Substance Use, Sexual Identity, and Health Care Provider Use in Men Who Have Sex With Men

Abstract

This article describes the association between substance use, sexual identity, and seeing a health care provider on a regular basis for 257 men who have sex with men (MSM). Data from in-person interviews were gathered from MSM who resided in Massachusetts between 2003 and 2007. A logistic regression analysis that controlled for demographic characteristics, health insurance status, HIV/AIDS status, drug use, and social support revealed that MSM who identified as heterosexual, compared with those who identified as gay or bisexual, were 60% less likely to access a health care provider on a regular basis. Further, the likelihood of seeing a provider regularly was 54% lower for MSM who had used illegal drugs in the past 30 days and 32% higher for MSM who had more social support. Study limitations and implications are discussed.

RÉSUMÉ

Consommation de substances, identité sexuelle et consultation de fournisseur de soins de santé chez les hommes ayant des rapports sexuels avec des hommes

Cet article décrit le lien entre la consommation de substances, l’identité sexuelle, et la consultation régulière de fournisseur de soins de santé. L’étude s’est portée sur 257 des hommes ayant des rapports sexuels avec des hommes (HSH). Les données provenant des entrevues ont été recueillies auprès de HSH ayant résidé dans le Massachusetts entre 2003 et 2007. Une analyse de régression logistique contrôlant les caractéristiques démographiques, le statut de l’assurance-maladie, le statut VIH / SIDA ainsi que la consommation de drogues et de soutien sociale, a révélé que les HSH qui se sont identifiés comme hétérosexuels ont 60% moins de chances d’accéder à un fournisseur de soins de santé sur une base régulière, que ceux qui se sont identifiés comme gais ou bisexuels. En outre, la probabilité de voir régulièrement un fournisseur a été inférieure de 54% pour les HSH qui ont utilisé des drogues illicites au cours des 30 derniers jours, et de 32% plus élevée pour les HSH qui avaient plus de soutien social. Les limites de l’étude et les implications sont discutées.

Mots clés: Consommation de substances, utilisation des soins de santé, HSH, identité sexuelle, soutien social

RESUMEN

Consumo de sustancias, la identidad sexual, y la utilización de proveedores de salud en hombres que tienen sexo con hombres

En este artículo se describe la asociación entre el consumo de sustancias, la identidad sexual, y ver a un médico de manera regular entre 257 hombres que tienen sexo con hombres (HSH). Los datos de las entrevistas hechas en persona fueron obtenidos de HSH que residían en Massachusetts entre el 2003 y el 2007. Un análisis de regresión logística que controló por las características demográficas, el estado de seguro de salud, el VIH / SIDA, el consumo de drogas y el apoyo social, reveló que los HSH que se identificaron como heterosexuales, en comparación con aquellos que se identificaron como homosexuales o bisexuales, tuvieron 60% menos probabilidades de tener acceso a un proveedor de salud de manera regular. Además, la probabilidad de ver un proveedor regularmente fue 54% más bajo para los HSH que consumieron drogas ilegales en los últimos 30 días, y un 32% más alto para los HSH que tenían más apoyo social. Los límites del estudio y las implicaciones son discutidas.

Palabras clave: consumo de sustancias, la utilización de servicios de salud, los HSH, la identidad sexual, el apoyo social

Keywords :

• substance use
• health care utilization
• MSM
• sexual identity
• social support

THE AUTHORS

Joseph R. Merighi, Ph.D., is Associate Professor of Human Behavior at Boston University School of Social Work. His research activities focus on social work practice in health care settings, end-stage renal disease, health risk behaviors, and gay identity development. He has a particular interest in cross-national studies and has conducted survey research in Australia, France, Portugal, and the United States.

Deborah Chassler, M.S.W., is Senior Research Associate and Associate Director of the Center for Addictions Research and Services at Boston University School of Social Work. Her current research interests include the implementation of evidence-based practices in community-based organizations and health services utilization among vulnerable populations. She works directly with community-based agencies that provide HIV prevention and substance abuse services. Her other interests include teaching research methods to social work students.

Lena Lundgren, Ph.D., is Professor of Welfare Policy, Director of Research, and Director of the Center for Addictions Research and Services at Boston University School of Social Work. She conducts large-scale quantitative research efforts on the relationship between injection drug use, substance abuse treatment utilization, and the spread of HIV. Her current research focus is on health disparities, with a particular emphasis on access to substance abuse treatment. She is also conducting a national study of the capacity of community-based organizations to implement evidence-based treatment as mandated through federal policy.

Hutson W. Inniss is the Vice President of Community and Organizational Development at Tapestry Health, Inc. He served as the director for Tapestry Health's Among Men/For Men Project, funded by the Substance Abuse Mental Health Services Administration, Center for Substance Abuse Treatment. Currently, he is the project director for the organization's capacity development program, funded by the US Department of Health and Human Services, Office of Minority Health. He is a 2007 Fellow of the Center for Disease Control and Prevention Association of Schools of Public Health's Institute for HIV Prevention Leadership.