Historically, LGBTIQ+ individuals who use drugs have faced dual stigmatization- one linked to their gender identity and sexual orientation, and another associated with their substance use. Additionally, this population has been subjected to exclusion and stigmatization by various state institutions, including those responsible for ensuring their health and well-being. This marginalization has hindered access to adequate healthcare services and perpetuated structural violence that deeply affects the community.

According to the 2021 National Survey on Sexual and Gender Diversity (ENDISEG), Mexico has approximately five million LGBTIQ+ individuals, representing 5.1% of the population over the age of 15 (INEGI, 2021). However, this population continues to experience high levels of discrimination and violence. The 2018 Survey on Discrimination Based on Sexual Orientation and Gender Identity (ENDOSIG) found that 86.4% of respondents believe that the rights of sexual and gender minorities are poorly or not at all respected in the country, highlighting a widespread environment of hostility across all social spaces (SEGOB, CONAPRED, and CNDH, 2018).

ENDOSIG (2018) data also indicate that six out of ten LGBTIQ+ individuals experienced at least one episode of discrimination in the 12 months prior to the study. This discrimination is particularly prevalent among people with non-normative gender identities, including trans women (74.4%), trans men (74.8%), and individuals with other non-conventional gender expressions (80.2%). The primary reported reasons for discrimination include gender expression, such as physical appearance (59.3%), clothing style (49.5%), and manner of speaking (42.6%) (SEGOB, CONAPRED, and CNDH, 2018).

For this reason, this study focuses on substance use within LGBTIQ+ populations, recognizing that the dual stigma related to gender and sexual identity and drug use deepens structural inequalities. This condition generates trajectories marked by vulnerability and unequal access to rights and services, reinforced and normalized both by broader social structures and by exclusionary state practices. Consequently, the state and its institutions bear the responsibility to implement policies that promote awareness, respect, and inclusion, ensuring equitable access to comprehensive and culturally competent healthcare. Any barriers to such access constitute violations of human rights and structural violence that demand urgent redress.

Research Methodology and Approach

This article presents the findings of a study on psychoactive substance use among LGBTIQ+ individuals in Mexico, conducted between 2023 and 2024 as part of the Cooperation Program between Latin America, the Caribbean, and the European Union on Drug Policies (COPOLAD III). The primary objective of this research was to understand the dynamics of drug use within the LGBTIQ+ community and develop practical tools to improve socio-healthcare services in this area.

Based on the study’s findings, two key resources were developed: the Fieldwork Technical Guide for Addressing Substance Use in Sexual Diversity Populations and the Toolkit for Socio-Healthcare and Specialized Centers for Intervention with Sexual Diversity Populations Who Use Substances.

The study adopted a mixed-methods approach, integrating both quantitative and qualitative methodologies within the framework of Participatory Action Research (PAR). Key activities included interviews with LGBTIQ+ individuals who use psychoactive substances, healthcare professionals, and representatives from civil society organizations; focus groups with LGBTIQ+ community members who use substances; participatory workshops focused on risk and harm reduction; and the administration of the Psychoactive Substance Use Questionnaire for Sexual Diversity Populations in Mexico.

Key Results

As previously mentioned, one of the data collection tools used in this study was an online questionnaire, administered between December 2023 and February 2024, with 236 participants from different states in Mexico. All respondents identified as drug users, allowing for an in-depth exploration of their experiences, practices, and perceptions. The sample consisted of 51.27% cisgender men, 20.76% cisgender women, 17.80% non-binary individuals, and smaller percentages of trans men (3.36%), trans women (2.54%), and other identities (4.40%). Regarding sexual orientation, 29.15% identified as gay, 22.88% as bisexual, 10.59% as lesbian, 13.14% with other orientations, and 2.54% as heterosexual.

Substance use was particularly high for alcohol (98.31%), marijuana (97.88%), and tobacco (91.53%). Among recreational drugs, LSD (59.32%) and poppers (57.20%) were prominent, along with psilocybin (38.56%) and methamphetamines (35.17%). Regular use was most frequent for marijuana (62.29%) and alcohol (61.44%), followed by tobacco (29.24%), poppers (22.03%), and methamphetamines (9.32%).

Regarding sources of information on substances, the internet was the primary source (77.97%), followed by friends (53.39%), civil organizations (38.56%), educational institutions (26.69%), and healthcare centers (13.98%). However, 12.71% of respondents reported not receiving reliable information.

