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All methed up
The comeback of HIV and STDs — and the drug that’s fueling it
BY DAVID S. BERNSTEIN

If gay culture sets the style that the straight world follows, Boston could be heading for a serious health crisis. On the local gay party scene, the hippest and hottest must-have accouterment is a bag of colorless, odorless, shiny rock-like fragments: crystal methamphetamine. And thanks largely to crystal meth, Boston is suddenly awash in diseases we thought were under control.

In two years, Boston’s syphilis rate has shot from 28th- to sixth-highest in the country, due primarily to its spread among men having sex with other men, according to the Centers for Disease Control and Prevention. The Massachusetts Department of Public Health (DPH) reports that gay and bisexual men in the state have also experienced a huge increase in antibiotic-resistant gonorrhea. Most disturbingly, the incidence of new HIV/AIDS cases in Boston started increasing in 2002, after years of decline — and according to DPH numbers released in October, sex with another man now accounts for more than half of new HIV-infection cases among men, after dropping to just 41 percent of cases in 1999.

The reasons for the problem are surely multiple and complex, but health officials and gay-community activists point to crystal meth, and the resulting risky sexual behavior among its users, as a primary culprit. The state’s Bureau of Communicable Disease Control has specifically named crystal meth as a cause of the troubling increase in syphilis among gay men in Massachusetts. Research in San Francisco has shown a direct link between crystal-meth use and recent increases in HIV rates there. In New York City, a public-policy task force report released last summer linked crystal meth to skyrocketing syphilis rates in the city, and added that "emerging evidence also suggests that crystal use may be contributing to an increase in new HIV infections."

"Every single person who has come to us with crystal meth has also just found out they are HIV-positive," says Jonathan Scott, president and executive director of Victory Programs Inc., a residential substance-abuse-treatment provider in Boston.

Until about two years ago, crystal meth — a/k/a Crissy, Tina, glass, crank, tweak, ice, chalk, go-fast — was virtually unavailable in Northeastern cities such as Boston. Long popular among Southern rednecks, Western biker gangs, and Midwestern housewives, crystal meth now is finally spreading to this region, thanks to its popularity on the gay-party circuit — and Boston appears to be at the forefront. Meth-related emergency-room visits in the city tripled from 1998 to 2002, according to the most recent data from the Drug Abuse Warning Network (DAWN), part of the US Department of Health and Human Services. That gives Boston the worst per capita meth problem of all the Northeastern metropolitan areas studied in the DAWN system, easily ahead of Buffalo, Newark, Philadelphia, and even New York City.

Still, crystal meth is around in far less quantity here than in other parts of the country, says Anthony Pettigrew, spokesman for the US Drug Enforcement Administration’s New England office. Pettigrew adds that almost no crystal meth is manufactured locally — although apparently enough is now brought in to feed the habits of about eight percent of all gay men in Boston, according to an ongoing Harvard study. It remains, to this point, a niche drug — a club drug for that portion of gay and bisexual men who join the roving, all-night "circuit party" scene or seek sexual hookups on Internet sites such as Manhunt.net.

But will it remain within that niche? MDMA, better known as Ecstasy or X, certainly didn’t. "X was big in the gay community in the ’80s, then hit the club scene in the ’90s," says Kevin Kapila, a South End psychiatrist who specializes in substance abuse. Already meth is gaining popularity as a club drug nationally, according to the National Drug Intelligence Center. Here in Boston, meth is becoming more readily available at nightclubs as the supply increases and partiers search for new highs. Cheap club drugs like GHB (commonly used by Boston-area strippers) and ketamine have become harder to get locally, and Ecstasy use in Boston has plateaued, according to the Office of National Drug Control Policy (NDCP), which also says that young Boston-area clubgoers are experimenting with LSD, PCP, mushrooms, and mescaline. It shouldn’t take these experimenters long to find out what gay partiers like about crystal meth — in fact, in a startling finding buried in the latest NDCP profile of Boston drug use, more ninth-grade students reported having used methamphetamines (5.9 percent) than Ecstasy (5.1).

Once it starts, the spread of crystal meth can be explosive. In 1992, Indiana admitted two users into methamphetamine substance-abuse treatment for every 100,000 people in the state — roughly the same rate as Massachusetts had two years ago. But by 2002, Indiana’s rate had multiplied more than 10 times over, to 23 per 100,000. In the same time period, Missouri’s meth-admission rate exploded from five to 86 per 100,000; Arkansas from seven to 125; Washington from 11 to 150.

If these rates of increase can spring from housewives looking to lose weight and bikers trying to stay awake, surely it could happen among clubgoers in Boston. If it does, it could bring dramatic public-health risks, perhaps including the spread of HIV/AIDS, but certainly other sexually transmitted diseases (STDs). "There would be a huge epidemic of chlamydia if this drug ever becomes popular among college students in Boston," says Sophie Godley, director of prevention and education for AIDS Action Committee.

Health officials here are not waiting around to see how big the problem gets. In fact, two years ago, the Boston Public Health Commission and the Massachusetts Department of Public Health joined up with Fenway Community Health Center, AIDS Action Committee, and Victory Programs Inc. to create a task force that has spawned education materials, public-awareness campaigns, and training for treatment providers. The task force just received a three-year federal grant for crystal-meth-prevention efforts targeted at gay men. It is also listening to public-health officials in places like San Francisco, Atlanta, and Seattle, where the crystal-meth problem is far more advanced, says John Auerbach, executive director of the Boston Public Health Commission. "They all said to us, ‘intervene quickly — you don’t want to deal with what we’re dealing with.’ "

To understand Boston’s new meth-fueled STD problem, you have to put away any discomfort you may have about the kinkier extremes of gay-male sexuality, and any concern about stereotyping gay promiscuity. The stubborn fact is this: some gay men use party drugs to loosen their inhibitions and to increase their stamina so they can have wild, all-night sex, sometimes with anonymous or multiple partners. This goes on in the straight world as well, except that those partiers have yet to catch on to the thrill of crystal. It is, by users’ accounts, a far more powerful and pleasurable aphrodisiac. On a meth high, they hook up with multiple partners; they forget to use precautions such as condoms; they engage in rougher intercourse, with more chance of tearing and bleeding — all increasing the risk of AIDS and other sexually transmitted diseases. The drug heightens stimulation (caused by the release of dopamine, the brain’s pleasure chemical), which makes sex more pleasurable, which heightens the desire for the drug, which speeds the physiological addiction. Sexual desire and craving for the drug become psychologically intertwined. Impatience with the delayed gratification from methamphetamine pills or even snorting can lead to switching to crack-style pipe smoking; "booty bumps," inserted anally immediately before sex; and injection. As usage continues, the drug’s other insidious effects deepen, including paranoia and severe weight loss. Users’ "normal" life begins to self-destruct from erratic behavior, according to treatment providers like Kapila, and their "party" life becomes more meth-centered.

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Issue Date: December 17 - 23, 2004
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