Certain trends in our culture start on the coasts and work their way to the middle of the country, or start with specific groups of people and then work up to the general public. For example, methamphetamine has been around much longer than most people realize. In World War II, the German, Japanese, and U.S. militaries sanctioned meth to assist combat troops and long-distance pilots with their stamina.
Curiously, the rise of the current “meth crisis” started in rural areas, such as in Missouri. Five years ago, the lead author was conducting substance abuse treatment for probationers in Maricopa County, Arizona, and 80% of his clients had meth-related charges. We see the use of crystal rising in all socioeconomic and ethnic groupings in our treatment facilities.
Gay folk have been trendsetters in fashion, music, theater, and the revitalization of neighborhoods across the country. But the latest trend that has been attributed in particular to gay men is not one to be proud of. For years in the gay community, there was a “quiet revolution,” if you will, going on. It started with the clubs and circuit parties associated with the “cookie-cutter” great-looking, shirtless men more than 15 years ago. Meth, this cheap-to-produce and easy-to-procure drug, allowed these partygoers to dance the night away with tons of energy, to hook up with other men for sex, to have sex for hours, and to not have to sleep. Even better, users rationalized, one lost weight on the drug, which contributed to its popularity in a culture obsessed with body image.
Over time, the connection between this drug and what it does to libido mushroomed among gay men. After decades of safer-sex ads, lectures, and education around AIDS, new sex clubs and parties evolved, advertising “bare backing” (anal sex without use of a condom) and “PNP” on the Internet. PNP stands for “party and play”; “party” is a euphemism for crystal meth and “play” means sex. So today, gay chat rooms are loaded with messages from gay men “seeking others for PNP.”
The result has been a documented rise in new HIV/AIDS cases because of this drug's use. The Los Angeles Gay and Lesbian Center reports that one-third of all new HIV infections are related to meth use, a figure consistent with that of other major cities such as New York City and San Francisco.
We all know that drugs lower inhibitions. So even those who would never think of unprotected sex while sober may engage in risky behavior under the influence of this party drug. Many of the patients we see at our facilities talk about the “incredible sex” they had while under the influence of this drug, to the extent that they fear having sex while sober.
The HIV connection
We know that HIV weakens the immune system and that the partying lifestyle, with its accompanying lack of sleep, food, and liquids, only leads to further deterioration. What you may not know is that meth actually eats through the immune system, causing a drop in T cells and natural killer (NK) cells that destroy cells infected by viruses. The drug, the lifestyle, and HIV take a major toll on those who are immunocompromised.
Not much is known about the interaction between meth and HIV medications. This is largely because of a lack of funding for such research from pharmaceutical companies and the government, as well as that the purity of meth varies significantly. Even if funding were available for research, it would be hard to get a consistent supply of crystal meth to create a baseline study. What we do know is that bad things happen.
For example, certain HIV medications, such as ritonavir and nevirapine, are designed to boost the effects of other medications. In 1997, a man with AIDS who had been taking ritonavir died suddenly after taking two hits of Ecstasy. His blood level of MDMA was the equivalent of 22 hits of Ecstasy.
Both meth and HIV medications are processed out of the bloodstream through the liver. The liver can accommodate only so much, and HIV medications take priority in the liver. Thus, meth can build up to dangerous levels in the bloodstream, which can lead to overdose and other conditions such as heart attack, stroke, and coma.
“Drug holidays” (not taking HIV meds for a period of time) are common among even occasional meth users. Unsupervised drug holidays, especially when partying, can lead to a drop in T cell counts and a rise in viral loads. Drug holidays are also dangerous because they can give the virus a chance to mutate and become immune to medications that an individual may be taking.
Consider these statistics about the gay and bisexual male population:
24% of MSM (men who have sex with men, the term used instead of “gay/bisexual men” in epidemiologic measures and most journals) in the Pacific region (California, Oregon, Washington, Hawaii, Alaska, and Guam) reported recent meth use. Those in this group reporting recent unprotected anal intercourse were four times more likely to have used meth before or during sex than those reporting no unprotected anal intercourse.1
More than 2,800 meth-related emergency-room mentions occurred in Los Angeles and San Diego alone in 2002.2
Meth use by HIV-positive MSM is associated with decreased medication adherence, which threatens treatment goals of viral suppression.3
MSM meth use is closely connected to sexual identity and sexual expression.4–6