Littoral spaces of performance : findings from a systematic review and re-analysis of qualitative studies on men who have sex with men, substance use and social venues

Substance use occurs at higher rates in men who have sex with men (MSM) than the general population, and, as a whole, is quantitatively linked to sexual risk behaviour. However, quantitative studies cannot adequately account for meanings, agency and role of social venue in shaping substance use, especially as regards sexual outcomes. To develop new theoretical constructs linking social venues and substance use in MSM, we systematically reviewed relevant qualitative studies and re-analysed them using a dimensional analysis method of grounded theory. Our analysis yielded an organising dimension of ‘littoral spaces’ in order to understand the meaning of MSM’s substance use in relation to the social venue. This space is characterised as different from everyday life, through the altering of social boundaries; defined by its illegal qualities; and described as ‘tribal’ and ‘ritual’. Substance use behaviours are embedded as performative regimes within these littoral spaces. Interventions for this population do not adequately account for the role of space in substance use behaviours. Harm reduction interventions, and interventions taking an approach focused on ‘durable’ planning for an entire evening, might offer improved effects