CRYSTAL METH FUELS HIV
Christopher Heredia, Chronicle Staff Writer Sunday, May 4, 2003  ------------------------------ ------------------------------ --------------------The use of crystal methamphetamine has reached epidemic proportions among gay and bisexual men, and 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.

Health experts estimate that up to 40 percent of gay men in San Francisco have tried crystal meth, a powerful form of what's commonly known as speed. Even more alarming, a Health Department study last year found that at one high- risk clinic, 25 percent to 30 percent of those with new HIV infections reported crystal meth use in the previous six months.

At a meeting about crystal meth in Sacramento last month, the state's top AIDS and HIV prevention officials came up with the smoking gun of
all statistics: Gay men in California who use speed are twice as
likely to be HIV- positive than gays who don't use it.

To be sure, the problem of methamphetamine use is not confined to gay
and bisexual men who like to party. Law enforcement officials say meth
use has spread to the suburbs, particularly among teens facing
boredom, peer pressure and undiagnosed psychological problems.Yet nowhere is the meth concern greater than in the gay community and
its teeming subculture of partygoers who attend weekend-long events
dominated by alcohol, drugs, sex and ramped-up dance music. Dancers
become one with the pulsating beat, their bodies turned into wildly
rhythmic instruments of vibration.

Dr. Jeffrey Klausner, director of sexually transmitted disease
prevention and control for the San Francisco Department of Public
Health, is convinced of the dangers.

"We have all sorts of levels of evidence," he said, "and it's all
pointing in the same direction: The crystal meth epidemic is playing
an important role in increasing sexual risk behaviors, and that is
leading to new HIV and STD infections.

"San Francisco officials are planning a televised hearing at 6 p.m.
Wednesday on crystal meth use in the gay community. The City Hall
gathering will include public health authorities, recovery program
officials and members of the gay community.

There are various reasons why the demand for the drug has grown among
the Bay Area's gay community. It's cheap - $30 for a high of several
days - easy to get, and powerful. It increases sexual stamina and
eases the pain of depression or loneliness. Others find it makes them
feel invulnerable - if only for a night.

After cigarettes, alcohol and marijuana, speed is the most commonly
used drug in the gay party scene. Known also as "crissy," ''tina,"
"tweak," and "crank," crystal meth is a powdery substance that can be
swallowed, injected, snorted or smoked.

It appeals to men along any paths of life: lawyers to waiters, stockbrokers to health-care workers - all have succumbed to the drug, a stimulant that mimics the body's natural adrenaline. Derived in the early 1900s from amphetamine, it was first prescribed, then made
available over the counter, in decongestants and bronchial inhalers.

Illicit makers quickly learned how to manufacture the drug cheaply and
in mass quantities. The chemical make-up of meth is similar to that of
amphetamine, but experts say meth has a stronger effect on the body's
central nervous system. Like amphetamine, it brings about heightened
activity, reduces hunger, and temporarily promotes a sense of
well-being.

"It's the perfect drug for gay men," said Michael Siever, director of
the Stonewall Project, a speed recovery program for gay men at UC San
Francisco. "What else allows you to party all night long whether
you're dancing or having sex? . . . at least, at first - before it
becomes a problem."

More and more, the dance is becoming a dance of death.

For when the music stops, there'll be more HIV-positive men than there
were,say, before the evening began. There'll be more meth users who've found they've crossed into addiction - it's a tough drug to kick. More immune systems of HIV-positive men will have been compromised, abused, treated harshly. More doses of medicine will have been forgotten, or just ignored.

The question is not, is crystal methamphetamine being used in the gay
community? The question, said Dr. Grant Colfax, director of HIV
prevention studies with the San Francisco Department of Public Health,
is instead, can the use of speed go much higher?

It could be said that Colfax belongs to an elite circle of health
workers who maintain the most knowledgeable insights into the sex
habits of the gay community and who track the progress of AIDS like a
security guard on maximum alert. And his chilling, current-day
viewpoint is this: "We have a dual epidemic - a speed epidemic and an
HIV epidemic that are both increasing."

