Evidence for increased substance use among homosexuals and bisexuals, obtained from population-representative samples, has been extensively cited elsewhere within this section. This page addresses some details of substance use among homosexuals and bisexuals.

Some drugs are more popular among male homosexuals than others,[1] especially poppers (nitrites), ecstasy, and methamphetamine, which they use to enhance sex.[2]

Drug-using homosexual and bisexual men are more likely to use multiple drugs than drug-using heterosexual men.[1] Both quantitative and qualitative data suggest that many drugs have a strong sexual meaning for homosexual and bisexual men;[1, 3] i.e., nonheterosexual men are not trying to seek medication for their sorrows, but using drugs to enhance sexual pleasure.

By the mid-late 1980s and continuing till 1992, American male homosexuals had reduced their consumption of alcohol and various other drugs, likely as a result of excessive AIDS deaths among their peers and the widespread belief among them that stimulants such as cocaine, crack, and amphetamines increased the likelihood of HIV infection and worsened the health of HIV-positive individuals.[4, 5] It would have been premature at this point to claim that decreasing prejudice toward homosexuality was responsible for the decrease in drug use among male homosexuals; besides, drug use declined in the general population itself during this period.[4] Stall et al. interviewed a probability sample (telephone-based) of 2,172 MSM in Chicago, Los Angeles, New York, and San Francisco between November 1996 and Feb 1998.[6] The current (past 6 months) drug use prevalence was: recreational drug use, 52%; alcohol use, 85%; multiple drug use (three or more drugs other than alcohol), 18%; three or more alcohol-related problems, 12%; frequent drug use, 19%; heavy–frequent alcohol use, 8%; nitrites use, 1 in 5; marijuana use, 50%; powder cocaine, 1 in 6; and ecstasy, 1 in 10. For comparison purposes, the prevalence of drug use in the past year among American men at the time was: marijuana use, 10.8%; cocaine use, 2.3%; and stimulant use, 0.9%.[7]

The discrepancy between MSM and heterosexual men is much greater for the use of illegal drugs than alcohol consumption.[6]

The CDC reported in 1996 that among homosexual and bisexual men with AIDS, 11% reported injection drug use and 20% of all male injection drug users with AIDS also reported sex with men.[3, 8] Most studies reveal that drug-injecting homosexual and bisexual men prefer cocaine or amphetamines (alone or in combination with heroin), and, more rarely, heroin alone.[3]

In general, homosexual and bisexual men more involved in substance use, whether injecting drugs or not, are more likely to participate in risky sexual behaviors,[3] but this relationship may not hold for alcohol.[9, 10]

Drug injecting homosexual/bisexual men have higher rates of HIV infection and sexual risk-taking behaviors than homosexual/bisexual men who do not inject drugs or heterosexual men who inject drugs.[3] For instance, Deren et al. reported that among drug injecting and crack smoking men, homosexuals and bisexuals reported more partners, a higher incidence of exchanging sex for drugs or money, and were more likely to be HIV-positive (57%) than heterosexual men (7%).[11] Behaviorally bisexual drug injecting men appear more likely to share needles in the past 6 months and to trade sex for money and drugs than exclusively heterosexual or homosexual men.[12]

Many studies have reported that HIV-negative homosexual and bisexual men with higher non-injecting substance use are more likely to become infected with HIV than those with lower substance use.[3, 13]

Goode and Troiden described 150 homosexual men, a third each from Manhattan, Suffolk County (a suburb of New York City), and Minneapolis, ages 20-40 years (Table 3.5).[14] As Table 1 shows, more frequent use of nitrites went with more prolific sexual behavior.

Table 1: Nitrite use and sexual behavior among homosexuals
Characteristic At least once weekly* Not used past 6 months**
Venereal disease 78% 48%
Robbed 33% 14%
Assaulted 22% 11%
Had sex with same partner less than half the time 44% 22%
Drunk weekly or more 48% 23%
Had 500 or more partners since age 18 38% 17%
Have had sex with 6 or more partners under 21 52% 16%
Likely to have engaged in group sex 96% 65%
Sexual intercourse at least thrice weekly in past year 67% 33%
Notes: *number = 27, **number = 65

Homosexuals use drugs such as nitrites to relax their internal anal sphincter in order to allow the insertion of fists or other large objects.[15, 16] Nitrites act like the drug, Viagra, helping to relax smooth muscle cells. The internal anal sphincter is a smooth muscle. The relaxation of the smooth muscle cells of arteries facilitates and prolongs erection, and decreases blood pressure. Nitrite intake decreases blood pressure and reduces the amount of hemoglobin capable of binding oxygen, thereby temporarily reducing oxygen supply to the brain. Sexual pleasure derived via brain hypo-oxygenation is a form of sexual masochism, the prevalence of which is much higher among homosexuals.

Other than prolonging erection and enhancing orgasmic pleasure, drug use by male homosexuals appears to facilitate their involvement in risky sexual practices by decreasing both anxiety and self-observation.[4] Anxiety and self-observation diminish sexual pleasure. Indeed, both alcohol and stimulants help decrease inhibitions.

Little prejudice is directed toward homosexuality among women compared to men, and homosexual women have, on average, a higher socioeconomic status than heterosexual women[17, 18] – yet homosexual women manifest increased alcohol intake and other drug use compared to heterosexual women (see the overview of mental health among nonheterosexuals).


Clearly, one should carefully consider whether discrimination and prejudice can hardly account for elevated drug use among homosexuals. For instance, as a general rule, substance use disorders are elevated among mentally ill individuals, and notably so for prisoners, schizophrenics, and individuals with antisocial personality disorder or bipolar disorder.(19) Substance use disorders occur in approximately 40-50% of individuals with schizophrenia and are associated with incarceration, homelessness, violence and suicide among them.[20] Interestingly, there is little evidence “that schizophrenic symptoms lead to substance use (self-medication), that substance use leads to schizophrenia, or that there is a genetic relationship between schizophrenia and substance use.”[20] There is an association between nonheterosexuality and schizophrenia as well as mood disorders and personality disorders.


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