Gay and bi men’s health is about much more than sex, HIV, and STDs. Mental health is a key part of our health, though we don’t pay nearly as much attention to it as we should. Mental health can also affect our sexual health, and is sometimes related to excessive alcohol and drug use.
Here’s some basic advice and some resources about mental health, drugs and alcohol, and sexual addiction.
First, if you have any mental health concerns, you’re not alone. Gay and bi men are at greater risk for mental health problems than others. Research shows that compared to other men, gay and bisexual men are more likely to experience depression and anxiety.
Even though there’s been terrific progress in achieving equality, there’s still a long way to go. Ongoing homophobia, stigma and discrimination can all have negative effects on our health.
Having people around you who care about you, both emotionally and practically, is key to your mental health. If you are unable to get support from your friends and families, you can try finding it by becoming involved in community, social, athletic, religious, and other groups. And certainly, a lot of people have made friends with people they’ve met on apps.
Mental health counseling and support groups that are sensitive to the needs of gay and bisexual men can be especially useful if you are coming to terms with your sexual orientation or are experiencing depression, anxiety, or other mental health problems.
While many gay and bi men may not seek care from a mental health provider because of a fear of discrimination or homophobia, it is important to keep this as an option and to find a provider that is trustworthy and compatible. Ask your friends, and local LGBTQ community centers, for the names of providers who are LGBTQ-friendly healthcare providers.
You can also search the Gay and Lesbian Medical Association’s Provider Directoryfor a list of providers in your area. It may take interviewing several of them to find one that’s right for you. Call ahead and ask if a provider you are considering has any LGBTQ patients.
If you are uncomfortable about coming out and being open with your provider, bring a trusted friend or family member with you to your appointment.
Below you’ll find information about drugs and alcohol, and suggestions for how to reduce your risk of any harm. Additionally, you’ll find resources for where to go for help if you think you, or someone close to you, may need it.
Traditional poppers have been popular among gay men since the seventies. Popular brands such as “Rush” and “Jungle Juice” are sold online, and in sex shops that cater to gay men as “video head cleaners” or “room odorizers.” These poppers contain amyl nitrite, a chemical that relaxes smooth muscle tissue and dilates blood vessels.
“Poppers” is slang for a variety of different alkyl nitrites solutions, particularly amyl nitrite. They are available over the counter and come in small, typically brown, bottles. The nitrates are a yellowish, strong smelling, and quite flammable liquid that are inhaled. They vary by strength and are used as a tool for sexual arousal.
Poppers relax muscles in the anus, which can make anal sex less painful. They also cause reactions in the body that increase sexual arousal.
If you are healthy, there appear to be no long-term consequences of using poppers. However, some people may develop persistent headaches. Tolerance to poppers does develop within two to three weeks of continuous use, encouraging greater use to get the same effect. But if you stop using poppers for a short period, this tolerance will be lost.
Poppers are dangerous for anyone with a heart condition, high blood pressure and for anyone who is asthmatic. Many people report allergic reactions such as rashes or eczema after frequent use. These symptoms often disappear when the use of poppers ceases.
The use of poppers with Viagra and other drugs taken for erectile dysfunction is particularly dangerous as it can lead to a dramatic fall in blood pressure and may prove fatal.
There’s a significantly increased risk of HIV transmission – nearly double – when using poppers and being the bottom and not using condoms. This appears to be due to increased blood flow to rectal tissues, which means that any tear in the rectum from anal sex can make it easier for HIV to be transmitted. There’s no evidence of any increased risk to the top.
Multiple studies have found a correlation between problematic alcohol consumption and STDs, although their causal relationship cannot be determined with certainty. A history of alcohol use has been correlated with having multiple sex partners, and unprotected sex. Alcohol may reduce inhibitions and diminish risk perception.
How Can You Reduce Your Risk?
Maybe you’ve woken up too many times regretting the things you did when you were drunk the previous night. Or, maybe you’re just tired of waking up late with a hangover. Whatever the reason, if you’re interested in making changes to how you drink, here are some pro tips.
Think about reasons you might want to make a change and reasons why you might not want to change.
Think about what alcohol is doing for you. How is it helping you?
Take a look at how drinking affects your mood, relationships, health, work, school, finances, and sex life.
Plan your party—decide when, where, how much, and with whom.
Bring a set amount of money.
Seek out a location and the company of lighter drinkers when you want to moderate your drinking.
Add abstinence days—i.e. “I take a break Tuesdays and Sundays.”
Don’t keep booze in the house.
Keep track of how often and how much you’re drinking.
Delay the first drink. Start later in the day.
Include food. Don’t drink on an empty stomach. Eat some food so the alcohol will be absorbed into your system more slowly.
If you can afford it, drink only in bars or restaurants—not at home.
Pace and space. Pace yourself. Sip slowly. Add ice to your drink. Alternate booze with water, juice or soda. Brush your teeth between drinks. It makes them taste gross and may slow you down.
Ask your bartender to give you a measured pour (not a heavy pour).
Stop sooner and go home at a set time.
If drinking has occupied a lot of your time, develop new interests. Participate in new activities, hobbies, and relationships—or, renew and reinvest in those that you’ve missed. If you’ve relied on alcohol to be more comfortable in social situations, to manage your moods, or cope with problems, seek support and strategies to deal with those areas of your life.
Headed out for a night on the town? Reduce the chances that something will ruin your party by following these 7 quick safety tips.
Don’t walk alone
Have a friend by your side when you are out partying. It’s great to have friends watch out for each other at a bar or club, walking between destinations, or on public transportation.
