Bay Area Reporter - November 3, 2005
Matthew S. Bajko, m.bajko@ebar.com

According to data from the Stop AIDS Project, the number of men who reported using speed dropped 8 percent between the first six months of 2005 and the last half of 2003. In 2003, 18 percent of the 1,305 men asked as part of the agency's street surveys said they had used speed in the last six months, whereas only 10 percent of the 809 men surveyed in 2005 reported using crystal. The Stop AIDS Project data is based on surveys of thousands of men over a two-year period, 4,197 of whom reported using crystal in the previous six months.

For the first time since 2003, more men surveyed reported using cocaine than crystal meth, with 92 men reporting using coke compared to 80 using meth in 2005. Overall cocaine usage has also fallen from 15 percent to 12 percent in the last two years.

"This is pretty significant. It is the first time we have seen this downward trend," said Willi McFarland, an epidemiologist with the health department. "It is a good indicator and could be - I am hopeful it is - part of why our HIV rate is changing."

Others are not so sure and remain skeptical about equating the drop in meth usage to the decline in the HIV rates.

"This drop of use in crystal looks like it is happening very recently in time. It doesn't fit well with the trends in new infections," said H. Fisher Raymond, assistant director of the HIV/AIDS statistics and epidemiology section in the AIDS office. "I don't think the drop in crystal relates to the drop in HIV rates. It doesn't match up in time. Down the road we may see a drop in HIV infections and crystal use both going down, then I would be more likely to say it is related."

Christopher Carrington, an assistant professor of sociology at San Francisco State University, said he had doubts on the data. Carrington, who studies gay men and their party habits, wondered if men really were using less crystal or if they are more reluctant to report using the drug now that meth has been stigmatized in both the media and campaigns like the city's "Crystal Mess" posters.

"As you stigmatize you get less reliant data. I think you have to be very careful," he said. "I am not convinced there has been a change in behavior. It could be I am a little bit suspicious."

Carrington did say that the data could point to the fact drug use comes in cycles and gay men are once again moving away from meth toward other drugs.

"A lot of people will use these various substances, ecstasy for example, and get burnt out. We have been through cycle after cycle of that in San Francisco with speed," he said. "A new generation gets to know the drug, its plusses and minuses, and as they do that you get a drop off."

Michael Siever, Ph.D., director of the Stonewall Project, which helps men struggling with meth addictions, reacted cautiously to the survey data.

"It wouldn't surprise me if there has been some reduction of use but I would want confirmation from more sources. I know from other data the numbers of people requesting help with meth are definitely up," he said. "I have been working in this field 15 years in this town. It has its fluctuations; it comes and goes. It has been the most popular drug for gay men for a long time. If usage is going down that is great."

Stop AIDS Project program director Mark Utterback said the agency has a track record of making men feel comfortable to accurately report their behavior to its outreach workers. And while the data shows a drop in meth use, he said more work needs to be done.

"We were, needless to say, thrilled to see there is such a significant decrease in that period of time. But we are still at an epidemic, which is 8 percent of the population. So crystal use is still a very serious problem for our community," said Utterback.

Alcohol

While much discussion of late has focused on meth's role in HIV transmission, Raymond said the data from Stop AIDS points to an even more troubling factor - the role alcohol probably plays in new HIV infections. The number of men reporting alcohol use has remained fairly steady over the last two years, fluctuating between 82 percent and 86 percent.

And the number of men who report combining sex and alcohol far outstrips the number using meth during sex. As an example, in the first half of 2005, 53 percent of the survey respondents had sex while using alcohol, whereas 7 percent of the men reported using crystal and having sex. In 2003, 59 percent of the men had combined sex and alcohol compared to 14 percent who engaged in sex while on meth.

"It is striking," said Raymond. "It might be interesting as meth and coke decline to see how alcohol impacts new infections. I am hopeful we can see alcohol again as an issue and somehow address it somewhat. I think alcohol potentially affects more people in the community and has a larger community effect than methamphetamine use."

Carrington said alcohol shows up as more of a problem than speed in his research on gay men in the party circuit crowd.

"I think it is a misnomer to say meth gives you a blank check and makes it impossible for you to monitor your behavior. I don't buy that. In a lot of my research the guys say even when I am high I am thinking about safe sex. A lot of them said they made worse decisions on alcohol than on meth," he said.

However, many health officials have warned for years that gay men using crystal have a higher risk for HIV infection and worried increased use of the drug would lead to higher rates of HIV. Despite the downward trend in HIV infections the city reported this summer, they continue to see crystal use as playing a large role in new HIV infections.

Dr. Jeffrey Klausner, director of the health department's sexually transmitted diseases control section, said the attention placed on meth by the health department, political leaders, and community groups over the last two years probably has influenced gay men's risk behaviors. But he said meth is still a key factor in people seroconverting.

"It wouldn't surprise me if meth use was declining. But to say it was not having an important impact is to deny the data," said Klausner. "I think people who diagnose patients with new HIV and people who take care of people with HIV would unanimously agree meth is a major problem in HIV prevention. Meth users are three times more likely to get HIV than non-meth users."

At the same time Klausner said he no longer feels the city is in crisis mode due to speed use.

"Crisis to me is an uncontrolled situation that has not been responded to. Three years ago we were in crisis," he said. "Now we are in response mode."

Supervisor Bevan Dufty, who held pubic meetings about meth use in the spring of 2004 and helped convince Mayor Gavin Newsom to appoint a special task force on crystal meth this past spring, sounded a similar note at a recent forum on crystal and HIV. When asked if speed use is a crisis, Dufty responded, "I think it is a challenge."

Steven Tierney, the city's HIV prevention director who co-chairs the meth task force with Dufty, disagrees with any notion that the crystal crisis is over.

"I would say as long as people are continuing to be challenged by crystal I still think it is a crisis," said Tierney, who this week announced he is resigning his position to take a job with the San Francisco AIDS Foundation.

One theory as to why San Francisco is seeing drops in everything from new HIV infections and STDs to substance abuse is that gay men increasingly are shifting away from a nonstop party lifestyle to forming long-term relationships and raising children. Jeff Sheehy, Newsom's adviser on HIV and AIDS policy, points to the mayor's allowing gay couples to marry in 2004 to bringing about a shift in attitudes.

"He has made marriage chic. Being married means you are in a long-term relationship and not being cracked out all night, going on the Internet and finding as many people as possible to have sex with," said Sheehy. "I know more people having more kids now than ever. We are seeing a percentage of the community making healthier decisions about their lifestyle. That is not to be critical about people who go out to party, but it seems to be a large part of it."

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