Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2054, Australia; Health Equity Research and Development Unit, Sydney Local Health District & UNSW Sydney, Sydney, NSW, 2054, Australia.
Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2054, Australia.
Int J Drug Policy. 2021 Jul;93:103163. doi: 10.1016/j.drugpo.2021.103163. Epub 2021 Feb 16.
Crystal methamphetamine (hereafter crystal) is associated with deleterious health outcomes, such as drug dependence and physical and mental health disorders. While some harms from crystal use can affect all users, there may be additional risks for people who combine the use of drug with sex. Compared with the broader population, gay and bisexual men in Australia report a higher prevalence of methamphetamine use, and crystal is the most commonly injected illicit drug among this population. The Crystal, Pleasures and Sex between Men research project was conducted between 2017 and 2019 and examined gay and bisexual men's crystal use in four capital cities in Australia, with the aim of identifying how to best support men who use crystal for sex. In this article, we examine how risk is understood and prioritised by gay and bisexual men who combine crystal use and sex and identify the range of risk reduction practices that they used. We classified these risks as those associated with the transmission of HIV, HCV and STIs, and those associated with dependence on either crystal or the sex it facilitated. Gay and bisexual men overwhelmingly prioritised the risk of dependence over any other risks associated with crystal-enhanced sex, and this prioritization was reflected in the risk reduction practices they employed. While some of the strategies that gay and bisexual men have adopted may contradict anticipated public health principles, they derive from a carefully considered and shared approaches to the generation of pleasure, the maintenance of a controlled form of feeling "out of control", and the negotiated reduction of risk. The consolidation of these strategies effectively constitutes a "counterpublic health" underpinned by forms of "sex-based sociality", which gives primacy to the priorities and practices of gay and bisexual men in Australia who combine crystal and sex.
冰毒（以下简称冰毒）会对健康造成不良后果，如药物依赖和身心健康障碍。虽然冰毒使用的一些危害可能会影响所有使用者，但对于那些将毒品使用与性结合起来的人来说，可能会有额外的风险。与更广泛的人群相比，澳大利亚的男同性恋和双性恋者报告冰毒使用率更高，而且在这一人群中，冰毒是最常被注射的非法药物。《冰毒、快感与男男性行为》研究项目于 2017 年至 2019 年进行，调查了澳大利亚四个首府城市男同性恋和双性恋者的冰毒使用情况，旨在确定如何最好地支持那些因性而使用冰毒的男性。在本文中，我们考察了那些将冰毒使用与性结合起来的男同性恋和双性恋者如何理解和优先考虑风险，并确定了他们使用的一系列降低风险的做法。我们将这些风险分为与 HIV、HCV 和性传播感染（STIs）传播相关的风险，以及与对冰毒或其促进的性依赖相关的风险。男同性恋和双性恋者压倒性地将依赖风险置于与冰毒增强性行为相关的任何其他风险之上，这种优先级反映在他们采用的降低风险的做法中。虽然男同性恋和双性恋者采用的一些策略可能与预期的公共卫生原则相矛盾，但这些策略源于他们对产生快感、维持“失控”的控制感以及协商降低风险的深思熟虑和共同方法。这些策略的整合有效地构成了一种以“基于性别的社交性”为基础的“反公共卫生”，优先考虑了澳大利亚将冰毒和性结合起来的男同性恋和双性恋者的优先事项和做法。
