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This Month in HIV: Crystal Methamphetamine and HIV/AIDS

August 2007

Luciano Colonna Executive Director of the Harm Reduction Project
Phil Hendricks Coordinator of the Crystal Meth Program at AIDS Project Los Angeles
Mark S. King HIV-Positive Writer and AIDS Activist, and Recovering Meth Addict Since 2003

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.

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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?

Image from 'Methamphetamine Abuse and Addiction,' a research report from the U.S. National Institute on Drug Abuse.
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.
Mark S. King: This was 1995. The mid-90s, 1995, 1996. Protease inhibitors were coming along in 1996 or so. We all felt as if we were getting a second wind, that we were -- maybe I wasn't going to die soon after all. I don't know ... Again, I don't want it to sound like a rationalization, but the emotional sigh of relief that I was feeling in the mid- to late-1990s allowed my underlying drug addiction tendencies to start searching out for some sort of escape. I found that on the dance floor and I found that by becoming more sexually active.

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]?

A version of this advertisement first appeared on phone booths in the Chelsea neighborhood of New York City in January, 2004. They were designed by local AIDS activists in response to meth's impact on the spread of HIV among gay and bisexual men.
A version of this advertisement first appeared on phone booths in the Chelsea neighborhood of New York City in January, 2004. They were designed by local AIDS activists in response to meth's impact on the spread of HIV among gay and bisexual men.
Phil Hendricks: It's definitely one of the sub-categories of crystal users. The mainstream gay population that picks up crystal on the dance floors and bathhouses and sex clubs, they are definitely the highest risk population that we are trying to reach.

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.

Can you tell me how you got involved with co-sponsoring the first conference on methamphetamine, and what you expected from having this conference?

Luciano Colonna: Well, what happened is the Harm Reduction Project has offices in Salt Lake City, Denver and Washington, D.C., and we provide a lot of direct services to marginalized populations. We've always provided services to the MSM community, as we provide a lot of services for individuals who are high risk for HIV. What we saw was that there were a lot of people abusing methamphetamine. At the time we saw a lot of people smoking it, and it made sense to us that they were going to start to inject it. We assumed that we were going to see a lot of people switch from smoking to injecting. That's clearly the case now. We are seeing more and more people injecting, not just in the United States, but globally.

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So we decided that it would be a good idea to put on a national conference, and we put out some feelers to some of our sister organizations. Needless to say, the response that we received was great. We immediately got a lot of national organizations to sign on, including the national Harm Reduction Coalition and amfAR. People just really wanted to speak.

And what was their interest? What did they think could be accomplished by having this conference? And has anything been accomplished?

Luciano Colonna: First of all, one of the things everyone wanted to accomplish was to not let the issue of methamphetamine be taken into the hands of "the feds," [laughs] the federal government and become another tool of the war on drugs. We wanted it to be handled with the tools of harm reduction. We could maybe reach out to drug users, reach out to the MSM community.

For example, one of the first things that happened, was we tried to reach out to a lot of groups. We tried to involve the drug-using community, the MSM community. We received a lot of grants from a lot of different partners, including the U.S. Department of Health and Human Services. They gave us money to bring in minority social workers from all over the country to attend the conference, but a representative from Indiana named Mark Souder found out that we had gay-MSM-driven plenaries and break-out sessions about gay men's health and he didn't like that. So he made a big stink in the House of Representatives and tried to get our funding cut. That eventually went to the Senate. The secretary of housing and human services got involved and it ended up in the White House. My organization, the Harm Reduction Project -- I'm their executive director -- we had a bunch of our funding pulled. A bill was introduced. They tried to cut -- it was ridiculous. [Click here to read an article about the conference and the ensuing controversy that Colonna, together with Allan Clear, wrote about in 2005.]

This was all about the conference?

Luciano Colonna: Yes, it was all about the conference. It was all about remarks I made. It was all about us having gay speakers at the conference. We live in a really sick society. They prohibited speakers from the CDC [U.S. Centers for Disease Control and Prevention] from speaking at our conference, although some of them came on their own time.

'Hurricane Tina' is a booklet containing a collection of interviews with 20 gay and bisexual men of color whose lives have been impacted by crystal meth. The booklet explores the reasons people use meth, addressing the impact loneliness, disconnection, poverty, homophobia and racism have on sexual decision-making. Click here to read the booklet online or download the PDF.
"Hurricane Tina" is a booklet containing a collection of interviews with 20 gay and bisexual men of color whose lives have been impacted by crystal meth. The booklet explores the reasons people use meth, addressing the impact loneliness, disconnection, poverty, homophobia and racism have on sexual decision-making. Click here to read the booklet online or download the PDF.
Click on image to enlarge.
In any case, you had the conference in the end.

