• By John-Manuel Andriote,

Washington Post  [8 November 2005]

ESTABLISHED in the US heartland and increasing in New York and Los Angeles, meth has had a low profile in the Washington area, where crack cocaine and marijuana are still the targets of most anti-drug programs run by law enforcement and public health agencies.

But meth use is increasing in portions of the gay community, according to local health officials, area addiction and mental health practitioners, and specialists in gay health issues. The District's Whitman-Walker Clinic, which provides HIV/AIDS and other health services to a largely gay clientele, reports that 75% of its new drug treatment clients list crystal meth as their primary drug of abuse.

Five Crystal Meth Anonymous groups meet near Dupont Circle, a neighborhood with many gay residents. Two and a half years ago there were none. Suburban treatment centres report an increase in meth-related referrals, including some in teenagers. The DC government has just awarded its first grant for an anti-meth public education campaign, which will target the gay community.

Over the past five years there has been a surge in the number of gay men in the Washington area seeking treatment for meth abuse. Kevin Shipman, manager for special populations in the District's Addiction Prevention and Recovery Administration, notes that the number of meth referrals to the Whitman-Walker Clinic's outpatient drug programs is five times higher this year than in 2000.

Whitman-Walker's Bullock-Smith said the men turning to her clinic for help with meth addiction are typical of Washington's professional caste - Type A personalities in fast-paced jobs that require a lot of mental energy. "It's not necessarily the folks who want to party all the time," she said.

She points out that people with untreated ADHD seem especially attracted to meth because, much like legally prescribed stimulants such as Ritalin, the drug paradoxically calms and focuses them. Researchers have suggested that, like crystal meth, methylphenidate amplifies the brain's release of dopamine, thereby improving attention and focus in individuals who have weak dopamine signals.

Because the drug's effects can include a supercharged libido, extended periods of high energy and sleeplessness and a much-

reduced ability to make sound judgments, unprotected and promiscuous sex is a high risk. Recent studies from San Francisco and Chicago confirm that gay meth abusers are at significantly heightened risk for becoming infected with HIV and other sexually transmitted infections.

Randy Pumphrey, executive director of the Washington Psychiatric Institute's Lambda Centre, which provides substance abuse services to gay people, said that in the past four years meth has increased from being "something we saw every once in a while" to the third most commonly abused substance, after alcohol and crack, among new clients.

If someone is dependent, said Pumphrey, "they are going to need a period apart from their environment - and also need hospitalisation" to deal with the paranoia, severe depression or even homicidal feelings that can accompany the detox process. After this acute phase, Pumphrey said, patients usually participate in a daytime treatment program for several weeks before joining an extended support program such as Whitman-

Walker's six-month evening program for recovering addicts.

Bullock-Smith explains that Whitman-Walker's three-phase addiction recovery program requires a substantial commitment. To graduate, clients must attend one to three meetings a week at the clinic, participate in an outside 12-step group, have a sponsor, undergo breathalyser and urinalysis tests to verify that they are not using, see a therapist, have a psychiatric evaluation and complete "lots of homework."

A committee including the police department and other district agencies, substance abuse professionals, youth organisations, nightclub owners and recovering addicts began to meet this summer to plan a response to what they view as a growing crisis. Like community-level anti-meth efforts in other cities, the DC Crystal Meth Working Group is planning a campaign aimed at educating the non-using public, preventing meth abuse among gay men and offering treatment referrals to current users. The District health department has provided a $42,000 grant for the group to work with Whitman-Walker on the campaign.

This is a good start, said group member Bruce Weiss, executive director of the Sexual Minority Youth Assistance League, which serves gay, lesbian, bisexual and transgendered youth. The group will seek $1 million from the DC government and try to ensure that fighting meth is included in the five-year plan of the task force advising the mayor on anti-drug priorities. •

• By Amy Herdy, Denver Post 

[14 March 2006]

IN DENVER, recent surveys show meth use among gay men to be double the rate of use in the general population. Nationally, the trend has been noted in cities from Los Angeles to New York.

Meth use among gay men is becoming a serious public health issue because it encourages behaviour that is risky for contracting HIV, the virus that causes AIDS, and other sexually transmitted diseases.

In a survey by Denver Public Health, 11% of men who had sex with men reported using meth in the past year. Five years earlier, 10% of gay men said they had used it at least once in their entire lives, said Dr. Mark Thrun, director of HIV prevention at the agency. In contrast, Thrun said, the number for the general US population of those who had ever used meth was less than 5%. "It's phenomenally higher than what we see in the heterosexual population, even given the rural epidemic of meth," Thrun said.

The reasons gay men use meth are as varied as each individual. But 'Fail', a hairstylist, believes many use it to simply feel they belong. "A lot of gay men have been beaten down and persecuted just for being gay," he said. "And then you do the drug and you feel like a queen bee all day long. It feels like it's your world, and you're in charge of it."

