Sexualized drug use, anxiety, depression, and suicidal ideation among men who have sex with men in Pakistan: Results of a multi-center cross-sectional survey.

Section 377 of the Pakistan Penal Code penalizes same-sex behavior with life imprisonment. There is a high degree of religious stigma against men who have sex with men (MSM) in Pakistan. The social and legal framework adds to the minority stress for MSM in Pakistan. We conducted a cross-sectional study aimed at examining the association of amphetamine-type stimulant (ATS) use with anxiety and depressive symptoms, and their association with suicidal ideation. Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Ask for Suicide Questionnaire-5 (ASQ-5) were used in this study. MSM were recruited from community organizations using convenience sampling from 5 July 2025-5 August 2025. A total of 735 participants identifying as MSM were included in the study. About 10.5% reported ATS use, and 25.4% reported SDU. The prevalence of moderate and severe anxiety symptoms was 12.45% and 14.4%, respectively. The prevalence of moderately severe and severe depressive symptoms was 9.4% and 8.4%, respectively. Around 26.8% of MSM included in the study were non-acute positive, and 6.8% were acute positive for the suicide screen. Having a homosexual partner and ATS use were associated with higher GAD-7 score, β = 1.044 (BCa 95% CI 0.083 to 1.919, p < 0.05) and β = 5.523 (BCa 95% CI 3.932to 7.257, p < 0.001), respectively. ATS use was also associated with an increased PHQ-9 score, β = 6.258 (BCa 95% CI 4.418 to 8.207, p < 0.001), ATS use, PHQ-9, and GAD-7 increase suicidal ideation with the odds ratios of 3.76 (95% CI 1.788 to 7.721), 1.166 (95% CI 1.106 to 1.229), and 1.152 (95% CI 1.093 to 1.214), respectively. Overall, ATS use was high among MSM and associated with the symptoms of anxiety, depression, and suicidal ideation. Comprehensive mental health screening and harm reduction programs for ATS use should be provided to MSM in Pakistan.