Journal of Addictive Behaviors,Therapy & RehabilitationISSN: 2324-9005

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Research Article, J Addict Behav Ther Rehabil Vol: 4 Issue: 1

Sexual Activities in Methamphetamine Users: A Qualitative Study on a Sample of Iranian Methamphetamine Users in Tehran

Masoomeh Maarefvand1, Azarakhsh Mokri2, Ahmad Danesh3 and Hamed Ekhtiari4*
1Department of Social Work, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
2Iranian National Center for Addiction Studies (INCAS), Tehran, Iran
3Regional Knowledge Hub, and WHO Collaborating Centre for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
4Iranian Institute for Cognitive Sciences Studies (ICSS), Iranian National Center for Addiction Studies (INCAS), Translational Neuroscience Program, Tehran, Iran
Corresponding author : Hamed Ekhtiari
Iranian Institute for Cognitive Sciences Studies (ICSS), Iranian National Center for Addiction Studies (INCAS), Translational Neuroscience Program, Tehran, Iran
E-mail: [email protected]
Received: May 10, 2014 Accepted: December 22, 2014 Published: December 24, 2014
Citation: Maarefvand M, Mokri A, Danesh A, Ekhtiari H (2015) Sexual Activities in Methamphetamine Users: A Qualitative Study on a Sample of Iranian Methamphetamine Users in Tehran. J Addict Behav Ther Rehabil 4:1. doi:10.4172/2324-9005.1000132

Abstract

It is known that psychostimulants including methamphetamine have a great effect on sexual behaviors. Since the rate of methamphetamine use has recently increased in Iranian population, there are concerns that this may drive up sexual risky behaviors among users. The result could shift the dominant mode of HIV transmission from drug injection to sexual contact in the country. The intention of the current study, which is the first one in Iran, was to restate the threat to the decision makers in the country.

 

Keywords: Methamphetamine, Risky Behavior, Sexual Activity, Iran.

Keywords

Methamphetamine; Risky Behavior; Sexual Activity; Iran.

Introduction

According to the 2013 World Drug Report, seizure and consumption levels of Amphetamine-type stimulants, including methamphetamine, are increasing. The Middle East and North Africa (MENA) region is among those in which high rates of amphetamine seizures are being reported. This could suggest a possibly high prevalence of psychostimulant users in this region [1].
Methamphetamine is a synthetic psychostimulant with sympathomimetic and cytotoxic effects. Because of these effects, addicted individuals may experience wide range of physical and mental disorders. Abnormal sexual behaviors are among those experiences that need special attention, specifically from the public health perspective. It is widely recognized that Amphetamine-type stimulants, including methamphetamine, can promote high-risk sexual behaviors such as unprotected sexual contacts and multiple sex partners [2-4]. This could be supported by looking into the effect of abstinence from methamphetamine on the level of engagement in high-risk sexual behaviors of the abstinent user [5,6]. The basis for association of methamphetamine abstinence with the level of engagement in high-risk sexual behaviors could be reasoned by pharmacological, instrumental, trait – based, and situational explanations [7]. Unsafe sexual practices and the multiple sex partners can put methamphetamine users at increased risk for HIV infection and other Sexual Transmitted Infections [8]. This is exceedingly important in countries where the rate of methamphetamine use is high or is in rise.
Despite of awareness about the association between methamphetamine use and high-risk sexual behaviors, few studies in the MENA region have examined the effect of methamphetamine use on sexual activities. This is highly important, as it is needed to keep decision makers sensitized on the matter.
In order to examine the effect of methamphetamine use on sexual activities, we conducted several focus group discussions with samples of methamphetamine users referred to two harm reduction facilities in Tehran. The motive for conducting this study were concerns about increasing use of methamphetamine in Iranian youth, which may fuel HIV transmission by high-risk sexual contacts. This is could happen in an era when less than twenty percent of young people aged 15 – 24 (15.5% for male and 17.5% for female) having correct knowledge about HIV prevention [9].

