Meth & HIV: Another Brick In the Stigma Wall

Crystal Methamphetamine (Meth) brings with it the allure of “ravenous” sex. Some gay men are caught in its grip. Smoke it; snort it; blast it. Are they stealing from their brain’s future fund in the pursuit of fun and greater sexual excitement, potentially creating irreparable damage, and fuelling anti-gay sentiment into the bargain?

Given that a lot of HIV+ guys play in scenes where “gear is the go”, what’s their future fund looking like? The combination of meth and HIV is a dangerous cocktail – meth is more toxic to those who are poz, according to a leading expert.

In this final part of The Stirrer investigation, two eminent experts help explore the problem: Dr Rebecca McKetin from the Centre for Research on Ageing, Health and Wellbeing at ANU; and Dr Chad Bousman from the Department of Psychiatry from Melbourne University.

Dr McKetin is at the cutting edge of the study into the effects of crystal meth, while Dr Bousman is the go to man for meth/HIV’s interplay with brain functioning.  She points to the National Drug Household Survey 2010. If you are a straighty180, you are likely to play around with stimulants in 2.1% of cases. If you are a gay man, then this jumps over threefold to 7.1%.

According to Geoff Honnor at ACON, men with HIV are twice as likely to play around with stimulants, which could mean up to 20% of HIV men partaking in the hard stuff. He explains why this could be:

“Crystal has a very specific association with sexually adventurous gay men’s (‘SAMs’) sexual practice, particularly as an IV injectable. It can trigger a ravenous sexual appetite of epic proportion. Its powerful, long-lasting effects can involve staying up for days on end and can redefine ‘extended sex session’).”

It’s not hard to see why people get themselves into trouble. According to Dr McKetin, 8% of all young men (not just the using population) will experience problems, quaintly called “stimulant use disorder”. Dr McKetin explains “this means: being dependent on the drugs; use at problematic level; using more for the same high; getting health problems and/or financial problems.” A significant number of users get themselves into strife.

Being the voice of reason in an otherwise emotive debate, Honnor believes that any moral panic is misplaced.

“Crystal’s strong sexually adventurous sub-cultural association (and gay poz guys are significant players in SAM scenes) probably provides a degree of containment.

“It certainly isn’t the ‘drug of choice’ among Australian gay men that some of the moral panic around its use might suggest… It’s certainly a powerful and potentially dangerous agent, with all that implies, and the wrecked lives track record to show for it. But there’s no evidence that any use will lead inevitably to dependence/destruction, albeit that often appears to be the only public narrative on offer.”

Dr Bousman explains that HIV+ people are at a greater risk of cognitive functioning impairments. So are people who use meth. Put the two together and the consequence could be permanent damage. There is a potential degustation of brain-fade just around the corner.

“HIV and meth play together in a symbiotic way, causing significant changes to the levels of important chemicals in the brain, such as dopamine”. says Dr Bousman.

The largest clinical trial of its kind has just kicked off with the Department Psychiatry at Melbourne University and both the Alfred Hospital and St Vincent’s in Sydney. This trial is looking at a potential treatment options for HIV associated cognitive impairment. Hopefully this will give some answers as to whether this deterioration can be slowed, stabilised or even reversed.

While the trial does not consider meth effects, at least one side of the equation offers some hope. Given the over-representation of meth use among poz guys this may result in less brain deterioration from HIV and thus take the edge off the total effects of meth and HIV .

Does all this feed discrimination and homophobia?

GLBTI detractors have claimed gay marriage is a greater health risk than smoking. Stirrer Andy Schmulow scrutinized this with the Anglican Church in mind.

So-called “lifestyle factors” have even been used to argue for discrimination to be entrenched. The tenor of some submissions to the Senate Inquiry into Marriage Equality was that as a community we were already broken:  we aren’t equal (smokers are healthier); and we deserve less than others.

While aligning GLBTI with smokers, or diabetics and others suffering diseases brought about because of environmental factors may or may not be accurate, perhaps the correct response is “so what”?  Who cares how we get here, this is a problem that needs some attention. After all, smokers, the obese, and extreme sports players also get community support should their choices bring bad consequences.

Part of that “so what” might include a kind retort to those detractors along the lines of  “Well maybe if you didn’t treat us like shit we might take less risks and feel less marginalised?”

Dr McKetin makes it clear that marginalised groups are more likely to take drugs, saying “there is a high prevalence in marginalised, unemployed, aboriginal and single people”.  So in a perverse irony, the very things the GLBTI community are criticised for, are in part caused by our critics.

Anti gay and gay hate groups cite our poor health as a reason to discriminate, but they have it backwards. Not being marginalised, being settled in loving relationships, and being part of a community will improve our health.  This leads to a reduction of risky behaviours in the pursuit of pleasure, escapism –  behaviours driven by self-loathing.

Dr McKetin and Mr Honnor both note meth use is generally on the decline. It seems that every step towards acceptance and equality is step away from “lifestyle” diseases, including a reduction in behaviours that can lead to HIV infection or  blasting our brains into oblivion with drug abuse.

While there is a significant overall downward trend in the use of crystal meth amphetamine since 2008, in the 2012 survey there was a slight, though significant uptick in the proportion of participants reporting crystal use. Time will tell which way the trend is now heading.

Either way, meth use is still a problem for many gay men, and long term consequences could be dire.  Looking it in isolation and only as a drug problem seems stupid, as it traverses HIV and broader mental health considerations. Given the numbers of users, a significant number of our community are helping to turn their minds into mush and inadvertently playing into the hands of those that hate us the most.

About the author

Miles has worked as an advocate and mediator for most of his life. His previous career was focussed on employment and discrimination cases. He now is a journalist and writer with a keen interest in LGBTI affairs and national politics. He plays on Twitter under @mileshef.