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"OF THE MANY REASONS I had unsafe sex while high on crystal, I think the most profound was simply that I was lonely. Meth got me close to men at clubs and in bed. And unsafe sex allowed me the deepest connection possible"
~ Kevin Koffler, POZ magazine �?nbsp;Last updated February 20, 2007 (We regret that some elements of this section are out of date) "CRYSTAL METH is the newest and most important threat to the HIV epidemic in the US."
~ Dr. James Dilley [Director, University of San Francisco AIDS Health Project] "I think the biggest single enemy of the gay community is crystal meth... In America the rising rates of HIV infections among young gays are almost all associated with crystal meth. So the real campaign should be against crystal meth."
~ Edmund White [Author] METHAMPHETAMINE use among men who have sex with men (MSM) in North America up until the late-1990s was confined mostly to the AIDS-devastated district of West Hollywood, Los Angeles. Crystal, in its current form, has been readily available on the West Coast since the early 1980s, when a new way was found to replicate the drug's chemical structure using cheap industrial chemicals and household products. Although crystal was being used by gay Californians to initiate, enhance and prolong sex, its constrictive effect on blood vessels made erections difficult to sustain for most users, rendering it unpopular with gay men elsewhere in the US. In the San Francisco Bay Area, for example, amphetamine use was cited in just 4% of drug-treatment admissions between 1986 and the first half of 1990, a figure which has since sky-rocketed. In Los Angeles, meth was also being used as a means to surviving the ruthlessly competitive movie capital due to its ability to quell feelings of anxiety and inferiority, boost self-esteem and heighten sensory perception, enabling users to feel at ease in social situations and to improve attention and intensify their focus on whatever activity they engaged in. Also taken as an appetite suppressant among the image-obsessed, Hollywood producers, agents, writers, actors and "fashionistas" are all said to have embraced meth. David Foerster, of the substance abuse body The Foerster Group, claims to have placed several Hollywood luminaries in rehab. "The problem has gone from epidemic to pandemic," he says. The catalyst for meth's viral-like spread throughout gay America and into mainstream society arrived in 1998 amid a blaze of publicity. Originally intended to treat erectile dysfunction in older men caused by medical problems like diabetes and spinal cord damage, Pfizer soon realised the potential for marketing Viagra as a drug that men of all ages could use simply to enhance their ability to achieve and maintain an erection over long periods, and began advertising Viagra as a wonder sex drug. With the power to reverse the impotence-inducing effects of drugs and alcohol, Viagra also inadvertently provided the solution to "crystal dick", and it was the gay party circuit - intense, sexually-charged dance events held across America and attended by thousands of gay men from every metropolitan city and beyond - that provided the geographical network through which crystal, aided and abetted by Viagra, would explode into the new millennium. Indeed, the upward trajectory of meth abuse among American MSM can be more or less measured alongside the marketing hype that fueled Viagra's iconic rise... "Pfizer's direct to consumer marketing of Viagra as a drug to enhance sexual performance aimed at men who don't necessarily suffer from erectile dysfunction is irresponsible, especially in light of the drug's known use as part of a 'circuit party cocktail' that is fueling the spread of STDs and HIV."
~ Michael Weinstein [President of AIDS Healthcare Foundation] When taken together, the dramatic increase in heart rate and blood pressure can lead to cardiac arrest and death, and constant meth use can result in gradual loss of sex drive, erectile dysfunction and impotence with or without the aid of the little blue diamond-shaped pill. Nevertheless, seemingly overnight Viagra transformed "Tina" from a "trailer trash" drug into the ultimate aphrodisiac. And with meth's ability to melt away rational thought, suddenly, years of ingrained safe sex messages seemingly never existed. While most gay men do not use crystal, it's easy to appreciate meth's appeal among the weaker-willed and more impressionable who are relentlessly and often mercilessly conditioned by society into believing the sex they innately desire is wrong. "Few talk about how external and internalised homophobia, with its 'stigma-shame-acting out' nexus, might be the catalyst to crystal addiction and to risk-taking behaviors leading to HIV infection."
~ Jean Malpass [The Body] Strong negative beliefs about who you are and your relationship with others lie at the root of depression. Loneliness, isolation and low perceptions of self-worth and body image fuel internal homophobia, feed
emotional insecurity and erode self-esteem, destroying one's ability to be naturally intimate with other people. Depression is up to six times higher among MSM and the trigger for aneasthetisingly addictive and destructive behaviours, which some realise in the habitual seeking out of risk-filled sexual situations that enable false intimacy. In such situations, the advent of meth in recent years has been hailed as the ultimate liberator from the recurring, judgmental soundtrack of socially-conditioned shame and religiously-indoctrinated guilt, completely silencing the negative messages, disinhibiting the user and erasing all barriers, enabling him to connect and initiate anxiety-free and boundary-less sex with ease. Meth acts as an 'equaliser', allowing users to meet across social spectrums and divides like age, class, race and economics, devoid of the anxiety that can impede sexual performance or social interaction between strangers. Such is the low self-esteem and sense of self-attractiveness of some driven to using crystal that a glass pipe and gas lighter are often the first items to greet users on entering each others' homes, along with an unwritten rule of the drug's culture that verbal communication and eye contact are to be avoided at least until the drug's intoxicating effects kick in. It would be wrong to use low self-esteem as the crutch for all gay men who use crystal meth. For some, meth underpins a culture of drug-fueled, reckless hedonism where peer and lifestyle pressure is the overriding factor for using. In such situations, meth is commonly introduced to unwitting first-timers and among reckless groups of friends as a "fun drug" or energiser, with no warning given or attention paid to its addictive qualities or devastating side effects, enabling users to party endlessly and feel exhilarated, loved and accepted. Those fully aware of the dangers may nevertheless decide to take a calculated risk to use, particularly in what they perceive to be a controlled situation, while others who harbour a deep-rooted, unrealised desire to bareback may use crystal fully conscious of the fact that it will tempt them into breaking that taboo. According to the Centres for Disease Control & Prevention, 15-17% of all gay men used crystal meth in the three months to August 2005. It is estimated that 30% of all gay men in the US have tried meth at some stage. |
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Experts in gay health worry about meth, sex In the gay community, the practice is referred to as "Party and Play" or "P 'n' P." On a chat room accessed through gay.com, one man refers to himself as "P 'n' P friendly." Another visitor to the site says he "likes to 'P and P.' " The phrase refers to a person's willingness to use methamphetamine and engage in sex, a growing practice that has gay community health experts and the Utah AIDS Foundation worrying about increases in high-risk behavior and sexually transmitted diseases, particularly HIV. "It is a big factor," said Chad Hermandorfer, 33, who worked for four years as an organizer of the Intermountain Gay Men's Health Summit. "When people get high or use drugs and alcohol, they tend not to be as safe. They do not use wise judgment. They are more promiscuous." <STYLE type=text/css>
</STYLE> "It is a concern," said Stan Penfold, executive director of the Utah AIDS Foundation. "We don't know how extensive it is, but we know it's happening." The foundation has created a Web site, www.utahtweaker.com, to provide education and referral resources to men who have sex with men and are former, current or future meth users. As in other social groups, methamphetamine or "crystal" use has exploded in the gay population. It is the most frequently used drug while having heterosexual or homosexual sex in the state, according to the Utah Bureau of Communicable Disease Control. In 2004, male-to-male sexual contact was the most common means of HIV/AIDS exposure, according to the bureau. Injection of drugs by gay men was the second-highest means of exposure. They account for 11 percent of the 751 current HIV cases in Utah, the majority likely doing meth. The Utah AIDS Foundation will host a substance abuse panel 6:30 p.m. Thursday at the Salt Lake City Public Library. Panel members will share personal experiences about how drugs affect their lives. "P and P" is part of a national drug and party culture in a portion of gay communities. Recent research shows meth use is associated with high-risk behavior and sexually transmitted diseases, including HIV, among gay men in San Francisco. A Centers for Disease Control and Prevention study of 388 men found 16 percent used the drug the last time they had sex. Another study showed meth users were twice as likely as non- users to be HIV-infected. And throughout the nation, health experts concerned about the gay community have scrambled to address the issue through ad campaigns and Web sites. "Anecdotally we know that the problem is very widespread and that it is leading to increasing in HIV infections," said Thomas Hughes, HIV prevention specialist at the Utah AIDS Foundation. Meth use contributes several complicating and dangerous factors for people in the gay community, he said. Meth users lose all inhibitions. They engage in sex for longer periods of time while high, which creates a considerable problem where disease is concerned, Hughes said. "There are more fluids being exchanged and there is a higher likelihood that sexually transmitted diseases -- including HIV -- will be transmitted." E-mail: [email protected]; [email protected] Deseret News, 2005 |
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While most US porn labels and directors exercise a zero-tolerance policy towards drugs on set, a range of "bareback" titles has emerged in recent years which capitalise on the demand for passionless, frenzied pig
sex. The makers steadfastly defend their right to depict condom-less sex between consenting adults, arguing that they are filling a public demand for such videos and that participants claim to already be HIV+, but safe sex advocates assert that bareback videos glorify unsafe sex and are a green light for their audiences to dispense with precautions. One US production company has admitted bribing actors of undisclosed status to perform without protection, while in the UK, three young men performing bareback for the Icreme label in 2007 were infected with HIV on the same shoot. "Several of my models have been transformed from the most beautiful men I have ever worked with to horrifying, weak creatures I would never be able to use in my movies again," gay porn producer Michael Lucas told New York Blade in 2004. Many porn actors survive hustling off the back of their films, and crystal is regarded by some as an essential tool to break down barriers with the client. A few also deal meth to clients to supplement their incomes. "The comedown can be soul-destroying. It gets deep into you. It's pervasive, and undermines your spirit as well as your personality. When I'm on crystal I don't like myself. I'm a dick."
