Growing correlation seen between HIV, meth use - Los Angeles Times, January 2005

For seven years methamphetamine helped Ron Conner believe he was the talented, sexy, bold man he had always dreamed of being. The 37-year-old graphic artist would have sacrificed everything to hold onto that glamorous vision of himself, and ultimately, he nearly did.

"I lost my house, two cars, my checking and savings accounts, my piano, my boyfriend, my good standing at UCLA," he said.

"I had sex with guys I knew were (HIV) positive, who said they were positive, and I just didn't care," Conner said.

Although Conner, who is sober and working again, did not end up HIV-positive, such is not the case for many gay meth users.

Health officials and AIDS activists nationwide are alarmed at the increasing correlation between new HIV diagnoses and methamphetamine use in the gay community. The drug's ability to heighten arousal and erase inhibitions is proving to be a deadly combination -- leading to risky sexual behavior that increases the chance of infection, both with HIV and syphilis.

Crystal methamphetamine has been in the gay party mix on the West Coast at least since the mid-1990s. But, more recently, the drug has pushed east, galvanizing health officials and gay community activists in Houston, Chicago, Atlanta, Miami and New York. Meanwhile, other circumstances have conspired to make the flare in usage among gay men particularly harmful to public health.

The Internet has made it easy to arrange liaisons and get drugs from home, while erectile dysfunction drugs like Viagra allow for encounters to last for hours, even days. Meanwhile, activists said, improved HIV treatment regimes have lulled some gay men, particularly those who did not experience the AIDS epidemic at its worst, into lax attitudes toward condom use.

"We've had ecstasy, pot, acid -- but this is the crack of the gay community," said Jason Riggs, spokesman for San Francisco's STOP AIDS Project, which recently launched a campaign aimed at casual users and those who might be tempted to try the drug.

Scientifically linking the use of crystal meth to the spread of disease is difficult, since multiple factors come into play. But studies in several cities show that a growing number of HIV-positive men report recent meth use.

One recent Centers for Disease Control and Prevention study based on San Francisco data showed that use of both crystal methamphetamine and Viagra was linked to a marked increase in risky unprotected sex. Others have shown that gay men who used meth were up to three times as likely to test positive for HIV than those who didn't.

"Our hypothesis is that it's due to riskier sexual practices while using meth," said Dr. Sam Mitchell of the San Francisco Department of Public Health. "We think it's probably causal."In Los Angeles County last year, a third of all people recently diagnosed with HIV reported using methamphetamine, according to a survey. The majority of those people are believed to be men who have sex with men.

That correlation is particularly disturbing because the same survey found that use of methamphetamine among HIV-diagnosed people had dropped steadily, from 13 percent to 5 percent, between 1990 and 2000, said Doug Frye, director of the county's HIV epidemiology program.

"Then kaboom, suddenly it started to take off," Frye said.

Health officials readily concede that methamphetamine use is not the sole factor in HIV infection rates. But because men who have sex with men still lead the nation in new HIV diagnoses, meth use within that group is of particular concern to federal officials.

Enough correlations have popped up across the country to spark a meeting of the Centers for Disease Control and Prevention on the topic last week.
"We know that among men who have sex with men, meth use has been associated with high-risk sexual practices," said Jessica Frickey, a spokeswoman for the agency's National Center for HIV, STD and TB Prevention. "This is an emerging issue. We want to make sure we have gathered the people together to talk about where we are and where we should be going."

Gay community activists and local health officials across the country have not waited for medical data to catch up with what they see up close. In West Hollywood, San Francisco and New York, they have unveiled aggressive anti-meth campaigns in the last year to change opinions about the drug and direct users to treatment programs. Some are traditional 12-step programs that insist on complete sobriety. Others, like San Francisco's Stonewall Project, reach out to men who aren't ready to stop using but want to minimize damage to themselves and others while high.

"Our community is being destroyed," said Cleve Jones, executive director of L.A. Shanti, a nonprofit organization that provides services to people with HIV/AIDS. L.A. Shanti has recently added two counseling programs for meth users.

