of Death: Crystal Meth Fuels HIV
San Francisco Chronicle
May 4, 2003
The use of
crystal methamphetamine has reached epidemic proportions among gay
and bisexual men, and
area health officials are warning that the mantra of HIV
prevention - safe sex - has been drowned out by a raucous scene of
loud party music, cheap meth and
estimate that up to 40 percent of gay men in
have tried crystal meth, a powerful
form of what's commonly known as speed. Even more alarming, a
Health Department study last year found that at one high- risk
clinic, 25 percent to 30 percent of those with new HIV infections
reported crystal meth use in the
previous six months.
At a meeting
about crystal meth in
month, the state's top AIDS and HIV prevention officials came up
with the smoking gun of all statistics: Gay men in California who
use speed are twice as likely to be HIV-
positive than gays who don't use it.
To be sure, the
problem of methamphetamine use is not confined to gay and bisexual
men who like to party. Law enforcement officials say
meth use has spread to the suburbs,
particularly among teens facing boredom, peer pressure and
undiagnosed psychological problems.
Yet nowhere is
the meth concern greater than in the
gay community and its teeming subculture of partygoers who attend
weekend-long events dominated by alcohol, drugs, sex and ramped-up
dance music. Dancers become one with the pulsating beat, their
bodies turned into wildly rhythmic instruments of vibration.
Klausner, director of sexually
transmitted disease prevention and control for the San Francisco
Department of Public Health, is convinced of the dangers.
"We have all
sorts of levels of evidence," he said, "and it's all pointing in
the same direction: The crystal meth
epidemic is playing an important role in increasing sexual risk
behaviors, and that is leading to new HIV and STD infections."
officials are planning a televised hearing at 6 p.m. Wednesday on
crystal meth use in the gay community.
The City Hall gathering will include public health authorities,
recovery program officials and members of the gay community.
various reasons why the demand for the drug has grown among the
Bay Area's gay community. It's cheap - $30 for a high of several
days - easy to get, and powerful. It increases sexual stamina and
eases the pain of depression or loneliness. Others find it makes
them feel invulnerable - if only for a night.
cigarettes, alcohol and marijuana, speed is the most commonly used
drug in the gay party scene. Known also as "crissy,"
''tina," "tweak," and "crank," crystal
meth is a powdery substance that can
be swallowed, injected, snorted or smoked.
It appeals to
men along any paths of life: lawyers to waiters, stockbrokers to
health-care workers - all have succumbed to the drug, a stimulant
that mimics the body's natural adrenaline. Derived in the early
1900s from amphetamine, it was first prescribed,
then made available over the counter,
in decongestants and bronchial inhalers.
quickly learned how to manufacture the drug cheaply and in mass
quantities. The chemical make-up of meth
is similar to that of amphetamine, but experts say
meth has a stronger effect on the
body's central nervous system. Like amphetamine, it brings about
heightened activity, reduces hunger, and temporarily promotes a
sense of well-being.
perfect drug for gay men," said Michael
Siever, director of the Stonewall Project, a speed recovery
program for gay men at UC San Francisco. "What else allows you to
party all night long whether you're dancing or having sex? . . .
at least, at first - before it becomes a problem."
More and more,
the dance is becoming a dance of death.
For when the
music stops, there'll be more HIV-positive men than there were,
before the evening began. There'll be more
meth users who've found they've crossed into addiction -
it's a tough drug to kick. More immune systems of HIV-positive men
will have been compromised, abused, treated harshly. More doses of
medicine will have been forgotten, or just ignored.
The question is
not, is crystal methamphetamine being used in the gay community?
The question, said Dr. Grant Colfax, director of HIV prevention
studies with the San Francisco Department of Public Health, is
instead, can the use of speed go much higher?