~ Aiden Shaw [Porn actor] Viagra's arrival coincided with the emergence of internet sex sites which represented a seismic shift in the way that MSM pursued sex, making it easier to access and more upfront. “It was spring �?9, and we were starting to see a small increase in the number of syphilis cases in gay men... and by the next spring there were already another ten. I asked this one guy how many sexual partners he had had in the past two months and he said 14. Then I asked him how many he had had in the past year. And he said 14. I said, ‘Well, what happened two months ago?�?The man replied: ‘I got online.�?�?BR>~ Jeffrey Klausner [San Francisco Department of Public Health] Overnight, sex became as easy to acquire as home-delivered pizza. A core group of users emerged who remained on-line 24 hours a day, compulsively panning and scanning each others' profile pictures and sexual demands with a view to hooking up with as many different partners as possible, many upfront in their preference for "BB" (bareback) action. "It was terrifyingly easy to find others like myself online," a recovering meth addict told The Advocate. "All you do is create a profile that contains "party" or "PNP", meaning "party and play" - euphemisms for a cluster of speeding, clench-jawed, sweating men who have been reduced by crystal meth to the status of rutting animals, each aware only of his own distorted desires." "With crystal and the internet, we’ve got bathhouse conditions again. Some gay sex sites have been turning a blind eye to crystal references and have even been encouraging them."
~ John Cameron Mitchell [Pop cult hero] Rationalising an unexpected fall in the number of new HIV cases among gay men in San Francisco between 2004-05, attributed largely to the efectiveness of hard-hitting AIDS campaigns, a Kaiser Family Foundation report surmised that such sites may now be helping to reduce the spread of HIV and STDs, due to HIV+ MSM using the services primarily to find others of similar status (serosorting). "What seems to have happened in San Francisco is that men with HIV now form a critical mass of potential partners, disclose their status upfront, and keep the virus within the boundaries of their own world."
~ Andrew Sullivan [AIDS activist] Overall, however, such sites have unquestionably facilitated the spread of HIV and crystal meth due to the ease with which they allow people to meet across social spectrums, devoid of the need for social graces like eye contact and conversation. "If you think of the traditional way that guys meet each other in bars, there are social norms," says Dr. Perry N Halkitis, a psychologist at New York University studying the correlation between meth use and HIV infection. "But when you're home alone, potentially getting high by yourself, those social norms go out the window." "When it started it was fun, but over time the tweakers drove everyone else away," says Scott, a former Men4Men4Sex.com (M4M) member. "The owners of M4M have themselves to blame because they failed to police their content to the point where it reached an absurd level of depravity. I mean, would they allow profiles that solicited others to shoot-up heroin or crack cocaine together? Of course not, yet they turned a blind eye to crystal." Hook-up sites like M4M and the UK's Gaydar continue to turn a blind eye to the problem of members using their services to openly promote unsafe sex practices and meth use. "I have no more power to regulate who hooks up with who than the bartender at a bar or the bouncer at a club," claims M4M site director Steven Alexander. Gaydar co-creator Henry Bedenhorst argues a similar line, insisting" "We can't stop people from barebacking, and banning users would only drive it underground. This way, others know who is into what," despite incidents such as that experienced by a Gaydar member who terminated his profile because he was being pestered to participate in "slamming parties" at a London apartment. "That was bad enough," he said, "but they were also stressing that the same needle had to be used by everyone." In contrast, SafeSexCity.com, established in 2003, provides an environment in which men can hook-up, confident in the knowledge that they will not be confronted or pursued by destructive individuals high on meth, while Manhunt.net provides free profiles to over 48 community-based organisations. "We offer free advertising space for programs like Syphilis is on the rise, Crystal Free and Sexy, LIFE OR METH, and many other important media campaigns such as clinical trials for HIV prevention and treatment," says Manhunt General Manager Stephan Adelson. "To ensure that members were aware of the increase in syphilis in their area, we sent a letter to all members in San Francisco to inform them of the current outbreak and encouraged them to get tested." Unique among hook-up sites, Manhunt has forged a partner notification program that lets members know when they may have been exposed to an STD through another member, helping to substantially reduce new cases of early syphilis. "We now include the option of listing HIV status in profiles," says Adelson. "'No PNP' is listed as something men are into, and we have added a help centre where members can find support professionals on the site quickly. Manhunt has accepted the call to facilitate change in our community by encouraging education and fostering honest, open communication, and we have done so at our own cost." All programs and services provided on Manhunt.net are free. "It is sad that others in this industry feel it necessary to charge their standard rates for the little that they do to support our community," Adelson concludes. "As webmasters in the dating/hook-up business, it is our social duty to facilitate positive change
in the communities we serve. We must overcome any fear-based rationalisations to do otherwise. We are in a unique position to facilitate change." |
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46% of men who have sex with men (MSM) who use crystal face greater risk of HIV infection, says a new US study that establishes an independent, causative link between the two. The study confirms that, when combined with other risk factors like unprotected receptive anal intercourse with multiple partners, meth increases the chances of seroconversion substantially, and also reports a threefold increase in the risk of acquiring HIV among those with a history of meth and popper use compared to those not using either drug. The analysis, reported by researchers associated with the Multicenter AIDS Cohort Study (MACS), will be published in a forthcoming issue of the authoratitive Journal of Acquired Immune Deficiency Syndromes. Previous behavioral studies into the link between meth use and HIV infection have served to demonstrate that MSM meth users are more likely to engage in high-risk sexual practices, putting them at an increased risk for HIV and other sexually transmitted infections. While such studies have shown that a correlation between meth use and HIV infection among MSM existed, they did not support the hypothesis of causation between the two, which the MACS does. "The strength of the MACS," according to David Ostrow, MD, PhD, of the Chicago MACS Centre and a member of the research team, "is that it is a relatively stable population of gay and bisexual men that has been followed prospectively since 1984, at the very beginning of the scientific study of the natural history of AIDS, with additional men recruited in 1987 to 1988 and 2000 to 2001. Given the semi-annual visits at which both behavioral and medical, as well as HIV testing and assessment is performed, we can look at causal relationships between sexual or drug behaviors and seroconversion, even though the exact nature of that causality is not necessarily elucidated in the study." Of the 6973 negative and positive MSM recruited into the MACS study, between 23 and 28% seroconverted at some point, while a similar number remained negative. 4,003 MSM who were HIV- upon entering the study were included in the meth analysis. Those who seroconverted were similar to those who remained negative in terms of age, race/ethnicity and educational levels but were more likely to have used meth, poppers, cocaine or ecstasy during participation, and 94% reported having unprotected receptive anal sex on at least one occasion. In light of the new findings, Dr. Ostrow advocates moving beyond criticism of studies that don't fully elucidate the causal relationship between meth use and HIV risk, particularly by numeorus Western HIV/gay men's sexual health organisations who have waited years for such proof to emerge, and who have used the lack of conclusive data to avoid taking effective action against meth. "It is dangerous to rely on the lack of a 'smoking gun' in terms of the exact mechanism to deny the need to recognise and change one's behavior to avoid HIV infection or transmission," Dr. Ostrow said. "This is analogous to the public outcry when I and others suggested in 1982 that gay men refrain from unprotected anal intercourse until we knew what was causing AIDS, as we definitely knew that unprotected anal sex was the leading route of infection or exposure to whatever the causal factor would turn out to be." [See AID$ INC. UNCOVERED] "In a study of HIV+ individuals being treated with highly active antiretroviral therapy (HAART), current meth users had higher plasma viral loads than those who were not currently using meth, suggesting that HIV+ meth users on HAART therapy may be at greater risk of developing AIDS."
