This article by Rod Knight identifies PnP-related areas where further investment and exploration are needed and is an informative read for policy makers, researchers and public health officials looking to better understand the current PnP-related context.
Knight begins by recognizing that currently, some support services tailored toward gay, bisexual, and other men who have sex with men (GBMSM) have failed to address the harms of substance use among GBMSM communities, meanwhile, conventional substance use programs tend to do little to acknowledge the significance of an individual’s sexuality and/or sexual behaviour for their substance use.
In response to these shortcomings, Knight outlines five key implementation gaps that are hindering efforts to adapt interventions to address the harms associated with PnP. 1) The spectrum of substance use is diverse among GBMSM who experience drug- and sexual-related harms: services that are nimble and respond to changing use patterns over time and across context are needed. As well, little is known about the treatment and care needs of substance dependent GBMSM vs. GBMSM who use episodically. Connectedly, little is known about the specific pathways by which PnP may lead to higher HIV risk (i.e., specific routes of administration, combinations of sex and drugs); 2) Life course perspectives are needed: service providers are in dire need of a syndemics lens in the PnP context – providers need to understand how unique trajectories and transitional periods may be implicated with different care needs; 3) Healthcare providers’ perspectives remain absent: currently, there is limited research that captures the experiences and perceptions of service providers working with GBMSM who PnP, making it difficult to adapt interventions and programming where necessary. As well, sexual health and substance use programmes tend to be highly segregated, and thus, service providers in each distinct field may lack knowledge about the relevance of their neighbour’s field. For instance, a sexual health nurse may have little training regarding sexualized drug use; 4) Research has yet to establish the best ‘mix’ of interventions in any given context: the syndemics pathway is well understood, however, policy and practice have sometimes failed to implement services in practice that match this model. For instance, few GBMSM health agencies offer wraparound services addressing mental health, substance use and sexual health in tandem.; 5) A variety of ethical questions remain unanswered: GBMSM have existing mistrust of the healthcare system and facing reminders of having their sexual lives policed may create barriers to service provision.
Ultimately, although not directly applicable for use in practice, the knowledge gaps and service shortcomings identified in this article may serve to familiarize providers with the current PnP context, and as well, may guide discussions with colleagues that may contribute to furthering research, policy and programming in this area.
Knight, R. (2018). Investments in implementation science are needed to address the harms associated with the sexualized use of substances among gay, bisexual and other men who have sex with men. Journal of International AIDS Society, 21(6): e25141. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5987811/