Research says HIV-positive men at higher risk for Meth use

Beautiful young men dance in the centre of the World. It's almost 3 a.m. on a Sunday morning and the dance floor at the downtown after-hours club is packed. Although the crowd is mixed, there are many more men than women, and most of them are gay. If anyone is over thirty-five, they hide it well.

These guys must have steady incomes, because the cover charge is $25, a can of Red Bull costs $7, and bodies like that don't come cheap. (Or easy.) The majority of men dance shirtless. They all have the same hairless, buff, porn-star physique, designer jeans that fit just so, and perfect hair. Every now and then, someone in the throng lifts a small vial to his nose, and sniffs. Is it the party drug K (ketamine)? GHB (gamma hydroxybutyrate)? Coke? Maybe it's Tina.

Tina is a circuit-party colloquialism for crystal meth. Throughout the year, some well-heeled gay men crisscross North America to attend circuit parties, weekendlong events comprising a series of dance fests that last all night. From time to time, a few of them engage in risky sexual behaviour frequently fuelled by powerful party drugs that make you feel like a million bucks. Crystal, which is also showing up to some degree in bathhouses, sex-play spaces, and via on-line hookups under the acronym PNP (party and play), is the drug du jour.

"It's evil," says gay club promoter Michael Venus over lunch at a sidewalk café in the West End.

Venus was shocked when he discovered that his best friend had been addicted to crystal for years. A drag entertainer and performance artist, he was a popular figure in Vancouver's gay nightlife scene.

"I thought he did it occasionally, but he was doing it all the time. He hid it really well. People always wondered why he was so 'up' all the time, and how he got so much done. But then he started to look sick, really sick, and he started to become a different person. He was lying and stealing”¦he ended up going back East to recover. We talk on the phone sometimes. He's really ashamed."

Venus says he tried it a couple of times, and that was enough. "It makes everything fabulous, and you feel like you can do anything. I understand why it's addictive. That's why I stopped."

Over the last year, gay men have been singled out with a few other groups as particularly prone to addiction, and mainstream news stories have associated crystal meth with risky sexual behaviour and HIV transmission. In the U.S., many powerful so-called faith-based groups have manipulated this supposed link in widely read articles attacking the evils of the "homosexual lifestyle". The association of crystal meth use with HIV is based primarily on hearsay, and potentially dangerous assumptions about its role in risky sex obscure other contributing factors.

"The media has overemphasized the use of crystal meth [among gay men] to the detriment of good reporting, and it detracts from the impact on straight people," says Perry Halkitis by phone from New York.

Halkitis is a research director with NYU's Center for HIV/AIDS Educational Studies and Training. He was involved with a yearlong study that monitored crystal meth use among 450 openly gay and bisexual men in New York City who identified themselves as party-drug users. Sixty-five percent of the participants had tried crystal at least once in the four months before the study began. By the project's end, only 31 percent reported using crystal within the same time period. At least one story misconstruing this study hit the newswires. It cited some iffy statistics from a few years back indicating that five to 25 percent of all gay men used crystal, and that the number had skyrocketed to more than 60 percent. The study focused on self-identified drug-using gay men, not all gay men, and like most news stories, this one did not differentiate between one-time use, occasional use, and addiction.

"Overall, among gay men in general, a more realistic figure for crystal use is probably 10 to 20 percent, and probably closer to 10," Halkitis says.

That number of people toying with a particularly toxic drug in any community is large enough to warrant serious concern. That's why individuals representing AIDS Vancouver, Vancouver Coastal Health Authority, YouthCo AIDS Society, and the BC Centre for Excellence in HIV/AIDS (BCCFE) have formed a working group on crystal use among Vancouver's gay men, as well as men who have sex with other men but don't identify themselves as gay. An outreach campaign-and no one has any idea what that means yet-will be administered at Gayway, AV's Davie Street drop-in centre for gay men.

"The biggest thing prompting us is the discussion in the [gay] community," says Michael Mancinelli, an HIV prevention and awareness educator at AIDS Vancouver. "They've seen their friends, lovers, and family members affected by it. An epidemic? I don't know."

Dr. Tom Lampinen of BCCFE has some surprising revelations based on the centre's multipronged, five-year Vanguard project study of several hundred young, HIV-negative gay and bisexual men.

"We saw that the trend toward the increase in unsafe sex is statistically independent from the trend toward increasing crystal meth use," Lampinen says by phone.

In other words, even if there is some crossover, one does not necessarily relate to the other. The Vanguard information is too detailed and extensive to relate here, but in a nutshell, Lampinen, like Halkitis, figures that crystal use among all gay men (including one-time and occasional users) is in the 10- to 20- percent range, although he leans toward the higher number. Another related Vanguard study indicated that the rate of crystal use is higher among HIV-positive men, though not the cause of their infection.

"Let's not ignore the elephant in the room; there's great currency in misinterpreting studies that show meth users are two to four times more likely to be HIV-positive," Lampinen says. "In fact, most often it's the other way around: HIV-positive men are at a two- to four-fold risk for using crystal meth."

BCCFE studies show that 8 out of 10 times, these men began using crystal after they had acquired HIV infection. Centre studies conducted with the British Columbia Centre for Disease Control also show that B.C.'s HIV rates among gay men increased 50 percent in 2000 and have not declined since.

So why have health agencies, as well as community groups at the grassroots level, failed for the past five years to respond to crystal meth as a substance-abuse problem among gay men, independent of HIV?

Another question gay men in this city need to ask themselves and each other is why, aside from the obvious pursuit of pleasure, are a substantial number drawn to a habitual use of crystal and other confidence- and/or sex-boosting substances. Can it have anything to do with self-esteem?

Besides the challenges of living in a homophobic world, gay culture pressures men to conform to an unrealistic physical ideal. But one day we all wake up to find that we're no longer young, beautiful, and at the centre of the world, and no drug in the universe can ever change that. Then what?