Structural Influences on Methamphetamine Use among Black Gay and Bisexual Men in Atlanta

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PROJECT SUMMARY Emerging data demonstrates a rise in methamphetamine (meth) use among Black gay, bisexual and other men who have sex with men (GBMSM). Meth is associated with myriad physical and social harms, and has the potential to exacerbate existing health inequities impacting Black GBMSM. Existing meth prevention and treatment interventions do not address the unique social position of Black GBMSM or the related health impacts of structural racism and discrimination (SRD). Based on our preliminary studies, we hypothesize that four forms of SRD are likely to influence meth use among Black GBMSM: housing discrimination, gentrification, racial and income segregation, and discriminatory LGBT community climate. Additionally, we posit that these forms of SRD operate through housing instability and inadequate service access to increase risk for meth use among Black GBMSM. The goal of this project is to generate knowledge that will inform the design of multi- level, culturally congruent structural approaches to prevent meth use and associate harms among Black GBMSM. Our study will be based in Atlanta, Georgia – an ideal setting to examine these questions given the cultural significance for Black Americans, large population of Black GBMSM, and recent SRD-related demographic shifts. Drawing on the risk environment framework as its theoretical foundation, this study will pursue three specific aims: (1) to examine the impacts of census-tract level measures of SRD on housing instability, service access and meth use among Black GBMSM in Atlanta; (2) to elicit narratives of meth use, housing instability, service access and SRD among Black GBMSM; and (3) to examine systems of structural influence and develop qualitative causal maps linking various forms of SRD, service access, housing and meth use among Black GBMSM. For the first aim, we will recruit N=300 Black GBMSM into a longitudinal cohort study, and conduct serial surveys every 6 months over a two-year follow-up period. Additional location and meth use data will be obtained monthly using ecological momentary assessment technology. Individual survey responses will be linked to geolocated census-tract level measures of SRD and service access. For the second aim, we will conduct a longitudinal qualitative study including in-depth interviews and walking ethnographies with N=40 cohort participants, to gather insights on their experiences with SRD, housing, service access and meth use. For the third aim, we will use a community-based system dynamics approach to convene a group model building workshop with key stakeholders (N=25), which will lead directly to the development of causal maps that will inform structural interventions. The proposed research is highly significant because of its potential to inform effective structural strategies for preventing meth use and ameliorating meth-related harms among Black GBMSM.