"For 10 years I lost loved ones -- every week in the papers, there were three pages of obituaries. I survived all this, and now we're continuing to be destroyed by this drug," Jones said.

In San Francisco, where one-third of gay and bisexual men are HIV-positive, the situation is equally grim. The STOP AIDS Project, which surveys 10,000 gay and bisexual men yearly and has analyzed county health data, reports that one-fifth of gay and bisexual men in San Francisco have used speed in the last six months. A third of men who recently tested HIV-positive had used the drug in the previous six months, the project found.

The curse of methamphetamine, also called speed, crank, tina and tweak, is not unique to the gay male community. As addictive as crack, more powerful than ecstasy and cheaper than cocaine, methamphetamine has become the leading demon in drug treatment programs nationwide.

But meth's inroads into the lives of middle-class, professional gay men threatens to destabilize the gay community at a time when it has largely bounced back from the initial ravages of the AIDS epidemic. Otherwise productive "weekend warriors" who believed that they could limit their use to special occasions or weekend parties now are finding themselves hooked.
In some cases, they are contracting HIV or syphilis, or realizing that they have probably infected others. They are losing jobs, friends and relationships as they sink deeper into addiction.

Conner is a case in point.

"For two years I was super-creative and super-productive," he said. "Then everything started to fall apart."

An overdose landed him in Cedars-Sinai Medical Center with an IV drip in his arm. Then came the hallucinations and voices, as paranoia set in.
One night, Conner said, "I heard someone under the floorboards said he was a Pisces and that I'd dumped him. He was threatening to kill me and my cat, pointing a gun under our feet as we walked across the floor. I called the police -- I actually called the police -- to come take a look under the building."
It was rock bottom. Soon after, he confessed his addiction to his father and stepmother who, along with friends, stood by him through treatment and recovery.

Figuring out how to reach a new generation of crystal meth users has proved to be vexing. Efforts have ranged from in-your-face campaigns to a more genteel approach that promotes a clean life.

"Our current campaign is to tell people there are sexy, glamorous, fit guys who you might want to meet one day who don't do this, and here's why," said Dan Carlson of New York's HIV Forum.

One of the group's previous campaigns -- "Crystal meth, nothing to be proud of" -- was criticized as "preachy," Carlson said, and some members of the forum's focus groups said that a wave of guilt and shame that it triggered drove them to use again.

"I have to say, negative responses to an ad are not necessarily bad," Carlson said. "We're not here to make people feel good about these ads; we're here to give people pause and prompt them to think twice about what they're doing."

The Van Ness Recovery House in Hollywood, a treatment center that specializes in gay, lesbian, and transgender addicts, now includes anti-meth messages with the condoms it distributes. "Meth wants you for the long haul. It's not a recreational sport," one reads.An anti-meth campaign in Los Angeles will enlist the help of owners of gay clubs and bars to post anti-meth posters in bathrooms and corridors."There's a sentiment toward recreational drug use that's accepted, almost a peer pressure not to talk about it, but we need to," said Jeff Prang, a West Hollywood city councilman. In San Francisco, Riggs' group plans to place posters in the bathrooms of 100 gay bars and clubs throughout the city. "Years of Safe Sex Up in Smoke," reads one. San Francisco public health officials last fall launched a billboard blitz of unflattering photos of gay men on speed called the "Crystal Mess" campaign: "Your career took up too much time anyway," read one. "Horny and impotent. What an attractive combination," said another.

Conner said he shares his story as a cautionary tale -- an anti-meth billboard come to life.

"Nobody starts using crystal meth thinking, 'I'm gonna become an addict,' " said Conner, who started using while he was a college student. "But I probably would never have started if I had better self-esteem."

A message that might have helped him during his depression and isolation, Conner said, is one that did not stigmatize addiction. "Maybe if I saw a billboard with like 50 men on it, men like me saying 'I used meth and kicked it,' then I wouldn't have felt so alone."