The study also identified both risky behaviors and harm reduction practices associated with the use of psychoactive substances,among the responders. Common harm reduction strategies included consuming in safe spaces with trusted people, staying hydrated, knowing the substance and its effects, and planning the environment and emotional/physical conditions for use. Risky behaviors included mixing substances, consuming doses above the suggested amount, using substances under stress or emotional distress, and reusing syringes. Additionally, exposure to unsafe environments was identified as a significant risk factor.

Experiences with healthcare services in Mexico revealed critical findings: most participants reported negative experiences within the public health system, including discrimination, stigmatization, and psychological violence based on their sexual orientation, gender identity, and substance use. The primary demands for improving these services included continuous training for healthcare personnel on sexual diversity and substance use, the creation of specific care protocols for LGBTIQ+ individuals, and the establishment of supervised and safe consumption spaces.

These findings underscore the multifaceted nature of drug use within the LGBTIQ+ community in Mexico. These populations often face heightened stigma, discrimination, and marginalization, which not only contribute to patterns of substance use but also severely limit their access to appropriate information, prevention tools, and healthcare services. Structural barriers-such as institutionalized homophobia and transphobia, lack of professional training among healthcare providers, and the absence of inclusive harm reduction strategies-further exacerbate these vulnerabilities.

The urgent need for inclusive and evidence-based public policies cannot be overstated. Such policies must prioritize harm reduction approaches grounded in human rights, and they must ensure the training of healthcare personnel to provide nonjudgmental, culturally competent, and gender-sensitive care. This includes addressing the specific needs of transgender, non-binary, and intersex individuals, whose experiences are often overlooked. Centering the voices and realities of LGBTIQ+ people who use drugs, these policies can help dismantle systemic inequities and promote a healthcare model that is truly inclusive, intersectional, and equitable-benefiting not only LGBTIQ+ individuals but society as a whole.

Context: Drug Use and Discrimination

Drug consumption in LGBTIQ+ communities is closely linked to the social and structural dynamics of exclusion they face. This phenomenon should not be seen as an isolated behavior but rather as a direct consequence of a complex interaction of social, cultural, environmental, and structural factors.

The physical and psychological violence, as well as the discrimination these communities endure, contribute to their increased vulnerability to drug use. As Prof. Santiago Peidro from the Buenos Aires University highlights (2021), the pathologization of non-hegemonic sexualities, backed by mental health institutions, has had devastating effects on the subjectivity of LGBTIQ+ individuals. Throughout history, psychiatric diagnoses have not only been used to classify certain behaviors as disorders but also to justify treatments intended to "cure" what was deemed pathological. This approach has contributed to the stigma and institutional violence that persists today.

According to ENDOSIG (2018) data, discrimination is frequent in healthcare services in Mexico for those with non-normative sexual orientations and gender identities. A quarter of trans people report discrimination during medical care, more than twice as much as lesbian women, with the highest reports of discrimination among those with non-normative sexual orientations (12%) (SEGOB, CONAPRED, and CNDH, 2018). Alarmingly, four out of ten people report not receiving adequate treatment, nearly a third had their health issues minimized, and 15% were even suggested therapy or treatments to "cure" or "correct" their sexual orientation or gender identity (SEGOB, CONAPRED, and CNDH, 2018).

Leadership and Empowerment in Sexual Diversity: The Role of Institutions

LGBTI+ individuals who use psychoactive substances, face a double stigma, which which is often intensified by intersectional factors such as race, skin color, social class, or gender identity. This phenomenon should not be viewed as an isolated act but as the result of the interaction between various social and structural factors of oppression. As people experiencing these forms of discrimination become politicized and informed about their rights, their ability to identify, question, and resist discriminatory practices increases. This process has been crucial in strengthening leadership within the community, driving demands for adequate care protocols, access to reliable information about substance use, and the promotion of self-care and harm reduction practices.

The leadership of these populations is not only an individual response to stigma but also serves as a collective tool for transforming public policies and advocating for rights. Such leadership must be accompanied by strong institutional support, going beyond formal recognition and promoting an inclusive environment. This environment must ensure equitable access to services, particularly in the healthcare sector, which often represents a major barrier to the collective well-being of these communities. Specifically, the lack of adequate mental health care is a significant obstacle, as the mental health of LGBTIQ+ individuals is often approached with pathologizing frameworks that ignore their experiences and realities.

