Sexual behavior, sexual identity, and substance abuse among low-income bisexual and non-gay-identifying African American men who have sex with men.

We examined the role of drug use and addiction in same-sex sexuality among non-gay-identifying African American men who have sex with men or with both men and women (MSM/MSMW). Between July 2005 and February 2006, we conducted seven focus groups with 46 predominately low socioeconomic status African American MSM/MSMW. A total of 29 men self-identified as HIV-infected and 17 self-identified as uninfected. Focus group transcripts were analyzed using consensual qualitative research techniques. Alcohol, crack cocaine, and crystal methamphetamine were the primary drugs mentioned by participants. Drug use was identified as playing a central role in same-sex sexuality for many African American MSM/MSMW. Participants described alcohol use and drug transactions, use, and addiction as motivating sex with men, allowing and rationalizing same-sex activity and unprotected sex, and facilitating access to male sex partners. Some of those in treatment for substance abuse indicated that a readiness to admit their same-sex activity and come to terms with their homosexuality/bisexuality was necessary for recovery. Because successful engagement of non-gay-identifying African American MSM/MSMW is essential to the reduction of HIV transmission and substance abuse in Black communities, findings call for drug treatment approaches that acknowledge and accept diverse sexuality in clients. Service providers and policy-makers may be guided by these findings toward building cultural competency among direct service staff. Future research should examine interrelated dynamics of sexual activity, identity, and drug use as they evolve within individual African American MSM/MSMW and compare the frequency with which sex, condom use, and substance use co-occur with male versus female partners.