BY PERRY N. HALKITIS WITH TODD M. SOLOMON | In 2004, activist Peter Staley used his stature in the gay community and political acumen (as well as his own money) to bring attention to the newest drug problem facing gay men in New York City. “Buy meth, get HIV for free,” his poster campaign advertised — and soon thereafter political officials and in turn, the New York City Department of Health and Mental Hygiene, took notice.
Those of us working in the world of research had long realized that methamphetamine, which had consumed much of the country west of the Mississippi, and had wreaked havoc on gay populations in cities like Los Angeles, San Francisco, and Seattle, was permeating our community. Yet despite mounting scientific evidence and the outcries of researchers and practitioners alike, city officials did not take notice. Staley changed all that.
Soon, there was interest by local officials, community-based agencies and service providers to learn more about meth and how to treat it — and money flowed from the City Council to leading agencies to help target this new “epidemic.” For several years, efforts to curtail the use of the drug became intimately intertwined with HIV prevention efforts. And rightly so, since illicit drug use and sexual risk behaviors are intimately entangled and mutually reinforcing.
But the drug — meth, crystal, Tina, crank or by any of its myriad know names — became to many the single causal effect to explain the rise in new HIV infections that were emerging as the millennium approached. In the minds of some, the solution to our problems was simple — eradicate meth use and HIV infections will also fall. Solutions would not prove that simple, as is evidenced by the fact that to date, no one therapeutic program has provided the magic bullet for meth addiction or for reducing the spread of HIV in our community.
Causal relations are not as simple as “x” leads to “y.” True, meth was probably implicated in the rise in new HIV infections, but not in the simple and linear fashion, as some would have us consider. Instead, research conducted over the last 15 years at our own research center — the Center for Health Identity, Behavior & Prevention Studies (CHIBPS) — and elsewhere has documented that the use of meth exists as part of a more complex array of behaviors that usually involves multiple or poly-drug use, and which functions synergistically with mental health burdens and sexual risk-taking behaviors.
Public health officials and service providers were correct to focus on drug use in an attempt to integrate HIV and mental health services. Where they went wrong is singling out one drug, instead of asking themselves why gay men are drawn to this or any other drug — and, for that matter, why a disproportionate number of gay men are abusing substances at all. I include alcohol in this mix because despite its legality, the abuse of alcohol is as problematic as the abuse of any powder or pill in terms of both addiction and HIV risk. The latter is a more interesting question and one that resonates more truthfully within the lives of gay men.
Solving the substance abuse problems many gay men face requires a complete overhaul in how we do business with regard to addictions and HIV treatment/prevention — as well as how we develop and integrate HIV service delivery. The solution must be holistic, so it does not separate HIV prevention and testing from drug counseling or mental health support.
Almost a decade later, the attention once focused on meth in the gay population of New York City has greatly diminished. Some would have us believe that this is because the drug is no longer abused, and that their peers have ostracized those few who are still using the drug. The latter may be true and likely the result of effective media campaigns, but this remains an area of speculation without the evaluation research to support it. The former is completely false. A stroll of any Internet site geared at sexual hook-ups will prove quite the contrary, especially as the clock approaches midnight and the night turns into day.
So why have we stopped paying attention to the meth problem?
First, let’s consider the meth problem in the context of a study we recently undertook at CHIBPS. The goal of our work was to help further delineate the effects of meth on decision making. For years, studies have suggested the notion that meth use is linked to sexual risk taking. Our work sought to delineate the pathways between use of the drug and sexual risk behavior, by examining the impact of the drug on decision-making processes. And while this was the main focus of our work, a main byproduct was our revelation that meth is a problem in New York City among gay men that has not gone away. Todd Solomon (a doctoral student in counseling psychology) was the project director of the study — which was known as Project MUSE. He describes what he saw as follows:
“Given its role in the potential spread of HIV in the gay and bisexual community, numerous campaigns have been enacted in the hopes of educating the public to its dangers. While some studies over the last several years have suggested a decrease in use of the drug, others have indicated the rise of methamphetamine use in the Black and other racial and ethnic minority communities. Further studies have documented its use and abuse as well as the way it has compounded the stigmatization already faced by these men.