~NIDA Researchers at the University of Buffalo have found that methamphetamine promotes the spread of HIV-1 in users infected with the virus due to physiological changes that favour transmission. Ingestion of meth increases production of a "docking" protein that enables the spread of the HIV-1 virus said Madhavan P. N. Nair, a professor of medicine and a specialist in immunology in the University's School of Medicine and Biomedical Sciences, and lead author of the study. "This finding shows that using meth is doubly dangerous," he said. "Meth reduces inhibitions thus increasing the likelihood of risky sexual behavior and the potential to introduce the virus into the body, and at the same time allows more virus to get into the cell." It is now being debated whether meth's ravaging effect on the immune system actually replicates many of the symptoms associated with full-blown AIDS regardless of whether HIV - or rather the antibodies that suggest infection - is present, in much the way that AZT is increasingly suspected of inducing and accelerating full-
blown AIDS symptoms and premature death in patients due to its high toxicity. Some MSM believed to be immune to contracting HIV, perhaps due to a rare protective protein in their blood, have developed full-
blown AIDS only since becoming addicted to crystal. MSM who used meth in the last year were found to be five times more likely to seroconvert than MSM who did not use, according to preliminary data collected by the Los Angeles Gay & Lesbian
Centre from 6,360 men it tested in 2006 for HIV and other STIs. The centre also found that 25% of all MSM reported using meth at least once during the period, compared with 18% of the 5,300 MSM it tested in 2005, with 43% of those newly-infected with HIV reporting some meth use. "There's no doubt in the minds of most experts that meth contributes not only to the transmission of HIV but other STIs," said Jonathan Fielding, director of the Los Angeles County Department of Public Health. The findings have once again prompted a news conference to increase public awareness about meth use along with a forum in West Hollywood to discuss expanded treatment options. Meanwhile, the LA County Department of Public Health has reported that around 10% of all MSM reported using crystal within a six-month period - a frequency about 20 times greater than in the general population. Meth has become the number one drug used by individuals seeking treatment in LA county-funded programs, with abuse rising across all demographic groups between 2001 and 2005. The county has funded three new HIV/meth-prevention programs addressing the disease and drug use aimed specifically at MSM. "At least 25% of occasional meth users are HIV+. This number rises to 40% in chronic users. At outpatient treatment centres 60% of clients are HIV+, while 90% of inpatient programs' patients are HIV+. In fact, meth users are more likely than heroin users to be HIV+."
~ Dan Bowers [HIV Plus] Because meth stimulates the central nervous system and focuses the user's mind on the present moment, all fears anchored in the past and future - including those based around HIV and AIDS - evaporate along with his inhibitions, and his deluded feeling of invincibility induced by the sensory high can easily tempt and persuade him to overlook his responsibility to protect both himself and his partner. Paradoxically, meth is used by some MSM specifically to disassociate from the fear attached to sex in the post-AIDS era. Combination therapies, protease inhibitors and other drugs in development are often cited as justification for unprotected sex, although there remains no cure or vaccine for AIDS, which continues to be a chronic and deadly disease. A 2005 survey in Los Angeles found that 7% of HIV- men took an AIDS medication before engaging in risky behavior believing that they would be protected against HIV. "People have safe sex fatigue; they are fed up of having to be afraid of HIV. In these circumstances, crystal is the perfect Petri dish for transmission."
~ Peter Staley [Founder of AIDS Meds] The results of a study by San Francisco's University of California reveal conclusively that meth use by HIV+ people: �?nbsp;Quadruples the risk of unprotected insertive sex with an HIV- person or a person of unknown status; �?Increases the risk of transmitting drug-resistant strains of HIV; �?nbsp;Raises the risk of having unsafe sex with a partner of unknown status if used with Viagra. The union of crystal and Viagra - and, to an extent, recreational drugs like GHB - has boosted the HIV transmission rate across the States in recent years, and a similar pattern is emerging in other countries where meth is gaining a foothold in urban gay communities. A 2005 London study found that a fifth of all HIV+ men in the city had used meth in the previous 12 months - twice the number of HIV- men - increasing to over 30% for those with multiple partners. HIV+ men are increasingly self-medicating with crystal meth in order to: �?nbsp;Erase chronic fatigue syndrome; �?nbsp;Alleviate the often unpleasant physical and psychological symptoms arising from the endless cocktail of often highly toxic drugs they are prescribed; �?nbsp;Quell feelings of hopelessness and despair, "survivor guilt" and the spectre of death, especially among those living in AIDS-ravaged ghettoes; �?nbsp;Temper negative self-perceptions and social rejection associated with being positive. Together with the rediscovered appetite for sex that crystal triggers, HIV+ users argue that the crash is a price worth paying, even though it is by far the worst drug possible for those with HIV because it: �?nbsp;Accelerates HIV replication five to 15 times faster than the replication of HIV not exposed to meth - thereby triggering the onset of full-blown AIDS - due to the erosion of the immune system caused by missed meals, vitamin depletion, weight loss and disrupted sleep patterns; �?nbsp;Ravages and depletes T-cell counts at an alarming rate by impairing the function of cytotoxic lymphocytes, which are critical for the immune system's first response to HIV, meaning that the user will need to go on medications sooner than he otherwise would have done (a HIV+ New Yorker is reported to have lost 250 T-cells over one weekend binge); �?nbsp;Boosts viral loads and susceptibility to illnesses because the mind-impaired abuser frequently forgets to take his time sensitive dosages of HIV medication; �?nbsp;Heightens the body's susceptibility to other strains of HIV (superinfection) and STDs; �?nbsp;Inhibits the effectiveness of HIV medications and increases drug-resistance (26% of meth users in a US study group were resistant to at least one drug, and regular users were 2.3 times more likely to have drug-resistant HIV than non-users and 3.9 times more likely to have resistance to efavirenz and/or nevirapine). �?nbsp;Floods the brain when used with protease inhibitors because it shares the same liver processing pathway, increasing the likelihood of addiction and brain damage (Amprenavir alone boosts the amount of meth in the bloodstream two-to-threefold, putting the user at risk of overdosing); �?nbsp;Exacerbates dopamine depletion (HIV+ infection alone destroys 12-20% of dopamine-associated brain cells), inducing an accelerated form of dementia (basal ganglia dysfunction) and Parkinson's-like movement disorders and loss of verbal skills (concurrent meth abuse and HIV infection appears to result in far greater impairment than each condition alone); �?nbsp;Damages the lining of the blood vessels in the brain allowing more HIV-infected cells to reach there, which can lead to HIV encephalitis (brain inflammation); �?nbsp;Is a long-acting, indirect sympathomimetic and far more immuno-suppressive than HIV, leaving someone immuno-suppressed for days on end regardless of whether they are positive or negative; �?nbsp;Increases the risk of rhabdomyolysis - a potentially fatal disease that destroys skeletal muscle - if the user needs to take a statin to lower cholesterol levels. The Centres for Disease Control and Prevention estimates the US HIV infection rate among MSM has risen 14% since 1999 - the biggest increase since the epidemic began over 25 years ago. It recorded an 8% increase in HIV diagnoses among MSM between 2003 and 2004 alone after several years of relatively stable data. "We don't yet have all of the answers regarding the factors driving these trends," Ronald Valdiserri, acting director of the CDC's National Center for HIV, STD and Tuberculosis Prevention, said at the time. "All our current research says that the vast majority of gay men are not using a condom every time they have sex."