A 2002 study of HIV+ men in California identified their main reasons for meth use: to enhance sex, to relieve boredom and to help them cope with negative emotions. On meth, a highly addictive psychostimulant, Fail was uninhibited and reckless, he said. He took chances with sexual partners he would not have normally looked at twice.

Meth has now been linked to an increase of HIV among men who have sex with other men, Thrun said. Since 2000, the rate of HIV diagnosis in the Denver area has risen steadily, from 115 cases in 2000 to 180 cases in 2004, with preliminary numbers for 2005 looking to be comparable to the year before.

The causes for the rise, Denver Public Health spokeswoman Cindy Parmenter said, are thought to be an increased awareness for testing, the use of meth and the practice of casual sex with partners procured through the Internet.

In the Denver survey, researchers interviewed 981 men, Thrun said. They found that one out of five HIV+ gay men reported using meth in the past year. "And when you think about what meth does - it makes you high, disinhibited, it makes you want to have sex and more sexually aggressive - they are less likely to wear condoms," he said. "There's a huge concern they will go out and spread HIV to other people."

From that same survey, Thrun said, health officials learned that meth users were three times as likely to have had unprotected sex within the past 12 months as non-meth users. Also, 9% of those men who were HIV- had used meth in the past year, while 21% of those who were HIV+ had used it in the same period.

Thrun stops short of saying there is direct evidence in the Denver area that meth use among gay males will cause HIV to spread, although studies out of San Francisco show that link, he said. "It's just a matter of time before we have that data in Denver," Thrun said.

One gay Denver man, who did not want his name used for fear of retaliation, said he began using meth shortly after being diagnosed with HIV. "I went straight from finding out to using crystal meth," he said. "I wasn't depressed at all if I was using meth." Yet soon, his addiction - costing him $200-$800 a month - consumed him, causing him to lose weight, become paranoid and crash hard when coming down from a high. "I lost my job, got evicted from my apartment," he said.

And he took sexual risks. "When I was at a bathhouse, I wasn't careful," he said. "I wasn't even thinking anything about that when I was on meth." He stopped using the drug three months ago, he said, when he was arrested for possession. He was sentenced to probation, rehabilitation and random drug screenings, and has a felony on his record.

Despite his recklessness, he doesn't think he infected anyone, because "all the people I messed with were (already) positive." He's now struggling to put his life back together. "Meth is dangerous, whether you're HIV+ or not."

The Colorado AIDS Project is partnering with Denver Public Health to run a centre for gay men in Denver's Capitol Hill neighbourhood, said CAP executive director Deirdre Maloney. The soon-to-open centre, which will offer HIV and STD testing, as well as education and activities, will be funded by a three-year, $100,000 annual grant from the national Centres for Disease Control and Prevention, Maloney said. "This is the first gay-specific health-related space that Denver has had," said Thrun, who will play a central role.

While Denver is a comfortable place for gay men to live, said Thrun, who is gay, it needs a medical environment where they are at ease discussing their specific health concerns.

Fail believes that a sense of isolation and low esteem contribute to the self-destructive behaviour of some gay men. "I think society has not respected gay men for so long that they don't respect themselves," he said. •

• Revised December 6

AS THE COUNTRY with possibly the most liberal attitude towards drugs in the world - where you can smoke pot in regulated cafes and marajuana is legally used for medicinal purposes - you might expect crystal meth to have taken off in a big way in Holland by now.

On the contrary. In 2003, The Health Association in the Netherlands funded a major survey to determine the general drug habits of its citizens, and to establish the underlying reasons why they use. The results make for enlightening reading.

It revealed that, by far, the majority of Dutch citizens who consume drugs on a regular basis do so mainly at weekends, and for enhancement purposes as opposed to escaping reality, and that only a small minority suffer with addiction problems. Among the hundreds of people questioned about their drug habits, the general finding established that drugs are primarily used on a controlled basis and once a week at most, accompanying social and recreational activities like clubbing and dancing.

The researchers attribute this finding to a general feeling of freedom, contentment and peace of mind among the Dutch in general, who live in a liberal (i.e. open, non-competitive and tolerant) society that is largely free of oppression or government and media-channeled fear-mongering.

Furthermore, the easy availability and cheapness of drugs in Holland (Amsterdam being a major world centre for ecstasy production and trade) is no indicator of consumption, with people tending to moderate their usage even though a pill costs around the price of a beer.

Most respondents were disparaging or dismissive about hard drugs like heroin or crack cocaine, with few being aware of anyone they knew who use. Similarly, to date, the Amsterdam gay community has emerged relatively unscathed from the arrival of crystal meth into Europe. Despite the drug's limited availability within the local scene, it has not been widely embraced, and reports of meth-related casualties are few and far between. •