Exploring Harm Reduction Practices in Sexualized Drug Use Among Sexual Minority Adults in California

Sexualized drug use (SDU), the use of recreational drugs to facilitate sexual activity, is a contributor to sexually transmitted infection (STI) diagnoses like human immunodeficiency virus (HIV). This study explores how people who engage in SDU use harm reduction strategies to reduce their risk of HIV/STIs and drug use-related harm. A convenience sample of sexual and gender minority adults residing in California who reported having engaged in recent SDU was recruited through online mobile hookup applications/websites ( n = 18). In-depth interviews were conducted via a semi-structured interview guide, and the transcripts were analyzed via a modified grounded theory approach. The average participant age was 42 years ± 12 years. All but one identified as a cisgender male, and all identified as gay, queer, pansexual, or bisexual. Over half (56%) disclosed living with HIV. Results suggest a two-step harm reduction approach: digital screening and real-time risk management. Strategies practiced online include discerning profile information and engaging in two-way communication. Real-time harm reduction included visually inspecting the body as a risk factor for STIs and substance use disorder and evidence-based practices, including biomedical HIV/STI prevention. Condom use was less commonly reported. Participants sought to moderate their drug use and engaged in self-care practices to limit the negative side effects of substances. Findings inform more nuanced SDU interventions at the individual, community, and policy levels that not only address overall health and sexual well-being but also mitigate substance-related harm. Participants’ unique approaches to blending recognized biomedical interventions alongside personalized methods of reducing risk reflect the importance of tailored and flexible harm reduction strategies.