Check with a friend
Hooking up? Have your friend check their gut feelings about someone you might be thinking about hooking up with. Let your friend know where you are going if you leave with someone.
Control your glass
Don’t let strangers pour or deliver your drinks. Don’t leave your drink unattended. Sadly, there are a lot of creeps out there.
Plan your transportation
Avoid driving. It’s a good idea to have a travel buddy for walking or taking the bus. Use your ride sharing app or get a cab. Sleep on your friend’s couch or floor.
Be prepared and have them with you.
Avoid mixing alcohol and other drugs
If you are drinking, avoid downers, benzos and opiates. These with booze can cause respiratory suppression, overdose or accidental death. GHB (Gamma hydroxybutyrate ) and alcohol do not mix! GHB is a powerful, rapidly-acting central nervous system depressant. When taken as a recreational intoxicant, it can be dangerous when the dose is too high or it is combined with alcohol or some other drugs. When mixed with alcohol, the depressant effects of GHB are enhanced. This can lead to respiratory problems, unconsciousness, coma, and overdose.
Avoid over-the-counter medicines
Aspirin, acetaminophen (such as Tylenol) and over-the-counter cold/flu medicines can cause liver and kidney damage when combined with alcohol.
Methamphetamine, also known as speed, is used by many gay men. Crystal meth heightens arousal, increases sexual stamina, and delays orgasm.
Meth increases the risk of HIV infection because of a decrease in inhibition and a higher pain tolerance. This can result in longer and more aggressive sex, but without feeling what’s going on, injury is more likely to occur and the risk of HIV infection increases.
For HIV-positive guys who use meth, it can be hard to remember to take HIV meds regularly, which can lead to an increased viral load. Once you’ve made the decision to take HIV meds, taking them as they’re prescribed is basic to taking care of yourself.
Using meth, even occasionally, helps people stay awake, which can often mean you’re not sleeping enough. Sleep is essential to good health, and supporting your immune system.
Project Neon provides information about crystal meth, HIV, hepatitis and other STIs to gay, bi and trans men. It provides accurate and truthful information about how crystal meth affects the mind and body, options for reducing sexual and drug using risks associated with crystal, and free help to better manage or stop crystal use. NEON is a program of Seattle Counseling Service.
This online library contains information about psychoactive plants, chemicals and the complex relationship between humans and psychoactive substances. The site is owned and maintained by the educational nonprofit Erowid.
Harm Reduction Coalition
The Harm Reduction Coalition is a national advocacy and educational organization that promotes the health and dignity of individuals and communities impacted by drug use. It provides information on overdose prevention, syringe access and safer using. People who use drugs and others can find videos, podcasts, webinars and written resources about reducing the harm caused by substances.
If you use club drugs, read more from DanceSafe, a national nonprofit, about how to use substances at events more safely. Read about heatstroke, managing your use, getting home safely and drug checking.
Any Positive Change
Use drugs more safely. Read about injection practices that will help you take better care of your veins and reduce the likelihood of disease transmission. Watch a video on how to deliver naloxone if someone you know overdoses. And find other resources about hepatitis and overdose. The site is operated by the Chicago Recovery Alliance.
Bluelight is an international message board that educates the public about responsible drug use (with a focus on MDMA) by promoting free discussion.
For gay guys who use crystal meth, this site includes information about how speed affects the body and the mental, sexual and social aspects of guys’ lives. Find discussion forums, tips for safer using and strategies for cutting back and quitting.
“PNP Hookup Tips” Pamphlet
Read tips, directly from guys who party with speed, about how to avoid pitfalls associated with hooking up on crystal.
Speedometer is a publication for guys who party with speed who are over age 18. It shares personal stories, interviews, opinions, harm reduction tips, quality porn, artwork, articles and information about local health, social services and drug treatment providers.
Sex addiction – and porn addiction – may not affect your STD or HIV risk at all. But it can, if it increases your number of partners in real life.
Sex should feel great. Feeling compelled to have sex often doesn’t. Some experts use the term “sexual addiction” as acting on those compulsive thoughts. Others prefer to call it hypersexual behavior. Both can be characterized as having many partners or watching a lot of pornography. There is a range of psychological and neurological mechanisms that can be related to compulsive sexual behavior.
Recent studies have also shown that watching pornography can also affect the kinds of behavior some men engage on in real life.
Here are some warning signs that someone’s behavior might be compulsive or addictive:
A need for a greater frequency or higher intensity of behavior to achieve the desired effect (tolerance)
Physical or psychological feelings of withdrawal when unable to engage in the addictive behavior
Desire or unsuccessful attempts to decrease or stop the behavior
Neglecting important social, work, or school activities because of the behavior
Continuing the behavior despite suffering physical or psychological problems because of or worsened by the sexual behavior
We often don’t hear about domestic or intimate partner violence among gay men, however, researchers believe that violence in same-sex relationships happens at about the same rate as violence in heterosexual relationships. This BETA Blog article by Enrique Vallejo provides insight into intimate partner violence in a gay relationship.
Similarly, our culture has thought of rape and sexual assault as something that largely affects girls and women, which can often make it difficult for men, gay or straight, to figure out when to step forward and seek services for sexual assault. This BETA Blog article by Emily Newman provides information on sexual assault within the gay community and what queer men should know if they’ve been victimized.
If you or someone you know has been the victim of intimate partner violence or sexual assault and are seeking help, below are useful resources for you.
Call the National Domestic Violence Hotline at 1-800-799-7233 for information and referrals