Club Drugs and HIV: Possible New Strain Offers
People tiring of
safe sex warnings just got a powerful reminder
that HIV and AIDS have not yet been conquered.
Last Friday, the
New York City Department of Health and Mental
Hygiene announced that a local man had been
diagnosed with a highly resistant strain of HIV.
While people with HIV sometimes develop drug
resistance over time, this man, who had not
previously been treated for HIV, has not
responded to three of the four classes of HIV
drugs. He also appears to have developed AIDS
unusually quickly after becoming infected with
HIV. It's possible that there are genetic
reasons for his drug resistance and for the
rapid progression from HIV to AIDS, and those
issues are still being studied.
genetic makeup, another possible reason for the
man's fast-moving infection is his drug use. The
unidentified man reported having sex with
multiple partners while under the influence of
the club drug methamphetamine, also known as
crystal meth. It's theorized that amphetamines
may suppress the immune system, allowing the
virus to replicate more quickly in the body.
Methamphetamine also contributes to unsafe sex
practices that make the spread of HIV more
likely. This highly addictive drug releases
people from their inhibitions, leading otherwise
sexually responsible men, women and teenagers to
engage in risky sexual behavior.
At a press
conference, New York City Health Commissioner
Thomas R. Frieden, MD, MPH, said, "This case…is
a wake-up call to men who have sex with men,
particularly those who may use crystal
Halkitis, PhD, a chair of the department of
applied psychology at New York University,
discusses the relationship between club drugs
such as methamphetamine and HIV infection.
What is the state
of the HIV epidemic today?
We've seen a worsening of the HIV epidemic in
the last several years. Infection rates were
stable during the 1990s, but in the last few
years there's been a spike in new HIV
transmissions across the population, especially
among gay and bisexual men. In this population,
there was a 14 percent increase in new HIV
infections between 1999 and 2001.
What has lead to
First of all, there's a fatigue around HIV in
the gay population and in the general
population. People feel that the HIV epidemic is
over, and they're more complacent about safer
sex practices. They think there is a cure and,
as a result, people are not being as safe or as
responsible in their sexual behavior. Number
two, prevention efforts haven't evolved as
people have become sophisticated about HIV. So
"use a condom every time" campaigns, which
worked fine in the early 1980s and the
mid-1980s, are no longer effective.
seeing a complex interaction between sexual
risk-taking and drug use in the gay population
and also in the straight population. We're
seeing this in particular with a subset of drugs
known as "club drugs" because of their
association with dance clubs and bars.
Are people still
going to clubs to do these drugs?
Twenty years ago, these substances were used a
lot in dance club situations. Our research shows
very clearly that people do them at home, they
do them with their friends, they do them in the
park—they do them wherever they need to do them.
Some people have suggested that maybe a better
label for them would be "party drugs" because
these are the drugs that people do to have wild
and inhibited sex, to go dancing, or to do both
of those things in combination.
Which drugs are
contributing to increase HIV risk?
We're talking about methamphetamine, also known
colloquially as "crystal." We're talking about
MDMA, which is known commonly as "ecstasy."
We're talking about ketamine, Rohypnol and we're
still talking about cocaine, to some extent.
Most importantly, we need to think about not
just each of these drugs in isolation, but these
drugs being used in combination with each other,
and in combination with alcohol and prescription
drugs such as Viagra.
Which drugs are the
most worrisome and why?
Perhaps the most worrisome is methamphetamine.
This is a psychostimulant and a form of speed.
Crystal is a hypersexual drug. It's a hugely
disinhibiting drug. We know, and it's been
clearly documented, that people who are using
this substance have sex without rational
thinking, they have multiple partnerings, they
just let go. They feel like they're on top of
the world, so nothing is a problem and any
logical thinking around safer sex practices gets
wiped away. Methamphetamine is also a problem
because it's a highly addictive drug from a
psychological perspective, so people have a very
difficult time coming off of it because the
cravings are so intense.
Does the way
methamphetamine is administered affect HIV risk?
