The Trouble With Tina: A Conversation About Meth

Joanna Eveland, M.D.
Joanna Eveland, M.D.

When I began my HIV practice in San Francisco five years ago, I quickly learned that methamphetamine was the drug of choice for many of my new patients and others in their community of urban gay and bi men. For many patients, meth use was a factor in their becoming HIV infected in the first place, and sometimes actually caused more health problems than HIV did.

As an HIV doctor, I care about this because methamphetamine is a really hard drug on the brain and the body. Chronic meth use can cause or worsen health problems such as dental disease, skin infections, and serious heart and lung problems. Especially concerning to me are the long-term neurologic and psychiatric side effects, which can persist even after stopping the drug. These can include symptoms of psychosis, including paranoia and hallucinations, anxiety and depression, as well as difficulty with attention and concentration. So, I invited Adam Carrico, Ph.D., a health researcher at the University of California, San Francisco, to share his expertise about meth use among gay men living with HIV.

I hear that meth is still a big part of the gay community in San Francisco -- that it's everywhere. In the mid-2000s, over 20% of gay men in San Francisco were using meth. Even though meth use has declined since then, it's still used as a party drug among gay men. What are the drugs that pose risks specifically for men living with HIV?

Three drugs that are really a concern for gay men who are living with HIV are meth, coke, and crack. While it's probably better from a health perspective to not use these drugs at all, we know that there are things that you can do to reduce the harms caused by them even if you're not going to fully abstain from using them.

For people with HIV, one danger of substance use is that it may interfere with medication adherence. We know from the SMART study that intermittent antiretroviral therapy (ART) is really harmful. Going on and off your meds causes inflammation and cardiovascular problems. For some people, meth benders can be quite intense -- lasting 24 to 36 hours on end. One goal for people using meth is to not let these binges interfere with medication-taking schedules. You might want to set alarms and plan out your party. How can you still be adherent even if you're getting high?

In our study of men who have sex with men who were living with HIV, we found that a big percentage -- 67% -- had undetectable viral loads when they were actively using meth. That was a little bit shocking, but exciting. People who use meth can do really well on HIV treatment.

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