Luciano Colonna: We had the conference, just so you know, anyway. We actually had two conferences. We had the second national conference. We did this because we wanted to get this information out there, and we wanted to make sure that the information wasn't going to be driven just by the federal government.

What was so amazing to me when I looked over the conference program was that it was just so detailed. It described meth's effect on pregnant women, meth's effect on Native Americans. It was very comprehensive in terms of the number of people it affects and it just seemed to be endless.

Luciano Colonna: Yes. And we also invited law enforcement. We invited health departments, and we did that at the second one as well because we wanted to get as much information as possible out there. It looks like we are going to have a third one in the United States, and we've been invited to have an international one as well because this is a really big problem in Asia and Africa. It's a big problem everywhere.

As Phil said, people use this drug to work long hours. Truck drivers have used this drug -- amphetamines are not a new problem. People have been using this drug for a very, very long time. We used to give this drug to servicemen to fly long missions.

Meaning the government or the military?

Luciano Colonna: Yes, there was just a Freedom of Information Act file [opened]. We are still giving this drug to our pilots who fly missions to Afghanistan, because we don't have bases close enough.

How is crystal meth then different from amphetamine?

Luciano Colonna: Well, crystal meth is a derivative of amphetamine. You fool around with some molecules and you get a stronger drug. It's a drug that's now injected or smoked. Amphetamines are still prescribed. It's a generic version of a drug that's given to kids now called Adderall. We give Adderall, which is amphetamine or dextroamphetamine, to kids with Attention Deficit Disorder.

Who makes crystal meth?

Luciano Colonna: Crystal meth is made in laboratories by people who are called cooks. [Laughs.] Some people call them chemists.

In the United States or in Mexico?

Luciano Colonna: It's still made in the United States, but a lot of it's been pushed to Mexico, since the ban on ingredients from cold medicines.

Image from 'Methamphetamine Abuse and Addiction,' a research report from the U.S. National Institute on Drug Abuse.
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.
How cheap or expensive is it?

Luciano Colonna: To make it?

Or to buy it.

Luciano Colonna: To buy methamphetamine, it's very cheap to buy the drug.

How cheap is cheap?

Luciano Colonna: Well, to get you high?

Yes, how much would I have to spend to get high for one day?

Luciano Colonna: I think it's 5, 10 bucks.

Mark, do you remember?

Mark S. King: Oh, much more than that! [Laughs.]

Luciano Colonna: Oh, to get high for a whole day? I don't know. Mark, how high do you have to be for a whole day?

Mark S. King: Generally speaking the price on the street is about $50 for a quarter gram.

Luciano Colonna: OK, $50.

Phil Hendricks: Really?

Mark S. King: That is something I would inject all at once. That was one injection when I was doing that.

And how long?

Mark S. King: Over the course of a weekend, I would inject four, five, six times.

So you need a lot of money.

A poster from the 'End Meth' media campaign of Partnership for a Drug-Free America. The image depicts 'meth mouth,' a phenomenon that occurs in some long-term meth users.
A poster from the "End Meth" media campaign of Partnership for a Drug-Free America. The image depicts "meth mouth," a phenomenon that occurs in some long-term meth users. Click on image to enlarge.
Mark S. King: It would be a few hundred dollars. Of course, it's like any other drug: You buy more, it costs less. There's always the package deal.

Luciano Colonna: You're getting pretty high though, aren't you?

Mark S. King: Well, remember that this was over the course of years, so I was building up resistance over several years. This was a drug that I began snorting a line of and being perfectly content with that and dancing all night.

It was funny hearing you talking about people using it for other purposes, to work or to clean or to be creative. I remember that. I remember that back in the early days of my addiction. I hear stories about that from hundreds of addicts who are trying to recover, having the early days when the drug actually did work, when it accomplished what you were hoping for, either great sex or productive work or what have you. And there are those among us who are not satisfied and are addictive by nature. It's a slippery slope. The days of using it to just work longer passed me by a long, long time ago. It became strictly a drug to use because I wanted to get high and exercise that high in ways that had nothing to do with work. But that's the trip that I took, and that people who turned out to be heavily addicted took.

"There is a study from the Los Angeles Gay and Lesbian Center that just came out showing that 25 percent of their new HIV infections were amongst people who had used meth in the last 12 months."

-- Phil Hendricks

I just wanted to say something else about what Luciano was mentioning about alcohol. That's certainly true -- I can imagine that alcohol use has got to be more prevalent with accessibility alone. What's been interesting to me to observe has been the number of people who are crystal meth addicts who don't fit the profile of people who may have otherwise been alcoholics, for instance, or that alcohol led them to crystal meth somehow. The drugs seem to have an allure that is marketed differently, a different attraction.

