Socio-Structural Correlates of Substance Use Among Gay, Bisexual, and Other Men Who Have Sex with Men In Ukraine

Background/Purpose: Gay, bisexual, and other men who have sex with men (MSM) in Ukraine experience intersecting vulnerabilities shaped by minority stress and structural discrimination, contributing to adverse mental wellbeing and elevated alcohol use. The COVID-19 pandemic introduced additional socio-economic disruptions that disproportionately affected MSM, yet limited empirical evidence has examined how pandemic-related economic instability may have shaped their substance use. This study addresses these gaps by evaluating the direct and indirect pathways linking COVID-19-related economic instability, stress, sleep quality, and alcohol consumption among MSM in Ukraine.

Methods: Data were collected from MSM in Ukraine between January and February of 2022 (N=1,198). Most participants identified as gay (76.6%) and lived in Kyiv (44.6%), with an average age of 30.6.

First, a COVID-19-related economic instability index (x̄=0.4, range 0-5) was created, consisting of job loss (19.6%), housing instability (8.9%), increased difficulty affording food (3.1%), rent (2.5%), and increased financial responsibility to support others (3.7%). Point-biserial correlation analysis examined the relationship between COVID-19-related economic instability and changes in alcohol consumption (unchanged/decreased vs increased (16.7%)), stress (unchanged/decreased vs increased (3.5%)), and sleep quality (unchanged/increased vs decreased (24.5%)). Next, to examine the direct and indirect effect of exacerbated COVID-19-related stress and sleep quality in the relationship between economic instability and increased alcohol consumption, generalized structural equation modelling was employed to estimate path analyses using a logit link function (p<.05). Covariates comprised age, sexual orientation, education, employment, and region.

Results: Greater COVID-19-related economic instability was associated with increased alcohol consumption (r=0.12, p<.001), increased stress (r=0.13, p<.0001), and decreased sleep quality (r=0.20, p<.0001). Increased stress was associated with unchanged/decreased alcohol consumption (r=-0.06, p<.05) whereas decreased sleep quality was associated with increased alcohol consumption (r=0.15, p<.0001). In path analyses, while greater economic instability was directly associated with increased alcohol consumption (b=0.44, p<.0001) and stress (b=0.74, p<.001), stress acted as a significant competitive suppressor. Specifically, the indirect pathway through stress significantly suppressed the total relationship between greater economic instability and increased alcohol consumption (b=-1.33, p<.05). Calculated via the delta method, increased stress was associated with an 83% reduction in the odds of increased alcohol use. Conversely, the indirect pathway through poorer sleep quality accounted for 61.2% of the total relationship between greater economic instability and increased alcohol consumption (b=0.48, p<.001). Economic instability maintained a significant direct effect on alcohol use (b=0.30, p<.01).

Conclusions/Implications: Findings link COVID-19-associated economic instability among Ukrainian MSM to increased alcohol consumption and exacerbated stress and sleep quality. Exacerbated sleep quality provided an indirect pathway connecting economic instability and increased alcohol consumption, suggesting reliance on alcohol as a sleeping aid. Conversely, stress mitigated increased alcohol consumption. Following the resource scarcity perspective, stressed MSM may be economically vulnerable, making alcohol unaffordable. Alternatively, stress may potentiate social isolation, reducing social drinking. Policies establishing robust social safety nets may support financial, mental, and substance use-related health of MSM. Social workers serving MSM experiencing financial instability should holistically assess sleep quality, stress, and alcohol consumption and integrate connections to economic support services to improve mental and substance use-related health.