Intersectional discrimination and drug use among sexual and gender minorities in Kenya and Rwanda

Abstract Background Substance use remains a significant public health concern. Intersectional discrimination, which happens when multiple marginalized identities come together, may make drug and alcohol use more unequal. This study examines the relationship between intersectional discrimination and the use of alcohol, bhang, khat, and tobacco among LGBTQ+ in Kenya and Rwanda. Methods Using a cross-sectional survey of 2,026 participants, we conducted bivariate chi-square tests and adjusted logistic regression models to test associations between intersectional discrimination and substance use (alcohol, marijuana, khat, and tobacco), respectively. We report adjusted odds ratios and 95% confidence intervals for logistic regression models adjusting for sexual orientation, gender identity, educational attainment, self-concealment, age, and country. Results Drug use varies significantly by demographic factors. Sexual orientation was significantly associated with bhang (marijuana) (χ² = 21.47, p = 0.000) and khat (χ² = 23.56, p = 0.000) use but not with tobacco consumption (p = 0.103). Adjusted regression models showed that intersectional discrimination was significantly associated with bhang (aOR=1.07, 95% CI: 1.02-1.11) and tobacco use (aOR=1.09, 95% CI: 1.02-1.17). Non-conforming gender identity was protective against bhang (aOR=0.67, 95% CI: 0.48-0.93) and khat use (aOR=0.63, 95% CI: 0.38-1.05), while higher education levels reduced the odds of khat (aOR=0.25, 95% CI: 0.16-0.39) and tobacco use (aOR=0.58, 95% CI: 0.35-1.00). Conclusions Intersectional discrimination is associated with higher substance use, particularly for bhang and tobacco, with notable substance use disparities across gender identity and sexual orientation, indicating the need for harm reduction interventions among LGBTQ+ in Kenya and Rwanda.