Bay Area Reporter - September 8, 2005
Bob Roehr

"But we kind of completely ignore methamphetamine in any other population. Almost all of the media is about these god-awful gay men who fuck like bunny rabbits while they're on drugs. But methamphetamine is all over the country, in all populations; it's having its good and bad effects in all those places, and we don't talk about that."

Siever's words rang true to those attending the first national Conference on Methamphetamine, HIV, and Hepatitis in Salt Lake City August 19-20. Meth is everywhere, including isolated rural communities in Utah; it's an all-American problem.

Meth trails only marijuana as the second most widely used illegal substance in the United States, and it is far more disruptive to individual and family lives. An estimated 12.3 million Americans, or 5 percent of the adult population, have used meth at least once, and 600,000 are believed to use it on a weekly basis.

The average age of the user skews younger than with most other drugs. And unlike most substances of abuse where the user is likely to be male, meth has a strong attraction to both sexes. Females comprised 42 percent of emergency room admissions for meth abuse in 2002. That comes to no surprise to those who know that it was marketed to women as an antidepressant and weight loss wonder in the 1950s and 1960s.

But according to Siever, "Almost all of the research is in gay men. Because of its connection with HIV, that's where all of the research is. There is very little research conducted in other populations and at other locations outside of urban areas."

One exception is a study of injection drug users who sought HIV testing at publicly funded sites in California in 2003 and 2004. Thomas Stopka, with the California Department of Health Services Office of AIDS, focused on 34,255 participants who identified as heterosexual, and compared them with a parallel group of men who have sex with men.

The group was 59 percent male and 41 percent female; 85 percent were between 20 and 40; and meth was the second most commonly injected drug. Meth injectors were less likely to use needle exchange programs and were more likely to share needles. They also engage in riskier sexual behavior and are less likely to use condoms.

However, despite this riskier behavior, Stopka said male meth injectors tested positive for HIV at a rate of 1.6 percent, less than the 1.8 percent of non-meth injectors. He attributed it to age and injection careers - meth users were younger and haven't been doing it as long, so the odds haven't caught up with them. Another factor is that meth injectors tended to be in the smaller cities where the rate of HIV is lower, and not in greater Los Angeles or San Francisco.

Two factors in this wave of expanded meth use that were not present in earlier waves are the presence of HIV and of needle exchange programs to reduce the risk of transmission of the virus and other pathogens through the sharing of contaminated needles.

Naomi Braine, a researcher at the Chemical Dependency Institute of Beth Israel Medical Center in New York, examined surveys from nearly 2,500 participants in 23 large needle exchange programs across the country. She found that amphetamine compared to heroin injectors were more likely to be younger, white, use multiple drugs, have riskier sexual behavior, have same-sex partners, and are more likely to be homeless, at least transiently.

Even while they are more likely to be homeless, they also are more likely to be employed. "The social context in which drugs are used strongly shapes the dynamics of risk in these populations, and will also affect service utilization," Braine said.

She suspects that being gay contributes to but is not the sole factor contributing to homelessness and risky behavior. "My guess is that youth has a great deal to do with it, above and beyond sexual orientation. As users use, one of the things that they learn is how to manage lives and use at the same time. Some become more stable with age."

Gays and meth

"Until we get the meth situation under control in San Francisco among men who have sex with men, we will not get the HIV epidemic under control," said Dr. Grant Colfax, an epidemiologist with the San Francisco Department of Public Health.

Various surveys have shown that anywhere from 17 percent to 43 percent of gay men in that city have used crystal within the last six months. But even the lowest figure "is about 10 times the level of meth use seen in the general population." He was not surprised that 43 percent of those who had attended a circuit party reported using crystal.

Most troubling to Colfax is that among people getting HIV tests at city clinics, the incidence of seroconversion was 6.3 percent, "these are sub-Saharan African rates," compared with 2.1 percent for non-users, he said. "What we are seeing is not just that meth use is associated with high risk sexual behavior, but that it is leading to greater numbers of HIV infections."

"If we could de-link the association between methamphetamine and HIV risk, we could have a real impact on the HIV epidemic," Colfax said.

David McGuigan saw tremendous parallels with the situation in Sydney, Australia, where he works with the AIDS Council of New South Wales. An estimated 75 percent of Australia's HIV infections are in gay men, in Sydney, 1 in 4 or 5 are infected with the virus. Some 80 percent of gay men reported using some street drug during the last 12 months, with crystal being the most common.

The men who practice unsafe sex do it for enhanced pleasure and do not attribute it to their drug use. "We've painted meth as causing people to do things, when it fact it doesn't," McGuigan said. He attributed use more to the cultural context and urged a better understanding of those factors.

It is important to remember, "meth is the best available antidepressant on the street," said UCSF's Siever. "This drug is fun, or at least it was in the beginning. And to deny that is disrespectful of the people who use it."

Rafael Diaz, with the Cesar E. Chavez Institute, has found what he calls "the fabulous effect" among Hispanic gay men in San Francisco who use meth and cocaine. Most use it because of the sense of energy that it gave them; 71 percent use it to have sex without guilt or shame; 57 percent said it helps them focus on sex without distraction; while others said it made them feel more attractive.

"These men are finding through this drug a way to connect with their bodies without feelings of dirtiness, sinfulness, or homophobia," Diaz said. He called it a factor of acculturation and acknowledgment of a gay identify.

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