~ Michael Shernoff [HIV+ gay psychotherapist] HIV+ men who engage in unprotected sex with each other (serosorting) are at risk of catching or transmitting more virulent and drug-resistant mutant strains of the virus. Re-infection (superinfection) can destroy the immune control built up fighting the original strain, jeopardising the progress of AIDS vaccines already in development. Some highly sexually active men who were assumed to be immune to catching HIV have seroconverted since succumbing to crystal, which is shown in tests to destroy the rare protective protein in their cellular make-up. Mental health problems like clinical depression and anxiety are greatly exacerbated by crystal use, particularly among those with HIV or AIDS. Manhattan-based psychiatrist Dr. Steven Lee - author of Overcoming Crystal Meth Addiction - reported that when he first became involved with the city's Callen-
Lorde Community Health Centre mental health clinic in 1999, one in 10 gay patients with psychiatric problems was meth-related. By 2004 that figure had risen to one in three. "Some of my patients talk about how they feel on crystal meth as akin to being robots programed with the sole purpose of doing more crystal and having more sex," Lee told the New York Times. "Most people will seek some form of escapism... But people living with depression, expressing feelings of despair and hopelessness, will often look in the worst places to find it... I know I never consciously set out to become infected [with HIV]. I just didn't value my life enough to care about protecting myself."
~ Joe Chown [Positive Nation] In a 2001 study of HIV+ men who use meth, published in the US Journal of Substance Abuse Treatment, 81% reported having a lifetime diagnosis of depression and 42% were taking psychiatric medications. Some participants reported being prescribed Ritalin by their childhood doctors because they were seen as hyperactive and/or suffering from attention deficit disorder (ADHD). Due to the restrictions of the US health-care system, they self-medicated their ongoing condition with crystal. Similarly, meth is used by some individuals with bipolar disorder to self-medicate the manic highs and depressive lows of the disease. 84% of the study group reported engaging in risky sexual behaviour with most tending not to disclose their HIV status to casual partners, operating from the assumption that it is the responsibility of the partner(s) to use condoms and/or to define what is "safe". Where HIV status was not discussed, participants assumed the partner or partners to be positive. In many cases, meth use tended to increase dramatically following the fatalistic perspective of an HIV diagnosis. Those who believed they were going to die described their decision to "go out with a bang", and meth was viewed as a means to an end. "I doubled my meth use," explained one of the survey's participants. "You go off and party blindly. Although it affects your health, you don't care because you're on your way out anyway." "Sex on meth is completely physical," described another. "It's about pushing my limits. The nastier the sex, the better; nastier being a lot of exchange of bodily fluids [and] multiple partners, one right after the other, for hours and hours of rough sex." Another survey respondent remarked: "I don't feel any real connection to my partner. I kind of detach myself from the whole situation knowing that this is just sex, and it's not going to lead to anything more. And I'm less concerned about hurting someone's feelings when on meth. You think differently on meth, like when they don't ask to use a condom. I think if that is what you want, then you take your chance buddy. Later I think that's not me - who was that person?" Other participants in the survey reported using meth to deal with social rejection arising from their HIV status ("Meth anaesthetises. It's a way to deal with emotional pain so that [rejection] isn't so hurtful") and memories of being abused during childhood ("I have these old tapes that say I'm not good enough, nobody wants me. Those tapes don't play when I'm on meth.")
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In February 2005, officials from the New York Department of Health and Mental Hygiene called a news conference to report that a resident infected with a highly drug-resistant and "aggressive" strain of HIV had progressed to full-blown AIDS within just months of diagnosis, raising the spectre that a hard-to-treat variant of the virus could be spreading, particularly among promiscuous meth users. Diagnosed with HIV in December 2004, health officials said the 46-year-old man - who used meth about once a month over the past five years, escalating to every weekend in 2004 - reported having unsafe anal sex with over 100 partners he met online and at Chelsea's notorious West Side Club bathhouse during the previous fall, including two occasions when he was the recipient of unprotected anal sex, which was not his usual practice. While the department has yet to conclusively confirm whether or not their original prognosis was correct, it did highlight "disturbing behaviour patterns" revealed by its investigation into the patient's recent sexual history. "The social network surrounding this case indicates that unsafe, anonymous sex, along with the use of illicit drugs including crystal methamphetamine, remains common," it said. "It's a wake-up call to men who have sex with men," said the department's Commissioner, Dr. Frieden, at the height of the scare, "particularly those who may use methamphetamine. "Not only are we seeing syphilis and a rare sexually transmitted disease - lymphogranuloma venereum - among these men; now we've identified this strain of HIV that is difficult or impossible to treat, and which appears to progress rapidly to AIDS. This community successfully reduced its risk of HIV in the 1980s, and it must do so again to stop the devastation of HIV/AIDS and the spread of drug-resistant strains." Dr. Frieden was accused by AIDS agencies and activists of using scare tactics with the intention of shocking gay men into practising safe sex, while some community leaders expressed a vehemence of denial not seen since the early 1980s when the first cluster of AIDS victims were reported to be exclusively among MSM. Awaiting the outcome of the ongoing investigation, Dr. James Braun, president of the Physicians Research Network - which represents clinicians who treat tens of thousands of AIDS patients - said that the transmission of a treatment-resistant strain of HIV was "a disaster waiting to happen, particularly in communities where safer sex is not practiced regularly, and in light of people using drugs like crystal meth", an opinion echoed by New York University psychologist Dr. Perry N. Halkitis - "This is what we were fearing all along" - and others who have long predicted the emergence of a supervirus resistant to the existing AIDS drugs. "You can't have a core group of people having sex with large numbers of people without amplifying any sexually transmitted disease that enters the system. I don't have any doubt that a resurgent HIV epidemic will hit the gay population in the near future."