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

According to Klausner, 25 percent of gay and bisexual men testing
positive for syphilis reported recent speed use. In addition,
HIV-negative gays who used meth were three times more likely to have
rectal gonorrhea than nonusers.The word, and the drug, have spread coast to coast.

Yves-Michel Fontaine, coordinator of substance abuse counseling and
education at the Gay Men's Health Crisis in New York, said: "We are
seeing more cases of crystal meth use than in the past. We're
definitely concerned about it, as are the gay men who are coming in
for counseling."

In California, a statewide study found that among the gay and bisexual
men tested in 2001 and 2002 at publicly funded clinics, 7.1 percent of
meth users were HIV positive, compared to 3.7 percent of those who
didn't use meth.

Of the total 63,098 gay and bisexual men who were tested, 10.5
percent, or 6,637 men, reported meth use.

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

For receptive anal intercourse - the riskiest form of sex - officials
found that 39.2 percent of gay non-meth users "always" use a condom,
compared to 24. 6 percent for meth users.

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

Say you seek help in San Francisco - anywhere in San Francisco. Your
name goes on the bottom of a long waiting list. You have to wait at
least a full month.

Three crystal meth treatment programs operate exclusively for gay and
bisexual men in San Francisco. Meanwhile, Narcotics Anonymous
chapters, complete with their time-tested 12 steps, are sprouting up
in this city, as well as in Seattle, Palm Springs, Atlanta,
Philadelphia and New York.

Experts have shown that heavy methamphetamine users, those who do two
to four grams a week, can suffer serious brain damage. Heavy meth use
has been shown to be the equivalent of 40 years of aging, affecting
movement and memory.

Although speed creates a sense of euphoria, it is actually knocking
out the brain's ability to produce dopamine, which is how the brain
naturally creates the sensation of pleasure. The addict then becomes
desperate for his fix because the drug offers a sense of well-being."

People are using the drug to feel better," said Dr. Nora Volkow, the
new director of the National Institute on Drug Abuse, "but they are
literally selling their soul to the devil."

While the effects of infrequent use of methamphetamine are unknown,
experts say the good news is that studies show that heavy users who
quit regained some of the brain's ability to produce dopamine.

A San Francisco Department of Public Health study, published in
February, of gay and bisexual men who frequented late-night dance
clubs, parks after hours, sex clubs, and adult bookstores found the
incidence of recreational drug use extremely high:

-- More than three-fourths of the 350 men in the street-based survey
reported use of noninjection drugs. Half said they had tried
methamphetamine in the previous three months.

-- Three-quarters of the men said they had had unprotected anal
intercourse in the same time period.

-- Nearly one-third of the men surveyed either said they already had
HIV or tested positive for the first time, which indicates they
possibly had transmitted HIV to casual sex partners while using drugs.

The study's authors concluded that the late-night party set is clearly
contributing to the rise in HIV infections and there is "urgent need"
for heightened HIV prevention outreach at these venues.

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

Crystal meth is anathema to safe sex. It leads to rougher sex and
uninhibited, risky sex; condoms are failing, or men simply aren't
using them.

Men on speed say that meth tends to make them "instant bottoms" - the
receptive position in anal sex - because the drug induces temporary
erectile dysfunction.

"We're trying to de-link substance use from risk behavior, to get guys
to be safer while using substances," Colfax said. "People use it and
they're not able to assess their risk behavior. We have a lot of work
to do."

Colfax concedes that not all men become addicts, but says even the
occasional or weekend user puts himself at serious risk for
contracting HIV. He wants the full array of programs - treatment,
counseling, prevention - tailor-made to the occasional user. Members
of that audience fall below the drug-dependency radar, Colfax said,
and walk around believing they're risk- free.

But the pitfalls of addiction lie just around the corner.

"Guys start with weekend use and it accelerates," said Board of
Supervisors President Tom Ammiano, who is co-sponsoring the crystal
meth hearing Wednesday with Supervisor Bevan Dufty.

Both Ammiano and Dufty are gay and said they're now hearing of
incidents in which men can't function at work because they're still
under the influence of meth from their weekend parties.