It could be said
that Colfax belongs to an elite circle of health workers who
maintain the most knowledgeable insights into the sex habits of
the gay community and who track the progress of AIDS like a
security guard on maximum alert. And his chilling, current-day
viewpoint is this: "We have a dual epidemic - a speed epidemic and
an HIV epidemic that are both increasing."
not only blames crystal meth for new
HIV infections, but also for the increase in syphilis and
Klausner, 25 percent of gay and
bisexual men testing positive for syphilis reported recent speed
use. In addition, HIV-negative gays who used
meth were three times more likely to have rectal gonorrhea
word, and the drug, have spread coast
Fontaine, coordinator of substance abuse counseling and education
at the Gay Men's Health Crisis in
New York, said:
"We are seeing more cases of crystal meth
use than in the past. We're definitely concerned about it, as are
the gay men who are coming in for counseling."
statewide study found that among the gay and bisexual men tested
in 2001 and 2002 at publicly funded clinics, 7.1 percent of
meth users were HIV positive, compared
to 3.7 percent of those who didn't use meth.
Of the total
63,098 gay and bisexual men who were tested, 10.5 percent, or
6,637 men, reported meth use.
found that condom use - considered the most effective barrier
against HIV - was lower among gay men who use speed.
anal intercourse - the riskiest form of sex - officials found that
39.2 percent of gay non-meth users
"always" use a condom, compared to 24. 6
percent for meth users.
sure-fire indicator of the presence of crystal
meth: the number of people asking for
help getting off it.
Say you seek
San Francisco -
anywhere in San Francisco. Your name goes on the bottom of a long
waiting list. You have to wait at least a full month.
meth treatment programs operate
exclusively for gay and bisexual men in
Meanwhile, Narcotics Anonymous chapters, complete with their
time-tested 12 steps, are sprouting up in this city, as well as in
Seattle, Palm Springs, Atlanta, Philadelphia and New York.
shown that heavy methamphetamine users, those who do two to four
grams a week, can suffer serious brain damage. Heavy
meth use has been shown to be the
equivalent of 40 years of aging, affecting movement and memory.
creates a sense of euphoria, it is actually knocking out the
brain's ability to produce dopamine, which is how the brain
naturally creates the sensation of pleasure. The addict then
becomes desperate for his fix because the drug offers a sense of
using the drug to feel better," said Dr. Nora
Volkow, the new director of the National Institute on Drug
Abuse, "but they are literally selling their soul to the devil."
effects of infrequent use of methamphetamine are unknown, experts
say the good news is that studies show that heavy users who quit
regained some of the brain's ability to produce dopamine.
A San Francisco
Department of Public Health study,
published in February, of gay and bisexual men who frequented
late-night dance clubs, parks after hours, sex clubs, and adult
bookstores found the incidence of recreational drug use extremely
-- More than
three-fourths of the 350 men in the street-based survey reported
use of non injection drugs. Half said
they had tried methamphetamine in the previous three months.
Three-quarters of the men said they had had unprotected anal
intercourse in the same time period.
one-third of the men surveyed either said they already had HIV or
tested positive for the first time, which indicates they possibly
had transmitted HIV to casual sex partners while using drugs.
authors concluded that the late-night party set is clearly
contributing to the rise in HIV infections and there is "urgent
need" for heightened HIV prevention outreach at these venues.
continuing to see guys who have been HIV-negative for years start
using speed," Colfax said, and subsequently contract the AIDS
meth is anathema to safe sex. It leads
to rougher sex and uninhibited, risky sex; condoms are failing, or
men simply aren't using them.
Men on speed say
that meth tends to make them "instant
bottoms" - the receptive position in anal sex - because the drug
induces temporary erectile dysfunction.
"We're trying to
de-link substance use from risk behavior, to get guys to be safer
while using substances," Colfax said. "People use it and they're
not able to assess their risk behavior. We have a lot of work to
that not all men become addicts, but says even the occasional or
weekend user puts himself at serious risk for contracting HIV. He
wants the full array of programs - treatment, counseling,
prevention - tailor-made to the
occasional user. Members of that audience fall below the
drug-dependency radar, Colfax said, and walk around believing
they're risk- free.
But the pitfalls
of addiction lie just around the corner.
