Reducing substance use harm among gay, bi and MSM


The rate of substance use amongst LGBT+ (lesbian, gay, bisexual and transgender) and MSM communities around the world is reported to be significantly higher than in other groups. This is believed to be in large part fuelled by the impact of stigma and discrimination faced by these communities.

These factors can lead to internalised homophobia and an unconscious sense of shame and anxiety. Substance use can also affect judgment, lessen inhibitions, and make users more likely to engage in high-risk sex and behaviours associated with HIV and other STIs.

That’s why OUT’s Engage Men’s Health (EMH) project has launched the Highs & Lows campaign to better enable gay, bisexual and other men who have sex with men (MSM) to reduce their risk around substance use.

“Living in a hostile world in which same-sex sexuality is seen as immoral or ‘dirty’ has a damaging impact on the mental health and self-esteem of LGBT+ and MSM individuals,” says Dawie Nel, the Director of OUT LGBT Well-being, the NPO behind the EMH project. “Substance use is often a means to feel free, confident and escape from a stressful daily life in which stigma, discrimination and violence are a reality.”

The Highs & Lows campaign follows the principle of “harm reduction” rather than the traditional abstinence-only model, which usually focuses on the criminal and “moral” aspect of substance use. Therefore, people who use substances are stigmatised, vilified and are less likely to seek health and other support when needed.

It is increasingly being recognised that forced quitting or abstinence is not always a realistic goal. In addition, those individuals who are interested in reducing their use, but not stopping completely, have been excluded from programmes that require abstinence.

“We want our communities to see EMH as a safe space where they will receive knowledgeable, confidential and stigma-free services with dignity,” says Nel. “We believe that substance use should be viewed as a primarily social and health issue, not a moral or criminal one. This progressive approach has been shown to be far more beneficial to society in a number of countries.”

EMH’s Highs & Lows campaign seeks to empower substance users to reduce their risk of using and help maintain their physical and mental well-being. With the support of Mainline International, the campaign encompasses the following:

  • Providing information to its community about many of the common substances used by gay, bisexual and MSM, including side effects and risks. This is published on the EMH website, on social media, in a booklet (with the support of NACOSA) and through in-clinic posters.
  • Offering comprehensive practical advice on harm reduction to minimise risks associated with substance abuse. Examples include using in safe environments; using clean needles if injecting; and getting onto treatment (ART) if HIV positive and PrEP (HIV prevention pill) if negative.
  • Offering insights into the shared experiences and motivations of gay, bi and MSM substance users through articles and social media posts.
  • Offering resources such as contact details for helplines and services for substance use, depression, suicide and other mental health and LGBT+ support.
  • Providing a free and anonymous one-on-one online support session with a trained peer harm reduction counsellor.
  • Hosting information sessions with mental health professionals to better equip them to assist gay, bisexual and MSM clients who use substances and to understand the principles of harm reduction.
  • Holding regular Community Advisory Group meetings with mainly homeless MSM who inject and use drugs, through which we encourage harm reduction and provide clean needles (in partnership with NACOSA).
  • Offering free and professional HIV and STI services in Johannesburg, Pretoria, Nelson Mandela Bay and Buffalo City to gay, bisexual and MSM. This includes HIV treatment, PrEP and PEP.

To access any of these services, members of the gay, bisexual and MSM communities can call or WhatsApp EMH on 082 607 1686 or visit

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