This Month in HIV: Crystal Methamphetamine and HIV/AIDS

Luciano, is this common? Do you know about the treatment facilities for people using meth? Is it easy to find something in the United States?

Luciano Colonna: Regarding treatment?

Yes.

Luciano Colonna: This is a concern -- the adaptation of existing programs towards meth treatment. A lot of treatment was geared towards opiate use. There's been a lot of adaptation of existing opiate treatment toward methamphetamine treatment, and a lot of cocaine treatment towards opiate treatment. There's certainly a lot of stuff happening out in Los Angeles. There's Matrix System, which is getting a lot of notoriety because it's been adapted by NIDA [National Institute on Drug Abuse]. It's good.

Are these free treatments or do you have to pay for them?

Luciano Colonna: Well it depends where it's being offered. It depends on which state is offering it. The bottom line is there is a waiting list everywhere to get into treatment. There are just not enough treatment beds. Treatment's really hard to get. Treatment really isn't that good as well. We work very closely with treatment facilities in a few states and in the District of Columbia.

I think that treatment facilities do the best that they can. When it comes to county and state providers of treatment, they are overtaxed. Although I think that state providers would really like to see treatment facilities sort of, maybe start all over, that's just not going to happen. You know, sort of shut their doors for a year or two and rebuild themselves from the ground up. There's no way that's going to happen. That's certainly something I would like to see happen. Treatment's kind of a mess.

Is there a national number that someone can call if they want to get off meth? If they feel like getting some support on the telephone?

Phil Hendricks: Even in Los Angeles we don't have a 24-hour line.

Luciano Colonna: No, no. Things are pretty messy. I would recommend that anybody who wants help get in touch with their local syringe exchange program or find a harm reduction program. That would be the first thing I would recommend that they do. If they can't do that, then I would recommend that they call a treatment facility or their county division of substance abuse and take it from there. [For more information on syringe exchange programs, click here.]

Mark S. King: There's also a Crystal Meth Anonymous program --

Luciano Colonna: Of course, that's a great idea. Crystal Meth Anonymous groups are really good.

Mark S. King:. -- in most major cities. www.cma.org, which is basically the AA model, the Narcotics [Anonymous] model, 12-step model support. Sometimes I think that we get too much of a subset within a subset. There are CMA meetings specific to crystal meth, whereas you can probably find as much support in a Narcotics Anonymous meeting if there's not a CMA in your area. I have a great deal of admiration for those programs.

Phil Hendricks: It's actually crystalmeth.org, not cma.org.

Mark S. King: Oh, is it? I beg your pardon. Thank you. It's crystalmeth.org.

Mark, I neglected to ask you, how did you finally get off of meth? Did these programs help you?

Mark S. King: Through a series of relapses, and a series of continuing to kind of pervert my values at every turn. I have been clean now. It's been over 30 days; that's not long. I'm feeling strong. I feel good about myself. I think that each one of my relapses has -- I don't want to rate them or talk about their severity. I can say that I'm encouraged by what's happening. What's happening with my own resolve, and just what's going on in my head. I think that I'm able to piece it together little by little. Today I am clean and happy about it.

Where do you get most of your support now?

Mark S. King: I go to Crystal Meth Anonymous meetings, Narcotics Anonymous meetings, even Alcoholics Anonymous meetings, although I have to say I haven't had a drink in years. To me it's kind of the principles of those programs that I find a lot of strength in. I don't mean to promote them in any way; I'm simply answering the question.

Phil, are these the kind of programs you refer people to?

Phil Hendricks: Yes. Our basic philosophy is whatever works for you works for you. A lot of people are curious, they want to reduce the harms and they're not necessarily for inpatient treatment. One of the nights of our group really is specifically all about where else can you turn for more services. We refer to CMA. We refer to NA. We refer to various outpatient types of programs. We've got three really good ones here in Los Angeles. We also refer people to rational recovery or smart recovery, as I think it's re-branding itself now. We ask people a couple of different questions, what they're looking for, and we'll refer them to the service or agency out here that is going to work the best for them.

Image from "Methamphetamine Abuse and Addiction," a research report from the U.S. National Institute on Drug Abuse. To view PDF of publication, click here. Click on image to enlarge.

Has anyone discovered if substitution therapy is good for people using meth?

Luciano Colonna: There's a lot of research going on in that area. Nothing has been approved, but there's a lot of research going on. NIDA is doing work in that area. There's a man named John Grabowski who's doing a lot of research in that area. If you do some research yourself on the Internet, you can find out what's going on.

I understand that even low-dose methamphetamine is being used sometimes.

Luciano Colonna: Well, amphetamines are being used.

Phil Hendricks: Then we have other people out here who are doing studies to promote their concoction for treatment; it's not substitution therapy, but it's another medical procedure. Of my clients who've gone through it, it's a mixed bag. Some have had success, some have not had success with it. There are all kinds of different medical interventions that are occurring.

Mark S. King: Is that the pharmaceutical drug they're giving people in rehab?

