This Month in HIV: Crystal Methamphetamine and HIV/AIDS
Has anyone written about why they think meth is particularly abused in the gay community?
Phil Hendricks: Oh, it's clearly not just in the gay community.
Mark S. King: It may be a different reason in every community. I know I tend to get gay-centric about these things, and think the sky is falling because so many of my gay friends are doing crystal meth, as if it doesn't affect other populations, which Luciano and Phil have outlined, actually it does and has, and probably predates gay men getting into it.
What's darkly amusing is -- leave it to gay men to sexualize a drug, which apparently may be one characteristic of the drug's use among gay men that may set gay men apart from other populations with regards to the abuse of crystal meth. But I'm making an assumption that Phil and Luciano may disagree with.
Before I go to them, I wanted to say something about my assumption, because if you look at activism around meth, it's very gay-centric. It may be because gay men have had such a strong response, and the gay community has responded to the meth epidemic so strongly.
Luciano Colonna: That is an excellent point. First of all, the gay community has responded to it very strongly. And we should look at the data. The number-one drug abused in the gay community is alcohol. Data-wise 10 percent of gay men are using methamphetamine. That's significant, but the number-one drug of choice is alcohol. Ten percent of [gay] men are using methamphetamine. If we look at sexual risk and methamphetamine and HIV, the correlation between HIV and methamphetamine -- there still need to be more studies done. We know that something is happening around that triangle of HIV, sexual risk and methamphetamine use in MSM. But we can't really say what is happening yet.
Phil Hendricks: I'm sorry, are you saying more research needs to be done to make a connection between HIV and crystal meth use? You don't believe that there is evidence to suggest there is currently a connection?
Luciano Colonna: There is an association between drug use and risk behavior, but it does not immediately imply causality.
Phil Hendricks: Are you saying that people who would choose to use crystal are people who would normally choose to enter high-risk situations?
Luciano Colonna: Yes.
Phil Hendricks: So the fact that someone who uses crystal meth is more likely to have unprotected sex with an anonymous partner [doesn't prove that meth use causes unprotected sex.]
Luciano Colonna: Exactly, so it's necessary to conduct research that examines potential confounding variables. Unfortunately, the existing research that's been done in the United States, where most of this research has been done, has tended to control for differing drug types, and adjustment for the confounding variables in North America has been poor. Much of the research in North America has been cross-sectional. It's been good, but it just hasn't been good enough. More research has to be done in North America. Now, I know, I've looked at the data, and a lot has been done. But more has to be done.
Phil Hendricks: I hear what you are saying, but I'm guessing Mark has an issue with it. Is that correct?
Mark S. King: Well, it's so hard to believe, but then again, researchers have to be real careful about having enough test subjects or what have you to be able to come to a conclusion. Certainly, based on my non-scientific observations as an addict, I'm floored by this. The number-one fantasy of any guy that has injected crystal meth five seconds ago is, "Get me as much as you can. Right now."
Luciano Colonna: Yes, you're right. You're right.
Luciano Colonna: You're right, but I'm not looking at it like that. I'm looking at it in the way that researchers are going to look at it.
Mark S. King: OK.
Phil Hendricks: I think that both Mark and I can hear the anecdotal stories and the personal experiences. But what you're saying is that the research paper needs to isolate out those differences.
Luciano Colonna: Yes, and I want you to know that I'm not a researcher. I thank God I'm not a researcher, because I would not want to think that way, and I agree with you guys. I'm just someone who was put in the unfortunate position of having to review research papers. This is what I, unfortunately, have learned.
Mark S. King: I appreciate your position. I'm just glad that we're all on this panel together, so you can parse closely what you need to say and I can say what I experienced.
Luciano Colonna: Yes, and on the other hand I totally agree with you absolutely, and I can say that. I agree with you. Anecdotally, and from working in a program -- I run group interventions for MSM and I know what's what. [Laughs.]
Phil Hendricks: The interesting question, I think we're probably going off of what this conference call is about, was that these people that didn't take risks before[, now are]; they found meth and then went to the bathhouse. The bigger question is: Did meth allow them to do the behaviors that they wanted to do, or did meth make them do the behaviors that they ended up doing? [In other words], did the drug make them do it, or did the drug allow them to do the things that they had fantasized prior to using the drug?
"Like any drug, you always need a little bit more, a little bit more. The same with your sexuality under the influence of meth. Barebacking is passé. It was not even exciting anymore. You had to go to another level. You had to go to major sex toys. You had to go to fisting. You had to go as far down that dark road as you can go."
