Usage de drogues et comportements liés à la santé parmi les HSH allemands : résultats d’une étude qualitative réalisée dans différents centres.
Cette étude qualitative analyse 14 entretiens de HSH usagers réguliers de drogues dans 3 villes allemandes. Ces usagers font état des différentes stratégies de comportements de santé par lesquelles ils tentent d’articuler expériences sexuelles, prise de drogues et exposition au risque du VIH. Les auteurs de l’enquête mettent en avant la multiplicité des facteurs explicatifs de la pratique du chemsex et l’effet démultiplicateur de leur interaction. L’amélioration de l’expérience sexuelle et des performances vient en premier dans la liste des motivations citées par les usagers, mais d’autres explications sont à prendre en compte, comme par exemple, le fait que l’usage de drogues permet de construire une identité sexuelle et communautaire, de supporter la violence morale et physique et de palier le stress de la discrimination.
Background : Men who have sex with men (MSM) are a risk group for new HIV infections. Drug use among men who have sex with men is often accompanied by risky sexual behaviours. Local AIDS help centres and gay advice centres are recording an increase in drug use among MSM clients in Germany. This study examines reasons for drug use and drug use contexts for MSM, including syndemic factors and experiences of social support.
Methods : The study is based on a qualitative research approach. We conducted 14 structured, in-depth interviews with substance-using MSM in three German cities. An interview guidance document was used that was developed on the basis of the syndemic approach. Data analysis was based on structured analysis of content.
Results : The MSM interviewed had extensive experience of drug use, in particular amyl nitrate, amphetamines, methamphetamine, ketamine, cocaine and cannabis. The drugs were used both at parties and in connection with sexual experiences (chemsex). Twelve men said that they had an existing HIV infection at the time of the interview. The men also reported experiences of violence and discrimination because of their sexual orientation. The social networks of the MSM and dating apps are highly relevant for experiencing chemsex. Certain places in the MSM community also have an impact on drug purchase, drug consumption and chemsex sessions.
Conclusions : MSM are a group that is vulnerable to psychological problems, in particular problematic drug use. This group requires specific help from drug services and AIDS support services that are orientated towards the life situation and substance use contexts of the clients. Both support systems should work together more closely and network. Furthermore, specific prevention strategies, aimed at both mental and physical well-being, should be developed for substance-using MSM.
