At last week’s HIV educators and researchers conference, Patrick Raw-storne and Heather Worth presented data which, for some, was surprising.
Their research showed significant increases in rates of unprotected anal intercourse had taken place prior to the popular use of crystal among gay men, and not after.
Drawing arguments from the results of the Sydney Gay Community Periodic Surveys, Rawstorne and Worth found there was no sufficient evidence of a causal link between crystal use and unsafe sex. Men who used drugs like amyl nitrite and alcohol, for example, were just as likely to report unprotected anal intercourse with casual partners (UAIC). The paper concluded the relationship between sex and drugs is extremely complicated and socially and culturally defined.
The findings followed comments made in December last year by Don Baxter, executive director of AFAO, that we are concerned that a number of these new [HIV] infections actually come from episodes of crystal bingeing.
No fewer than three surveys at the time indicated crystal meth use was on the rise in Sydney and reports that crystal use had become a major health problem for gay men in the United States only increased a sense of alarm. Local health organisations frequently see the US experience as an indicator of future problems (including the latest syphilis epidemic) and anecdotal reports presented to Star journalists suggested it was already a major problem.
What happened? Sean Slavin, research fellow at the Australian Research Centre in Sex, Health and Society at LaTrobe University, said crystal is still a problem.
I have some reservations about the data that Patrick presented -¦ Slavin said. While agreeing that I don’t believe there is a causal relationship between crystal meth and unprotected sex, I think there is an association and I would expect that Patrick would agree with that.
Slavin worked for four years on an ethnographic study in Sydney on gay male party drug users, some of whom used crystal, and he also contributed towards a seroconversion study.
I think this debate about unprotected sex and whether there’s a causal link is really an esoteric one, he said.
Drawing conclusions about the social, cultural and epidemiological effects on any drug, of course, is a fraught affair.
To begin with, to focus on just crystal alone might suggest to the community that other drugs aren’t equally perilous, a problem which makes even the publication of this article potentially damaging. The reported effects of the drug are also shaped by how the gay community tends to use it, for example, for sexual play within sex-on-premises venues. In such an environment a whole different set of rules and pressures come into effect, of which crystal is only a part.
However, at least pharmacologically, crystal meth does seem like a recipe for unsafe sex. Users report a sense of invincibility and the removal of sexual inhibition, not to mention a prolonged period of effectiveness. Dr Robert Finlayson told the Star last December that many gay men he treats report that they become much more of a -˜bottom’ and seek partner after partner after partner.
David McGuigan, ACON’s director of community health, is not convinced.
You can have all of that and use condoms, he said. People who know about drugs would say -˜a drug can’t make you do something’ -¦ I think it’s difficult to say for somebody who’s always used condoms all of the time, they have a dose of crystal, that automatically they jump to unsafe sex.
Kane Race was part of a panel on crystal meth at the conference along with McGuigan and Slavin, and agrees that the causation is difficult to prove and hugely problematic.
Crystal releases neurotransmitters like dopamine and adrenaline and serotonin and that produces feelings of confidence and stamina and euphoria, Race said. But in and of themselves those physical effects do not necessarily produce things like being an insatiable bottom. I think they combine with a number of cultural elements -¦
I wouldn’t want to pin it on sex-on-premises venues either. It’s aspects of a much broader re-evaluation of risk among at least some gay men in the context of medical advances [in HIV] which makes risks that might previously have been completely unthinkable, thinkable in different sorts of ways.
Slavin believes, however, that regardless of other cultural or social elements surrounding the drug, crystal is different, and gay men are suffering in ways beyond the question of HIV.
I think there are also a lot of other harms associated with crystal, often more acute, to do with the way it upsets the patterns of their lives, their finances, their emotional life, Slavin said.
I think what has slightly taken us a while to realise is that crystal is not just the same as other party drugs such as ecstasy, and has specific properties and specific effects that I don’t think gay men were entirely prepared for, he said. I think one of the really important things is, ecstasy is self-limiting, so in the course of the night the more ecstasy you take, the less the effect will be -¦ Crystal is not self-limiting in that way and people describe it as very -˜more-ish’.
Slavin suggested we need really practical harm reduction advice about crystal, which McGuigan explained is about to be released by ACON in the form of a booklet.
Both Slavin and McGuigan admit that one of the messages -“ for at least some gay men -“ is not to use crystal at all or to have breaks from the drug.
I think we need to have a discussion about the fact that for some men, they would be best to stop using crystal entirely, Slavin said.
McGuigan tentatively suggested, I guess there’s a message for some people with crystal, maybe it’s time that you had a break or you stopped. I think sometimes, for some people, abstinence is the answer for drug use. However, he said such advice is more likely to be given in the context of counselling than a print media campaign.
Both men admit the message runs contrary to harm reduction/harm minimisation strategies that have become the mainstay of HIV and drug welfare organisations. Their comments also inadvertently confirm that crystal meth is worthy of individual attention.
Slavin said the debate on crystal had to be careful, precisely because of the HIV sector’s relationship to national drug policies.
National drug policy is, under the current government, in some ways difficult to work with, he said. It’s driven by a set of assumptions and ideologies essentially, that run contrary to the way that we’ve traditionally done HIV prevention in this country. And we use harm reduction as a framework for approaching drug use.
Slavin is keen to stress that his major recommendation is really practical harm reduction advice of the type ACON is about to release.
Slavin’s final suggestion should ring a few bells.
How do we provide support and advice and referral pathways most importantly for people who would like to stop using crystal altogether? he asked. The kind of side effects and problems that people on amphetamines present with can sometimes jar with the services that are geared to opiate patients -¦ and the sort of gay men I’ve spoken to have had reservations about going to mainstream alcohol and drug services.
In October last year, The San Francisco Chronicle cited three crystal meth treatment programs operating exclusively for gay and bisexual men in San Francisco, with Narcotics Anonymous chapters specifically aimed at crystal meth addiction reported in Seattle, Palm Springs, Atlanta, Philadelphia and New York.
Sydney may be next but, in the meantime, McGuigan has some more familiar harm minimisation advice.
If you’re planning a really long session, be prepared. Have as much [safe sex materials] there as you possibly can. Make sure that if it’s a party, for example, that everybody brings along their own equipment or it’s provided for people, he said.

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