"If They Don't Drink, They Can Die of Stress": Motivations for and Effects of Substance Use Among Gay and Bisexual Men and Other Men Who Have Sex With Men in Kenya.

Given the multiple layers of intersectional stigma and discrimination faced by gay and bisexual men and other men who have sex with men (GBMSM) in Kenya, substances may be used to cope with minority stressors. The majority of research on substance use for this population has focused on reporting rates of substance use and its association with HIV risk and mental health. This study provides an in-depth and nuanced exploration of what motivates substance use and substance use reduction, and how substance use impacts various aspects of Kenyan GBMSM's lives. Individual in-depth interviews were conducted with 60 GBMSM (ages 20-45) in Western Kenya as part of a larger study focused on developing an HIV prevention and sexual health promotion intervention. Thematic qualitative analyses were conducted by a diverse team of analysts. Substance use was perceived to have positive and negative effects within three primary thematic areas of functioning: sexual health, physical health, and economic well-being. Motivations or reasons for using substances included coping with stigma, increasing social connectedness, increasing sexual confidence, lowering sexual inhibitions, and peer pressure. Various motivations or reasons to reduce substance use were discussed, including improving sexual health, improving mental well-being, having better sex, maintaining power during sex work, and maintaining physical good looks. These data provide a more complex understanding of the role that substance use plays in Kenyan GBMSM's lives, and provide valuable information for community-based interventions to prevent negative health outcomes from substance use.