Healthcare institutions have a responsibility to adopt approaches that not only respect but also affirm LGBTIQ+ identities, creating spaces where individuals can develop personally and communally without fear of discrimination. For these practices to be effectively implemented, public policies must integrate a reparative approach that goes beyond recognizing the human rights of these populations and also considers their historical reparations. This involves the creation and implementation of policies that ensure non-discriminatory medical care, incorporating specific strategies to address the oppressions faced by LGBTIQ+ individuals.

Achieving these objectives requires the training of healthcare staff in human rights, as well as the development of care protocols that respect and value the identity of each person, free from judgment or pathologization. This transformative approach is crucial for ensuring that LGBTIQ+ communities are not only included in the healthcare system but also feel respected and affirmed in their identities. In this regard, structural change within institutions is necessary to replace oppressive practices with those that promote autonomy, dignity, and respect, regardless of sexual orientation or gender identity.

An example of such spaces and alternatives is the Clínica Especializada Condesa, located in Mexico City, which provides comprehensive and respectful care to LGBTIQ+ populations and people who use substances. Its multidisciplinary approach, encompassing both medical and psychosocial areas, ensures dignified and affirming access to healthcare services. This model significantly contributes to improving individuals’ physical and emotional well-being, a fundamental condition for the full development of their capacities.

The implementation of care models based on harm reduction, intersectionality, and self-determination is a crucial step to ensure equitable access to quality healthcare services. Initiatives such as the creation of safe consumption spaces managed by LGBTIQ+ collectives, training substance users as community health agents, and demanding inclusive care protocols are key to transforming the current reality. These actions not only improve access to services but also consolidate leadership structures within the community, enabling influence in political and social decision-making processes.

In the long term, these strategies will benefit not only LGBTIQ+ individuals who use psychoactive substances but also future generations, ensuring that these individuals are recognized as political actors with agency and the capacity for transformation. The development of inclusive policies and the decolonization of health and drug approaches will allow equitable access to services without discrimination, fostering a fairer and more dignified society. To achieve this goal, equity must be translated into concrete public policies that guarantee the right to a dignified life, access to healthcare, and autonomy for those who have been historically marginalized.

Biography

Jorge A. Aragón.- Indigenous Zapotec sociologist with experience in social and community projects, applied social research, and multisectoral political coordination. Specialized in drug policies from a harm reduction, pleasure management, public health, and social justice perspective. Has contributed to the development of intervention models for substance users, as well as the prevention of early and problematic psychoactive substance use. His work focuses on the promotion and defense of human rights for key populations, primarily people who use drugs, through the implementation of tailored approaches that address the specific needs of each group and sociocultural context.

References

Estay, G., Valenzuela, V., & Cartes, R. (2020). Atención en salud de personas LGBT+: Perspectivas desde la comunidad local penquista. Revista chilena de obstetricia y ginecología, 85(4), 351-357.

Instituto Nacional de Estadística y Geografía (INEGI). 2021. “Encuesta Nacional sobre Diversidad Sexual y de Género (ENDISEG) 2021. Nota técnica”. https://www.inegi.org.mx/contenidos/programas/endiseg/2021/doc/endiseg_2021_nota_tecnica.pdf.

Peidro, Santiago. (2021). La patologización de la homosexualidad en los manuales diagnósticos y clasificaciones psiquiátricas. Revista de Bioética y Derecho, (52), 221-235. Epub 25 de octubre de 2021.https://dx.doi.org/10.1344/rbd2021.52.31202

Rodríguez Romero, E.G. y Antonio Aragón, J. (2024). Caja de herramientas para centros sociosanitarios y especializados para la intervención ante el consumo en poblaciones de la diversidad sexual. COPOLAD, CONASAMA y EPISTEME SOCIAL

Rodríguez Romero, E.G. y Antonio Aragón, J. (2024). Guía técnica de trabajo de campo para el abordaje de consumos de la población de la diversidad sexual. COPOLAD, CONASAMA y EPISTEME SOCIAL

Secretaría de Gobernación (SEGOB), Consejo Nacional para Prevenir la Discriminación (CONAPRED), y Comisión Nacional de Derechos Humanos (CNDH). 2018. “Encuesta sobre Discriminación por motivos de Orientación Sexual e Identidad de Género 2018 (ENDOSIG)”. Resumen Ejecutivo. México. https://www.gob.mx/cms/uploads/attachment/file/473668/Resumen_Ejecutivo_ENDOSIG_16-05_2019.pdf.