“Our study, while not specifically designed to target racial and ethnic minority populations, clearly indicated that it is these men who are currently using meth. Over 70% of our sample identified as Black or Hispanic — and given that we made no effort to oversample these specific groups, these results may be indicative of the populations who are continuing to use this drug. More specifically, the racial breakdown was 57% Black, 14% Latino, 14% Mixed, 14% White, and 1% Asian/Pacific Islander. Further, more than half the sample indicated making less than 10,000 dollars per year, being unemployed or on disability, having no more than a high school education and being HIV positive.
“Lastly, the average age of our study participants was 41. About 80% had been using methamphetamine for over a year, and approximately half, 50%, had been using between 2-10 years, with another 19% having used for 10 years or more. On average, the men reported 8 days of use in the month prior to the interview, and roughly 70% met the diagnostic criteria for methamphetamine addiction. Thus, what was once a main drug of abuse for young, White, educated, middle and upper middle class gay men, has now potentially moved into communities with even fewer resources to deal with this problem, further compounding the multiple adversities already faced by these men.”
While the data that we have collected in Project MUSE are still preliminary, some patterns and trends are worth noting. First, Solomon alludes to a decrease in use of meth — based on studies. The fact is that we do not have any epidemiological data on the national level to indicate the pervasiveness of the methamphetamine addiction among gay men. To date, major surveillance studies including the “National Survey on Drug Use and Health” do not include a sexual orientation in their data collection. Without this basic demographic information, no true or accurate statement can be made on the prevalence of meth use among gay men or on the incidence of new use among gay men coming of age. All our knowledge is based on conjecture from piecing together findings from a variety of behavioral studies. In fact, an effort being led by Ed Craft of the Substance Abuse and Mental Health Services Administration, seeks to bring together all that we know about meth use and its pervasiveness across the entire population, including gay men.
Yet this valiant effort is no substitute for the lack of inclusion of sexual orientation items on large epidemiological surveys. Even AIDS surveillance fails to identify us as gay, choosing instead the behavioral term “MSM” — Men Who Have Sex With Men — despite the fact that we know that most men who become infected with HIV from another man are gay. Thus, without this information we have no true sense of how meth use or any other health problem truly affects us or how pervasive these problems are in our population. Professional organizations, including the American Psychological Association, have called for the inclusion of such measures in large-scale epidemiological and surveillance studies, but this is only a small first step in helping to realize this goal.
Second, and more relevant to the issue at hand is the evidence, once again, of the health disparities faced by gay men, particularly gay men of color. What we do know is that HIV incidence continues to rise among Black and Latino gay men, and that young Black and Latino gay men continue to become infected at rates much higher than their White peers. Evidence from Project MUSE, and from our previous study of methamphetamine use among Black men (known as Project HOPE) also suggests that the meth epidemic has also landed within the same segment of the population. The latter should be of no surprise to anyone. Like most epidemics, including HIV at the onset, the disease is usually manifested equally across all socioeconomic strata, but eventually, and across time, the disease becomes embedded most heavily in those communities with less income, less access to services, higher levels of poverty, and to those who experience higher levels of discrimination.
So where is Tina? The meth problem here in New York City has not gone away. It has simply moved to segments of our community that often go unnoticed and underserved. Methamphetamine abuse and addiction is still very evident in the gay population of New York City, although not necessarily confined to the A-list White circuit party crowd. The men who seem to be most affected are the ones who are also facing numerous other health, social, and emotional burdens in their lives. And while this reality may not be sexy to some or provide for the makings of splashy media campaigns, it is a reality. It is our hope that public health officials will once again take notice and address the needs of these gay men, who are often less empowered to advocate for their own needs, and who are vitally important to the fabric of the gay community.
Perry N. Halkitis, PhD, is Professor of Applied Psychology and Public Health at the Steinhardt School of Culture, Education, and Human Development, New York University. His book, “Methamphetamine Addiction: Biological Foundations, Psychological Factors, and Social Consequences,” was published in 2009 by the American Psychological Association Press.