"Guys start with
weekend use and it accelerates," said Board of Supervisors
President Tom Ammiano, who is
co-sponsoring the crystal meth hearing
Wednesday with Supervisor Bevan
Ammiano and Dufty
are gay and said they're now hearing of incidents in which men
can't function at work because they're still under the influence
of meth from their weekend parties.
tremendous amount of denial around speed use,"
Ammiano said. "It's pernicious. We're
also hearing stories of people failing in rehab after eight, nine
tries. It's very brutal."
speed doesn't induce the severe withdrawals or vomiting associated
with heroin, but those who stop taking meth
often face depression, agitation and intense cravings for the
experts say, speed's strong association with sex and partying make
it all the harder to kick.
The police have
stepped up narcotics enforcement at late-night dance clubs and on
the Internet to staunch the wave of speed flowing into the party
scene. But in
possession of methamphetamine is only a misdemeanor - a
frustration to police who want to mandate that people get
All one has to
do to find speed is log onto several Web sites, where speed is
traded using code words. In the clubs, men exchange what are known
as "bumps," or snorts, on the dance floor or in rest room stalls.
prevalent," said Capt. Tim Hettrich,
head of the San Francisco Police Department's vice unit. "We're
trying to kick a- as much as we can. We go out to the clubs and
make a buy. That's one guy. Once others see
that happen - we're dead in the water for that club for the rest
of the night. We're trying to get the major suppliers."
prosecutor Liz Aguilar-Tarchi, who
leads the district attorney's narcotics unit, says the problem is
exacerbated by sex club and dance club owners who turn their backs
on drug use.
"How can it be
that the club owners' security does not know?" she says. "They are
aware. 'Culpable' is a strong word. I
haven't seen any evidence they are involved, but they sort of shut
one eye to it."
Hammer, who is gay, said the solution is not incarceration, but
getting more people into treatment programs early on.
At a late-night
dance club, he pointed out to a friend that there was no line for
alcohol. "You could get a beer without standing in line," Hammer
recalled. "Yet when you walked out on the dance floor, people were
obviously on something. I think it's a terrible tragedy,
especially for the younger people coming out."
Gay dance party
promoter Don Spradlin said he had gone
to great lengths to keep drugs out of his events, which include
the annual Gay Pride dance party in City Hall and the Halloween
Hell Ball in October.
the drugs get in, past the pat downs of security guards, past the
roving eyes of bouncers with flashlights. So
Spradlin also posts health pamphlets and provides plenty of
condoms at the club.
"I get irritated
that the gay clubs get singled out," he said. "Club owners have
made extraordinary efforts to keep drugs out. Their licenses are
threatened. I'm very anti-crystal. It's sad. I hate it."
56, a gay man, said health officials and the gay community must
address issues of self-esteem and addictive behavior. The
"use-a-condom-every- time" message of the 1980s doesn't work
anymore, he said.
The danger of
crystal meth has been kept under
cover, most agreed, by its cloak of shame. Gay men have stopped
talking about condoms, and crystal meth
use among friends is kept quiet.
A forum on the
subject last fall at the Gay, Lesbian, Bisexual and
Community Center was sparsely attended, much to the regret of
our community," said Jed Herman, a Stop AIDS Project worker who
has heard of meth's destructive toll
on not only the user but also on lovers, friends and families. "I
don't know what the answer is. The obvious problem is getting
people in the door who are clearly at
high risk for HIV transmission."
Herman said the
Stop AIDS Project's Crissy campaign,
which encouraged men to get help if they thought they had a
problem, quickly ran out of money. One of the dangers of crystal
that hasn't been broadcast widely is that mixing it with Viagra
can raise heart rate and blood pressure and lead to death. Men on
speed commonly use Viagra to counteract the erectile problems
caused by meth.
- cocaine, crystal - mixed with Viagra increases your risk for
heart attack," said Fontaine of the New York Gay Men's Health
the supervisor, is hoping the City Hall hearing will further
discussion to combat speed addiction.
untrained eye, it's invisible," Dufty
said. But it's also widespread.
"It's a currency
that's being traded like dollar bills all around our community.
It's impacting people in their 20s, 30s, 40s and 50s. I've heard
lesbians talk about crystal use. I recognize people are going to
make their own choices. But we have a responsibility to make it an
informed choice. As community leaders and friends, we have to
speak loudly about the clear and present danger of crystal