Nearly one in three gay and bisexual men who tested positive for HIV at a major Los Angeles clinic last year acknowledged using crystal methamphetamine, an illegal drug that increases sexual risk taking, according to a new study.
That's almost triple the rate of methamphetamine use in HIV-positive men in 2001, officials at the Los Angeles Gay and Lesbian Center said. They presented their data, based on 19,300 tests over four years, at the National HIV Prevention Conference in Atlanta.
Although there is general agreement that meth is a growing threat to gay and bisexual men nationwide, the latest numbers were higher than some experts expected.
"It does surprise me," said Dr. Jeffrey Klausner, director of sexually transmitted disease control in San Francisco. "It's an important and serious problem."
Quentin O'Brien, the Gay and Lesbian Center's director of health and mental health services, called the increase startling. When asked if the problem had peaked, he said, "No one knows. We're on the upward trend right now."
For years, the likelihood of unprotected sex has been associated with use of alcohol, cocaine, amyl or butyl nitrate ("poppers") and other drugs. The growing methamphetamine epidemic is the latest challenge.
Meth increases arousal and reduces inhibitions, often prompting users to seek sex with multiple partners, heightening the risk of contracting HIV, experts said.
The drug can be smoked, snorted, taken orally or injected intravenously. (HIV, the virus that causes AIDS, can be spread directly if a person uses a contaminated needle during an injection.)
Those who test positive for HIV aren't the only ones who use meth. More than 10% of all gay and bisexual men who were tested for HIV at the center last year admitted using meth, nearly double the rate in 2001.
The center asked all gay and bisexual men tested there whether they had used crystal meth since their last HIV test or in the last two years, whichever was more recent. Of the total, 942 tested positive for the AIDS virus.
Los Angeles County public health officials said the study mirrors their own preliminary findings among gay and bisexual men recently diagnosed with AIDS.
"It's just all kind of validating the same thing," said Dr. Douglas Frye, medical director of the county's HIV epidemiology program. "It looks like there really is an increase in meth use among people with HIV and AIDS.... In the gay community, it's always been a West Coast, white thing. Now it seems to be generalizing."
Indeed, the Gay and Lesbian Center's study shows increases in all race and age groups.
Later this month, one local group serving HIV-positive clients will begin a small marketing campaign on sex-seeking websites and in the gay press, encouraging meth users to become educated and seek treatment.
The campaign's slogan is "Get off now," said Demetri Moshoyannis, executive director of Being Alive, a coalition of people with HIV and AIDS.
"One of the things we need to do is create a different social norm in the gay community, making it unfashionable to use crystal," Moshoyannis said. "We want to get to the point where peers are saying to one another, 'No, I don't use crystal, and nobody's doing that now.' "
In the past, those who treated substance abuse and those who treated HIV did not necessarily collaborate.
"There's been HIV funding and there has been drug treatment funding, and those are different arms of the government, of the county," said Cathy Reback, a researcher and director of prevention at the Van Ness Recovery House in Hollywood.
As meth use has been increasingly linked to HIV, though, "there has been tremendous movement in the right direction," she said. Reback and colleague Steve Shoptaw plan to open a clinic in West Hollywood this year to provide meth abuse treatment to gay and bisexual men, along with education on how to reduce their HIV risks.