New data shows that the number of MSM using cystal meth in San Francisco has almost halved  in three years, thanks largely to no-nonsense, PC-free campaigns like 2004's Crystal Mess.

Dr. Willi McFarland, director of HIV/AIDS statistics and epidemiology at the San Francisco Department of Public Health and an expert on drug trends, has released data from surveys of nearly 5,000 men who have sex with men (MSM) - spanning 2003, when US experts first started observing and acknowledging the correlation between crystal use and HIV infection, to early 2006 - showing the number of users within the three years the data was collected falling from 11.8% to 6.6%. The fall was lower among HIV+ MSM, for whom the rate of crystal used with sex fell from 24.8% during the same period.

The accumulated data persuasively points to what most MSM meth users have known all along; that risky sexual behaviour - particularly unprotected anal sex -increases when meth is combined with sex. "There has been a heightened awareness about the potential risks of crystal meth use," says Steven Tierney, co-chair of the Mayor's Task Force on Crystal Meth. "We set out to change the community norm that this was not just another innocent party drug – that this one was a little more dangerous – and that people should be careful. That's had a big impact." The number of agencies providing services focusing on crystal meth addiction have risen from six to 34 since the Task Force was estabished, and it has been successful in securing sizeable state funding.

Meth's decline among the Bay Area's MSM is directly related to a corresponding fall in new HIV transmission
cases, which have leveled off since 20012. The stable infection rate of between 800-1000 a year is attributed to successful, hardhitting prevention campaigning by community agencies, particularly the Stop AIDS Project, and widespread serosorting, in which men seek out same HIV-status sex. 2005 recorded an overall 21% decline in new cases since 2001, bucking a trend which saw an overall 8% increase in MSM across the US in 2005, according to the DPH annual HIV/AIDS Epidemiology Report for 2005.

Indeed, so effective have upfront campaigns been at reducing HIV infections among gay men that HIV itself has been demoted from epidemic to endemic status by the city's leading health officials.

"It's encouraging and shows that social marketing campaigns can be effective, that the San Francisco gay male community cares about these issues and that they can be effectively mobilised," says Dr. Jeffrey Klausner, director of the STD Prevention and Control for DPH, although Jason Riggs, communications director at the Stop AIDS Project, cautions: "We've seen a decrease, but it doesn't mean that we are not also concerned about its ongoing use and infection rates."

Health officials, meanwhile, are at loggerheads over whether to encourage serosorting as a method of restricting HIV infection, noting that HIV- men who serosort cannot be certain that their patner is HIV- too, while HIV+ men risk acquiring STDs which may compromise an already weakened immune system, as well as contracting new strains of the virus which may impede the effectiveness of antiretroviral medications. "It is not our responsibility to be encouraging people to do things that have an element of risk involved just because they may be, overall, a good public health strategy," says Robert McMullen, executive director of the Stop AIDS Project. "It is a loaded gun."

"Crisis to me is an uncontrolled situation that has not been responded to. Three years ago we were in crisis. Now we are in response mode."
- Dr. Jeffrey Klausner [San Francisco Department of Public Health]

San Francisco has led the way in educating gay men about the dangers of crystal meth and stigmatising its use.

In January, the Stonewall Project launched the "Hot Sex Without Crystal? Hell Yes!" poster campaign, featuring eight well-known gay porn actors who volunteered their time to promote the message that hot sex on a natural high is not only possible but sexy too. Posters are appearing around the Castro area.

Due to funding constraints, Stop AIDS Project has not launched a new HIV-specific campaign since 2002, instead opting to focus its advertising on combating meth use and reorganising its HIV prevention work to target specific areas where MSM congregate, such as gyms, bars, the internet and the leather community. In 2004, the Project teamed up with the San Francisco Department of Public Health's HIV Prevention Program to launch the confrontational Crystal Mess campaign in an effort to combat soaring HIV and syphilis infections caused by meth use. With images of users tweaking, crashing and engaging in high-risk behaviours, the posters adopted a no-nonsense, in-your-face approach with messages such as Crystal plays more tricks than you can, Hot? Not and You're in for a bumpy ride.

A year earlier, a televised "hearing" on local public-
access cable TV, designed to bring the meth problem into the open, was attended by public health authorities and members of the gay community. At the same time, the San Francisco Chronicle published a three-part article, The Dance of Death: "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," wrote journalist Christopher Heredia, who reported that health experts estimated up to 40% of gay men in the city had tried crystal, while a 2002 study at one high-risk clinic found that 25-30% of those with new HIV infections had used the drug in the last six months.

"It's unraveling our community," a Stop AIDS Project spokesman told the Chronicle, while San Francisco prosecutor Liz Aguilar-Tarchi, head of of the district attorney's narcotics unit, said that the problem was being amplified 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 asked. "They are aware. Culpable is a strong word...but they sort of shut one eye to it."

That summer, a frustrated 45-year-old resident plastered bright neon orange posters around the Castro area, proclaiming Queer Life is Fresh. Speed is Whack!! "The community has gotten lost on speed," the anonymous guerilla stickerer told the Bay Area Reporter. "It looks away at all kinds of problems. I am sick and tired that the community doesn't want to talk about it. It affects all of us, even though we think it doesn't." His unorthodox approach sparked fierce debate in the local community and among staff at substance abuse and HIV-prevention agencies.

Almost every gay man in San Francisco, and in many other cities, knows someone who has lost a friend, roommate or partner because of that person's crystal use. Moreover, crystal use is eroding trust and friendships, the very foundations of community.
~ Jason Riggs [Stop AIDS Project]

San Francisco's declining rates of HIV infection and meth and substance abuse may in part be due to a shift in attitudes spurred on by the city's relentless efforts to allow gays to marry. "(He) has made marriage chic," explains Mayor Gavin Newsom's advisor, Jeff Sheehy. "Being married means you are in a long-term relationship and not being cracked out all night, going on the internet and finding as many people as possible to have sex with. I know more people having more kids now than ever. We are seeing a percentage of the community making healthier decisions about their lifestyle."