”Fears over gay community drug use” read the BBC headline from the third of June 2005, reporting a study that found around one in five gay men in London had used methamphetamine, a drug which in the United States has been linked with risky sexual behaviour and accelerated HIV disease progression.
There have been rumblings in the London gay press for at least a couple of years that methamphetamine use had crossed the Atlantic and was set to become one of the drugs of choice of gay men in the UK’s capital. Anecdotal evidence seemed to support this. Profiles on the popular cruising website gaydar have been seen with the headline “Looking for Tina” (a US street term for methamphetamine), and personal testimonies on the American website Lifeormeth.com from gay men in London recount how methamphetamine use led them to throw caution to the wind and have unprotected anal sex.
In the US, methamphetamine use has been singled out as a major new challenge to HIV prevention and treatment. In particular, concerns have been raised that use of the drug is linked to an increase in unprotected sex, which has been facilitated in part by the use of erectile dysfunction drugs such as Viagra (methamphetamine can cause erectile problems). Consequently, this has lead some US doctors to call for the recreational use of Viagra and similar drugs to be made illegal.
Warnings that methamphetamine use would lead to a dangerous new development in the HIV epidemic were seemingly confirmed earlier this year. Media attention around the world was grabbed when the New York health department announced that a gay man who regularly used methamphetamine had been infected with a multidrug resistant strain of HIV and had experienced rapid disease progression.
Studies have also shown that the HIV-positive methamphetamine users have higher viral loads than non-users, thought to be related to poorer adherence to HIV medication and lack of self-care. Taking methamphetamine has also been shown to worsen brain damage caused by HIV infection.
Unsurprisingly, HIV prevention workers and physicians are anxious that methamphetamine does not become a drug of choice amongst gay men in the UK, and the UK’s largest HIV charity, the Terrence Higgins Trust recently produced a safer sex information leaflet on “Crystal”. Meetings of the gay men’s group at the advocacy organisation the UK Coalition of People living with HIV and AIDS have also focused on methamphetamine use, and the message boards on their website include postings expressing concerns about emerging use of the drug. Indeed, so worried are health workers about the use of the drug becoming widespread in London, that government money has been earmarked to fund a post to educate HIV-positive gay men about the potential risks of methamphetamine use.
What does research actually say?
The finding that approximately 20% of gay men use methamphetamine in the UK’s capital seems, on the surface at least, to confirm that the use of the drug is becoming an issue. Not least because the research comes from such a reputable source, having been conducted by investigators at London’s City University, who since 1998 have used an annual survey of gay men attending gyms in central London and using internet cruising sites to monitor trends in sexual and drug use behaviours.
In March 2004, the City University investigators surveyed almost 750 gay men attending six gyms in central London. The men completed a self-administered questionnaire. The headline finding was that 21% of these men had used methamphetamine at least once during the previous twelve months.
This finding supports earlier research conducted by investigators at the City University. In 2003 they established that 15% of HIV-positive gay men attending HIV treatment clinics had used methamphetamine, as had 10% of HIV-negative men having an HIV test and 7% of gay men using internet chat rooms and cruising sites.
As in the US, a connection was also found between use of methamphetamine and unprotected anal sex.
However, it was also found (yet unreported by the BBC), that although one in five gay men completing the gym survey had used methamphetamine at some time in the past year, very few men were regular users of the drug. Overall, 15% of men said that they had used the drug only once or twice in the previous year, 5% said their pattern of use was once or twice a month, and only 1% (that is a grand total of eight men who completed the survey) reported using methamphetamine once or more a week.
Investigator, Professor Jonathan Elford, emphasised this point: “Our research represents the first data on crystal methamphetamine usage among gay men in London. It shows that while one in five gay men in London have used it, most are infrequent users.”
Further, Prof Elford’s research found that methamphetamine was only one of several drugs used by gay men taking part in the survey, with 90% reporting the use of other recreational drugs such as ecstasy, cocaine and ketamine.
Nor does the connection with unprotected sex appear as clear-cut on further examination. As Prof Elford explained: “We found an association between crystal methamphetamine usage and men having unsafe sex. ” However, he adds that this is not the only drug for which this association was found, adding “this was also true of men who used cocaine, ecstasy and ketamine.” Nor is the nature of the association between drug use and sexual risk behaviour clear-cut. As Prof Elford explains: “It could be that some gay men follow a riskier lifestyle in general and crystal methamphetamine is just part of this picture.”
Overall, Prof Elford urges a cautious interpretation of his research, noting “usage in [London] has remained static over the last three years and the levels reported here are nothing like on the scale of crystal methamphetamine usage in the US.”
Official government drug seizure figures also indicate that methamphetamine is far from exploding in the UK. Indeed, statistics from 2002 (the latest available) showed that total seizure of all amphetamines (including methamphetamines) actually fell from the year before.
Others are also urging caution. THT’s Will Nutland recently commented, “Crystal is increasingly, and simplistically, being linked in the eyes of the mainstream (and parts of the gay) press, to unsafe sexual behaviour amongst gay men. Just as with the net last year, a bunch of couldn’t-care-less bug chasers the year before and bathhouses in the 80s, crystal has become the casual explanation for HIV infections amongst gay men.”
And research from the US also suggests that the connection between drug use and usafe sex, including methamphetamine use, may actually be more complex than is often assumed. One large study found that, as in London, poly-drug use (including legally available alcohol and poppers) was associated with HIV risk behaviour, and a study amongst young gay men in South Beach, Miami, a gay resort often associated with partying, found no association between HIV infection status and drug use.
Finally, in the context of the scare about methamphetamine use in London, what should one think about the “New York resistance case”, which excited so much anxiety in the early months of this year and seemed to confirm the link between methamphetamine use, taking impotence drugs, reckless sexual behaviour, the acquisition of mutlidrug resistant HIV and rapid disease progression? In February many investigators, together with aidsmap urged that this case should be treated with caution. A report in the June 5thLos Angeles Times highlights how some doctors and much of the media over-hyped the case. It is to be hoped that in future there will be more reasoned reporting of issues involving gay men, drug use and HIV. Recent coverage of methamphetamine use by London’s gay men suggests that we may have to wait some time for this to be the case.