How Meth Is Devastating The World’s Gayest Cities

In New York alone, use of crystal meth has more than doubled in the past five years. Is "party and play" culture to blame?

Crystal meth use is on the rise in America’s gay meccas. From the avalanche of capital Ts and cloud emojis on hookup apps, to the lost souls wandering the streets of any gayborhood, the impact of methamphetamines on our community can be seen all around us. Many of us have lost a friend or a loved one—or even ourselves for a time—to tina.

Powerful, relatively cheap, and often habit-forming, meth has been called “the second great gay plague.” It isn’t a problem unique to queer men, of course, or even metropolitan areas. Across broad swaths of the rural South and Midwest—in old mill towns and withering industrial centers, mostly—amphetamines vie with opioids to fill the void left by meaningful employment.

But crystal meth is often used by gay and bisexual men in combination with other substances (poppers, Viagra, GHB) in marathon sexual encounters that can last days. Meth boosts confidence and endurance while reducing inhibitions, increasing the likelihood of bareback sex, multiple partners, intravenous drug use, and other high-risk behaviors that can lead to the transmission of HIV and hepatitis C.

Last year, a the CDC’s National HIV Behavioral Surveillance (NHBS)—a long-term observation of the sexual risk, testing, and treatment behaviors of men who have sex with men, found that meth use among gay/bisexual men in New York had more than doubled since hitting an all-time low of 4.3% in 2011.

The increase in San Francisco was less dramatic but started higher, 11.9% in 2011, before increasing to 13.1% in 2014. Usage in L.A. has remained basically unchanged since 2011, falling just a fraction of a percent to 11.5%. Those numbers are significantly higher than the national average of 6.4%, though reports of usage among gay and bisexual men living with HIV are dramatically higher at 16.9%.

Unfortunately, the NHBS report collects little information about meth use beyond usage numbers, and there’s been no major scientific inquiries into the relationship between queer men and crystal since before the age of hook apps and PnP culture. But a handful of studies published across the Global West in the waning days of 2016 give us a glimpse into the impact of meth on our gay and bisexual brothers in the modern era.

injection drugs

A study in the International Journal of STD & AIDS analyzed associations between chemsex, STI diagnoses, and sexual behavior among gay, bisexual, and other men who have sex with men. The researchers behind the cleverly titled (for a research paper) “Chemsex and the City: Sexualized Substance Use in Gay Bisexual and Other Men Who Have Sex With Men Attending Sexual Health Clinics” conducted a retroactive review of case notes for all gay and bisexual men visiting two national health centers in South London popular with men who have sex with men, between the months of January 2015 and June 2016.

Of the 818 case histories included in the analysis, 30% disclosed recreational drug use, 57% reported engaging in chemsex and 13.5% injected drugs into their veins. PnP was associated with increased numbers of sexual partners, group sex, sex for drugs or money, fisting, sharing sex toys, injecting drugs, lots of alcohol consumption, and the use of “bareback” sexual networks. Just as in the results from the NHBS, men living with HIV were significantly more likely to combine sex and drugs. Subjects spoke about their reasons for “partying” in interviews with clinicians—to bolster low self-esteem, to dull the pain of internalized homophobia, or to manage the stigma associated with living with HIV. Unsurprisingly, those participating in chemsex reported escalation of use in times of enhanced stress: Being diagnosed with HIV, the end of a relationship, moving to London were all associated with increased use.

On the other side of the world, an Australian study delved into breaking the cycle of sex and meth. Treatment options for methamphetamine dependency are frustratingly limited. There exist no FDA-approved medications for methamphetamine dependence or withdrawal, and—in the United States at least—many queer men have few options beyond their local 12 Step program.

In the journal PLOS One, Australian scientists examined the effectiveness of the Substance Support Service program at ACON—the largest organization in the country focused on the health of LGBT people. One of few queer-specific drug treatment services on the continent, it provides free counseling for LGBT individuals seeking assistance for substance abuse.

Treatment consists of a highly structured initial interview and, typically, up to 12 sessions with a mental-health professional, drawing on a number of therapeutic methods—including acceptance and commitment therapy, motivational interviewing, and cognitive behavioral therapy—each of which are client-centered, evidence-based practices for treating mental disorders which are partially rooted in Eastern concepts like mindfulness and meditation.

Records for 101 clients—all of whom identified as gay excepting one bisexual man—were included in the analysis. The majority (82.2%) had used meth in the four weeks prior to treatment. Some 56.4% reported they were HIV-positive, 36.6% were HIV-negative, and the remaining 6.9% didn’t know their status.

Many of those involved with the study were heavy users. The most common means of consumptions among participants was injection (58.4%), followed by smoking (32.7%); 92% of participants were deemed to be dependent on methamphetamines, and 31% had previously been treated for drug or alcohol dependence. Many of the participants dropped out of the program over the course of the study. Of the initial 101 gay and bisexual men seeking treatment, only 60 remained four weeks into the program. By the eighth week that number had dropped to 32. A 70% dropout rate is clearly not optimal, but many of those who stuck with the program saw a significant reduction in the number of days and amount of methamphetamine use, and intensity of methamphetamine dependence. Among participants who reported using crystal in the four weeks before the beginning of treatment, 35.3% reported complete abstinence from meth at the first follow-up, and by 33.3% participants at follow-up two.

Drug abuse transaction

While both the U.K. and Australian studies hint at fascinating insights into the intersection of drugs and the psyches of gay and bisexual men, each study is hampered by shortcomings that limit their usefulness.

The U.K. study relied upon documentation of routine clinical care, and as a result is lacking in key data (the participants perceptions of meth’s dangers and adverse consequences or detailed questions about frequency of use, for instance) which would allow for a richer analysis. The Australian study lacked a control group, so while we are able to say that ACON’s Substance Support Service is effective, we can’t determine the extent to which the positive outcomes were due to factors other than the treatment received. They are both very limited in scope, and what either one can tell us about understanding and/or treating crystal meth dependency among gay and bisexual men living in the United States is up for debate. But given how few research dollars are allocated for studying queer men and crystal meth, we have to take what we can get.

As Pete Staley points out in POZ magazine, the NHBS is the only study that has consistently surveyed gay men about their meth use over time. We need a research project which really wrestles with the issue of gay and bisexual men and our relationship to crystal meth in the modern era.

Just such a study is apparently being conducted in Canada, which is awesome, I’m all for more science wherever I can get it. But as great as it is to have studies conducted in Canada, Australia, and the U.K., the usefulness of research conducted outside of the United States will always be limited.

If we want to fight this scourge successfully, we need to know why we use it and how to break free.

Brenden Shucart live in Atlanta, where he is writer, actor and advocate for people living with HIV.