"The familiar taste of poison": a qualitative study of multi-level motivations for stimulant use in sexual minority men living in South Florida.
Leah Davis-Ewart, Ji-Young Lee, Michael Viamonte, Jos�� Colon-Burgos, Audrey Harkness, Mariano Kanamori, Dustin T Duncan, Susanne Doblecki-Lewis, Adam W Carrico, Christian Grov
Author Information
Leah Davis-Ewart: Miller School of Medicine, University of Miami, Miami, FL, USA.
Ji-Young Lee: Department of Mental Health Law and Policy, University of South Florida, Tampa, FL, USA.
Michael Viamonte: Miller School of Medicine, University of Miami, Miami, FL, USA.
Jos�� Colon-Burgos: Robert Stempel School of Public Health and Social Work, Florida International University, Miami, FL, USA.
Audrey Harkness: School of Nursing and Health Studies, University of Miami, Miami, FL, USA.
Mariano Kanamori: Miller School of Medicine, University of Miami, Miami, FL, USA.
Dustin T Duncan: Mailman School of Public Health, Columbia University, New York, NY, USA.
Susanne Doblecki-Lewis: Miller School of Medicine, University of Miami, Miami, FL, USA.
Adam W Carrico: Miller School of Medicine, University of Miami, Miami, FL, USA.
Christian Grov: Graduate School of Public Health and Health Policy, City University of New York, 55 West 125th Street, Office 812, New York, NY, 10027, USA. christian.grov@sph.cuny.edu.
BACKGROUND: In the US, stimulant use is associated with a 3-6 times greater rate of HIV seroconversion in sexual minority men (SMM) than in those who do not use stimulants. Annually, 1 in 3 SMM who HIV seroconvert will be persistent methamphetamine (meth) users. The primary objective of this qualitative study was to explore experiences of stimulant use in SMM living in South Florida, a high priority region for the Ending the HIV Epidemic initiative. METHODS: The sample included 25 SMM who use stimulants, recruited via targeted ads on social networking apps. Participants completed one-on-one semi-structured qualitative interviews, conducted from July 2019 through February 2020. A general inductive approach was used to identify themes relating to experiences, motivations, and overall relationship with stimulant use. RESULTS: Mean age of participants was 38.8, ranging from 20 to 61 years old. Participants were 44% White, 36% Latino, 16% Black and 4% Asian. Most participants were born in the US, self-identified as gay, and preferred meth as their stimulant of choice. Themes included: (1) stimulants as cognitive enhancements for focus or task completion, including transitioning to meth after first using prescription psychostimulants; (2) unique South Florida environment where participants could be open regarding their sexual minority status while also being influential on their stimulant use; (3) stimulant use as both stigmatizing and a coping mechanism for stigma. Participants anticipated stigma by family and potential sexual partners due to their stimulant use. They also reported using stimulants to cope with feelings of stigma due to their minoritized identities. CONCLUSION: This study is among the first to characterize motivations for stimulant use in SMM living in South Florida. Results highlight both the risk and protective factors of the South Florida environment, psychostimulant misuse as a risk for meth initiation, and the role of anticipated stigma on stimulant use in SMM. Understanding stimulant use motivations can help to shape intervention development. This includes developing interventions that address individual, interpersonal, and cultural factors that drive stimulant use and increase risk of HIV acquisition. Trial registration NCT04205487.
