Crystal Meth, HIV and the Gay Community
An Epidemic Within an Epidemic
Tom, a 24 year-old white gay man from the south, recently came out to his family after relocating to New York to attend graduate school. Although he was excited about this step forward in terms of his academic and personal life, he soon found himself isolated and lonely, growing disappointed with the gay community. Added to this was the realization that his parents were having difficulty dealing with his coming out and were becoming increasingly distant emotionally. Within a few months, Tom was introduced to crystal by a friend in a dance club and rapidly started using the drug during sex. For him, crystal was synonymous with access to a network of people that he felt connected to. And, although educated about HIV and safer sex, he began having unprotected sex and eventually tested positive for HIV. It was this diagnosis which led him to seek counseling.
In the midst of his guilt, shame and hopelessness, Tom bravely named the meanings of his behaviors. Somehow for him, hanging out with and having sex with young and older, positive and negative guys made it feel that there was a bond between generations. Emotionally disconnected from his family of origin, he found in sex partners and friends a new place to belong. In this new place, he hoped to find New York and its gay community to be were as exciting and friendly as he had hoped them to be. Crystal was simply the price to pay for admission.
Mark is a 34-year-old white gay man originally from New England. While he came across as successful both professionally and socially, he described his life as a "suffocating stillness." Both social and financial achievements had failed to pierce the shell of his loneliness. Single for a couple of years after a long-term relationship in which he did not feel "loved in return," Mark had Friday night Internet-based hook ups on crystal that offered a sudden burst of passion that was destructive but refreshing nonetheless. During these twelve-hour escapades, Mark would allow himself all the emotional intensity and the sexual expression that his competitive, gender-stereotypical and homophobic upbringing could not tolerate in a lifetime. These pockets of time provided the breathing room necessary to continue to comply with the rest of his unsatisfying week. A captive of his own loneliness, he wanted to lose himself in the moment and in someone else.
Mark is part of a generation that was bombarded with HIV prevention messages. While he didn't lose close friends to AIDS, he took the issue very seriously and had, until then, always had protected sex. However, after a few therapy sessions, he understood how tired and angry he felt about "having to wear a condom." Somehow, it meant for him that gay sex leads to diseases, which felt stigmatizing. He realized that when he was high, gay sex did not feel unsafe. Unprotected intercourse was just a way to have sex and to see nothing wrong with it. Mark also seroconverted the year he was using crystal.
Sean is a 56-year-old African American gay man living with HIV since 1988. After his difficulty of finding a black gay community, and his journey through the tragedies of AIDS, he identifies -- with both pride and guilt -- as a survivor. He misses his friends, most of whom died in the '80s and '90s, and misses the drug-driven sex he has on crystal when he tries to delay his next visit to the bathhouse. Crystal gives him enough energy to get through the day. He knows that he should stop using but "staying alive" is all he's managed so far. In the steam room, still struggling under the weight of his unacknowledged losses, he forgets the memories he grew too tired to carry. So he remains isolated, distanced by the fact that no one talks about him as a gay black man, as an elder, or as a vital part of our community's history. "Very few people," he says, "really want to remember the hell previous generations went through."
Struggling With Crystal Meth
Like Tom, Mark and Sean, many of our friends, partners or clients are struggling with their use of crystal meth. Although the topic has been extensively covered in public forums and articles in the gay press, crystal meth addiction remains an unresolved issue. How do we understand the problem in the context of the gay community? Is it a gay phenomenon? Has everything been said about the connection between the HIV epidemic and the crystal meth epidemic? How do we make sense of the destructiveness at the core of the crystal meth users' stories?
Most people who have first-hand experience, or who have educated themselves on the issue, know the intensity, effects, costs and damage of a crystal meth addiction. We have heard about the power of the stimulant drug on self-esteem and sexual drive and the trance-like illusion that captures body and soul. We have also heard of the life-threatening cost of the addiction, and the paranoid and isolated qualities of the downward spiral.
However, we know less about the underlying issues leading people like Tom, Mark and Sean to become addicted to crystal meth. What suffering leads them to lose themselves in the cycles of acting out, escapism and, sometimes, alienation? Maybe the most important components of the crystal meth phenomenon are the least talked about: homophobia and internalized homophobia. Both the prejudiced attitude towards us for our different sexual orientations, and the way we've internalized that attitude, results into lowering our sense of self-esteem, self-respect and self-worth. Indeed, if television shows like "Will and Grace," "Queer Eye for the Straight Guy" and "Boy Meets Boy" are supposed to tell us that being gay is fine and safe, then why are so many gay men still jeopardizing their lives and health for drug-induced connectedness, passion and human contact? Why don't they see other ways to break out from isolation and depression?