~ Gabriel Rotello [author of Sexual Ecology: AIDS and the Destiny of Gay Men] Dr. Jeffrey D. Klausner, the director of sexually transmitted diseases for the San Francisco Department of Public Health, publicly stated his belief that meth, and not the HIV virus itself, was to blame for Patient Zero's rapid acceleration to full-blown AIDS, as the drug is known to drastically lower CD-4 cell counts. With such an alarming picture emerging from the twilight world of meth-fueled sex, gay rights groups and AIDS prevention workers expressed anguish and dismay that the 25 year fight against the disease appears to be lost. Fearing that aggressive government intervention might ensue in light of the publicity surrounding the New York case and unless recklessly promiscuous gay men quickly change their behaviour, some are advocating a radical approach to the spread of crystal meth-induced unsafe sex; directly targeting those who knowingly engage in such behaviour and attempting to stop them before they can infect others. This could involve showing up uninvited at sex venues and confronting patrons head-on, or infiltrating web sites and thwarting liaisons that involve meth. "It makes a community stronger when we take care of ourselves," says Ana Oliveira, executive director at GMHC [Gay Men's Health Crisis], "and if that means that we have to be much more present and intervene with people who are doing this to themselves and others, then so be it." "Gay men do not have the right to spread a debilitating and often fatal disease. A person who is HIV+ has no more right to unprotected intercourse than he has the right to put a bullet through another person's head."
~ Charles Kaiser [Historian and Author] Others are sceptical of such an approach, which would have been unthinkable in the pre-meth AIDS era when gay men protested state efforts to close bathhouses and vigorously fought attempts to trace those infected with HIV. "That was the era when Jesse Helms and others were saying that gay people got what they deserved, and that the government shouldn't spend any money to help them," said David Evans, an HIV prevention advocate. "There was a time when people thought, Oh my god, they're going to put us in camps!" "We don't want public health vigilantes going out and taking matters into their own hands, particularly if it means breaching the confidentially and civil rights of people with HIV. Frankly, I find it pretty scary."
~ Jon Givner [Director of the HIV Project at the Lambda Legal Defense and Education Fund] Walter Armstrong, editor-in-chief of POZ magazine, suggested a more sensitive, interventionist-based approach involving gay organisations using traditional public health measures, such as more widespread screening and a partner-notification effort to track recently-infected meth users. "Why would it not be possible to get them together to communicate to each other, and then to their sex partners, that lives are being put at risk by reckless behaviour?" he wrote. Walt Odets, a clinical psychologist, thinks such a move would smack of a witch hunt, preferring instead to identify the underlying causes of drug abuse and self-destructive behaviour, including the paradox of living in a society that rejects committed gay relationships while condemning gays for having sex outside those relationships. "Gay men," he said, "are using methamphetamines as an anti-depressant." Ongoing adverse coverage of the role meth is playing in the lives of MSM risks igniting a backlash among New Yorkers who are fed up with the inconsiderate behaviour of abusers, including from within the gay community itself. Wrote one embittered Chelsea resident in the New York Blade: "The WMD are in the back rooms, no pun intended, and guess what? I am sorry that I have already sent my year-end contribution to GMHC... The world is over-populated so a not fond farewell is wished to you all." "It is just a sin when we know how [HIV] is transmitted from one person to another. [They] should be able to conduct themselves such that they don't catch it themselves, and certainly that they do not infect anybody else."
~ Michael Bloomerg [Mayor of New York City] �?nbsp;Recent studies suggest that up to a quarter of new HIV infections in the US may be with drug-resistant strains - up from 13% ten years ago - with 8-20% resistant to one drug class, and 1-4% multidrug-resistant. |
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New data shows that the number of MSM using cystal meth in San Francisco has almost halved in three years, thanks largely to no-nonsense, PC-free campaigns like 2004's Crystal Mess. Dr. Willi McFarland, director of HIV/AIDS statistics and epidemiology at the San Francisco Department of Public Health and an expert on drug trends, has released data from surveys of nearly 5,000 men who have sex with men (MSM) - spanning 2003, when US experts first started observing and acknowledging the correlation between crystal use and HIV infection, to early 2006 - showing the number of users within the three years the data was collected falling from 11.8% to 6.6%. The fall was lower among HIV+ MSM, for whom the rate of crystal used with sex fell from 24.8% during the same period. The accumulated data persuasively points to what most MSM meth users have known all along; that risky sexual behaviour - particularly unprotected anal sex -increases when meth is combined with sex. "There has been a heightened awareness about the potential risks of crystal meth use," says Steven Tierney, co-chair of the Mayor's Task Force on Crystal Meth. "We set out to change the community norm that this was not just another innocent party drug �?that this one was a little more dangerous �?and that people should be careful. That's had a big impact." The number of agencies providing services focusing on crystal meth addiction have risen from six to 34 since the Task Force was estabished, and it has been successful in securing sizeable state funding. Meth's decline among the Bay Area's MSM is directly related to a corresponding fall in new HIV transmission
cases, which have leveled off since 20012. The stable infection rate of between 800-1000 a year is attributed to successful, hardhitting prevention campaigning by community agencies, particularly the Stop AIDS Project, and widespread serosorting, in which men seek out same HIV-status sex. 2005 recorded an overall 21% decline in new cases since 2001, bucking a trend which saw an overall 8% increase in MSM across the US in 2005, according to the DPH annual HIV/AIDS Epidemiology Report for 2005. Indeed, so effective have upfront campaigns been at reducing HIV infections among gay men that HIV itself has been demoted from epidemic to endemic status by the city's leading health officials. "It's encouraging and shows that social marketing campaigns can be effective, that the San Francisco gay male community cares about these issues and that they can be effectively mobilised," says Dr. Jeffrey Klausner, director of the STD Prevention and Control for DPH, although Jason Riggs, communications director at the Stop AIDS Project, cautions: "We've seen a decrease, but it doesn't mean that we are not also concerned about its ongoing use and infection rates." Health officials, meanwhile, are at loggerheads over whether to encourage serosorting as a method of restricting HIV infection, noting that HIV- men who serosort cannot be certain that their patner is HIV- too, while HIV+ men risk acquiring STDs which may compromise an already weakened immune system, as well as contracting new strains of the virus which may impede the effectiveness of antiretroviral medications. "It is not our responsibility to be encouraging people to do things that have an element of risk involved just because they may be, overall, a good public health strategy," says Robert McMullen, executive director of the Stop AIDS Project. "It is a loaded gun." "Crisis to me is an uncontrolled situation that has not been responded to. Three years ago we were in crisis. Now we are in response mode."
- Dr. Jeffrey Klausner [San Francisco Department of Public Health] San Francisco has led the way in educating gay men about the dangers of crystal meth and stigmatising its use. In January, the Stonewall Project launched the "Hot Sex Without Crystal? Hell Yes!" poster campaign, featuring eight well-known gay porn actors who volunteered their time to promote the message that hot sex on a natural high is not only possible but sexy too. Posters are appearing around the Castro area. Due to funding constraints, Stop AIDS Project has not launched a new HIV-specific campaign since 2002, instead opting to focus its advertising on combating meth use and reorganising its HIV prevention work to target specific areas where MSM congregate, such as gyms, bars, the internet and the leather community. In 2004, the Project teamed up with the San Francisco Department of Public Health's HIV Prevention Program to launch the confrontational Crystal Mess campaign in an effort to combat soaring HIV and syphilis infections caused by meth use. With images of users tweaking, crashing and engaging in high-risk behaviours, the posters adopted a no-nonsense, in-your-face approach with messages such as Crystal plays more tricks than you can, Hot? Not and You're in for a bumpy ride. A year earlier, a televised "hearing" on local public-
access cable TV, designed to bring the meth problem into the open, was attended by public health authorities and members of the gay community. At the same time, the San Francisco Chronicle published a three-part article, The Dance of Death: "Bay 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," wrote journalist Christopher Heredia, who reported that health experts estimated up to 40% of gay men in the city had tried crystal, while a 2002 study at one high-risk clinic found that 25-30% of those with new HIV infections had used the drug in the last six months. "It's unraveling our community," a Stop AIDS Project spokesman told the Chronicle, while San Francisco prosecutor Liz Aguilar-Tarchi, head of of the district attorney's narcotics unit, said that the problem was being amplified 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 asked. "They are aware. Culpable is a strong word...but they sort of shut one eye to it." That summer, a frustrated 45-year-old resident plastered bright neon orange posters around the Castro area, proclaiming Queer Life is Fresh. Speed is Whack!! "The community has gotten lost on speed," the anonymous guerilla stickerer told the Bay Area Reporter. "It looks away at all kinds of problems. I am sick and tired that the community doesn't want to talk about it. It affects all of us, even though we think it doesn't." His unorthodox approach sparked fierce debate in the local community and among staff at substance abuse and HIV-prevention agencies. Almost every gay man in San Francisco, and in many other cities, knows someone who has lost a friend, roommate or partner because of that person's crystal use. Moreover, crystal use is eroding trust and friendships, the very foundations of community.
