Rethinking “the Devil In the Network”: A Qualitative Socioecological Analysis of Crystal Methamphetamine Use Among Black MSM

Background and Purpose: Crystal methamphetamine (CM) use among Black men who have sex with men (MSM) has increased in recent years and is associated with heightened HIV risk, mental health burden, and structural marginalization. Despite these disparities, social work research has largely emphasized individual-level risk behaviors with limited attention to the broader socioecological conditions shaping substance use. Grounded in a socioecological perspective, this study examined multilevel factors influencing CM initiation, continued use, and cessation among Black MSM in New York State.

Methods: We conducted semi-structured, in-depth interviews with Black MSM (N = 14) residing in New York State. Participants were recruited through community-based organizations, peer referral, and online outreach between 2023-2024. Interviews (60-90 minutes; virtual) explored substance use history, social and sexual contexts, mental health, and service engagement. Data were analyzed using rapid qualitative analysis within a qualitative descriptive approach, guided by a socioecological framework to examine influences across individual, interpersonal, community, and structural levels.

Results: Participants' mean age was 37 (SD = 5) and included individuals reporting both current (n = 4) and prior (n = 10) crystal methamphetamine use. Most participants were recruited from New York City (n = 10), with additional representation from Western New York (n = 3) and the Mohawk Valley region (n = 1). Participants reflected various socioeconomic contexts, including differing levels of employment, substance use patterns, and access to care. At the individual level, continued use was linked to coping with stigma, psychological distress, and unmet mental health needs. At the interpersonal level, participants described the role of sexual networks and racialized desirability in shaping exposure and initiation. Community-level factors included limited access to affirming spaces and culturally responsive services. Structural influences, such as economic instability, housing insecurity, and barriers to healthcare, further constrained participants’ options for support. Participants demonstrated awareness of these multilevel conditions and expressed a preference for harm reduction-oriented, community-rooted services. Most harm reduction practices were self-directed, with limited engagement in formal services.

Conclusions and Implications: Findings highlight the necessity of addressing CM use among Black MSM as a complex socioecological phenomenon rather than an individual behavior. Importantly, findings highlight the intrinsic autonomy of Black MSM, who often navigate high-stigma environments through self-directed harm reduction and community-based protective strategies. Social work practice should prioritize self-determination-centered, culturally responsive, and harm reduction-oriented approaches that integrate mental health care, housing stability, and peer support. Policy efforts should invest in structural interventions and community-based organizations that center Black MSM, while reducing stigma across healthcare and social service systems. These findings contribute to social work research aimed at advancing equity-driven, contextually grounded responses to substance use.