I've been in many meetings and support groups for people who are alcoholics and/or people who are on crystal meth, and the profile of those two people seems very different to me. That's just my observation. Crystal meth is certainly attractive among gay men. That's only my experience. As they have mentioned, around the country, and around the world, there are many, many types of people using it. But certainly among gay men and those most at risk for HIV infection, it seems to be very attractive to those who just happen to be at highest risk for HIV because they are sexually active and they are using the drug for that purpose.

Phil Hendricks: So, just to clarify my point: When it comes to abuse, alcohol is by far the most abused drug. The reason why APLA is involved as an HIV organization is just due to the high sexual risks that meth users tend to engage in. The number of partners goes up, the sexual activities they tend to engage in tend to be more high risk than that of the general population. You can't tie the connection between meth and HIV much more strongly here in Los Angeles than any other co-factor that may be involved. There is a study from the Los Angeles Gay and Lesbian Center that just came out showing that 25 percent of their new HIV infections were amongst people who had used meth in the last 12 months. [Click here to read more about the study on meth use and HIV transmission.] When you take that and you minimize it by what percentage of the gay community that is actually using meth, it just shows that there is a huge correlation between meth use and HIV infection.

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.

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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.

Image from 'Methamphetamine Abuse and Addiction,' a research report from the U.S. National Institute on Drug Abuse.
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.
Mark S. King: I hear what you're saying about who they were to begin with, but I'll tell you, I've regularly run across guys who are otherwise not big risk takers who had good jobs and all of that, but stumbled across meth once upon a time. Now they want to be weekend warriors, away from their lover, who thought they were in a committed relationship, away from their responsible jobs. They were in bathhouses collecting as much semen as they could possibly get. It was directly related to the crystal meth. It was: "Get me high and get me fucked."

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 passť. 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.

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.

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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.

"I would recommend that anybody who wants help get in touch with their local syringe exchange program or find a harm reduction program."

-- Luciano Colonna

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.
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.
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.

Resources

To browse through The Body's collection of articles about crystal methamphetamine, click here.

To read more about substance use and HIV, click here.

Click here to find substance abuse treatment in the U.S.

Crystal Meth Anonymous
A worldwide free program by and for crystal meth addicts seeking recovery.

Crystal Methamphetamine Program of AIDS Project Los Angeles (APLA)
APLA's crystal methamphetamine program aims to reduce the risk of HIV infection and the social isolation caused by meth use through community forums and workshops. For more information or to sign up for workshops, call Phil Hendricks at 213-201-1308 or e-mail phendricks@apla.org.

www.crystalneon.org
This user-friendly, sex-positive site focuses on harm reduction for gay and bisexual men, and includes a section for HIVers; offers an information library, the "Ask Dr. Dick" forum and real stories by crystal meth users.

The Harm Reduction Project
Offers a variety of services in Salt Lake City and Denver, including peer education, drop-in centers and harm reduction training. Offers an online library of addiction news and information.

Meth Stories: Affecting Your Community
This site focuses on the effects of meth use and how to quit; includes personal stories of people affected by meth addiction.

Narcotics Anonymous (NA)
Information on NA offices throughout the world.

Nar-Anon Groups
An international group for relatives and friends who are concerned about the addiction or drug problem of another. Meetings are free.

Tweakends
On this interactive Web site for gay men, a crystal ball answers your meth questions; the site lists tips for staying safe while using, resources for quitting and information for people who are HIV positive.

www.tweaker.org
A down-to-earth, sometimes wacky, sometimes serious site for gay men who use crystal; provides information, resources and support.

This is not a comprehensive listing. Click here for more general resources on addiction and recovery.

Recent Research

Crystal Meth Use High (6%) Among Gay Men in the North Carolina: High Rates of HIV, Anal Sex Without Condom Use, STDs, Sex With Females, Viagra Use
From natap.org (August 2007)

Gay Men Who Use Methamphetamine Have Greater Risk of HIV Seroconversion
From aidsmap.com (May 29, 2007)

Methamphetamine Use Causes Stroke
From aidsmap.com (January 2, 2007)

Recent Infections With HIV in Gay Men: Study Finds Meth and Erectile Dysfunction Drugs Play a Part
From aidsmap.com (November 17, 2006)

Methamphetamine Used by 10% of Gay Men in London, Higher Level of Use Seen in HIV-Positive
From aidsmap.com (July 11, 2006)

Harm Reduction

Taking Care of Your Veins

Avoiding Arteries and Nerves When You Want a Vein

Good Needle Insertion

Think Sink! (Injection Hygiene)

Levels of Risk (Finding the Right Place to Inject)

For more safer injection techniques, click here.




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