Los Angeles isn’t the only meth hotspot in the U.S. In South Texas, advocates are expressing alarm at how a rising rate of meth use is causing a spike in HIV rates, despite—or possibly because of—the COVID-19 crisis.
Like a recent online roundtable in Los Angeles, an upcoming webinar hosted by Poderosos will address the rise in meth use among men who have sex with men (MSMs)—this one focusing on Latinx people. Oscar Lopez, CEO of the Texas-based Poderosos, will be leading the discussion, and he told TheBody that the problem is growing because the COVID-19 crisis is accelerating the use of meth and hooking up while high.
“Folks may be sheltering in the daytime—but at night, people are lonely, losing their jobs and housing, and hooking up with strangers online,” Lopez said. And very often, they’re using meth when they hook up, which can put their health and lives at risk in several ways.
Federal Intervention Needed on a Human Scale
Poderosos is based in the Harlingen-McAllen region of South Texas, and the webinar will emphasize the unique challenges of Latinx MSMs in that region but will also apply to MSMs anywhere in the U.S., according to Rick Prieto, harm reduction manager at Poderosos. He says that part of the discussion will be about soliciting solutions.
“We need LGBT- and meth-specific interventions, and those with cultural competencies with this population. It’s important to identify behavioral and mental health institutions for training at the federal and state level.”
Prieto said that any response to meth needs to be comprehensive and take intersectionality into account. He believes federal dollars should fund evidence-based interaction, possibly incentivized programs like “pee clean” efforts that pay people for stimulant-free urine. And pre-exposure prophylaxis (PrEP) should be part of the solution, too—that’s especially important in South Texas.
“Here, it’s not like being in LA,” Prieto said. “There are only two clinics here that provide PrEP. Many medical providers don’t want to prescribe it. Or [doctors] don’t know what to do; they don’t provide lab work. So you have a lot of men just lying and telling their partners they are on PrEP.”
More innovative intervention solutions, he said, could even include partnership with hookup apps. “I’ve heard that even straight people are downloading [gay] hookup apps just to score drugs.”
Triple Jeopardy for Gay and Bisexual Men Who Use Meth
The rise in meth use has serious consequences for MSMs, beyond the dangers of long-term stimulant abuse. Centers for Disease Control and Prevention (CDC) figures show Latinx people represent approximately 17% of the U.S. population but 21% of people living with HIV/AIDS and 26% of all new HIV diagnoses.
There is a solid body of evidence that meth use increases the risk of contracting HIV among MSMs. A recent report from researchers at the University of Texas, El Paso, found that participants—MSMs living in the border town Ciudad Juarez, Mexico, who used meth—had more sex partners, were more likely to have unprotected receptive anal intercourse, and were more likely to get HIV.
Oralia Loza, Ph.D., and her colleagues found that the men who shared that they had sex with men had, compared to the men who did not have sex with men:
- More sex partners in the past year (seven versus three).
- Higher rates of engaging in sex work in the past year (52.6% versus 6.8%).
- Higher rates of HIV positivity (10.5% versus 1.4%).
The study did not determine why the men using meth had these results. But, in an email, Loza said, “Based on the work of other investigators, factors that place Latino MSM at risk for drug use may be based on internalized homophobia, stigma, and not being open about their sexual identity.”
Not surprisingly, there is no social distancing during hookups, meth or no meth. That’s an additional problem due to the wildly spreading novel coronavirus infections in Texas. If a man contracts COVID-19 from a partner but avoids getting sick, he could still pass it on to friends or family members in a multigenerational household.
“I counted 43 of my Facebook friends who have lost a sibling,” Lopez said.
A recent article suggests that meth use and HIV could be risk factors in contracting COVID-19, and also in the severity of symptoms. And in a 2019 national survey of service providers who were asked which types of substance use had the biggest negative impact on people who were not virally suppressed, meth use came in second only to alcohol use disorder (though providers in Texas and California ranked meth above alcohol).
What does this say about intervention? Prieto said that it needs to be evidence-based, stigma-free, and tailored to the local population, like the most successful programs in San Francisco.
Evidence-Based Intervention, From San Francisco to Texas and Beyond
But even efforts in San Francisco are somewhat hampered by a national health care system that prioritizes abstinence, according to Mike Discepola, vice president of behavioral and substance use health at San Francisco AIDS Foundation.
“Even in San Francisco, where the Department of Health has a philosophy of harm reduction, most treatment programs are full abstinence. It’s because the health care system in the U.S. is all or nothing. We as providers have to get out of our way. Are we there to help, or take the moral high ground?”
As an example of this all-or-nothing attitude, Discepola said it’s hard to find treatment programs that consider how people are using drugs while having sex, or that talk about sex and intimacy at all.
“We have to be willing as a society to accept people who want to abstain from some drugs, at some times. We should be asking questions like, ‘If you want to inject meth and have wild sex, do you know whether it’s a clean needle? Do you know how much, and how long you are using? Do you know the HIV status of the others?’ People can create harm reduction plans on how much drug they want to use. If that doesn’t work, we can try something else. When we have that conversation, people’s options are broader.”
Discepola agrees with Prieto that contingency management programs like “pee clean” could work across the country if the federal government puts money toward it. A contingency management program could be incentivized in California if Senate Bill 888 is passed. SB 888, introduced by state Sen. Scott Wiener (D-San Francisco) earlier this year, is a response, he said, to the increasing number of meth overdose deaths and the dearth of medical treatment for meth addiction.
“SB 888 legalizes Medi-Cal coverage for ‘contingency management’—$ incentives to stay in meth recovery,” Wiener tweeted when the bill was introduced in February. “It’s a proven method to help people get & stay sober.”
Other innovative and stigma-free sources of support for meth users can be found through the site Tweaker, Smart Recovery, and Harm Reduction Works.
The Poderosos webinar is Wednesday, Aug. 12. Visit this link to register.