Adam Bourne is Professor of Public Health and Director of the Australian Research Centre in Sex, Health and Society at La Trobe University in Melbourne. He leads a large program of research in LGBTQ+ health and wellbeing, including multiple AOD-relate projects.

Introduction: Unique sociocultural factors inform experiences of impactful (or 'problematic') drug use among LGBTQ+ populations, including a higher prevalence and different contexts of use. This paper explores how these factors (re)shape the social norms and practices associated with drug use as well as the harm reduction practices that are utilised.

Method: Semi-structured interviews with LGBTQ+ persons (n=40) with experiences of impactful illicit drug use; focus groups and interviews with (n=40) with professional stakeholders employed in the AOD sector in Victoria, Australia were conducted between March and September 2024. Discussions centred around LGBTQ+ individuals’ understandings of impactful drug use, and harm reduction strategies utilised.

Results: Self-identifying a ‘problem’ with AOD use had been challenging for many participants when faced with cultural norms and expectations regarding alcohol and drugs that were perceived as operating differently within LGBTQ+ communities. Though ostensibly positioned as a means of managing anticipated drug harms, harm reduction strategies were often enacted within the context of stigma and marginalization that is commonplace among LGBTQ+ people and are complicated by constraints on both participants’ resources and the (un)availability of LGBTQ-affirmative support. Harm minimization strategies variously functioned: (i) to attenuate undesirable side-effects of substance use while facilitating access to desirable effects (including access to LGBTQ+ community), (ii) to recoup a sense of personal agency in the face of marginalisation, and (iii) as community-held practices.

Conclusion: Understandings of impactful use stem from community norms and shared experiences which prescribe thresholds for impactful or problematic use, thus shaping perceptions of harm and intervention needs. Harm reduction efforts within LGBTQ+ communities have historically been applied through a prism of HIV prevention and care, however our findings suggest that this narrow focus should be broadened in ways that acknowledge the unique LGBTQ+ drug practices, cultures and norms that inevitably shape perceptions and responses to harm.