To the best of our knowledge, this is the first study to have examined the association between financial hardship and drug use among MSM in the European Union, as well as one of few studies examining the association between recent financial hardship and drug use among any MSM population. The results demonstrate that almost half of the participants had experienced financial hardship (46%) and the majority (83.7%) of them had used at least one type of drug in the past 3 months. In addition to alcohol use, inhaled nitrites was the most commonly reported drug used in this sample, consistent with other studies among MSM [28, 29]. Although the effect sizes were of relatively small magnitude, our findings suggest that higher levels of financial hardship are significantly associated with overall drug use, as well as the use of tobacco, marijuana and inhaled nitrites after adjusting for covariates. This result is meaningful as effect sizes can be affected by sample characteristics and should be interpreted in a research-specific context [30, 31]. Wong et al. [16] presents similar result reporting that childhood financial hardship was associated with increased risk of recent drug use among young MSM in Los Angeles [16]. However, no significant associations were observed between alcohol and club drug use in this study.

Meyer [6] proposed the minority stress perspective [6] to conceptualize the association between increased levels of stress due to exposure to victimization, discrimination, rejection, hostility and negative attitudes about homosexuality, and greater levels of drug use among sexual minority populations. Since financial hardship could be both a cause and a consequence of discrimination [32], there is a possibility that experiencing financial hardship may contribute to this type of stress, which may result in increased drug use among MSM.

Furthermore, there were several limitations to this study that are important to mention. First, there was a difference between the exposure and outcome measurements with regard to the time period included; financial hardship was measured at the time of the survey, while drug use was measured based on the past 3 months. Therefore, participants may have reported financial hardship during any period of their lives, including current or past hardships, or hardships spanning the lifetime. In addition, no causal inferences can be drawn due to the cross-sectional design of the study. Reverse causality and a potential bidirectional relationship cannot be ruled out (e.g., consumption of drugs may contribute to financial hardship). Also, our study relies on a single item to measure of financial hardship as conducted by other previous studies [26, 33]. Future studies involving multiple scales/indicators of financial hardship are warranted. Moreover, self-reporting was used to collect data, which could have introduced social desirability bias, reporting bias, or recall bias, particularly among MSM [34]. Therefore, for example, we may have underestimated the exact prevalence of drug use. Because some of study variables were not collected with the aim of maximizing the participation rate, there may have been residual confounding from other unmeasured covariates (e.g., income, education status, race/ethnicity and binge drinking) related to substance use. Finally, we focused on MSM in the Paris metropolitan area who used a single geo-social networking application. The relatively low response rate precludes generalization of our results.

Despite these limitations, this study adds to the body of literature, highlighting general drug use in addition to specific drug use, and describes the association of financial hardship and drug use among MSM. Future research with MSM should utilize longitudinal and qualitative research to better understand causal relationships and identify mechanisms for the association found. This research can provide better direction of structural interventions and policies to reduce health inequalities, identify factors (e.g., social exclusion, discrimination) associated with financial hardship and provide drug screening services to MSM.