The Impact of Methamphetamine on Sexual Behavior, Vulnerability, and Pleasure Among Sexual and Gender Minority Individuals: Implications for Harm Reduction and Improving Sexual Health

Methamphetamine (meth) use remains a persistent and evolving public health challenge among sexual and gender minority individuals, a population already disproportionately affected by human immunodeficiency virus (HIV). Beyond its well-documented role in HIV transmission, meth fundamentally alters users' experiences of sex, intimacy, and pleasure. Understanding this intersection is critical to informing therapeutic and harm reduction approaches. We conducted semi-structured, in-depth interviews with 29 sexual and gender minority individuals assigned male sex at birth who used meth within the prior month. Interviews (mean = 54.9 min) were recorded, professionally transcribed, and analyzed using a reflexive thematic approach. Participants (mean age = 37.9 years) were racially and ethnically diverse (75% nonwhite) and 83% identified as gay. Nearly all described an initial non-sexual introduction to meth with use eventually becoming tightly intertwined with sexual behavior. Four major themes emerged: (1) from first introduction to "party-n-play" culture - a transition linking meth with sexual arousal and sexual networks; (2) meth shifting sexual behaviors - heightened arousal, prolonged encounters, and altered roles; (3) meth use and sexual violence during meth-related encounters - including being given meth without consent; and (4) "meth ruined sober sex" - diminished sexual pleasure without meth. Findings highlight that for many sexual and gender minority individuals, meth use and sexual experience may become inseparable, reshaping notions of desire, consent, and intimacy. Therapeutic and recovery interventions must explicitly address this fusion - acknowledging that reducing meth use often entails redefining sex itself. Clinicians should integrate trauma-informed, sex-positive frameworks to support recovery and reestablish healthy sexual functioning.