Disease Elimination Program, Burnet Institute, Australia; School of Public Health and Preventive Medicine, Monash University, Australia.
Australian Research Centre in Sex, Health and Society, La Trobe University, Australia.
Int J Drug Policy. 2022 Oct;108:103808. doi: 10.1016/j.drugpo.2022.103808. Epub 2022 Jul 30.
Gay and bisexual men (GBM) have higher substance use prevalences than general population samples - often attributed to stigmatisation of sexual minority identities. We examined how influential public health research on substance use among GBM interprets this behaviour and what GBM-specific identities emerge through the discourses employed.
We searched Web of Science for publications on substance use among GBM, selecting 60 of the most cited papers published during 2000-2020. We studied the language used to describe and interpret drug-using behaviour using critical discourse analysis, focusing on interpretive repertoires and subject positions.
Three distinct discursive tendencies were identified. First, in constructing a target population, GBM who use illicit drugs are positioned as deficient, socially irresponsible, and maladapted to dealing with stigmatisation and HIV risks. Second, in shifting the focus beyond the individual, the gay community is conceptualised as offering a safe space for socialisation. Nonetheless, gay community spaces are problematised as promoting substance use among vulnerable GBM through aggravating loneliness and normalising drug use as a form of maladaptive (avoidance) coping. Third, counterdiscursive movements add nuance, context, and comparisons that relativise rather than generalise substance use and focus on pleasure and self-determination. Such discourses centre the need for interventions that disrupt homophobic socio-structures instead of individualising approaches to limit non-conformity.
'Expert' assessments of substance use among GBM perpetuate pathologising understandings of this behaviour and promote abject subject positions, contributing to perpetuations of intergroup stigma and social exclusion based on drug and sexual practices. Our findings highlight the need for deliberate and critical engagement with prior research and a conscious effort to disrupt dominant discourses on GBM's substance use.
男同性恋和双性恋者（GBM）的物质使用流行率高于一般人群样本，这通常归因于对性少数群体身份的污名化。我们研究了公共卫生研究如何解释 GBM 中物质使用的这种行为，以及通过所采用的话语出现了哪些 GBM 特有的身份。
我们在 Web of Science 上搜索了关于 GBM 物质使用的出版物，选择了 2000 年至 2020 年期间发表的最具引用价值的 60 篇论文。我们使用批判话语分析研究了用于描述和解释药物使用行为的语言，重点关注解释性剧目和主体位置。
确定了三种不同的话语倾向。首先，在构建目标人群时，将使用非法药物的 GBM 定位为有缺陷的、不负责任的、无法适应处理污名化和 HIV 风险的人。其次，将焦点从个体转移到同性恋社区，将其概念化为社交的安全空间。然而，同性恋社区空间被问题化，因为通过加剧孤独感和将药物使用正常化为一种适应不良（回避）应对方式，促进了脆弱的 GBM 中的物质使用。第三，反话语运动增加了细微差别、背景和比较，使物质使用相对化而不是普遍化，并关注快乐和自我决定。这些话语将干预的重点放在破坏恐同的社会结构上，而不是将方法个体化以限制不合规行为。
“专家”对 GBM 物质使用的评估使这种行为的病理化理解得以延续，并促进了屈辱的主体地位，导致基于药物和性实践的群体间污名化和社会排斥的延续。我们的研究结果强调了需要刻意、批判性地参与先前的研究，并有意识地努力打破关于 GBM 物质使用的主导话语。
