This Month in HIV: Crystal Methamphetamine and HIV/AIDS
This is Bonnie Goldman, editorial director of The Body. I'd like to welcome you to This Month in HIV. Today we're going to look at the intersection of methamphetamine and HIV. Many researchers are discovering that methamphetamine use is causing the rate of HIV to triple in some communities. However, meth use isn't just a problem because it's an HIV risk factor. Meth use has also become a major issue among people who already have HIV. Research suggests a growing number of HIV-positive people in the United States are using or addicted to meth. One community that has been particularly hard hit by this drug is the gay community, and we will be talking about this with today's panelists.
In terms of meth's effect on HIV and HIV medications, there are far more questions than answers at this point. However, meth use -- just like any other drug addiction -- can cause people to neglect their HIV medications and their general health, possibly causing drug resistance and accelerating HIV progression.
So how do we, in the HIV community, begin to address the meth epidemic? What do we need to know? We brought together three people to help shed some light on this topic.
Our first guest is Luciano Colonna. Luciano is the executive director of the Harm Reduction Project, which co-sponsored the 1st National Conference on Methamphetamine, HIV, and Hepatitis. Welcome, Luciano.
Luciano Colonna: Thank you.
Our next guest is Phil Hendricks, coordinator of the Crystal Meth Program at AIDS Project Los Angeles. The program provides counseling and support for crystal meth users and their friends, lovers and family members. Phil specializes in risk reduction education for high-risk gay and bisexual men. Welcome, Phil.
Phil Hendricks: Thank you.
Our final guest is Mark S. King. Mark has been living with HIV since 1985. He has been an AIDS activist, writer and community organization leader since the early 1980s in Los Angeles. He advocates for prevention education and addresses other critical issues for people living with HIV. Mark is an award winning writer, and several of his articles are available at The Body. [Click here to read his articles on The Body.] Mark also has been recovering from an addiction to methamphetamine for the last four years. However, during his recovery, he has had relapses. He has now been clean for more than 30 days. Welcome, Mark.
Mark S. King: Thank you, Bonnie.
Mark, I wanted to start with you. Can you tell us how you became involved with crystal and why you found it so addictive?
Mark S. King: Wow. Sure. It's kind of two-fold. One is: My personal experience as somebody who used recreational drugs. Much like many people in the gay community, I certainly had drug abuse problems in the 1980s with cocaine, but what happened for me, I believe, in the 1990s is my work in HIV as a community person was kind of coming to a close and I was exhausted and I was -- this may sound like a bit of rationalization here -- but I was emotionally looking for a way out, I was looking for some sort of escape. At about that time, meth was really taking hold on the party scene. Whereas previously it was other recreational drugs, crystal meth was starting to creep into that scene as well as onto the dance floor, etc.
What year was this?
What happened is probably a route that a lot of gay men see. Crystal meth use didn't stay on the dance floor. It came over into my sexual life, into my friends, into my home. Over the course of several years, it pretty much took it's time, but certainly by 2001 and 2002, I was an actively, regularly-using crystal meth addict who had gone from snorting it to smoking it to injecting it.
Where was this taking place, in Atlanta?
Mark S. King: In Atlanta and, after my move, in Fort Lauderdale, Fla. Really when I moved to Fort Lauderdale and I left the AIDS community work behind -- I needed to go somewhere where nobody knew me and people stopped questioning me about my AIDS work, where I could just be a drug addict. Because by that time the real insanity of drug abuse, and the way it affects your thinking and priorities had set in. I wanted to be in Florida where nobody knew me, where I could be free to have all of the sex, unprotected by the way, and drugs that I wanted.
How prevalent was meth in Fort Lauderdale?
Mark S. King: Absolutely prevalent. You're talking to a drug addict who was seeking it out, but I think that even those who have a more objective view -- probably your other panelists -- would probably agree that it had really taken root. If you were a single, sexually active gay man, the chances that you had done meth, or at least been around those who were ... I only knew people who were doing crystal meth. Socially and sexually, those were the only people that I sought out. Crystal meth and sex were synonymous to me, so I wouldn't pursue one without the other.
Tell me about the sexual identity part. Why was that so attractive to you?
"I had been repressing my sexuality for so long, so much during the AIDS crisis. We were scared to have sex for a while and then we were being so extremely cautious about sex for so long. I wanted to escape that. I wanted to escape the boundaries of all of that."