Few talk about how external and internalized homophobia, with its "stigma-shame-acting out" nexus, might be the catalyst to crystal addiction and to risk-taking behaviors leading to HIV infection. As Tom's story illustrated, one of the ways homophobia and crystal meth use are connected is through the mechanics of identity. For Tom, doing crystal was a way of adhering to the norms of the group that he wanted to be a part of. Disconnected from his family of origin and high school friends, Tom found in the "rituals" of sex parties and circuit parties an environment that supports his identity as a gay man. It made him feel that he was part of a community of inclusion and counter-balanced the sense of shame and invisibility that his family's reaction had triggered in him.
Another way in which internalized homophobia and crystal use are connected is brought up by Mark's comments: shame and stigma. When sober, anal penetration was always physically difficult and associated with a sense of shame, yet when high on crystal, he turned into a voracious bottom. Along with his inhibitions, his moral judgments about his sexuality flew away. When he was high, getting fucked was not a sign of weakness, femininity or imprudence, as he used to think, but a normal thing that gay men do and give each other.
|Art by John McRae.|
Another link between crystal and HIV is disenfranchised grief. I suggest that crystal meth addiction is one of the symptoms of a lingering "community depression" due to unacknowledged or under-acknowledged losses from AIDS. Could the three-day sex/crystal binges, in a half-unconscious state, be the result of the emotional de-humanization of ourselves in a world where our lives -- and deaths -- are susceptible to being trashed, minimized, or devalued? Like Sean, for 23 years now, many gay men have lost friends and lovers to AIDS. I often wonder whether these losses have been honored as they should. Also, in addition to medical and psychosocial grief created by the disease, many gay men feel ashamed and guilty for contracting HIV or developing AIDS, which is still a taboo subject. Could crystal meth addiction be a sign of our unacknowledged suffering?
Still, the type of suffering and issues underlying crystal meth abuse are partially different for HIV positive and HIV negative men. NYU Researcher Perry Halkitis, in a 2002 interview with POZ magazine, argued that for HIV-negative individuals, crystal meth use can be a way to overcome social anxiety and connect with guys, socially, emotionally and sexually. For HIV-positive guys, Halkitis claims, the use would be more "specifically about sex, feeling hot, desirable and finding a mental space where there is ... ultimately no HIV."
So comes the question: "Is crystal meth a gay drug?" While my experience with clients suggests that crystal addiction is a social issue, often times brought upon by internalized homophobia and the ramifications of the AIDS epidemic, I disagree with labeling the "crystal epidemic" as a gay phenomenon. Similar symptoms could be developed by any disenfranchised and oppressed community living in the paradox of being, on one hand, ever growing and self-empowering and, on the other hand, kept to the margins of normalcy and legality. Just as alcoholism in Native American communities and violence in the Black youth communities are not "people of color issues," crystal meth is not a "gay issue." It is another crisis that calls for a contextual understanding of the psychological and social factors pushing an oppressed community towards healing or destruction.
Recommendations for Action
I also want to share how my clients have been instrumental in promoting their own healing. Although research is needed to validate these arguments, the steps below reflect how quite a few of my clients have taken themselves out of the pit:
Work towards stopping crystal use. If the pattern of use has become abusive (more than you want) or addictive (out of control), a period of full abstinence from crystal is necessary. Moreover, even if they only initially intended to "take a break" from crystal, some people who stop and continue the therapeutic process of recovery choose to not go back to crystal, which is then too strongly associated with a very chaotic period of their life. This does not mean that harm reduction programs, also called "recovery readiness" programs, are not just as helpful as abstinence-based programs. They are extremely important for those who can't seem to stop but know that the party is over and need to get help.
Do more than one thing. It is crucial to invest in a multifaceted process. Recovery from crystal usually takes more than self-help groups or psychotherapy alone. The best is a combination of: psychotherapy, medical, and psychiatric treatment to address underlying chemical imbalances; twelve-step meetings or support groups that expose you to other people's recovery and resources; and most importantly help with breaking through social isolation. It is crucial to build a community of professionals and friends where it is comfortable and safe to be gay, HIV positive or negative, and in recovery from crystal.
Go deeper. Long-term recovery goes beyond getting the crisis and the use under control. Whether through therapy and/or through spiritual examination, people need to take a deep look at what led them to lose themselves so profoundly. As Tom, Mark and Sean demonstrate, shame, loneliness, depression and grief are at the core of what needs to be addressed.
Find passion and meaning. Recovery is hard work. It entails a clear dedication to oneself. Such motivation is more easily found by being connected to yourself and to those who nurture a life that you feel enthusiastic about. Professional, personal, relational and geographic choices sometimes wait to be made. Remember that recovery is the opportunity to give your life meaning and purpose where your freedom prevails, again or maybe even for the first time.
Jean Malpas, M.A. is a psychotherapist formerly with the New York Lesbian, Gay, Bisexual & Transgender Community Center and currently in private practice. He can be reached by phone at 212-255-4138 or at JeanMalpasMA@hotmail.com.