~ Jason Riggs [Stop AIDS Project] San Francisco's declining rates of HIV infection and meth and substance abuse may in part be due to a shift in attitudes spurred on by the city's relentless efforts to allow gays to marry. "(He) has made marriage chic," explains Mayor Gavin Newsom's advisor, Jeff Sheehy. "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. I know more people having more kids now than ever. We are seeing a percentage of the community making healthier decisions about their lifestyle."
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Syphilis has made a major comeback among MSM in America - several years after rates had declined so low that a strategy had been formulated to eliminate the STI by 2005. For the seventh year in a row, the rate of secondary and primary syphillis infection across the US between 2006 and 2007 increased by 14%, to 11,181, with MSM comprising approximately 64% of cases compared to only 5% of all reported cases in 1999. Syphilis rates are up to 4.9 times higher among crystal users, while men who use meth and Viagra together are 6.1 times more likely to have syphilis than those who used neither drug. Syphilis sores and other STDs increase the chances of HIV sero-conversion two to five-fold and can cause bigger than usual drops in CD4-cell counts and greater increases in viral loads in those infected with the virus, according to a report in the journal AIDS. In New York City, syphillis rates soared 62% in 2007, almost exclusively among MSM. Two-thirds of New York-based MSM infected with both syphilis and HIV are known to engage in unsafe sex. With the risk of syphilis spreading via bisexual men into mainstream society, several cities including Los Angeles have aimed syphilis campaigns on web sites and billboards at heterosexuals, despite the surge in syphilis and HIV transmission since 1998 being linked to the rapid spread of crystal meth among MSM, which continues to go largely ignored and unchallenged. Official rates of syphilis and HIV infection in countries where crystal meth usage among MSM is rife clearly do not tell the whole story. A sizeable minority of gay men are psychologically predisposed to self-harm, with some actively seeking out and indulging in behaviours destructive to themselves and others. Anecdotal evidence strongly points to crystal meth being embraced by such individuals, despite knowledge of where using the drug can lead, and who are least likely of all MSM to voluntarily take an HIV test. In Australia, it is estimated that 70% of MSM meth users never get tested, while in London, a 2005 study reported that more than five times as many HIV+ men with multiple sexual partners use crystal than HIV- men. Some users simply don't recognise the symptoms of seroconverting as their systems are too wasted and ravaged by meth. "I think many gay men have this kind of built-in self-
destruct button. After years of sexual frustration and really low-grade discrimination, it stores up somewhere and some drugs can really release that..."
~ Rufus Wainwright [Singer / Songwriter] Gay journalist David Evans, writing in POZ magazine, suggests that around 5% of HIV+ gay men keep a particular community's "viral wildfire" burning, and that the 95% of HIV+ gay men who fall outside of these "hot spots" typically have little effect on driving the epidemic. "It's long been known that some contribute much more to the spread of HIV than others," he says. "Ignoring that fact hampers our ability to slow HIV/STD transmission," he says. However, crystal is considerably exacerbating the numbers of otherwise responsible, self-respecting gay men who are linking up with the 5% core group, many of whom are rapidly seroconverting. A case in point is New York's "Patient Zero", [see "A wake-up call"] who suddenly found himself pulled into the high-risk "twilight world" of meth, saunas, sex parties and internet hook-ups. "If community-based prevention, including condom and clean needle distribution, can be said to be a failure, it is precisely because it has failed to adequately reach this crucial 5%," says Evans. "Science has advanced us a long way from the old notion that everyone is equally at risk and responsible, but prevention has yet to catch up." This nucleus of destructive individuals are also among those most likely to resort to injecting, or "slamming", crystal meth. "Slammers are a special breed among us," wrote Christopher Murray in New York Blade in April, "who push the envelope of what is acceptable among gay men, and who may help us understand the outer limits of behaviour that symbolises tensions that all of us share." During his research, one slammer told Murray that, in his opinion, "the prevalence of injecting meth is in direct relation to where gay culture is at," implying that the intense feelings of being an outsider - combined with the difficulty many gay men experience accessing intimacy - are instantly overridden by shooting meth, an act which merely "confirms the uniqueness of the loner mystique." Clearly, HIV transmission figures don't take into account how STDs are being indiscriminately passed on within this subgroup, and to those who overlap within it. Falling outside of the reach of research and studies conducted to determine the extent of risky sexual behaviours, despite being key players in the virus' spread - particularly via men who occasionally stray or crossover into their world, or those who also have sex outside of the core group - some regard HIV as a self-fulfilling prophesy and openly profess to having a "death wish", and a few are even vocal in their intent to bareback regardless and "to take as many others as possible down with me" [sic]. "People with HIV alone do have the power to stop new infections," asserts David Evans, "and not only through facing fears of disclosure and always protecting sex partners, as profoundly important as those are. The personal responsibility that is increasingly focused on all HIVers also offers the chance for our community to be leaders once again in prevention. Failing to do so, we risk being scape-goated - lumped together by an AIDS-weary, moralistic nation as reckless infectors... The ugly truth is that our epidemic is still driven by sexual promiscuity and drug addiction. As this news gets louder and more public, you needn't be psychic or paranoid to predict Jerry Falwell and James Dobson giving impassioned speeches, run hourly on Fox news, to criminalise gay sex in the interests of national secuirty. "Failing to reach - and reach out to - the most despised and irresponsible among us will lead to retribution against all HIVers." Craig Hayworth, the Director of Services at Callen-Lorde in New York City, acknowledges the frighteningly intensive role crystal meth is playing in the dramatic increase in HIV infections. "Much of the evidence is anecdotal," he told HX magazine last year, "but we know that almost 75% of our patients newly-infected with HIV say crystal meth use played a part in their engaging in unsafe sex." A 2003 survey by New York City's Department of Health and Mental Hygiene found that only 45% of men who had sex with men reported using condoms. "Few of us would ever admit it, but many HIVers consider the virus a gift certificate - a pass to unlimited pleasure. Some think they've earned the right to unprotected sex."
~ River Huston [POZ magazine] |
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So I am staring at my pile of pills. Two Kaletra, an AZT, two Invirase, Bactrim. Add to the mix a Claritin and a couple of Tylenol for the inevitable headaches. I will wash it down with a teaspoon of Mepron, and make sure I eat a decent meal with it, though the meds have made my taste buds interpret anything as metallic. I’m bitching, I know. Worst part? I isolated myself from anyone who might want to come over and hang out, mainly because Kaletra gives a person gas beyond my capacity to articulate. It's the worst of stuff; that's why forensic examiners dab Noxema or Menthol ointment under their nose before unzipping the body bag. It's like being an overinflated bag of humiliation... So I gag down the pills, at the cusp of feeling JUST a little better (my body’s signal that its time for more toxicity).
