Methamphetamine used by 10% of gay men in London, higher level of use seen in HIV-positive

Approximately 10% of gay men in London have used the recreational drug methamphetamine, according to a study published in the online edition of the journal Addiction. Use of methamphetamine by gay men has previously been linked to HIV risk behaviours by researchers in the United States. Although investigators from the City University in London found a link between use of methamphetamine and unsafe sex, they were unable to establish a causal link between use of the drug and risky sex. The investigators also found that use of methamphetamine formed part of a repertoire of drug use behaviour and the link between unsafe sex seen for methamphetamine was also present for other more widely used and less stigmatised recreational drugs, such as ecstasy.

Methamphetamine was recently recommended for reclassification as a Class A drug in the United Kingdom, but despite some sensationalist and alarmist media claims there is, in fact, very limited and conflicting evidence about the extent of its use by gay in the UK.

Investigators from London’s City University, who have undertaken extensive research into the sexual behaviour of gay men, recruited a total of 700 gay men to a study in an attempt to further understand the extent and implications of methamphetamine use by gay men in London. The men completed a questionnaire about their drug use and sexual behaviour. A total of 400 men were HIV-positive and were recruited at an HIV treatment centre, the remaining 300 HIV-negative men were recruited at a sexual health clinic and an HIV testing centre.

Methamphetamine was used by 13% of HIV-positive men in the previous year and 8% of HIV-negative men. But the City University investigators stressed that most men were infrequent users of the drug. Of men with HIV, 9% said that they had used the drug once or twice in the previous twelve months, 3% said they used it once or twice a month, but less than 1% - fewer than four individuals who took part in the survey – said they used the narcotic on a weekly basis.

The findings of the City University study are broadly in line with that of the 2005 National Gay Men’s Sex Survey which found that a little over 6% of gay men in London reported use of the drug in the previous year, although higher levels of use were seen amongst HIV-positive men.

However, an earlier study conducted by the City University investigators involving 500 gay gym users found much higher levels of methamphetamine use, with almost 20% of men surveyed reporting use of the drug between 2003 – 2005. This study was widely quoted in the media as showing that one-in-five gay men in the capital used methamphetamine, however, investigators are now stressing that the 20% usage figure seen amongst gym users “probably reflects meth use among gay men who are part of the London club-drug scene – the sample is not representative of all London gay men.”

A connection was also established between the use of methamphetamine and other recreational drugs, with 90% of meth users reporting the use of another narcotic. Men who used methamphetamine were also more likely than other men to report the use of cocaine, ketamine and ecstasy.

In the US and Australia, methamphetamine use has been blamed for an apparent increase in levels of unsafe sex. Investigators from City University found that men who used methamphetamine were two to three times more likely to report unprotected sex than men who did not use the drug. Investigator Professor Jonathan Elford commented, “We found a clear link between crystal meth use and unsafe sex. Men who used crystal meth were at least twice as likely to report unsafe sex as other men.” But Prof. Elford was eager to stress that the association between methamphetamine use and HIV risk behaviours was far from clear-cut as men who used cocaine, ecstasy and ketamine were also twice as likely to report unsafe sex.

Prof. Elford added that much is still unknown about the nature of the association between methamphetamine use and unprotected sex, “it could be that some gay men follow a riskier lifestyle in general and methamphetamine is simply part of this picture. More research is needed to establish cause and effect.” Furthermore Prof. Elford continued “we can’t say that crystal meth use leads to unsafe sex, we need to be aware of the link between the two. Research into specific episodes of drug use and high risk sex would throw light on this issue.”

Several education campaigns have been targeted at gay men about methamphetamine in recent years. The UK’s largest HIV charity, the Terrence Higgins Trust, has outreach workers in gay clubs in the Vauxhall area of the capital and the UK Coalition of People Living with HIV and AIDS has also been undertaking research into the extent and implications of methamphetamine use amongst HIV-positive gay men.