Check it Out: • 1 LB of METH = 5 LBS of   TOXIC WASTE • In 2004 alone, there were more   than 10,000 meth lab cleanups   at a cost of $18.6 million (Source: DEA, NIDA, NIH, USDHHS)

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The Many Faces of Meth: Before After

(Source: Multnomah County Sheriff's Office - Faces of Meth™)

Meth Use Leads to Increased HIV Infections Among Gay Men

More than two decades after the emergence of the AIDS epidemic, the use of a highly addictive club drug has fueled a resurgence of HIV infections among gay men in the United States.

Crystallized methamphetamine, a powerful synthetic stimulant that produces a long-lasting euphoric high, has become one of the most popular - and dangerous - abused drugs in America. Within the gay community, widespread use of the drug has been associated with an increased prevalence of unsafe sex practices and a resultant spike in HIV transmission.

Writing in the May 23, 2005 edition of The New Yorker, Michael Specter noted one study in which one-quarter of men who used meth in the previous month were HIV positive. "The drug appears to double the risk of infection (because it erases inhibitions but also, it seems, because of physiological changes that make the virus easier to transmit)," Specter wrote. "And the risk climbs the more one uses it."

The U.S. Drug Enforcement Agency (DEA) has categorized methamphetamine as a Schedule II stimulant, meaning that the drug has a high potential for abuse and can be legally acquired only with a non-refillable prescription. However, according to the National Institute on Drug Abuse (NIDA), most of the methamphetamine that makes it onto the street is a version that is synthesized in small, illegal labs both in the United States and abroad.

Among illegal users, one of the most popular forms of the drug is crystal meth, which resembles tiny shards of glass or shiny bluish rocks. This version is most commonly ingested by smoking (heating the rocks and inhaling the fumes), though some users inject the drug, swallow it in pill form, or take it as a suppository.

Meth use triggers a massive release of the brain chemical dopamine, which is associated with emotions such as joy, pleasure, and motivation. Dr. Richard Rawson of the UCLA Integrated Substance Abuse Programs told PBS Frontline reporters that meth-related dopamine releases can be as much as 12 times higher than the release that is prompted by eating food, having sex, and engaging in other naturally pleasurable activities.

Among the most devastating downsides of the drug, though, is that in addition to stimulating the brain's pleasure receptors, it also destroys them. Thus, meth users have to take increasingly larger doses of the drug to get the same high, leading to a degenerative cycle of continued damage.

NIDA Director Dr. Nora Volkow, who has led studies on the lasting effects of meth use on the brain, said that the drug can lead to permanent debilitation. "There is a concern that methamphetamine abusers may be at increased risk for neurodegenerative disease as they age," Volkow wrote in a message on the NIDA website.

The Gay Men's Health Crisis, a not-for-profit education and advocacy group founded in response to the AIDS epidemic, says gay men are attracted to crystal meth for a variety of reasons. According to the "Crystal: What You Need to Know" page on the GMHC website, in addition to offering an intense and relatively inexpensive high, meth may also appeal to gay men as a means of overcoming the following emotions and experiences:

• Loneliness and isolation -

  Because crystal meth is often used in social settings, the drug may help assuage feelings of isolation in some gay men. Some users say the drug diminishes their self-consciousness, allowing them to interact with others more readily.

• Poor body image -

  Some gay men report that one of the effects of a meth high is that they feel greater self-satisfaction, especially about their bodies.

• Loss of energy -

  Some HIV-positive men told the GMHC that taking crystal meth offsets the weakness and lethargy that is associated with some HIV medications.

• Poor self-esteem -

  Some gay men say they use meth in an effort to feel less insecure and more confident.

• Depression -

  As with many abused substances, crystal meth appeals to individuals who are attempting to self-medicate themselves out of the sadness and emptiness associated with undiagnosed depression.

In the first years of the 21st century, health officials began expressing concern about a meth-related rise in HIV and other sexually transmitted infections among gay men. Among those who sounded the alarm was Dr. Jeffrey Klausner, the director of sexually transmitted disease prevention and control for the San Francisco Department of Public Health.

After attending an April 2003 conference in which it was announced that the rate of HIV infection among gay meth users in California was almost twice that of gay men who abstained from meth, Klausner told San Francisco Chronicle staff writer Christopher Heredia that "the crystal meth epidemic is playing an important role in increasing sexual risk behaviors, and that is leading to new HIV and STD infections."

Heredia, who reported his conversation with Klausner in the May 4, 2003 edition of the Chronicle, said that the doctor also identified meth as the primary culprit in an uptick in syphilis and gonorrhea among gay men.

Two years later, Klausner told New Yorker writer Michael Specter that meth had an accomplice in its invasion of the gay community: the Internet. "It turned out that crystal methamphetamine and the Internet were the perfect complements for high-risk sex," Klausner said in Specter's May 23, 2005 article. "Crystal washes away your inhibitions. Makes you feel good and want sex. And the Internet is there to respond to your whims. It's fast, it's easy, and it's always available."

For many in the gay community, the explosion of meth use brought back memories of the early years of the AIDS epidemic. After years of advocating and practicing safer sex, many gay men were returning to extremely high-risk behaviors.

Many factors contributed to this change. Ironically, among the most commonly cited influences were medical advances that had transformed HIV infection from a virtual death sentence to, in many cases, a manageable condition. While prolonging and enhancing the lives of HIV-positive individuals, this breakthrough also had the unintended side effect of removing the fear of infection that once spurred many safer-sex initiatives.

Twenty years removed from the devastation of the mid-1980s, many in the community adopted a 21st-century approach to the unsafe lifestyles of that era, incorporating the access offered by the Internet with the euphoria associated with meth. As Specter wrote in The New Yorker, "The first thing people on methamphetamine lose is their common sense; suddenly, anything goes ..."

But a few years into the meth epidemic, signs of hope are emerging.

In his July 26, 2007 article in Wired magazine, Aaron Rowe reported that the San Francisco Department of Public Health had recorded a three-year decline in meth use among gay men. Earlier that year (March 14, 2007), the Aidsmap website had reported that investigators associated with the City University of New York had found that crystal meth was "rarely used by younger gay men in New York City" - and that men who did use the drug reported that they still used condoms during sex.

Though there are signs that meth use is on the decline, no one is assuming that the risk has passed. As Rowe's Wired article documented, research by the San Francisco Department of Public Health indicates that drug use among gay men remains cause for concern:

• HIV-negative homosexual men who used meth before sex were almost three times as likely to engage in risky behavior as were men who didn't use the drug.

• The use of cocaine and amyl nitrate was also associated with an increase in unsafe sex acts.

• Drinking alcohol just before sex was linked to a 10 percent increase in the likelihood of engaging in high-risk sexual behavior - a statistic that was particularly concerning because more than 50 percent of the men who were surveyed said that they drank before having sex.

One of the national leaders in the fight against drug abuse told Chronicle staff writer Heredia that individuals continue to be seduced by the false promises of drugs such as crystal meth, only to end up in a place far removed from the paradise they had envisioned

"People are using the drug to feel better," NIDA Director Volkow said, "but they are literally selling their soul to the devil."