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

Gap 1: The spectrum of substance use is diverse among gbMSM who experience drug- and sexual-related harms Gap 2: Life course perspectives are critically needed Gap 3: Healthcare providers' perspectives remain absent Gap 4: We do not know what the best "mix" of interventions are in any given context Gap 5: A variety of ethical questions remain unanswered There are a variety of ethical considerations that require careful attention as interventions are adapted to address drug- and sexual-related harms experienced by gbMSM. For example, previous discourse in this area has challenged the public health impetus to intervene "on" gbMSM's sexual lives, a population who has experienced decades of public health intervention and surveillance. Integrating community-based principles (e.g. sex positivity; anti-oppression) with key team science principles (e.g. high-quality communication; mutual trust; power sharing) may allow those working in this area to address the ethical challenges "head on." Filling the key implementation "gaps" identified above will provide new opportunities to effectively and ethically address the harms that are associated with the sexualized use of substances among gbMSM. As funding commitments are dedicated towards the growing field of implementation science (e.g. by: US National Institute on Drug Abuse; Canadian Institutes of Health Research), the onus will be on integrated and multi-disciplinary teams (e.g. researchers, interventionists and community stakeholders) to collect, monitor and respond to "feedback" (i.e. adaptations) in ways that optimize (and effectively integrate) the substance use and sexual healthcare intervention "landscapes" for gbMSM. None to declare. RK drafted and finalized the manuscript. Knight is supported by Michael Smith Foundation for Health Research Scholar Award. US NIH Grant Number: 1R01DA043408-01