~ Jonathan's HIV Blog [AIDSMeds.com] In 2003, Rolling Stone magazine caused a storm across gay America by claiming that a number of gay men - "bug chasers" - deliberately set out to have high risk sex in order to contract HIV. The article, In Search of Death, suggested that 25% of HIV seroconversions among gay men in the US may be intentional, although the writer later claimed that the figure was fabricated without his consent. In 2006, British HIV+ journalist Ricky Dyer went undercover as an HIV "gift giver"/"breeder" for a BBC documentary, I Love Being HIV+, in which he secretly filmed numerous online encounters with "chasers" who had told him they were keen to "poz up". In reality, most of the men he met kept their ambition at the level of fantasy. Says Dyer: "Whether genuine or fantasy, bug chasers tend to fall into two main groups; 'Russian rouletters', who get off on brinkmanship and risk, and 'control seekers', who seek to eliminate that same sense of risk by getting HIV+." "Recently I was asked if I wanted to 'breed in negative arse'. It took me a while to work out what I was being asked to do... I can't be the only person who thinks that if someone is choosing the prospect of a lifetime of stomach cramps, diarrhoea and muscle wasting over having sex with a condom, they could really do with working on their self-esteem."
~ Joe Chown [Positive Nation] 2,500 men who have sex with men (MSM) were diagnosed with HIV in the UK in 2005, the highest number since records began. Data from a recent London gay men's sex survey concluded that while HIV- men are extremely aware of the HIV risks associated with receptive unprotected intercourse, a significant proportion still do not practice safe sex for a multitude of psychological reasons, including: �?nbsp;A desire for love, trust and intimacy greater than the fear of HIV;
�?nbsp;A misguided assumption that HIV happens to other people;
�?nbsp;A belief that HIV infection is not the worst thing that can happen;
�?nbsp;Repeated negative tests, confirming a sense of immunity;
�?nbsp;Fatalism regarding the perceived inevitability of becoming infected;
�?nbsp;The prospect of engaging in lots of unprotected sex with other HIV+ men;
�?nbsp;A willingness to share a partner's sero-status;
�?nbsp;The acquisition of attention and "victim kudos";
�?nbsp;The hope that having the virus will empower and make the individual a better person;
�?nbsp;Simple, plain excitement. "For some men, sex without a condom fulfills a variety of deeply important needs, some of which are actually spiritual. Then there are men who have taken on the identity of the barebacker because it is their way of remaining a sexual outlaw."
~ Michael Shernoff [HIV+ gay psychotherapist] "I [didn't] care enough about myself to prevent it happening... And perhaps, if I am really honest, I actually wanted some means of opting further out of 'normal' society that had never welcomed me... HIV was a further step away for someone already conditioned to feel like an outsider."
~ Paul Bakalite [Positive Nation] When the crystal meth high is thrown into the equation, it can prove potently persuasive in influencing such a person to risk acquiring HIV, and during the crash period when his mind is depressive and raped of self-
worth and respect, safe sex can fall way down the list of considerations. A 2002 study of 518 MSM in New York found that 49% blamed the rise of barebacking on "boring" safe sex campaigns and 48% cited treatments. 1,500 New Yorkers a year still die from AIDS-related illnesses, and a further 1,000 don't discover their status until already sick. "Some HIV prevention experts label the treatments 'protease disinhibitors', because they have lulled many gay men into believing that contracting HIV is less like getting cancer and more like getting diabetes, merely a matter of swallowing a few pills a day."
~ Johann Hari [Attitude Magazine] The "Lazarus effect" of combination therapies in stemming and even reversing the progression to full-blown AIDS - by blocking viral replication within existing cells at different stages in the life cycle of the virus - means that young MSM today aren't witnessing the harrowing, relentless death toll that defined the 1980-90s. Neither are they registering the impact of sustained, upfront safe sex campaigns which have all but dwindled in the wake of antiretrovirals arriving a decade ago, when AIDS agencies worldwide prematurely and recklessly hailed them as a silver bullet. "HIV meds aren’t a cure and can be lethal themselves. Despite all the advances, someone diagnosed with HIV is still likely to die from complications associated with the virus or the meds they’re taking to fight it. That’s a message that’s not getting out there, especially to younger gay men. A 21-year-old who learns today he has HIV can expect to die in his mid-40s."
~ Chris Crain [New York Blade] A tidal wave of complacency by the gay men's HIV sector has culminated in today's soaring conversion rates, particularly among younger MSM who naively perceive AIDS as a treatable and manageable disease, yet who have no concept of consuming a cocktail of noxious drugs at set times each day that induce, night sweats, nausea, insomnia, constipation and loss of appetite, to name a few of the side effects that are part and parcel of keeping AIDS at bay, not to mention the increased risk of developing lung, liver and heart disease and/or cancer from these toxic medications.
[See AID$ Inc. Uncovered] "When protease inhibitors arrived in 1995, consultants hit hard and hit early. By putting their patients on triple therapy regardless of CD4 count, they thought they were treating them correctly. After five years they saw the side effects: lipodystrophy, osteopaenia, lactic acidosis, enuropathy, heart, kidney and liver problems"
~ Jon Kaiser [US HIV Physician] HIV medications have created a further dichotomy in that the complacency that has crept in in their wake and served to undermine the threat of exposure to HIV has seen increasing numbers of MSM being diagnosed with HIV too late for such treatments to be effective. With up to 50% of people with HIV in the West aware of their status, in 2006 as in 1986 MSM are dying of ignorance, but this time around for all the wrong reasons; the British HIV Association alone estimates that 35% of HIV-related deaths in the UK are due to late diagnoses. "Having lived with, worked with and spent an inordinate amount of time with HIV+ people, I think I've seen, heard, smelt and dealt with just about every side effect known to man and a few that I swear have not yet made their way into medical books."
~ Andrew Balkin [Plusve] "Whenever I enter my [AIDS] clinic, no one is happy and most seem close to tears... Half of the people I chat to there say the same: 'Why did it have to be me, why do I have to live like this?'"
~ Andrew Nield [Positive Nation, June 2006] While the last decade has seen a stripping away of negative images and perceptions of HIV+ men, at what point does a more enlightened attitude actually become counter-productive? "You used to walk down the street and see death everywhere. People with lesions on their faces, people on crutches and in wheelchairs, if they could even go outside. I used to go to memorial services every weekend. This was a community of ghosts, and that is not true anymore."
~ Michael Siever [Stonewall] Adverts for protease inhibitors invariably portray HIV+ individuals as rippling, testesterone-soaked sportsmen engaging in active outdoor pursuits ranging from sailing to rock-climbing. Indeed, for many HIVers who once stared death in the face, muscle-enhancing steroids and growth hormones are part and parcel of their prescribed medication, leading some MSM to naively equate HIV as a short cut to a desired physical ideal. "All the ads in the gay press talk about how healthy, happy, active and handsome you can be if you take this new drug. Of course, it takes three pages for these ads - two for the photo of the healthy, active man and the other page for the eight-point type of horrifying side effects."
~ Here Magazine Some campaigners argue that propping up the self-esteem of HIV+ men has served only to overtake and obstruct HIV prevention work. "HIV prevention is not supposed to be about making positive men feel good about themselves," says New York psychologist Walter Odets. "It's supposed to be about protecting negative men." "AIDS prevention messages had not weighed the needs and experience of HIV- men specifically, choosing instead to broadcast a generic "play safe" themed tailored to avoid offending men who were HIV+. Other language in the AIDS liturgy seemed to dangerously minimise the impact of HIV and failed to state plainly that being HIV- is better than being HIV+."
