Harmen Beurmanjer

28 Chapter 2 Gay and bisexual men Two studies (Halkitis & Palamar, 2006; Hammoud et al., 2018) examined GHB use in gay and bisexual men and compared this group with a group gay and bisexual men without GHB use. The average age was 32 to 38 years. Most of them were employed (77–85%) and well-educated (57–66% college/university level). Of the total studied population 20% to 29% reported GHB use, on average 6 days in the past four months. Reported locations of GHB use were dance clubs (63%), parties (37%), sex parties (37%), friend’s place (36%), sex clubs or bathhouses (31%), bars (29%), and at home alone (14%). Participants who used GHB were more likely to use other substances, mainly methamphetamine (56%), MDMA (47%), and ketamine (41%). Most mentioned reasons for GHB use were sexual reasons (30%), availability of GHB (25%), or to lose inhibitions (24%). Findings indicate that GHB is a key drug in chemsex among gay and bisexual men (Hammoud et al., 2018), but not all gay and bisexual men use GHB forsexual reasons (Halkitis & Palamar, 2006). Gay and bisexual men using GHB recreational seemed to have lower overdose rates (15%) compared to other groups using recreational GHB (Hammoud et al., 2018). As overdoses were more common among gay and bisexual menwho used GHB at least monthly or more compared to less GHB use (Hammoud et al., 2018), the on average low frequency of GHB use among gay and bisexual men could be an explanation for the relatively low overdose rates. Factors associated with GHB use in the past 6 months were: being HIV-positive, having more gay friends who use drugs, a greater number of sexual partners, group sex, and unsafe sex with casual partners (Hammoud et al., 2018). People driving under the influence of GHB Individuals arrested for driving under the influence of GHB (Jones, Holmgren & Kugelberg, 2007, 2008) were mainly male (95%), with an average age of 26 years. Sixty-one percent of cases had used other drugs besides GHB. The mean concentration GHB tends to increase with the age of offenders ( P <.05). People living with HIV (PLWH) using GHB In one study, 50% of outpatients with an HIV infection (Camacho, Matthews, & Dimsdale, 2004) usedGHB. They experienced increased energy (21%), euphoria (18%), andweight-loss (11%). The population was mainly male (89%), mostly between 26 and 39 years of age. Synthesis of results The identified GHB-using populations in the included studies can be categorized as recreational GHB use without adverse effect (e.g. (frequent) drug-induced comas); recreational GHB use with adverse effect (e.g. (repeated) comas), and people with GUD. Across all people using GHB, the majority (55% to 90%) were males, in their late twenties and early thirties. Most people start using GHB recreationally for its euphoric effects. GHB is often used by experienced drug users (Grund et al., 2018), potentially explaining why