Absolutely. When a person first starts using it,
methamphetamine is usually snorted. Eventually
chronic users begin to smoke it because it is a
more effective way of ingesting the drug; it
gives a better and a longer and a faster high.
Eventually, people who are dependent on the
substance become injectors of methamphetamine.
They inject it in their veins or muscles because
it creates a much quicker and more intense high.
So transmission through injection and the
sharing of needles and the sharing of works
creates another route of HIV transmission that
is linked to methamphetamine use.
Do we know how much
club drug use is affecting HIV risk?
We know—anecdotally in New York City and from
documentation on the West Coast—that when we
look at gay men who have become HIV-positive,
more often than not, in the last several years,
these men report having used methamphetamine
with sex. So while we're not able to put an
exact number on it, you can bet that a large
percentage of new seroconversions are among
people who are drug users.
methamphetamine make oral sex riskier?
We know that the mouth produces saliva, which
has protective factors that assist in the
prevention of HIV. When people are high on
methamphetamine, they have extremely dry mouths.
Suppose an HIV–negative person is using
methamphetamine and is having sex with an
HIV–positive person. That is more dangerous than
having sex with a person who is not high on
What role does
depression play in drug use?
We should never deny the fact that drugs make
people feel good; that's why they do them,
right? What we know, also, is that people often
use drugs in our society to mask bad feelings.
So people who are experiencing depression or
loneliness or low levels of self-esteem, which
can be addressed with therapy and with
medications, are self-medicating by using these
substances. The unfortunate cycle that develops
is that people who are depressed, for example,
go on crystal, use crystal, feel better while
they're high and then crash and feel even worse
than when they started. When we address HIV in
the United States, I think it's incredibly
important that we think about the link that
exists between drug abuse, mental health and
HIV. Addressing one of those issues in isolation
doesn't seem to be sophisticated any more. We
need to address all those three things together.
How does drug use
affect people on HIV therapy?
What we know, from our work, is that
adherence—taking your medications the way you're
supposed to take them—is a problem across the
board. If we believe the literature, people are
supposed to be adherent 95 percent of the time.
It's very hard for people to be adherent 95
percent of the time when they're high. When
they're feeling good, the last thing they want
to do is actually stop to remember to take their
medications. Number two, we know that
methamphetamine is an immunosuppressant.
Methamphetamine that is sold on the street is
not pure methamphetamine. It's been cut with
talc, heroin and variety of other substances
that have an effect on people's immune systems.
Number three, and probably most alarming of all,
is that some recent studies indicate that even
if an individual is highly adherent to his or
her medications, if they are using
methamphetamine, replication of the virus in the
brain is accelerated.
What is your advice
to people who use methamphetamine?
To people who haven't started and who hear
wonderful tales about this drug, don't start
using it. This is not a wonderful drug. The
price that you will pay in the long run is not
worth it. To people who have started, I say look
for help. Because what do we know about
methamphetamine and its effects on people's
lives? People become physically ill and they
become socially ill. They lose their friends,
they lose their family and they lose their jobs.
Methamphetamine has often been referred to as
the "Grim Reaper" because of horrible and
devastating effects it has on people's lives.
How can people
reduce their risk of HIV?
Clearly, one of the strategies is abstinence
from both sex and intravenous drug use. For
young adults and for adolescents, becoming
totally informed and educated about HIV and its
transmission is going to be a very important
strategy, as well as considering delaying the
onset of sex until an individual is at a point
where he or she can make the right choices
around sex. The consistent use of condoms, of
course, is important with anonymous or casual
partners. Even in the context of some
relationships that are not monogamous, the use
of condoms is actually a really good idea.
Finally, the mixing of sex and drugs is not a
good idea. A glass of wine is very different
from two lines of methamphetamine. The
combination of drugs and sex is where a lot of
the risk is happening now and where a lot of the
transmissions are actually occurring.
important for individuals in our country to
remain informed. The disease is constantly
changing. There are new medications that are
coming out that are effective. But people are
not necessarily living their whole lives with
HIV; people are still dying. So remaining
informed about HIV and remaining informed about
strategies for safer sex is important.