amfAR, The Foundation for AIDS Research

Community Forum Addresses Crystal Meth Crisis

February 9, 2004—The "in" drug on the gay party scene, methamphetamine, is bringing a frightening partner to the dance—HIV.

A 2001 study by the U.S. Centers for Disease Control and Prevention (CDC) found 95 percent of men who attend circuit parties—weekend-long dance parties where sex with multiple partners is the norm—use some kind of party drug and of those, 28 percent had unprotected sex. According to the CDC, rates of new HIV infections among gay men have risen 17 percent between 1999 and 2002.

To discuss the risks of methamphetamine, or crystal meth, and brainstorm ways to combat an alarming and dangerous trend, HIV Forum NYC, with sponsorship from amfAR and other organizations, hosted a community forum in Chelsea, Sunday, February 8. Moderated by actor and activist Harvey Fierstein, "The Crystal Meth – HIV Connection. Challenging a Culture of Disease" featured

 

"You are willing to do things you've never done before and willing to try things you've never done before, without regard to risk," says Peter Staley, AIDS activist and amfAR Board Member 

presentations by AIDS activist and amfAR Board member Peter Staley, Dr. Steven Tierney, from the San Francisco Department of Public Health, Dr. Steven Lee, a New York City psychiatrist, and an unidentified member of the gay community who is currently recovering from a crystal meth addiction. HIV Forum NYC is an organization that is devoted to bringing HIV prevention to the top of people's minds, through a series of public meetings. Two additional meetings are planned on other prevention issues.

"We became frustrated with what we were observing around us in the culture of barebacking in the gay community and a general complacency among gay men," says Carlson, a marketing consultant who co-organized the event with psychologist Dr. Bruce Kellerhouse. "More importantly, there's a lack of a coherent, aggressive response from our community organizations."

The speakers discussed the psychological and physical aspects of methamphetamine addiction, as well as the benefits and drawbacks of risk reduction and abstinence programs. Members of the community spoke powerfully about the toll crystal meth had taken on their friends and about the emotional issues, such as loneliness and internalized homophobia, that seems to drive people toward embracing the drug.

Climbing the Club Scene 

Use of methamphetamine, a laboratory-created stimulant that can be snorted, smoked, or injected, is rising fast. In the late 1980s the drug took hold on the West Coast, especially in San Francisco, Los Angeles, and San Diego. By the late 1990s, methamphetamine arrived on the East Coast and its use is now reaching epidemic rates in most major metropolitan areas. Experts predict use of the drug will soon spread to heterosexual teens and young adults, just as ecstasy did.

Although the proportion of the gay population that uses methamphetamine remains relatively small, it is growing fast. Dr. Perry Halkitis, a researcher in applied psychology at New York University, says his data suggests that among New York City's gay population, use of methamphetamine has jumped from 8 to 9 percent six years ago to 15 to 20 percent now. Studies show that among party drug users, as many as 65 percent use methamphetamine, often in combination with other substances.

Methamphetamine has edged out other party drugs, such as ecstasy and ketamine, as the drug of choice at gay bars, circuit parties, and sex clubs because of its ability to induce a euphoric high, wipe out inhibitions, and stimulate marathon bouts of "tremendous, mind-blowing sex," says Carlson.

 

The Evil One 

That euphoria doesn't last, however, and when the inevitable crash comes the effects are severe. Users experience severe depression, paranoia, and suicidal ideation. Long-term users may experience psychosis and Parkinson's-like tremors. And because crystal meth is so addictive, it can quickly destroy people's lives.

"We're seeing overwhelming evidence of this here in New York now, with young gay urban professionals with great jobs, beautiful apartments, boyfriends, the works, starting this drug as an elixir for their mid-life crisis and within six months, everything they have is gone. They're dealing with methamphetamine-induced psychosis and they can end up homeless on the street," says ACT UP activist Peter Staley, a member of the amfAR Board of Directors.

"It's a very scary thing. The Grim Reaper, the Evil One—that’s what it's referred to on some websites. That's a great name for it because it is an evil substance," says Dr. Halkitis.

For users who are HIV positive, the news is even worse. For one thing, men who use methamphetamine are more likely to miss doses of their HIV medicines—leading to drug resistance. Even in men who are taking their medication, methamphetamine makes antiretrovirals less effective. Some studies have shown that methamphetamine seems to increase viral replication in the brain, says Dr. Halkitis.

"That's a huge problem. You have replication of the virus and possible non-adherence causing mutation, and potential transmission of mutated virus," warns Dr. Halkitis. "The virus is going 'All right! It's time to multiply!'"

 

A Spreading Scourge 

As more people use methamphetamine, the opportunity for HIV transmission grows. Methamphetamine provokes a primal sexual urge, according to Dan Carlson, and its stimulant properties allow users to satisfy that urge for hours, even days, on end. At the same time, the drug triggers a dopamine rush that affects the part of the brain that controls inhibition, essentially shutting it down.

"You are willing to do things you've never done before and willing to try things you've never done before, without regard to risk," says Staley. "So it’s not just a personal responsibility equation and a morality equation, but there is a chemical reaction that goes on here that complicates all those factors."

The mass marketing of Viagra has raised the stakes even higher. Originally, men who used the drug were receptive partners, because methamphetamine prevents erections. With Viagra, users—who could be HIV positive—are now insertive partners who can infect the men they're having sex with.
 

Breaking the Silence 

Combating the epidemic of methamphetamine use will be a challenge, in part because of the growing complacency about HIV prevention among the gay community. Added to that, says Dr. Halkitis, mental health issues, such as depression and isolation, may be fueling its popularity.

Complicating matters is a reluctance, so far, to publicly address crystal meth addiction. "For obvious reasons the gay community is wary of airing its dirty laundry in public," says Staley. "At this stage I think what everybody needs to do is to start speaking out so that when a young gay man arrives in New York, when somebody offers him crystal meth for the first time, he will have already heard from a friend or through mass media of the very significant dangers of this drug," says Staley.

"I hope the forum is a resounding call to action for our service organizations to begin to enact programs and outreach efforts and PSAs to combat the epidemic and instill HIV prevention on the agenda in the gay community so that it is constantly top of mind among our political leaders, our service organizations, and among our members. Because it is ultimately our responsibility to take care of our own well-being and our own health," says organizer Carlson.