Transcript Module-7x

PROMOTING THE
HEALTH OF MEN
WHO HAVE SEX WITH
MEN WORLDWIDE
A training curriculum
for providers
Module 7:
Supporting Gay Men
and other MSM Who
Use Substances
2
Learning Objectives
3
1
Describe the reasons for, and known patterns of, drug and alcohol
use among gay men and other MSM
2
Name the common drugs used by gay men and other MSM
3
Increase the level of comfort discussing substance use within the
clinical setting with gay men and other MSM
Module Overview
1
Getting comfortable talking about drugs and alcohol
2
The link between drug use and HIV transmission
3
Drugs commonly used by gay men and other MSM, and their
effects
4
Approaching drug use in the clinical setting
5
Drug and alcohol use screening tools
6
Interventions for decreasing drug and alcohol use
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8
4
Potential signs of drug or alcohol abuse
Gay men and other MSM who do not report problematic drug or
alcohol use
Pre-reading Assignment
Questions for discussion:
1
What relevance does the drug use scenario presented in the
case study have for your country or local context?
2
Why do you think it is harder for gay men and other MSM to
negotiate around safer sex?
•
3
5
One reason may be drugs, what are others?
What are strategies that you may recommend to encourage gay
men and other MSM who uses drugs to connect with a
healthcare provider?
Talking About Drugs and Alcohol
1
2
6
Many individuals will go through life using substances either
regularly or on occasion without any disruption or negative
impact to their social, professional, or physical lives.
It is also important to recognize that for some others, substance
use can be problematic each time they use drugs and alcohol or
under specific circumstances
Group Activity
Substance Use Awareness
7
Drug and Alcohol Use
Do gay men and other MSM use drugs and alcohol more
than others?
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1
Several studies suggest the presence of higher rates of drug
and alcohol use among severely marginalized populations
2
There is a clear link between higher drug and alcohol use, and
experiences of social discrimination
•
Criminalization
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Outright rejection
•
Isolation
•
Denial of basic human rights
Drug and Alcohol Use
Why do gay men and other MSM use drugs and alcohol?
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1
To cope with anxiety, depression, isolation, and loneliness
2
Because drugs and alcohol may be common or appear
normalized in some social venues
3
To help individuals to relax, overcome social inhibitions, and
increase confidence while seeking sexual partners
4
To provide psychological enhancement of sexual experiences
5
To escape from “fear of rejection” given their HIV positive status
Drug and Alcohol Use
What are known patterns of drug use among gay men and
other MSM?
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1
Episodic (i.e., weekly/monthly use is greater than daily use)
2
Higher reported rates of drug use among gay men and other
MSM who are ethnic minorities, younger, and live in urban areas
3
Take more than one drug during the same session or within a
given time frame (poly drug use)
Drug Use and HIV Transmission
1
Drug and alcohol use may be linked to HIV risk, especially through
the sharing of injection equipment and/or unprotected sex with a
serodiscordant and viremic partner
2
Substance use can lead to high-risk sexual behaviors through the
loss of sexual inhibition while under the influence of certain drugs
3
Use of specific substances such as cocaine or methamphetamines
are associated with interruptions in antiretroviral therapy
•
4
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Can increase chances of HIV and STI transmission
Substance use is linked to a higher likelihood of HIV transmission
among MSM being treated for STIs
Commonly Used Drugs and Their Effects
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List of Drugs
Street Name/Regional Variation
Alcohol
-
Amphetamine
speed, uppers, sulphate, whizz
Cannabis
marijuana, Mary Jane, dope, pot, spliff, hash(ish), weed, puff,
grass, herb, draw, wacky backy, ganja, hemp
Cocaine
coke, Charlie, C, snow, blow, a toot,
Bolivian/Peruvian/Colombian marching powder
Crack cocaine
rock, base
Crystal methamphetamine
Crystal, Tina, meth, ice, crank
Ecstasy
E, MDMA, X, XTC
GHB/GBL
Gina, G, liquid ecstasy
Heroin
smack, skag, junk, horse
Poppers
amyl, butyl, isobutyl nitrate, aromas, liquid incense
Approaching Drug Use
In the clinical setting:
1
Build rapport and confidence with the client
2
Remind clients that any information they share, or that is
documented, is confidential
•
3
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If information will be shared, healthcare providers must reveal to the
client with whom it will be shared and under what circumstances
Remember to always use a non-judgmental and nonconfrontational approach when discussing drug use with clients
Approaching Drug Use
1
Normalizing: “Many people find it difficult to talk about sex and drugs….”
2
Transparency: “I need to ask you some specific questions about your drug use
to better understand your health needs and provide the best possible care”
3
Asking permission: “Would it be OK if I asked you some questions about your
alcohol use?”
4
Option of not answering question: “If you’re not comfortable answering any of
these questions, you don’t have to answer them.”
5
Offering response choices: “How often do you mix drugs together? Never?
Sometimes? Always? Almost Always?”
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7
14
Avoid asking for judgments or opinions: “How often do you drink in a week?”
or, “How many drinks do you drink in one setting?” is better than asking “Do you
get drunk?” or, “Do you drink often?”
Ask specific instead of general questions: “Have you ever used marijuana?”
or, “Have you ever used cocaine?” is better than asking “Have you ever used
street drugs?”
Screening Tools
1
The best method for assessing the way forward is
•
Identify what the client’s goals are in relationship to drugs, and
• Engage in an open discussion about whether or not the client’s current use
aligns with where they want to be.
2
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The role of the healthcare provider is to motivate the client to
articulate their personal goals and come to a clear understanding
of where they stand with their goals in relationship to their current
substance use
Potential Signs of Substance Abuse
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1
A tolerance to the substance
2
Withdrawal symptoms
3
Loss of control concerning the substance (or the inability to stop
using the substance despite the desire to do so)
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Failed attempts to stop using the substance
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A preoccupation with the substance
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The continued use of the substance despite negative
consequences
Unreported Problematic Drug Use
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1
Providing health information related to drug use from credible
sources in an honest and non-judgmental manner
2
If drug use is within the context of sex, then engage in a
conversation about sexual health as well
Summary
1
Research suggests gay men and other MSM are more likely to use drugs and
alcohol when compared with adults in the general population
2
A proportion of gay men and other MSM who use drugs and alcohol also do so
for pleasure and recreation that include the use of drugs and alcohol in the
sexual context or within social settings like dance clubs and bars
3
Substance use can lead to high-risk sexual behaviors through the loss of
sexual inhibition while under the influence of certain drugs
4
Ways to handle substance use in the clinical setting include:
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•
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Identify what the client’s goals are in relationship to drugs
Engage in an open discussion about whether or not the client’s current use
aligns with where they want to be
Healthcare providers must exercise compassion, confidentiality and nonjudgment while adopting harm-reduction approaches