-- Mark S. King
Mark S. King: I think it was attractive to me: A) Because I had been repressing my sexuality for so long, so much during the AIDS crisis. We were scared to have sex for a while and then we were being so extremely cautious about sex for so long. I wanted to escape that. I wanted to escape the boundaries of all of that. I don't say that was good thinking [laughs], in any respect. But again this became a lot of my drug addict thinking, "Get me away from all of those restrictions. Let me just run free."
Crystal meth, one of its attractions is that it has a reputation for unleashing wild abandon in terms of your sexuality. It has the reputation of keeping you up for days. People go on marathon sex binges when they are using crystal meth that can go on for days and days, partially because it keeps you awake, partially because I think there's a group psychology going on in that community that it's a sex drug. Whether or not it actually does that in your brain, I'm not qualified to say, but it certainly has that reputation. It sort of gives you that feeling that you are sexually invincible. You just go on and on and on and put yourself in increasingly high-risk situations. So high risk that barebacking is the baseline activity. I don't recall in the last several years of my active drug using condoms ever being discussed or present. They were a complete non-issue and beyond that sharing needles, coming inside another person, all of those, as high risk as you can get. As a matter of fact, I believe for me at least, and certainly for drug addicts that I know, the fetishing of the drug and the fetishing of the virus itself and the risks that you are taking are very much a part of that culture.
When you say fetishing, what do you mean specifically?
Mark S. King: What I mean is the fact that my sexual fantasies and those of the people that I was hanging around with were inseparable from our use of the drug. For the last several years, I never did crystal meth unless I was naked, for instance. It wasn't something I was doing on dance floors. I long ago abandoned going to night clubs. If I went out at all it was to a sex club, where I would be doing crystal meth. So there is a fetish involved where you are meeting up with another drug addict and the subject of crystal meth and how we are going to do it -- "Do you have needles?" -- those sorts of topics, were as sexually exciting as speaking of any particular sex act we could name. They were, again, completely synonymous.
Phil, does this sound very familiar to you in terms of your work at APLA [AIDS Project Los Angeles]?
We see all kinds of different populations, from different ethnicities to different socio-economic classes, also getting involved in crystal. It really seems to be hitting everybody regardless of who they are.
People interact with the drug differently. People who are sharing needles and having high-risk sex are definitely one of our target populations that we are trying to work with and minimize the risk. There are also people using it for work. There are people using it for creative outlet. People using it for managing being homeless. There are all kinds of different reasons people use it. It's not solely sexual for all the people we are seeing.
How addictive is it? Can you just use it once or twice or three times, like alcohol?
Phil Hendricks: Well, with addiction, the definition of addiction implies that it is someone using a substance multiple times. There are a lot of campaigns out that say that you cannot even risk using it once. But [using meth] once kind of opens the doors and lets people realize what crystal can do. Addiction is built around repetition of something over and over.
As far as on the scale of drugs, crystal meth is probably in the same class as cocaine, but it's not as severe [an addiction] as alcohol or heroin. Both of those have potentially fatal detoxes, whereas the cravings for crystal will last for a long, long period of time. The mental addiction and the physical addiction aren't as severe [in crystal meth] as some other drugs. But it's very drawing and very addictive for a large percentage of people, above most other drugs.
Luciano, we had talked about this last week when I contacted you. You were telling me that methamphetamine is the number one drug in the world in terms of abuse.
Luciano Colonna: I'd really like to comment on what Phil just said. It was really nice to hear his response to the question.
"Meth is not the most abused drug within the MSM community. Alcohol is actually the most abused drug."
-- Luciano Colonna
As far as seizures go and treatment goes, after cannabis, yes, amphetamine, methamphetamine is the most used drug in the world.
I'd like to comment on its use in the gay community. I think there's a lot of hyperbole in the media around its use in the gay community. It's certainly a bad drug, meaning that it causes a lot of bad things, certainly. We just heard that. It causes a lot of damage, especially after you use it for a while. And I think it causes a lot of pleasure for people who use it. However, it also causes a lot of damage because it's not only used alone. It's often used in conjunction with other drugs, and in the gay community it's also often used in conjunction with alcohol. I think individuals in the MSM [men who have sex with men] community should look at the role that alcohol plays in the gay community, continues to play in the gay community, along with methamphetamine and the impact it has on HIV, meaning alcohol. I think we should discuss that more. When we look at methamphetamine, methamphetamine use is actually declining. Meth is not the most abused drug within the MSM community. Alcohol is actually the most abused drug.
Copyright © 2007 Body Health Resources Corporation. All rights reserved. Podcast disclaimer.
This article was provided by TheBody. It is a part of the publication This Month in HIV.
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