by Ferd Eggan
Have you ever used drugs in conjunction with sex? Apparently you're not alone. A sample of the men at Christopher Street West last June showed us that 25% had used one particular drug-crystal methamphetamine-within the last six months. I believe we gay men have always used drugs and alcohol as a coping mechanism to deal with the issues of gay oppression: we drink or take drugs because life is difficult, dating is dangerous, and relationships are frightening. And the drug that is most popular now, back from the 70s, is crystal, used among gay men as a sexual enhancement.
It's mostly white and Latino gay men who use crystal, although it is definitely spreading to Asian/Pacific Islanders and African-Americans. One anecdotal report says that crystal is competing with crack as the preferred drug among Black gay men. Crystal definitely stimulates and prolongs sexual arousal, so it is increasingly popular and increasingly problematic for AIDS prevention. The drug is enjoying very brisk sales at a time when (coincidence?) many gay men are experiencing the difficulty of maintaining safer sexual behavior over the long term.
You get your crystal from a gay dealer who usually delivers-at least in WeHo-do a line or two with your friends at a gay dance club, party with new friends through a gay 976 line or a gay sex club, and experience exaggerated tiredness, then chill out at an all-night sleazy gay bar. All these institutions have grown up to facilitate gay drugs and sex. And as many as half of regular crystal users who have "tweaked" for more than a year are HIV+.
The City AIDS Coordinator's Office contracted Van Ness Recovery House to carry out a study of gay men who are using crystal meth. We believe there are at least 10,000 men in the self-constituted gay community who are regular users. This does not mean only injectors. (Despite widespread ideas that injectors are the worst of the users, the Van Ness study seems to indicate that those men who take the drug by squirting it up their butts are most likely to engage in unsafe sex.)
Some in our community are getting rich off this drug and sex trade. But among the gay men who are using the drug, some are getting the sexual action they desire and some are having a burst of energy that makes them feel strong and healthy. Of the men interviewed, some are getting really messed up and hurt, and some are functioning just fine. Everyone says you have to pay for the excitement or energy with an uncomfortable crash afterwards.
Epidemiologists here in LA think that crystal is an important factor in the still-growing AIDS epidemic among young gay men. The truth is that the epidemic is not spreading uniformly; African-American and Latino gay men are seeing a sharp rise in new infections, as are young women from those communities. The sub-culture of gay men who use crystal is rapidly becoming saturated with HIV. Similarly, the use of crack cocaine as a sex drug by African-American gay/bisexual men has accelerated the spread of HIV.
A Community Campaign
As an attempt to address this problem on a community level, a number of AIDS prevention groups that work with gay/bisexual men have undertaken a contract with the City AIDS Coordinator's Office to call attention to the problems of HIV, sex and drugs. The campaign is designed to open discussion by our community about our problem: we have suffered from gay and gender oppression, from racism, from AIDS, and we have kept silent as our whole community tries to cope in ways that are not always successful. It's not individuals who have a drug problem; our communities have a drug problem, along with all the other problems. "Suddenly Everybody's Talking About Crystal and Sex" is an attempt to begin with a community solution. Check out the schedule (see box, next page). You are invited to discussion groups where people can talk about how their sexual lives are affected by these issues, and have a free lunch, too!
Sex, Drugs and HIV
People with HIV/AIDS may want to know a a few facts about crystal that relate to their health. Many readers have heard about the MACS (Multi-Area Cohort Study) of thousands of gay men conducted since 1979; it has been the source of a great deal of information about the progression of AIDS in individuals and in the communities. The MACS study tells us there is no correlation between drug use and disease progression. That means that researchers cannot prove one way or another that drug use has an effect on whether we remain well. Common sense tells us, however, that we want to do what we can to keep body and soul together by eating well, drinking plenty of water so we excrete the toxins that are bad from our prescription drugs, and resting/sleeping well. Gay sense tells us we need to look our best.
We asked a few Los Angeles doctors, including a psychiatrist and a neurologist, what they advise their patients about crystal meth. They see many men and women who are using the drug, and all of them point to health risks. Psychiatrist Dr. Eric Bing, head of Spectrum Mental Health Services at King-Drew Medical Center, is researching the prevalence of depression and other diagnosable mental illnesses among people with HIV. He speculates that some HIV+ individuals use crystal and other stimulants as self-medication for depression, fatigue and other effects of HIV disease. Both Dr. Bing and neurologist Dr. Aaron Aronow say that they would prefer to address the underlying problems and work with patients to improve mental health. They are realistic, however, about their work: they do not condemn or abandon patients who are using drugs. Instead, they try to understand and to help individuals make the best choices they can in their own unique life situations.
Both of these researchers and many other AIDS doctors have said that race and economic class and gender/sexuality have enormous impact on all issues relating to physical and mental health, including use of drugs. The Van Ness study found that middle-class men with demanding jobs were much more likely to maintain a pattern of occasional weekend use. Sex workers, whether they are porn actors or transgender or male hustlers, said they sometimes rely on crystal to be able to perform and-for poor kids on the Boulevard-to stay awake when they have no home in which to sleep. From all economic backgrounds, those who were interviewed said that long-term, heavy use of the drug (every day for a year or more) was destructive to their health. Many of the HIV+ individuals in particular expressed a desire for a place where they could talk about all the issues of their lives, without having to hide their drug use from friends, doctors and others.
A Special Support Group
Based on these findings, Being Alive has agreed to sponsor a weekly support group for HIV+ men who are using crystal. It won't be a 12-step meeting, and it won't require that everyone take some kind of pledge of abstinence. We are asking people to come and find support, but also to help develop more information and more useful methods to help people cope.
If this group sounds useful to you, you can call Scott Shatsky, Volunteer Coordinator at Being Alive, for more information. Or you can just come to 3626 Sunset Boulevard in Silver Lake on Friday night, October 25, 7-9pm. (By the way, if you think you personally have problems with this drug and want to stop, call 213.463.1191. You'll get a call back from someone with the training and experience to really help.)
We hope this group can offer social support without judgment, where you can explore ways to improve life without being required to follow someone else's rules. Coping with immune system problems is bad enough without self-righteousness or disdain for those whose behavior is different from our own. The news about new medications, however promising, will be difficult to implement in the individual lives that make up the community of people with AIDS. Now, more than ever before, we should build the solidarity that has been the lifeline for all of us in facing the disease.
(Ferd Eggan is AIDS Coordinator for the City of Los Angeles.)