UC Berkeley

Sexual minority men (SMM) have historically been exposed to stressors that translate into poor social and health outcomes. Methamphetamine use is an outcome representing a powerful health disparity for SMM. Sexual compulsivity (SC) has been centered in SMM’s health research; however, its role in SMM’s methamphetamine use remains underdeveloped. Guided by syndemics theory, intersectionality, and revised stress and coping theory, the purpose of this mixed methods study is to contextualize the role of SC in the methamphetamine-using behaviors of SMM living with HIV. Data were collected from 2014-2019 through an RCT testing a positive affect intervention in San Francisco. Cross-sectional survey data (N= 129) were used for quantitative analyses and participants (n = 24) were purposively sampled to take part in semi-structured interviews for qualitative analyses. Narrative analysis revealed that most participants experienced adverse events as youths, specifically related to sexuality. Additionally, they reported that sex was related to methamphetamine initiation and subsequent use, and that methamphetamine was disruptive to relationships. Narrative analyses surfaced a sequential pattern of disconnection at foundational, relational, and recovery levels, revealing themes of negative affect, isolation, SC, depression, trauma, and other mental health issues across the life-course. Network analysis suggests two specific significant positive associations: between depression and negative affect and between PTSD and depression. Constructivist grounded theory analysis highlighted six themes regarding participants’ relationships with/on methamphetamine. Findings highlight the influence of life-long experiences of syndemically related psychosocial factors in the methamphetamine-using behaviors of SMM. Findings suggest peer-based interventions focus on holistic, integrated approaches to tend to SMM’s histories of adverse events and mental health issues, which diminish relational capabilities. SC should be understood as a potentially maladaptive coping strategy developed by SMM as a response to stigmatization and discrimination. Taken together, these findings can help inform cutting-edge methamphetamine use and mental health interventions for SMM.