Cycles of Stigma and Shame: Gay Men, HIV and Meth Use

David Fawcett, Ph.D., L.C.S.W.
David Fawcett, Ph.D., L.C.S.W.

David Fawcett, Ph.D., L.C.S.W., is the author of Lust, Men and Meth: A Gay Man's Guide to Sex and Recovery. He is also a person with HIV, therapist and clinical hypnotherapist in private practice in Ft. Lauderdale, Florida, who serves as the mental health and HIV expert for's "Ask the Experts" forum.


As a longtime fan of Fawcett's articles about HIV and stigma, I was eager to discuss what he's seen and learned about issues of stigma surrounding gay men and methamphetamine use.


In Part 1 of the interview, we began our discussion of how anti-gay and other stigma can trigger meth use, even as use of the drug can add another layer of stigma.


(In part two of the interview, we explore how stigma affects the relationships of people who use meth, gay community stigma about meth use and ideas for non-stigmatizing support for people dealing with meth addiction.)


How would you describe the realities and the impact of stigma when it comes to meth use?

Stigma is really woven throughout addiction and meth use, especially for the LGBTQ community. A lot of gay men have multiple layers of stigmatized identities -- just being gay, being addicts, sometimes being sex workers, sometimes having a mental health diagnosis, sometimes being on disability -- and all these compounded things have a cumulative effect of emotional pain that people respond to by numbing.

Any addiction accomplishes that numbing. But methamphetamine particularly, because of its sheer potency, is more effective -- I think probably the most effective -- of anything we've ever seen for that. For that reason, I think those stigmatized identities really can lead people into a desire to just escape.

Stigma goes in other directions as well. Because a minority of men in the gay community use methamphetamine and [the others] see the destruction that it creates, the [broader community] stigmatizes users. So within the community it's polarized. They think, "How could anybody do that to themselves? How could they do that to their friends?" I've had meth users kind of laughingly say these are guys who are consuming quantities of alcohol every day.... But within the realm of gay addictions, meth by itself is stigmatized.

The prevention messages for a long time contributed to that stigma. We know these don't work anymore, but I'm talking maybe 10 years ago when the first wave of publicity came out. The prevention messages were all fear based about what meth could do to you. They would take pictures of skulls and all the terrible things that meth did.

All of those are factually correct but it didn't do anything to help people get off methamphetamine. The users continued to use; they just felt worse about it and went further underground. So I think stigma, again, contributed. Even with people trying to be helpful at getting prevention messages out, stigma was a problem. So it really divided the community.

Something else I've discovered since I've been promoting the book is that we, as a community, are really resistant to talking about meth. It's interesting because in the U.K. where there's an equally devastating problem in the gay community, it's front-page discussion -- in The Independent and The Guardian, and on television shows and stage plays -- all kinds of conversations. It's very difficult to generate that in the United States. I don't know if it's because the gay community is just resistant to yet another stigmatized behavior that we have to talk about or address, or if it's our kind of prudishness to not talk about sex in a healthy way, in general, in our culture. But it's really interesting. There's something special about the stigma of meth in the United States that even compounds all that.

I think stigma really is tangled up in every dimension of methamphetamine use among gay men.

Indeed. It's sort of a cause and effect, and a surrounding condition that's so deeply interwoven. When you're working with men who are seeking to change or overcome their meth use, how do you help them deal with the multiple stigmas in their life that led to a desire to numb, which are then compounded by dealing with the stigmatization of their use of meth? How do you help build people's resilience to dealing with the specifics of the stigma of gay men and meth use, as users?

Right. It's a step-by-step process, for sure. First of all, by the time people come to me, they've already started to address that themselves. Meth use, like all addiction, really, is very isolating. And it's destructive to social relationships. So people end up having [connections with] only basically other meth users.

I've had clients -- when I ask who their support system is they will name only other drug users. Those are the only people left in their lives. So to burst out of that is overcoming stigma to some extent already. But by the time they reach me, I try to link them up with a safe environment. That would be Crystal Meth Anonymous or other 12-step programs or specific therapy groups that I've vetted where they can find a safe container in which they can explore these issues.

That's just the beginning because meth is such an effective numbing agent. Once they start to experience life without the comfort of the drug as a barrier between them and their harsh, raw emotions, that's when all kinds of skills and tools need to be instilled.

There's a process -- clinically, we call it titration -- of gradually exposing people to these things in a way that they can handle without having their resources and their skills be overloaded. With methamphetamine, particularly, the most devastating link is this fusion between meth and sexual behavior where, for neurochemical reasons, meth bonds with sexual desire. When you take away methamphetamine, many people lose all sexual desire as well.

Eventually that does heal. It comes back. But what happens is that they have to confront being sexual without the benefit of any kind of alcohol or drugs to numb the feelings and reduce their inhibitions. I've had many men describe this as a second coming out -- it's that dramatic, in terms of claiming who they are, in terms of their sexuality and their intimacy, and even their social relationships -- without the benefit of that cushion of drug use.

It's a gradual process. There's no one right or wrong way. I think it's individual. But the overall theme would be to create a safety zone for people as they build their strength to deal with these other things.

Because for some of these multiple stigmatized identities -- such as just even being gay sometimes -- there are other resources that can help with that, other kinds of social supports. If they have a diagnosis of depression, or if they're a sex worker, or if they're on disability, I try to link them up with other resources because (and I hate to say this as a therapist, but...) I think the most healing modality is really a group context in combination with individual psychotherapy. But I think it's that group element, where people can really start to reestablish relationships that are healthy and practice them, and be safe and learn and get back on their feet. It's kind of a crawl, then stumbling in the process, like learning to walk.

As a long-time expert here at, you've been a true resource, modeling how to speak out against stigma, and how to treat people with respect and give them the information they need. We also want people to know that they could contact you here.


This transcript has been slightly edited for grammar and clarity.

JD Davids is the managing editor for and