~ Duncan Osborne [Author, Suicide Tuesday] In San Francisco, Stop AIDS Project was vehemently attacked by politically-correct AIDS organisations and community health groups for its upfront, non-sugar coated but truthful 2002 HIV Is No Picnic campaign - a series of posters depicting the ravages of AIDS, including lipoatrophy (above) and crix belly - while more recently the city's AIDS Health Project was bombarded with complaints for displaying a banner proclaiming "Stay Healthy, Stay Negative", due to the slogan's implication that HIVers are not healthy. "I really wish people could come and sit in here for a day and observe all the wasting, all the fat bellies. If we had these photos out there, maybe things would be a little different."
~ Sally Putnam [Nurse Co-ordinator, AIDS Consultation Centre, Maine] During the early years of the disease, MSM who displayed AIDS symptoms were often made to feel alienated from the rest of gay society. Today, in large coastal cities around the US, being HIV+ is the status quo and HIV- men can find themselves marginalised and even excluded from the HIV+ mainstream; a form of reverse social stigmatisation that is prompting some to deliberately dispense with precautions and become infected simply in order to conform to the so-called "norm", or fraternity, of HIVers. AIDS service agencies are run by committees largely comprising HIV+ men, so it is reasonable to surmise whether the interests of HIV- men have been sufficiently, or even impartially, represented in recent years. "If the owners of unsafe sex clubs are like tobacco farmers, the policy wonks at GMHC and the libetarians of ACT UP are like tobacco company spokesmen - all AIDS doublespeak and no common sense."
~ Gabriel Rotello [Author, Sexual Ecology] Politic correctness and the reluctance to risk offending HIVers has stymied honest, truthful and open debate about AIDS to such a degree that the rising tide of transmissions can be leveled squarely at their collective failure to convey appropriate and effective messages that are designed, above all else, to ensure that negative men stay negative. A recent London HIV campaign by GMFA (Gay Men Fighting AIDS) around condomless sex, for example, was roundly condemned by health professionals and HIV- and HIV+ men alike for resembling an HIV+ recruitment exercise for HIV-
men. "So long as a campaign is directed at those genuinely at high risk of infection, there's nothing wrong with employing harder-hitting tactics to induce a bit of fright. If that protects health and saves lives, then frankly, the end justifies the means, and we shouldn't shy away from it."
~ Peter Gill [Author, Body Count: How they turned AIDS into a Catastrophe] "95% of HIV+ people would not care if an advert implied it's dumb to fuck without a condom, or that saggy arses and diarrhoea stink and will ruin your lovely gay image - whatever it takes to deter someone going through what they went through!"
~ Ricky Dyer [HIV+ journalist] Says Louise Hogarth, director of the 2003 documentary film The Gift, which explored bug chasing and "gift givers": "I want to see less death out there and more life. No one really knows anymore what it means to get HIV. Herb Ritts died but nobody mentioned HIV. There's great denial. We in the gay community have almost made it positive to be positive. People don't discuss their status, and when they're negative they're kind of ashamed, but when you're positive you're out and proud." Doug Hitzel, who features in Hogarth's film, moved to San Francisco when he was 19. "He was too young to get into bars, wasn't a bodybuilder, and the one community he was accepted into was the barebacking community," she continues. "You weren't allowed to reveal your status, and if you asked to use a condom you were told to leave. Doug was gay but totally accepted it in his high school. His family supported him. It was the gay community that was the problem." |
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Meth abusers can be prone to ruthless and potentially lethal acts of sexual sabotage, manipulation and deception. "Mark" describes an incident at Fire Island one July 4 weekend. "I went home with a cute guy from the NYC Lesbian & Gay Centre's annual fundraiser party," he recalls. "He was speeding ahead of himself on Tina, but I always play safe and so assumed that it was me calling the shots. I seldom get penetrated, but this guy wasn't too well-endowed and so I thought why not? I saw him reach for a condom, rip open the packet and he put it on his dick. Five minutes later he pulled out. As I always do after sex, I immediately reached around to make sure that the condom was intact. But there was no condom - he had whipped it off just before entering me. I had to go on medication (PEP) for 30 days to safeguard against possible HIV infection, and I suffered nausea and chronic fatigue. "The point is," stresses Mark, "I made the conscious decision to play safe with this guy, yet he deliberately
betrayed my trust and may have endangered my life. The scary thing is, the exact same thing happened to me in 2003 in San Francisco. Is the whipping off of condoms just prior to entry a common practise among meth abusers that others aren't aware off? I know guys who have tested positive yet swear blind that they practised safe sex 100% of the time. Tweakers have no conscience, and some seem determined to spread their HIV far and wide and go to any lengths to do so. And they are acting with impunity." It may be only a matter of time before crystal is cited in criminal prosecutions for the intentional or reckless transmission of HIV, raising a mine-field of medical, legal and ethical questions. In the UK, 72% of respondents to a Gay Times survey condoned prosecutions for the transmission of HIV due to non-disclosure, arguing that they provide justice and act as a deterrent. However, while AIDS charities generally agree that it is acceptable to prosecute individuals who intentionally infect others, they argue that prosecutions for "reckless transmission" are wrong and increase stigma, discourage people from getting tested and could drive the AIDS epidemic underground. Daniel Sokol, medical ethicist at the Imperial College Faculty of Medicine in London, argues: "Even if there is no intent to cause harm at all, the person can still be blamed morally if he could have reasonably expected to have put the partner at risk or if he should have known. He has a duty to be informed about his condition and its transmitability. We can still criticise a reckless driver even if he didn't intend to cause any trouble and didn't know he had too much to drink. Ignorance is not enough to get us off the moral hook." "[HIV]-negatives need to know that you can't trust someone who's using crystal meth."
~ Paul Lukakis [Singer] During an HIV/crystal meth forum in New York City in November 2003, moderated by long-time AIDS activist Harvey Fierstein, one member of the audience stood up during the heated open-mic session and fumed that he had seen "people with KS lesions barebacking twenty-something twinks in sex clubs," and that HIV had become "a badge of honour." Other evidence suggests the emergence of "seroconversion parties" staged by a minority of HIV+ men who systematically target and "recruit" negative men into their world. At a 2004 crystal meth forum at West Hollywood's City Hall - attended by 200 mostly older gay men, activists and medical specialists - one member of the audience stood up and shouted: "Where are the youth tonight? Us old guys should be at the back of the line cheering on the youth, not at the front of the line carrying the flag," prompting another to comment: "In case he missed something, our youth has been systematically devoured and spat out, first by AIDS and now crystal meth in the face of our so-called community's shameful indifference and complacency." In his provocative landmark speech in New York City in November 2004, AIDS activist Larry Kramer branded as "murderers" positive gay men who have unsafe sex without disclosing their HIV status, regardless of whether they are acting under the assumption that if their HIV status isn't queried, their partner must be positive too. "I wish we could understand and take some responsibility for the fact that for some years we have been murdering each other with great facility," he said, "and that down deep inside of us, we knew what we were doing..." In the US, as many as 50% of new HIV infections are from the 25% of HIVers who do not know their status, and the other 50% from the 75% who do, suggesting a major communication breakdown among partners who make incorrect and naive assumptions about each others' status due to lack of openness and non-disclosure. In recent years a form of "viral apartheid" has emerged, with HIV- men openly seeking others on internet hook-up sites - even though a declaration of negative status can never be guaranteed, least of all trusted - and HIV+ men indulging in unsafe sexual practices with each other, despite the risk of acquiring treatment-resistant strains, which is far higher during the earlier years of infection. The alarming rise in meth-induced HIV transmissions in recent years has served to undo most of the tireless work of safe sex campaigners in North America and elsewhere since the start of the AIDS crisis. With new rates of infection now higher than at any time since the early 1990s, the potentially lethal union of crystal meth and Viagra has emerged as the new epidemic. Life or meth? The choice is yours... �? �?DEAD MEN WALKING: On the next page, an ex-abuser talks about sex on crystal (includes graphic language)... |
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