Materials and Methods

Using a purposeful sampling, 50 abstinent methamphetamine users (30 males and 20 females) referred to three Non Government Organizations (NGOs) in Tehran for treatment (Rebirth Society Organization in Verdij and Chitgar Residential Centers and Congress 60 in its main office) joined the study to share their personal experiences. Three rounds of focus group discussions (FGDs) were conducted (two with males and one with females) to explore the matter. Verbal consents were obtained from the participants before each FGD.
Probing questions focused on the effect of methamphetamine use on sexual drive and desire, performance, disinhibition, risk taking, and compulsivity. Because of probable discussions about taboo subjects (sexual behaviors), the research team avoided tape recording during the FGDs. Detailed notes were taken and driven comments from the notes were written on a piece of paper to put on a wall for further discussion. During the FGDs and tea-breaks, clients could review the responses/comments on the wall and add any related comment(s). After each session, reflections of participants were written down immediately as quotations. Two authors reviewed the quotes and discussed themes. Sampling was stopped when the saturation confirmed by research team. In order to achieve an overall understanding, all notes were read several times. Initial analysis of the notes resulted in some generalized themes and categories being created. We made repeated comparisons and modifications to achieve similarities in categories and narrow them down. To ensure trustworthiness of the findings, member-checks method was used to confirm credibility of the responses. Furthermore, the set of themes was reviewed and discussed by two authors several times in order to finalize it.

Results

As it was planned, three FGDs were conducted among abstinent methamphetamine users. Table 1 shows demographic characteristics of the participants.
Table 1: Demographic characteristics of the participants disintegrated by recruitment site.
During the interview, participants were questioned about their drug use and sexual behaviors in the past year and month. Table 2 shows collected information relevant to these questions broken down by recruitment site.
Table 2: Drug abuse and sexual history of the participants disintegrated by recruitment site.
Using the main questions and follow up probing questions, responses were collected and relevant themes were explored. The themes could be supported by quotations from the responders.
Impact on sexual desire and pleasure
A cluster of replies was focused on methamphetamine’s impact on the desire stage of sexual acts. Participants unanimously expressed that in early and mid stages of methamphetamine use, it increases sexual desire and prompts users to have sex. According to participants methamphetamine use seems to extremely enhance sexual pleasure and, as a result, intercourse becomes rewarding:
Male, 23 years old, Single
“Everybody looks beautiful and arousing”
Male, 27 years old, Married
“You feel that you want to have sex with many people”
Male, 31 years old, Married
“Meth [methamphetamine] increases your fantasy about sex ... If you have fantasized about something and then perform it, it becomes even more pleasurable”.
Impact on sexual performance
Most participants emphasized the impact of methamphetamine use on their sexual performance. Although the answers were less unanimous, it was repeatedly stated that methamphetamine has different impacts on performance depending on the stages of abuse. Beneficial effects appear in the early stages, but at later stages the effect is usually negative and associated with impotence, decreased hardness of the penis, impaired or spontaneous ejaculation, and loss of pleasure in climax:
Male, 30 years old, Married
“At beginning you get a boost in your performance”
Male, 27 years old, Married
“You are able to have sex after ejaculation and get to orgasm again without delay or a gap”
Female, 25 years old, Single
“You have great desire for sex but you can’t do it”
Impact on sexual assertiveness and lack of inhibition
Methamphetamine was claimed to increase sexual assertiveness, and the power to negotiate and demand sex from partners and other people. Participates stated that it enabled them to persuade or even deceive people to comply with their sexual demands. It would give them a sense of prowess and self-esteem. They would set aside concerns and hesitation and make clear straight forward demands, whereas, when abstinent they would feel shameful to make such recommendations. Sexual innuendo with strangers, colleagues and family members were facilitated:
Male, 32 years old, Divorced
“I could set aside laws and regulations for sex”
Male, 31 years old, Married
“I would do anything to get sex and could go any far”
Male, 28 years old, Single
“You get heightened self-esteem when it comes to women ... You are able to “con” women into sex”.
Engaging in unusual practices and reckless and taboo acts
One major feature that constantly emerged in the discussion groups was methamphetamine’s capability to encourage people to perform unusual and usually high-risk sexual acts with a lack of shame or remorse. Some claimed that all unusual acts must have been fantasized before and you should have an inherent, though concealed predilection toward them. For example, “you must have latent homosexual feeling in order to perform them under methamphetamine. Methamphetamine only releases your fantasy world”. Others stated that de novo fantasies and acts totally alien to the individual might appear:
Male, 27 years old, Married
“You find great interest in group sex and orgies ... and you might perform sex with same sex people”
Female, 24 years old, Single
“You like to perform sex in unusual and inappropriate locations and never ask your partner to use condom”.
Sex becomes compulsive
An important feature that emerged from the content of the focus group discussions was the compulsive nature of sexuality. It was stated that after methamphetamine use, and during sexual pleasure seeking through methamphetamine, sexual urges become more and more irresistible and compulsive. Clients described feeling on edge and forced to perform sex, otherwise tension is built up and individuals feel irritable, frustrated and depressed. After succumbing to the urges, they felt guilty and ashamed. Meanwhile, sexual issues become a cornerstone of their lives. Many stated that after long-term methamphetamine use, nothing except sex makes sense and the final point to methamphetamine use is pure sexual preoccupation. They have trouble concentrating on anything other than sex and it centers the world of the addict:
Male, 26 years old, Married
“Despite fatigue and physical discomfort I insisted on continuing to have sex”,
Female, 23 years old, Single
“Sex was not for pleasure but for giving me comfort and relaxation ... I needed to perform sex in order to return to normal life”
Male, 41 years old, Married
“If I failed to have sex I became angry and very frustrated”
The above-mentioned issues clearly show that sex becomes compulsive and pursued not purely for sake of its pleasure but compulsively to decrease tension and alleviate negative mood.
Sexual pleasure as a reason for methamphetamine use
Another topic, which was closely related to the study objectives and covered during the FGDs, was sexual pleasure as a reason for methamphetamine use. A few clients indicated that their first use or motivations for use were sexual issues:
Male, 34 years old, Married
“... I forced my spouse to use meth [methamphetamine] to make her more aroused and sexually disinhibited”
Male, 26 years old, Married
“If I used meth [methamphetamine], even if my partner did not use meth [methamphetamine], she became more disinhibited and gradually more promiscuous”
Male, 23 years old, Single
“Before taking meth [methamphetamine] I must be in the sexual “phase” and fantasize about it otherwise I wouldn’t feel much of its impact ... you must anticipate sexual effects in order to experience them”.

