The Stop AIDS Project hosted one in a series of forums on crystal use in the gay community on Thursday, March 20. The project's goal, according to facilitator Matthew Denckla, is to "break the silence" around the issue and raise awareness of the connection between speed use and HIV risk behavior. The event brought together health experts, users, former users, and interested community members.
Michael Gorman of the University of Washington discussed the recent increase in methamphetamine use, especially on the west coast, and noted that we are in the midst of the "third postwar epidemic" of speed use. The first was in the 1940s, when many soldiers and civilians were introduced to the drug during World War II, and the second took place in the 1970s. The current epidemic is heralded by a significant increase in methamphetamine-related emergency room admissions and deaths. Gorman noted that there are a variety of different "user profiles" of populations that use the drug, from the "outlaw bikers" who add speed to their coffee, to blue-collar workers who see crystal as the "poor person's cocaine," to members of the young, gay, dance and party scene.
Methamphetamine may be used in several forms: smoked, snorted, or injected. Injection using shared needles raises concerns about HIV transmission. Gorman noted that among speed users in treatment in San Francisco, 56% have injected the drug. He emphasized that little is known about the population of speed users as a whole, and that further research is needed.
How it works Ð and doesn't
Libby Sajo, a nurse practitioner at the Haight Ashbury Free Clinic Detox, discussed the biology of methamphetamine use. Speed works by increasing the action of excitatory neurotransmitters, chemical messengers that are responsible for communication between nerve cells. Speed use can "burn out" these neurotransmitters, leading to a post-use "crash."
Initial effects include increased energy and a feeling of enhanced sociability.
Side effects may include cardiovascular abnormalities, seizures, tooth decay, depression, and psychotic behavior, especially following prolonged use. Sajo and others noted, however, that it is unclear how often speed use precedes mental symptoms and how often methamphetmine is used to "self-medicate" a pre-existing condition. Withdrawal following prolonged use may result in insomnia, depression, and craving for the drug. Currently, no pharmacological treatment for speed addiction is available, and Sajo's practice focuses on supportive psychological counseling and amino acid supplementation.
While speed use is not known to directly worsen HIV disease, it may lead to lack of sleep, inadequate nutrition, and difficulty adhering to a strict antiviral regimen. Calling attention to recent news reports that use of the protease inhibitor ritonavir could lead to overdose levels of the drug ecstasy, Sajo noted that speed may pose a similar risk. It is widely reported that crystal has an aphrodisiac effect, and much has been made of the "speed-sex connection." Delayed ejaculation and prolonged intercourse may lead to a higher rate of condom breakage and an increased risk of HIV transmission. Sajo cited a study that found that women who use methamphetamine are more likely to engage in risky sexual practices, including unprotected anal intercourse.
Former users talk
Four former or current crystal users discussed their own experiences with the drug. "Miles" used crystal and a variety of other drugs and alcohol. He is an adherent of the 12-step philosophy, and does not believe that purely "social" or recreational use is possible over the long term. Noting that the recovery community is one of the largest gay/lesbian "organizations," he stated his belief that drugs are often used to help ameliorate a feeling of being different and not belonging. He concluded that crystal "makes you feel good all the time, but if you feel good and are happy without it, you don't need it."
"Clayton," in contrast, is an occasional crystal user who views the drug as a "party accessory." He said he sees speed as a "dance drug" and has never had sex while using it. Clayton does not feel his speed use is a problem. He knows many people who use the drug once every few months, and claims that he tends to get "much more screwed up on alcohol." He urged the community to "depathologize" speed use, and encouraged harm reduction efforts that reached out to occasional users. "Matthew," like Clayton, used the drug "for party reasons, never for sexual reasons." He noted that crystal is "very prevalent, easy to get, and accepted in the bar social scene." Matthew found that speed use "became a problem when mixed with other drugs."
Finally, "Dan" said that for him, crystal use was indeed related to sex, providing him with an "E ticket to the sexual experiences I wanted to have." He found that using speed enabled him to have sexual interactions with men which he could not allow himself to have otherwise. Dan feels that the stigma surrounding use of the drug and the "fear of being judged" gets in the way of finding social support to deal with one's use. It was not until he tested HIV positive that Dan recognized his speed use as a problem. He sees crystal use as "one of the worst things you can to do your health if you are HIV positive," and concluded, "I wouldn't be infected with HIV if not for speed."
Denckla concluded the presentation with the results of a recent Stop AIDS Project survey of speed use among gay and bisexual men in the Castro, Polk, and South of Market. Among the 411 men surveyed, 43% had used speed and 56% had not. Users spanned a range of ages; the largest group was between 30-39, challenging the common notion that speed use is a problem of youth. The majority of both users and non-users sampled were white, but a disproportionately greater percentage of users were men of color. Speed users tend to believe that speed is the most popular substance used by gay and bi men; non-users think it is more popular than any substance except alcohol. Among speed users, 65% did not always use a condom during anal sex, compared to 48% of non-users. A striking difference was that among speed users, 55% had only one sexual partner and 31% had more than one, while among non-users, 85% had one partner, and 13% had more than one.
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