-- Mark S. King
Mark S. King: I believe that it's a little bit of both. In my experience, meth certainly released inhibitions that allowed me to go to certain places. I also believe that there's a point where you cross a line. In my sexual experience and that of people I know, we all got to a point where our heads just got twisted. Our heads just got twisted. I participated in things, and fantasized about things that I don't believe are my true nature sexually. I really don't. I mean dark things. It seemed to always be a case of one-upmanship. Like any drug, you always need a little bit more, a little bit more. The same with your sexuality under the influence of meth. Barebacking is passé. It was not even exciting anymore. You had to go to another level. You had to go to major sex toys. You had to go to fisting. You had to go as far down that dark road as you can go. What used to work didn't work anymore. I believe there is a point in which you cross the line, where the sexuality you are exhibiting is no longer yours. That is a result of what the drug is doing to your head. That is my personal opinion.
Mark, could you talk a little bit more about what you were doing while on the drug. You had a background in AIDS organizations. Why would you stop wearing a condom?
Mark S. King: Why indeed?
It had been drilled into your head, you've taught other people, you were very well aware of it. Did the taking of the drug make you forget? What happened?
Mark S. King: It gave me permission to forget. I was the one that did the forgetting.
Why would you want to forget?
"We had great prevention messages in the 1980s -- they were called funerals."
-- Mark S. King
Mark S. King: Well, you know that's a really good question. I think it's [something that] not only applies to my psyche individually, but sociologically to what's going on with gay men. I believe at around 1996 when meth started creeping into my life, as I was saying earlier, we were all suffering from general safe prevention exhaustion. Barebacking started creeping into the picture, at least among those in committed relationships.
Like I said, I think initially it was due to my own issues, which had to do with, I don't know, exhaustion, loss, grief, resentment over having to stifle my sexuality in a way, and not seeing the results, not seeing what it was all good for anyway. Because, hey, here are protease inhibitors.
It's the same sort of message that people like Phil are having to combat today, which is show us the proof. Show us the proof that all of this having to use condoms and not being able to just get down and dirty when we're having sex means something anymore. We had great prevention messages in the 1980s -- they were called funerals. We don't have that as much today. There wasn't a lot of payoff for me to continue with the safer behavior.
Is it stupid? Of course it was. It was also happening during a time when I was allowing the prevalence of the crystal meth in my own personal life, which became a daily thing, to screw with my brain. As any good drug addict knows, the drug addiction becomes the dominant force in your thinking, in your manipulation, and in your rationalization of things. I was hanging around with people for whom condoms, you know, what the hell is that? We all figured each other was positive. If they weren't, welcome to the club. We were just a twisted little group of people, not so little of a group. They're out there on the merry-go-round right now as we speak. I think that it's a larger thing. I'm glad to hear earlier that we're talking about the gay community addressing this. I know that it may be true. I don't believe that we're addressing it nearly enough. The last time I relapsed with crystal meth and kind of revisited that whole scene, picking people up online and going to houses and letting one house party of crystal meth addicts lead to the next and lead to the next, I saw plenty of just personal destruction of lives going on. I don't think regular, respectable gay and lesbians are noticing or paying attention to or have any idea of the scope of it. Am I off base with that?
Phil Hendricks: I have a couple of things. I have some concerns about the generalization of your experience to every other gay man's experience.
Mark S. King: Well that's why I say it's mine. I think some of it may apply.
Phil Hendricks: I'm not saying that what you're saying isn't true for a lot of people. That community definitely exists. It is very large here in Los Angeles. There were just some terms that were making me uncomfortable, like the term "respectable" gay people. The clients that I work with are all very respectable people.
Mark S. King: I apologize.
Phil Hendricks: I think that the way people interact with methamphetamine isn't necessarily going to be to throw all limits out the window. While for a lot of people that does happen, what it's all about is: where is your limit to begin with? Are you going to stick to that? What are you going to do when you cross that line? If you cross that line, what steps are you going to take to make sure that you get back into a position where you are comfortable with what's going on in your life?
Mark S. King: How effective, if you don't mind me asking, have you found that to be? When you were talking earlier about chances are, and I've seen it to be true, that you're snorting it the first time I see you, the next time we hook up you're going to be smoking it, the next time we hook up you're going to be shooting it up. It's a slippery slope. How many people actually know when to back off?
"Among the people that come to our group -- again, a self-selecting group of people who are looking for help -- there's quite a bit of success with people being able to monitor how much meth they take, their progression, which modes they're willing to do."
