Young gay men in New York rarely using crystal meth for sex

Crystal methamphetamine is rarely used by younger gay men in New York City during sex, according to research presented to a gay men’s health prevention conference in London. Investigators from the City University of New York also found that the drug was not necessarily a risk factor for unprotected anal sex, and that many men were able to have safer sex whilst using the drug.

Methamphetamine use by gay men in the United States has recently become a major concern. Several studies have suggested that use of the drug is linked to riskier sexual behaviour and a poorer clinical outcome in HIV-positive patients. Although studies have found that few gay men in the United Kingdom use the drug, a recent study suggested that HIV-positive men with large numbers of sexual partners were the group most likely to report using the drug.

Research conducted in New York City in 2002 found that 14% of gay men aged between 18 and 25 had ever used methamphetamine. Although this level of use was higher than that seen amongst heterosexual or lesbian women, it was not significantly different to reported use seen in heterosexual men (11%).

Investigators at the City University of New York then conducted further study investigating a range of health issues amongst 400 18 to 29 year-olds (100 of whom were gay or bisexual men) attending dance clubs in the city between 2004 and 2007. Only one of the men recruited to the study reported being HIV-positive. Qualitative and quantitative data from this study were presented to the annual CHAPS gay men’s HIV prevention conference.

The men in the sample were highly drug experienced, with 96% reporting use of cocaine, and 89% the use of ecstasy.

Use of methamphetamine was also widespread with 58 men reporting ever having used the drug. There were no significant demographic differences between users and non-users of the drug. Use of methamphetamine within the last four months was reported by 23 men (46%), and most of these men reported using the drug as a “treat”, twice a month or so. The same proportion of individuals said they used the drug during sex. However, only eight of the men reported first use of the drug in a sexual setting, with the majority of users saying that they took the drug in a club, bar or somebody's home. In addition, some men reported that they first took the drug believing it to be cocaine or another drug.

Many of the men reported that their sexual desire increased after taking methamphetamine, and that their inhibitions were lowered. One 28 year-old told the investigators: “[Sex was] really all I wanted. And it felt so good too…it felt good to be that sexual.” Reduced inhibitions and decisions that were later regretted were evident in the testimony of one 23 year-old African American: “It was hardcore that night – there were like toys involved, it lasted for like eight hours, there was no condoms and it was crazy. And I wouldn’t have done half the stuff I did that night had I not been high.”

But other men were more circumspect about the role of methamphetamine in their sexual decision-taking: “I think the risk factor’s always there”, said a 21 year-old, “and I think it’s just the human condition. So, like, yeah. I don’t think it’s caused me to be unsafe [be]‘cause I think clearly on Tina [methamphetamine].” Prof. Parsons, who presented the data, stressed that there was no significant relationship between the use of methamphetamine and unprotected sex, indeed he emphasised that men who did not use the drug were just as likely to report unprotected anal sex as men who did use methamphetamine.

Guilt about methamphetamine use was reported by a just over a quarter of men. One individual told the investigators: “I mean, except for the drugs and the guilt and the having sex with strangers, the sex was good.”

Although many men viewed methamphetamine as a “sex drug” this was far from universal. Of the men who did combine the drug with sex, reduced sexual functioning emerged as a common theme. One of the (majority of) men who did not combine the drug told the investigators: “Tina – there’s no way you could ever have sex. I don’t understand how anyone can ever have sex on Tina.”

Many of the men viewed their usage of methamphetamine within the context of cocaine use. One 22 year-old told the investigators: “[Coke is] crystal’s younger, weaker, disabled sister.” Other men mentioned that they had reduced or avoided use of methamphetamine only to increase their use of cocaine, which they viewed as less stigmatised or dangerous. Some men justified their cocaine use saying “at least I’m not a tweaker.”

The results of a small London study examining drug use, including methamphetamine use, by gay men were also presented to the conference. Of the 84 individuals included in this study, over a quarter did not use any drugs and 13% had never heard of methamphetamine. Twelve men reported use of methamphetamine, with most saying that they used the drug infrequently, although some said that their use of the drug would increase if it was cheaper (the drug currently costs much more than cocaine and other 'club' drugs such as ecstasy in London). Although use of the drug was associated with sex and sex-seeking, its use was not associated with an increased risk of unprotected sex, and only a few men reported taking the drug at sex parties.