After Meth, I'm Still the Boss

One of the things I've been doing a lot of recently is reading emails from supporters around the world. I've heard tragic stories of loss and love, courageous stories of survival and encouraging stories of hope and happiness. While I've heard from all types of people, the majority are from men and women living with HIV. We are a community who've been through something life altering and that brings you closer together even from thousands of miles apart.

But there's an undercurrent in so many of the messages: meth. I was expecting to hear from a lot of people who have come through meth or are still grappling with meth. What I wasn't expecting is just how many have meth and HIV in the same sentence.

My encounters with meth started in late 2002, at the beginning of the "meth epidemic" that swept through major cities around the country. And my meth use mirrored the timeline of the epidemic, with the largest number of people using meth being recorded in 2004-2005. In a 2004 CDC study, the rate of use among gay men in San Francisco, Los Angeles and New York City was 22%, 16% and 14% respectively. That's an astounding number: nearly a quarter of all gay men in San Francisco in 2004 were using meth. In 2005, the Center for HIV/AIDS Education Studies and Training (CHEST) did a study of men in New York City. Their findings indicated that MSM (men who have sex with men) who used methamphetamine were THREE times more likely to contract HIV through receptive anal intercourse than MSM who did not use the drug. (Letendre)

Now you might think "Oh it's 2015, surely we've gotten away from meth, I've only ever heard of it from watching Breaking Bad." And though the numbers have decreased since 2004 -- 13%, 13% and 6% in 2011 according to the CDC study I mentioned above -- I would venture to say that the rate of infection amongst those who use meth is the same today as it was then. In a Seattle study by the National AIDS Treatment Advocacy Project released in 2013, meth-using MSM were 5.2 times more likely to be diagnosed with HIV than MSM who did not use the drug. In other words, MSM who used meth accounted for up to 20% of all new infections during that study.

Since I've been through meth firsthand, these numbers are not surprising to me. I had only done meth maybe three times before I became positive. I could go on any hookup site or app right now and point out the guys using meth -- every five or six profiles is probably going to have a reference (sometimes obscure) to that person's meth use, you just have to know what to look for. Never mind the fact that there are hookup sites built just for guys looking for other guys who PNP (party and play).

I could go on about meth and I will discuss in another article soon, but my goal here is to talk about why guys seem to be contracting HIV more often while on meth. Let's talk about some of the factors involved:

  1. The drug lowers sexual inhibitions, impairs judgment and provides the necessary energy and confidence to engage in sexual activity for longer periods of time. (Yeon) For a lot of guys I've spoken to, when you're high you are up for anything and all of the rules and regulations you had during sober sex go right out the window; there are many ways in which this can lead to contracting HIV.
  2. Since you have all this energy and drive you to have sex off and on for a long time, for me it was usually three to four hours. I don't know about you, but too much fun tends to lead to raw and sore body parts -- these raw body parts could create an open wound situation.
  3. Meth is a well-documented cause of erectile dysfunction. (Yeon) So the guy who can't get an erection might choose to be the bottom instead, and bottoming carries a higher risk of infection than topping.
  4. Meth causes "mucosal dryness" -- imagine the worst cotton mouth you can and times it by five in your mouth and anal area. This dryness can cause tissue tears, and everyone knows that a tear is a gateway to infection.
  5. When I was on meth and especially when I was coming down from meth, I always felt less inclined to take good care of myself, including forgetting to take my medication or skipping a doctor's appointment. This could lead to having sores in the mouth that haven't been checked, or ulcers or hernias in the rear that could present a problem, amongst a host of other problems.

But, for me, the real concern is medication adherence. Luckily I never developed a resistance to any ARVs I was on, but it's so easy to create a resistant strain of the virus by not taking your medication every day. So a guy who's not taking care of himself could be putting his partners at risk because his viral load is not suppressed even though he might think it is.

Okay, enough facts and statistics. The point? There are still 13% (or more) guys in the gay community using crystal meth. I am going to say that every gay person in this country knows someone who has done meth or is doing meth ... you probably don't know it, but you know someone. And if those guys doing meth are still three times more likely to contract HIV than men not using, we've got a big problem.

There is absolutely no better way to talk about what we need to do now, as a community, than to quote the men who bravely took steps to address the meth problem in New York City in 2005 -- Peter Staley and others from the Crystal Meth Working Group bought a full-page ad in the New York Times. It's 2016, but their messages are, unfortunately, as relevant today as they were then:

So, here's what we're going to do.

We will take responsibility for our lives and the health of our community. We will make informed choices about sex and partying, and urge our friends and lovers to do the same.

We will not be silent. We will talk to other gay men about the dangers of crystal meth. We will create real prevention campaigns so that every gay man knows the real risks of meth use.

We will show compassion for those who are addicted. Meth is the problem, not those in its grasp. Addicts need treatment, not stigma. And if they're in denial, they need to be challenged by those who love them.

We will fight for more money for drug treatment. We will advocate for treatment programs tailored to the needs of gay men.

And finally, we won't let crystal meth destroy another generation of gay men. We will continue fighting the hatred that seeks to diminish our self-worth, our sexuality, and our relationships. We will continue to create and strengthen our political groups, our churches, our sports teams, our social clubs, and our families. We will lead by example as we have done before.

This article was reprinted with permission from Central Voice.