Crystal Methamphetamine Use among MSM in Los Angeles County: A Situational Assessment Jane Rohde, MPH Planning and Research Division Office of AIDS Programs and Policy Summit on Methamphetamine Abatement and Treatment October 29, 2005

2 What We Know about Crystal Meth Associated with a feeling of euphoria  Often used to initiate and enhance sexual encounters 1,2 Results in decreased inhibitions  Users typically have more sexual partners than non- users 3  Highly associated with risky sexual behaviors such as decreased use of condoms, anal sex, fisting and prolonged sexual activity 3,4,5,6  Gay and bisexual men who use meth have a greater prevalence of HIV infection than MSM who do not use the drug 3,7 1 Halkitis et al. (2001), 2 Reback (1997), 3 Molitor et al.(1998), 4 Purcell et al (2001), 5 Reback et al. (1999), 6 Shoptaw et al (1998), 7 Chesney et al. (1998).

3 Background Los Angeles County Risk Assessment Survey (CRAS) Survey Questions  Demographics  Drug and sexual risk behaviors  Perceptions about sex, drug use and condoms  Service utilization Eligibility Criteria  Clients receiving HIV prevention services from agencies funded by health department  12 years of age or older  Not previously surveyed in 2004

4 Substance Use among CRAS Respondents (n = 5,046) Alcohol71% Tobacco59% Marijuana39% Crystal Methamphetamine17% Crack Cocaine16% Other Opiate13% Cocaine (not crack)12% Club Drugs (Special K, Ecstasy, GHB)11% Heroin11% Speedball7% Inhalant6% Other Amphetamine3% LSD/Acid2% Other Drugs2% Source: Janson, M CRAS Data (weighted)

5 CRAS Respondent Drug Use by BRG Percent n= 578 Source: Janson, M CRAS Data (weighted)

6 CRAS Meth Users by BRG n= 856n% MSM MSM MSM/IDU MSM/W485.6 WSR F/IDU HM/IDU505.8 Undetermined Numbers may not equal 100% due to rounding and missing data Source: Janson, M CRAS Data (weighted)

7 Limitations Data captured are cross-sectional Service providers are targeting a high-risk population

8 Objectives Gather information on current strategies and interventions in LAC Identify existing gaps in HIV prevention and substance abuse education among MSM from the perspective of experts in the field Gain a deeper understanding of the issues surrounding crystal meth use in LAC

9 Objectives (Cont’d) Determine to what extent meth use is perceived as a community norm and how this affects acceptance and use of the drug Gather information for the local community to make informed decisions about the kinds of interventions needed

10 Methods “Key informants” identified as having expertise in HIV/AIDS/substance abuse field and work with MSM 26 “key informant” interviews conducted (March – July 2005)  Direct providers of services  Researchers in the field  Indirect providers

11 Findings Why users use meth Accessibility and acceptability help make crystal the “perfect drug for the perfect group at the perfect time.” Who uses crystal “Meth is not just another party drug, but an elixir that temporarily assuages a long record of affliction. For this reason, it is the perfect gay drug.” HIV and meth use “…meth disorganizes behavior sufficiently so that people who are HIV infected already are out there having a lot of sex, passing the virus.”

12 Findings (Cont’d) The sexual experience and meth “There aren’t enough people who are willing to have the conversations that they need to have regarding sexual identity and practices.” Sexual addiction “The bottom line is there is such thing as an obsessive compulsive sexual behavior that is bringing wreckage to your life. Gay or straight.” Relapse “The compulsivity is so substantial that I have to put a geographic wedge between them and the hood and remove them across town to literally get them out of there.”

13 Issues/Challenges Role of internet in facilitating sexual encounters Need for creation of a healthy sexual space “I would say the biggest barrier is we have an emotionally shut down community.” “We don’t expect people to stop having sex. This is like a harm reduction model to some degree where we really work to define what is healthy for them, what is healthy non-destructive behavior.” Scattered efforts and lack of collaboration or knowledge about existing programs in LAC Lack of communication between doctors and pharmacists

14 Issues/Challenges (Cont’d) Importance of changing community norms around meth use Community dialogue is crucial “I think community dialogue works. We need to expose people to how to talk about this topic and teach them how to do this.” Need to create trust in the community to encourage open dialogue “Anyone doing work around public health stuff needs to be asking drug and alcohol questions. If we aren’t talking about it everywhere … then we aren’t doing our job. If sexual health and risk taking isn’t talked about either, then we’re missing it. Until we’re finding some of these things out from these people, we won’t know how to address this problem.”

15 Recommendations Convene a crystal meth working group Collaborate with other urban areas Increase number of in-patient treatment beds in drug and sexual addiction facilities  Treatment facilities should be sensitive to issues affecting MSM “It is unacceptable and unethical to ask gay men to hang their sexual identities at the door.”

16 Recommendations (Cont’d) Conduct more comprehensive trainings covering meth use, sexual orientation and sexual addiction  Private physicians (CMEs)  Pharmacists  HIV counselors and outreach workers  Drug treatment center staff

17 Recommendations (Cont’d) Develop a continuum of interventions targeting the user at multiple stages of use  Social marketing campaign Driven by direct research in the field MSM population has been inundated with the HIV/safe sex message Variety of messages – also target ‘recreational users’ Identify a key community leader to function as a spokesperson Fear campaigns won’t work “My sense is you cannot talk about the negative consequences without acknowledging all the good things men are experiencing on this drug. Here’s just another campaign that’s telling you, Here is your brain fried on drugs – which is an old story.”

18 Recommendations (Cont’d) Create a website that is Los Angeles County focused Use the internet creatively for possible interventions Create resources for peers and friends of users Identify alternative funders to support and fund interventions

19 Recommendations (Cont’d) Identify increased funding sources for research surrounding crystal meth  Need for analysis and dissemination of existing local data  Use of ethnography to determine how an individual’s meth use affects ability to define and negotiate safety and risk  Need more specific data on women and meth use

20 Resources “A Key to Methamphetamine Related Literature,” NY State Department of Health National Library of Medicine’s PubMed database: ystalmeth/docs/methamphetamine_index_0_9_5.pdf

21 Thank You To all the participants interviewed who generously volunteered their time and candidly shared their thoughts around this timely and important issue

Jane Rohde, CDC Specialist Planning and Research Division Office of AIDS Programs and Policy 600 South Commonwealth Avenue, 2nd Floor Los Angeles, California Phone: Fax: Contact Information: