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Dance of Death: Crystal Meth Fuels HIV

By Christopher Heredia, San Francisco Chronicle
May 4, 2003

The use of crystal methamphetamine has reached epidemic proportions among gay and bisexual men, and San Francisco 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 reckless intercourse.

Health experts estimate that up to 40 percent of gay men in San Francisco 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 Sacramento last 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.

Dr. Jeffrey 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."

San Francisco 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.

There are 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.

After 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.

Illicit makers 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.

"It's the 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,

say, 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."

Klausner not only blames crystal meth for new HIV infections, but also for the increase in syphilis and gonorrhea.

According to 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 than nonusers.

The word, and the drug, have spread coast to coast.

Yves-Michel 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."

In California, a 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.

Researchers found that condom use - considered the most effective barrier against HIV - was lower among gay men who use speed.

For receptive 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.

Consider one sure-fire indicator of the presence of crystal meth: the number of people asking for help getting off it.

Say you seek help in 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.

Three crystal meth treatment programs operate exclusively for gay and bisexual men in San Francisco. 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.

Experts have 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.

Although speed 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 well-being.

"People are 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."

While the 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 high:

-- 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.

-- Nearly 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.

The study's 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.

"We're continuing to see guys who have been HIV-negative for years start using speed," Colfax said, and subsequently contract the AIDS virus.

Crystal 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 do."

Colfax concedes 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 Dufty.

Both 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.

"There's a 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."

Abstaining from 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 drug.

What's more, 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 San Francisco, possession of methamphetamine is only a misdemeanor - a frustration to police who want to mandate that people get treatment.

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.

"It's extremely 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."

San Francisco 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."

Club scene

Prosecutor Jim 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.

But invariably 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."

Spradlin, 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 Transgender Community Center was sparsely attended, much to the regret of outreach workers.

"It's unraveling 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.

"Any amphetamine - cocaine, crystal - mixed with Viagra increases your risk for heart attack," said Fontaine of the New York Gay Men's Health Crisis.

Dufty, the supervisor, is hoping the City Hall hearing will further discussion to combat speed addiction.

"To the 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 meth."

Original article:  http://www.sfgate.com/cgi-bin/article.cgi?file=/c/a/2003/05/04/MN281636.DTL

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