Minority Stress, Psychological Distress, Sexual Compulsivity, and Avoidance-Based Motivations Associated with Methamphetamine Use Among Sexual Minority Men Living with HIV: Examining Direct and Indirect Associations Using Cross-Sectional Structural Equation Modeling

Abstract

Objective

Sexual minority men (SMM) living with HIV report significantly greater methamphetamine use compared with heterosexual and HIV-negative peers. Greater use may be related to stressors (e.g., HIV-related stigma) faced by SMM living with HIV and subsequent psychological and behavioral sequelae. We tested an integrated theoretical model comprised of pathways between stigma, discrimination, childhood sexual abuse, psychological distress, sexual compulsivity, and cognitive escape in predicting methamphetamine use among SMM living with HIV.

Methods

Among 423 SMM living with HIV, we tested a structural equation model examining factors hypothesized to be directly and indirectly associated with methamphetamine use. Analyses were adjusted for demographic covariates and sampling bias.

Results

The model showed good fit (CFI = 0.96, RMSEA = 0.01). Heterosexist discrimination was associated with psychological distress (β = 0.39, p < 0.001) and psychological distress was associated with sexual compulsivity (β = 0.33, p < 0.001). Sexual compulsivity was associated with cognitive escape (β = 0.31, p < 0.001), which was associated with methamphetamine use (β = 0.51, p < 0.001). Psychological distress was associated with methamphetamine use via serial indirect effects of sexual compulsivity and cognitive escape (β = 0.05, p < 0.05).

Conclusions

Heterosexist discrimination contributed to psychological distress among SMM living with HIV. Psychological distress is linked to methamphetamine use via sexual compulsivity and cognitive avoidance. Interventions seeking to reduce the likelihood that SMM living with HIV use methamphetamine should include coping strategies specific to heterosexism and related psychological distress.

Keywords:

• Sexual compulsivity
• HIV
• sexual minority men
• methamphetamine
• minority stress
• psychological distress

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 We would like to sincerely thank an anonymous reviewer who provided feedback on an earlier draft of the manuscript. Their critical analysis of our findings and the limitations of our model ultimately promoted a more fruitful discussion, including considerations for practitioners supporting SMM living with HIV who use methamphetamine and avenues of future research.

Additional information

Funding

Engage/Momentum II is funded by the Canadian Institutes for Health Research (CIHR, TE2-138299; FDN-143342; PJT-153139), the Canadian Foundation for AIDS Research (CANFAR, Engage), the Ontario HIV Treatment Network (OHTN, 1051), the Public Health Agency of Canada (4500345082), and Toronto Metropolitan University. Graham W. Berlin is supported by a Social Sciences and Humanities Research Council doctoral scholarship; Shayna Skakoon-Sparling is supported by postdoctoral fellowships from CIHR and CTN; David M. Moore and Nathan J. Lachowsky are supported by Scholar Awards from the Michael Smith Foundation for Health Research (5209, 16863); Trevor A. Hart is supported by a Chair in Gay and Bisexual Men’s Health from the OHTN; Daniel Grace is supported by a Canada Research Chair in Sexual and Gender Minority Health. Adhm Zahran is supported by an Ontario Graduate Scholarship.