HIV & Meth Page 3

According to the Gay Men's Health Crisis, those in the gay community often fall prey to meth use because of unique social or psychological pressures because meth bestows a feeling of belonging, sexiness, and confidence upon the user. This will ultimately mean that addiction-treatment must address the feelings of low self-esteem and alienation that encourage or abet addiction. This would be at least one logical first step in loosening meth's grip on the gay community, along with the integration of addiction treatment, HIV intervention and relevant mental health services.

Data going all the way back to August 17th, 2005 involves a study conducted in the years 2000 and 2001. We don't generally reference studies that old on our site, but reliable data are scarce. This study looked at 3,000 San Franciscans who received anonymous HIV tests in those years and concluded that crystal meth users are likely to drop their inhibitions and engage in activities such as unprotected sex with multiple partners.

For those who said they used crystal meth during sexual encounters, the infection rate was close to 8 percent. For those who said they had not used the drug, the HIV infection rate was 2 percent. Seems like a small change, but apply the populations and you're talking about some huge numbers.

More recently, (April 2007) officials said that in West Hollywood, nearly 30 percent of people who test positive for the HIV virus at testing sites reported using crystal meth within six months of being tested. That's an awfully compelling correlation.

We mentioned the concept of "condom fatigue" in the gay community. Consider that in the context of "circuit parties" in big cities, which sometimes host as many as 80,000 participants, 25% of whom report being HIV-positive and 43% of whom report using crystal meth at the parties. An astounding 39% of these HIV-positive men report engaging in unprotected anal intercourse during the parties. Then the party is over, the attendees fan out back their respective home towns and any new infections that were picked up are dispersed throughout the continent and ultimately, throughout the world.

Alarmingly, data from the L.A. Gay and Lesbian Center Survey in 2004 show that nearly one third of men testing positive for HIV report having used crystal meth since their last test (or in the last two years, whichever was most recent), and gay men in California who use meth are more than twice as likely to be HIV-positive than those who don't. The "use a condom every time" message doesn't seem to be getting through as well as it used to, and many think that meth's judgment-impairing effect is partially to blame. In other words, no amount of traditional sex education can be effective if this drug makes users abandon everything they have learned thus far about safe sex practices.

The combination of methamphetamine and HIV infection also has unique effects on the brain. Research published in the August 2005 issue of the American Journal of Psychiatry indicates that methamphetamine abuse and HIV infection cause significant alterations in the size of certain brain structures, and in both cases the changes may be associated with impaired cognitive functions; such as difficulties in learning new information, solving problems, maintaining attention and quickly processing information. Co-occurring methamphetamine abuse and HIV infection appears to result in greater impairment than each condition alone, so in this case, meth and HIV have what could be described as a "synergistic" effect when combined. In other words, as far as actual brain destruction or impairment goes, with meth and HIV, "the whole is more destructive than the sum of the parts."

So from the perspective of what the gay community is trying to achieve, methamphetamine use is not just an issue of drug policy, its an issue of communicable disease transmission and should be treated as such. Many feel that trying to confront the HIV epidemic without an equally effective and concurrent anti-meth awareness and education program is going to seriously undermine progress made to date. As no pharmacological intervention yet exists for meth, as a part of an overall drug strategy, development of harm reduction strategies and cognitive behavioral therapies tailored to the unique needs of the gay population are critical to realizing measurable success.

The Department of Public Health in San Francisco recently launched three new studies that it hopes will reduce both methamphetamine addiction and the risky sexual behavior that can be associated with it. The new studies will focus specifically on gay male methamphetamine users and the drugs to be tested are bupropion, (a.k.a. "Wellbutrin", "Zyban") a drug commonly used to treat both depression and nicotine dependence, the antidepressant mirtazapine (a.k.a. "Remeron") and aripiprazole, (a.k.a. "Abilify") which is a mood stabilizer. (They must have a great time coming up with these names!)

The FDA has previously approved each of the drugs that will be used in the studies, but none have been approved for treating meth dependence specifically. (Currently, there are no FDA-approved "pharmacological" (drug-based) treatments for methamphetamine addiction.) This study will attempt to determine if these drugs can mitigate or attenuate key factors that result from meth addiction, including, but not limited to withdrawal and cravings, and meth-related psychosis.

We concede that the "meth use-HIV" connection is a complicated issue, and no single study will provide all the information necessary to formulate hard policy or funding allocations because God only knows that takes forever under the best of circumstances. But with similar trends in the HIV/Meth connection being observed in almost every other region of North America, the United Kingdom and elsewhere, do we not yet have sufficient evidence that there is indeed a connection between meth and higher levels of HIV?

This thing swims like a duck, looks like a duck, quacks like a duck and responds to the name "duck." How many more studies are needed before government health officials everywhere at least unanimously acknowledge that what we have here is a duck!

As with any issue, there are some in the gay community who have voiced objection to meth or "Tina" being vilified by the media, and contend that methamphetamine is not so bad if "it's used responsibly." Well, from our perspective - from what we see day in and day out, the words "methamphetamine" and "responsible use" are oxymoronic and frankly, laughable. Undoubtedly, there are indeed long-term users of meth who haven't come apart at the seams - yet. But "yet" is the caveat, and it's a big one.

On the next and final page of this section, we look at yet another example of the "systemic" roots or underpinnings that meth has within certain demographic groups.