Minority stress and stimulant use among US adult sexual minority men: A systematic review

Abstract

Purpose

Minority stress theory posits health disparities among sexual minority men (SMM; i.e., non-heterosexual) result from experiences of sexual minority stigma (SMS). This systematic review synthesizes quantitative findings on the association between minority stress and stimulant use among US adult SMM.

Methods

PubMed, PsycInfo, CINAHL, and Scopus searches between November 2022 and October 2023 identified 991 studies, with 13 meeting selection criteria: English, peer-reviewed publication reporting an estimated minority stressor–stimulant use association among US adult SMM. Minority stressors included enacted, internalized, or anticipated SMS or identity concealment. Stimulants included methamphetamine, cocaine/crack cocaine, and diverted prescriptions. Proportions of studies and estimates indicating statistically significant associations were examined in total and for each minority stressor–stimulant pair.

Results

Many studies included primarily Black/Latino (69.2 %), urban (76.9 %), young adult samples (38.5 %). Significant associations were reported in 42.9 % (6/13) of studies but represented only 38.2 % (13/34) of unique estimates. Most estimates involving composite stimulant outcomes were nonsignificant (86.7 %, 13/15). Most estimates of enacted SMS–methamphetamine (66.7 %, 2/3), internalized SMS–methamphetamine (66.7 %, 4/6), and internalized SMS–cocaine/crack cocaine (83.3 %, 5/6) associations were significant. Findings suggest sexual orientation (i.e., gay vs bisexual) may moderate internalized SMS effects. Few studies examined prescription stimulants and none examined anticipated SMS or identity concealment.

Conclusions

Further research is needed examining the use of various stimulants independently, not in composite, and testing for moderation by sexual orientation. Findings suggest multi-level approaches targeting enacted SMS and individual-level approaches targeting internalized SMS may benefit SMM who use methamphetamine or cocaine/crack cocaine, respectively.