infection among GBM. Drug use, particularly when used to enhance sexual pleasures has been associated with CLAIC and with incident HIV infection among GBM.
All jurisdictions have health promotion campaigns targeting drug use in general; ACON has specific programs targeting drug use among GBM; HIV-prevention campaigns targeting GBM usually also address drug use. Yet, drug use remains high within gay communities and rates of associated harms are largely unknown. Also, the specific role of drug use in HIV infection and sexual risk behaviour remains unclear. Little research has been conducted into the patterns and contexts of GBM’s drug use, and how this varies over time, or understandings of harm reduction.
Little is known about gay community norms regarding drug-using behaviours and harm reduction or beliefs about associated harms or how these norms intersect with behavioural norms around sexual risk behaviour.
The Flux Study is being conducted nationally in Australia using online survey techniques. The study will monitor changes in drug use and associated harms, beliefs and attitudes, and engagement with gay community networks over time through self-completion of online questionnaires at six-monthly intervals.
A unique integrated system of digitally linking individually tailored questionnaires, study databases, and communications with participants, was developed for this study and was named the Flux Automatic Management eSystem (FAME) . It was designed to be specific to this study but can be adapted to other research projects.
Between September 2014 and July 2015, a total of 2,250 participants completed the baseline questionnaire, of whom 1,710 (76.0%) consented to six-monthly follow-up. At baseline, over half (50.5%) the men reported the use of any illicit drug in the previous six months, and 28.0% had used party drugs. In the six months prior to enrolment, 12.0% had used crystal methamphetamine, 21.8% had used EDM, and 32.1% had used amyl nitrite. Among the 1,710 men enrolled into the cohort, 790 men had used none of these drugs.
Having successfully implemented FAME to establish the first entirely online cohort study of drug use among Australian GBM, the Flux Study will be able to provide data on incidence and factors associated with initiation and cessation, and changes in patterns of drug use and related harms over time. The high rates of illicit drug use in this sample indicate the need for longitudinal enquiry and follow up to assess continuing and changing patterns of drug use over time within this population.
Outcomes of the proposed study will include:
- New knowledge of the incidence of drug-using behaviours and associated harms among GBM.
- Better knowledge of how social norms, particularly those regarding shared understandings of risk and pleasure, explain drug-using and other risk behaviours of GBM.
- Research-based evidence on the differences between distinct networks of GBM in Australia.
- Practical recommendations for health promotion, alcohol and other drugs (AOD) and HIV/Hepatitis C virus (HCV)-prevention agencies and policy makers to improve the targeting of prevention messages to local gay communities, and to promote sustainable behaviour change.
- Newly generated data to further advance social research concerning the interconnections between drug use and sexual behaviour, sexual mixing, and modelling HIV/HCV epidemics in Australia.
- Australian Research Council (ARC), ARC grant number: RG132750