"There's a tremendous amount of denial around speed use," Ammiano
said. "It's pernicious. We're also hearing stories of people failing
in rehab after eight, nine tries. It's very brutal."

Abstaining from speed doesn't induce the severe withdrawals or
vomiting associated with heroin, but those who stop taking meth often
face depression, agitation and intense cravings for the drug.

What's more, experts say, speed's strong association with sex and
partying make it all the harder to kick.

The police have stepped up narcotics enforcement at late-night dance
clubs and on the Internet to staunch the wave of speed flowing into
the party scene. But in San Francisco, possession of methamphetamine
is only a misdemeanor - a frustration to police who want to mandate
that people get treatment.

All one has to do to find speed is log onto several Web sites, where
speed is traded using code words. In the clubs, men exchange what are
known as "bumps," or snorts, on the dance floor or in rest room
stalls.

"It's extremely prevalent," said Capt. Tim Hettrich, head of the San
Francisco Police Department's vice unit. "We're trying to kick a- as
much as we can. We go out to the clubs and make a buy. That's one guy. Once others see that happen - we're dead in the water for that club
for the rest of the night. We're trying to get the major suppliers."

San Francisco prosecutor Liz Aguilar-Tarchi, who leads the district
attorney's narcotics unit, says the problem is exacerbated by sex club
and dance club owners who turn their backs on drug use.

"How can it be that the club owners' security does not know?" she
says. "They are aware. 'Culpable' is a strong word. I haven't seen any
evidence they are involved, but they sort of shut one eye to it."

Club scene

Prosecutor Jim Hammer, who is gay, said the solution is not
incarceration, but getting more people into treatment programs early
on.

At a late-night dance club, he pointed out to a friend that there was
no line for alcohol. "You could get a beer without standing in line,"
Hammer recalled. "Yet when you walked out on the dance floor, people
were obviously on something. I think it's a terrible tragedy,
especially for the younger people coming out."

Gay dance party promoter Don Spradlin said he had gone to great
lengths to keep drugs out of his events, which include the annual Gay
Pride dance party in City Hall and the Halloween Hell Ball in October.

But invariably the drugs get in, past the pat downs of security
guards, past the roving eyes of bouncers with flashlights. So Spradlin
also posts health pamphlets and provides plenty of condoms at the
club.

"I get irritated that the gay clubs get singled out," he said. "Club
owners have made extraordinary efforts to keep drugs out. Their
licenses are threatened. I'm very anti-crystal. It's sad. I hate it."

Spradlin, 56, a gay man, said health officials and the gay community
must address issues of self-esteem and addictive behavior. The
"use-a-condom-every- time" message of the 1980s doesn't work anymore, he said.

The danger of crystal meth has been kept under cover, most agreed, by
its cloak of shame. Gay men have stopped talking about condoms, and
crystal meth use among friends is kept quiet.

A forum on the subject last fall at the Gay, Lesbian, Bisexual and
Transgender Community Center was sparsely attended, much to the regret
of outreach workers.

"It's unraveling our community," said Jed Herman, a Stop AIDS Project
worker who has heard of meth's destructive toll on not only the user
but also on lovers, friends and families. "I don't know what the
answer is. The obvious problem is getting people in the door who are
clearly at high risk for HIV transmission."

Herman said the Stop AIDS Project's Crissy campaign, which encouraged
men to get help if they thought they had a problem, quickly ran out of
money. One of the dangers of crystal that hasn't been broadcast widely
is that mixing it with Viagra can raise heart rate and blood pressure
and lead to death. Men on speed commonly use Viagra to counteract the
erectile problems caused by meth.

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

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

"To the untrained eye, it's invisible," Dufty said. But it's also
widespread.

"It's a currency that's being traded like dollar bills all around our
community. It's impacting people in their 20s, 30s, 40s and 50s. I've
heard lesbians talk about crystal use. I recognize people are going to
make their own choices. But we have a responsibility to make it an
informed choice. As community leaders and friends, we have to speak
loudly about the clear and present danger of crystal m