Discussion

The findings of this study showed the effect of methamphetamine use on high-risk sexual behaviors. A wide range of effects from heightened sexual desire and pleasure, to increase in the number of sexual acts were expressed by the participants due to methamphetamine use. Our results show that methamphetamine could promote irregular sexual behaviors such as lack of inhibition in sexual act and engagement in unusual sexual practices. According to the respondents, uncontrolled sexual acts could become more compulsive in the long term. Such a combination can lead to sexual practices, which under normal conditions would have been regarded as inappropriate and taboo by individuals.
Users often reported having numerous sexual partners and being less likely to use protection/condoms in their sexual acts, a finding that is consistent with previous studies [3,10]. In addition, the respondents expressed that long term methamphetamine use is associated with sexual dysfunction including problems in erection and ejaculation as well as diminished desire and interest in sex. Findings of this study, which were similar to the findings of previous studies, raise concerns about the effect of methamphetamine on sexual behavior norms of the users. This may put the users at higher risk for HIV and other Sexual Transmitted Infections. The process could become more complicated, when cultural norms of the society hinder users from seeking counseling and medical care. This is more distressing, when it is reported that less than 20 percent of youth in the country both correctly identify ways of preventing the sexual transmission of HIV and reject the major misconceptions about HIV transmission [9]. Meanwhile people not using methamphetamine but living around the methamphetamine users, such as drug naive partners of methamphetamine users, will be affected by methamphetamineassociated sexual behaviors as well. High-risk sexual behaviors could contagiously spread through partners of methamphetamine users and even gradually change sexual behavior norms of the society.
Future studies should focus more on measuring the effect of methamphetamine use on high risk sexual behaviors, and finding solutions/interventions for treating those experiencing concurrent addictive and sexual disorders. . More specifically, future works should be focused on the methods of measurement and ways of intervention. Defining the prevalence of methamphetamine use, and the existence of such high risk sexual behaviors among methamphetamine users, are other areas of studies that needed to be explored.
We acknowledge that the study has its limitations, which are inherent in qualitative studies. Also, this data is coming from a sample of methamphetamine users referred to three treatment centers in Tehran, which may not necessarily be representative of methamphetamine users in the country. Further, as the collected
information on sexual behaviors was self reported, the findings may underestimate the actual sexual risk behaviors in the respondents. This is mostly due to the stigma that is attached to these behaviors and their discussion.

Conclusion

It seems that the association between methamphetamine use and high risk sexual behaviors is tight. Moreover, it is said that only a small percentage of Iran’s younger generations have correct knowledge about ways of preventing sexual infections. Therefore, methamphetamine driven sexual behaviors, in combination with a lack of correct knowledge about ways of preventing sexual infections, is a real threat for further expansion of the HIV epidemic in Iran. Further studies are needed to explore the situation, and look for solutions to mitigate the threat in the country.

Acknowledgments

We would like to thank two NGOs; Rebirth Society and Congress 60 and their direct managers Mr. Abbas Deilamizadeh and Mr. Hossein Dezhakam for helping us to run FGDs. We would also like to thank the FGD participants that helped us kindly during the study. The authors are grateful to Ms. Georgianna Dolan-Reilly for helpful comments to review the article. Authors declare no conflict of interests.

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