-- Phil Hendricks
Phil Hendricks: Among the people that come to our group -- again, a self-selecting group of people who are looking for help -- there's quite a bit of success with people being able to monitor how much meth they take, their progression, which modes they're willing to do.
We've had numerous people quit meth on their own without going to different treatment facilities. We've had numerous people who have "backed down," so to say. They were a slammer and they've gone to just snorting. We have people who use a lot less frequently than they used to. We're having success with our programs. We're meeting people where they're at. We're letting them set what their goals are, and really working with them on what techniques they are willing to do to reduce harms associated with this drug. When the goal is set by the client, they have a lot more success than if we were to come in and say "You need to not use meth."
Can you tell me what sort of programs AIDS Project Los Angeles has?
Phil Hendricks: Specifically, the program that I coordinate has two sets of group level interventions that we work with. One is for gay and bisexual men who have used crystal in the past 90 days. It's a harm reduction program. It's over four nights, over four weeks.
Basically, they get crystal meth 101: the history of meth; why people use meth; the short-term effects; the long-term effects; how it affects the various body parts, whether that be the brain, the mouth, the lungs, the heart, the liver, the kidneys, the digestive system, sex drive.
We [look at the] intersection of crystal, HIV and STDs [sexually transmitted diseases]. Then we go into harm reduction tips, eating, drinking, sleeping and taking your HIV meds. That's one of the biggest reasons why people who are HIV positive progress so much faster, because of the non-adherence to the medications that they are on.
We review safer strategies for swallowing, smoking, snorting, injecting, hotrailing, booty bumping. Then we give them an overview of: if you're going to stop, here are some very typical things that most people experience in their first year of sobriety of methamphetamine. Here are some tips on how to combat these things like: boredom, teaching people how to schedule their time from morning to night, teaching people how to get involved in various group activities, how to find a support network in a society that isn't all about using drugs.
As an ex-crystal meth user myself, I've found that by far the majority of gay and bisexual men aren't using crystal. As a crystal user, I could find the crystal users really quite easily. As someone who is no longer using crystal, I run into crystal users in my work life. Generally, in my everyday life outside of my job, I'm not seeing a whole lot of gay and bisexual men that are using crystal.
"When you say, you know, upward ranges of 10 percent of gay men are using crystal, we also need to realize that 90 percent of gay and bisexual men are not. Instead of being a community that looks at ourselves from a deficit base, we really need to be a community that looks at our strengths."
-- Phil Hendricks
When you say, you know, upward ranges of 10 percent of gay men are using crystal, we also need to realize that 90 percent of gay and bisexual men are not. Instead of being a community that looks at ourselves from a deficit base, we really need to be a community that looks at our strengths.
The other set of workshops we do are for gay and bisexual men or other people who are involved in the lives of the crystal meth users. We teach how to build a supportive community that's there for the people who are using crystal.
Basically, when my crystal problem gets out of hand, all of my friends tell me to get lost, because I stood them up for dinner, I didn't return their phone calls, all that type of stuff. Then I go hang out with a subculture of gay and bisexual men who are all crystal users. That's when someone's risk starts skyrocketing like Mark's did. Does that make sense?
In this group, for the social affiliates, we teach them crystal 101, HIV and STDs. We teach them motivational interviewing. It's basically a non-confrontational way of moving people from the pre-contemplation like "crystal is fun" to contemplating that "hey, there's a downside to crystal," to helping people develop a plan on how to reduce or eliminate the risks associated with crystal meth use.
How long have these programs been in effect at APLA?
Phil Hendricks: A little bit over two years now. I guess we started in June of 2005. We've just started our third year.
Are there a lot of other programs in AIDS organizations across the country now similar to that? Would you know that?
Phil Hendricks: In Los Angeles, we were one of three that were funded by our local health department. That has now been expanded to five in the Los Angeles area specifically. I can't talk about necessarily across the country. There has been a lot of research money that has come in, so we have a lot of different crystal meth programs for specifically the gay and bisexual community. We have studies, research programs. We have treatment programs that are being evaluated -- so contingency management where people get paid an increasing amount of money for clean urine samples. We have a couple of programs here that are practicing that. One of them has just moved from a research point to a health department program. In Los Angeles, we have enough. The biggest problem that we're seeing here is if I have a client who is HIV negative that is looking for a treatment facility, there's often a one-month to six-month wait for someone to get a bed at a treatment facility if he/she is HIV negative.
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This article was provided by TheBody.com. It is a part of the publication This Month in HIV.
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