Pleasure and Vulnerability: A Cross-Sectional Study on Sexualized Drug Use, Motivations and Structural Vulnerabilities Among Trans and/or Non-Binary Communities.

Sexualized drug use (SDU) is an emerging and understudied phenomenon among trans and/or non-binary populations (TNBP). This study aimed to analyze the prevalence of SDU, gender differences in the use of 14 different substances, motivations for engaging in SDU and factors associated with emotion regulation-related SDU among TNBP who reported this practice. We conducted a cross-sectional online survey with a convenience sample of 1772 participants over 15 years of age, recruited through social media accounts of LGBTIQ+ organizations and influencers and 39 gender identity units in Spain. SDU was defined as intentional use of substances during sexual experiences within the past year. Motivations for SDU were assessed. Factors associated with emotion regulation - driven SDU were analyzed using Poisson regression with robust variance. The gender distribution was 35.3% trans men, 22.6% trans women, and 42.1% non-binary individuals. Overall, 10.5% of participants reported SDU and 1.4% reported chemsex. Cannabis (7.5%), poppers (4.8%) and ecstasy (3.2%) were the most frequently used substances. Among SDU participants, nearly two-thirds identified pleasure as their primary motivation, while the rest cited emotion regulation. Emotion regulation-driven SDU was associated with trans men and non-binary identities, migrant background, lower socioeconomic status, having experienced anxiety in the past year, and having ever suffered physical violence. Emotion regulation-related SDU was linked to structural vulnerabilities. These findings highlight the need for public health policies that consider the specific characteristics of TNBP communities, including their motivations for SDU and the role of systemic violence and discrimination in shaping substance use practices.