Phil Hendricks: There's that study. There's a pharmaceutical company that's doing inpatient medical intravenous-like drugs. It's quite expensive though. There are several different medical interventions that are at least in the research portion of the projects.

Phil, I don't know if you would know the answer to this, but I understand that there were some case studies of interactions between HIV medications and crystal meth. Is that something that you teach about?

Phil Hendricks: There have been studies that have shown that methamphetamine does increase HIV replication. There are not enough studies on that. There hasn't been, what's the word, well enough proven. The bigger case we point out to the clients we're working with is that if you are staying up for days and days on end and you're not eating, you're wearing your immune system down. Also, people who are on crystal runs tend to neglect taking their medicines. That's poor adherence; a surefire indicator of disease replication. We try to work with people on how to minimize those impacts: how to take your medicines when you're on a run, how to make sure that you get the nutrition that you need, how to stay hydrated.

Isn't the other problem that other sexually transmitted diseases are transmitted to people with HIV and they're harder to treat because of this?

Phil Hendricks: Yes. From our point of view, HIV and STD infections among people who use crystal meth are three- or four-fold that of the regular population. It's really about getting diagnosed, getting treated and then waiting until the infection has subsided. As far as difficulty treating the specific STD, unless you're talking about MRSA [methicillin-resistant Staphylococcus aureus], where I know there's been quite a bit of difficulty, we haven't seen a lot of people who've had difficulty treating gonorrhea or chlamydia.

Has the growing rates of syphilis in different communities in the United States been linked to methamphetamine? Does anyone know? Luciano?

Luciano Colonna: I don't know. There's so much hyperbole around MSM, the MSM community and methamphetamine use that I wouldn't be surprised if I've come across an article or two. I wouldn't necessarily link it to methamphetamine. I might link it to messing around on methamphetamine.

There was another interesting study at the International AIDS Society conference in Australia. They were finding pockets of the sexual transmission of hepatitis C among HIV-infected people. They did not mention crystal meth but one could guess that might be another piece of the puzzle, because they haven't seen this before. They're seeing this and they're saying, "there's a change in behavior somehow that we're seeing HCV transmission."

Mark S. King: I was treated for hepatitis C three years ago for, what was it, 10 or 12 months with the interferon from contracting it by sharing needles. I would imagine that it must be a big problem, a growing one. I know that there are people who shoot up crystal meth who never would have before considered sticking a needle in their arm.

Phil Hendricks: You're purely talking about the sexual link?

That's right. They weren't using intravenous drugs. In this one study, it was a group of men in Amsterdam, Paris, and another place where they found transmission of hepatitis C. It was only done sexually. These men have never used intravenous drugs.

Phil Hendricks: Logically, it just follows that if there are members of this community that are pushing their limits and getting into much more extreme sexual acts, that's definitely going to raise the potential for hepatitis C transmission through sexual contact. I can speak frankly here correct? For people going from anal sex sexual encounters to more exotic sexual behaviors, like fisting or having sex for hours on end, that's going to obviously result in lesions or wounds where hepatitis C infection could occur.

A poster from the "Crystal Clear" media campaign of the STOP AIDS Project. The campaign focuses on crystal meth abuse in San Francisco's gay community.

Luciano Colonna: One of the things that I'm very concerned about around methamphetamine and the gay community is, I've used the word hyperbole. Back in the 60s the term "speed freak" was used. I think that the concept now is the gay man on methamphetamine is becoming the new "speed freak." The media is turning the gay man into this monster "speed freak," and that really concerns me.

Phil Hendricks: I couldn't agree more. As a gay man, I feel that methamphetamine is another thing that's being thrown on to demonize the population. We as people who are working in the field need to work and be very aware of new studies, the things that we put out, the articles that we read, and how we present this problem. At the same time it is very important that we address this within our community as it's reeking havoc amongst some of our members. With HIV rates increasing, and with more and more research pointing at crystal as being one of the larger cofactors of HIV infection, we need to be very thoughtful and very deliberate in the way that we address stuff. Instead of piling more demonization onto our population, our community, we need to try to work from within our communities to come up with a solution to this.

Mark, were you going to comment?

Mark S. King: I was just saying that at the same time we don't want to make the same mistake we made in the early 80s. Which was that we were so protective of our image that we allowed bathhouses to stay open maybe longer than they should have. I see it as a public health issue. There are going to be people who demonize us no matter what. If they can't find crystal meth, they'll find something else. I appreciate our wanting to be sensitive about it, but I don't believe that we are doing enough as a community to address it. Maybe some of that hesitation has to do with not wanting to be demonized or look bad. The fact is we do look bad. There are many gay men who are hooked on crystal meth. We are gay tweakers. That is what many of us have become. Not the 90 percent, that's for certain. I'm not interested in a public relations campaign, I'm interested in addressing a problem that's real, and telling the truth about it.

OK. Well I'm afraid we've run out of time. Thanks very much Phil, Mark and Luciano for a fascinating conversation. Hopefully, by talking about this and telling people about the resources out there, we can fight this destructive epidemic.

Click here to e-mail Mark S. King.

Click here to e-mail Phil Hendricks.

Click here to e-mail Luciano Colonna.