I observed in the comments section of one of Professor Volokh's posts that there is a very large subset of gay men who engage in highly dangerous behaviors: meth & promiscuous, unprotected sex. The gay men didn't believe it.
See ANDREW JACOBS, "Gays Debate Radical Steps to Curb Unsafe Sex," New York Times, February 15, 2005:
That frustration has been ratcheted up by the growing popularity of crystal meth in New York, which many say has led to an abrupt increase in unsafe behavior and a spate of infections. Although exact figures are difficult to determine, a recent survey of gay men found that 25 percent had tried crystal meth in the last few months.See also here for a discussion of the dramatic increase in syphilis cases caused by promiscuous unprotected sex by gay men who are HIV+, and figure that they have nothing left to lose.
And this one:
A study by the Los Angeles Gay &Lesbian Center of 19,000 men who have sex with men (MSM) tested there for HIV between 2001 and 2004 shows a near doubling – from 5.8 to 10.3 percent – of reported use of crystal meth. Among MSM who tested HIV-positive, crystal use had nearly tripled – from 11.7 percent to 30.2 percent – in the same time period. Among users, 86.6 percent report use of the drug during sex.And here:
“We are desperate for more MSM-specific treatment programs for meth users,” said Craig E. Thompson, executive director of AIDS Project Los Angeles (APLA). “Crystal use is ten times greater among gay men than the general population. Up to twenty percent of gay men report using it. While there is no proven link to date between crystal use and the rise in HIV rates among gay men, it is clear that what was perceived as a west coast phenomenon is now a national emergency.”
Crystal meth - which can be snorted, smoked or injected - has been a popular gay party drug on the West Coast for more than a decade, and in New York since the late 1990s. In many cities, however, gay activists and health officials were not quick to confront the fact that the drug, by curbing inhibitions and boosting energy, encourages unsafe multi-partner sex and thus increases the risk of HIV transmission.From the Atlanta Journal-Constitution:
In New York, alarm over meth intensified in February, when health officials reported a rare strain of highly resistant, rapidly progressing HIV in a gay man who regularly engaged in meth-fueled sex parties. But the tide began turning against the drug a year earlier, when gay activists held the first of several forums on the epidemic and an ex-addict named Peter Staley circulated posters with an eye-catching message: "Buy Crystal. Get HIV Free."
Increased publicity about the gay meth epidemic comes at an awkward time for the national gay-rights movement as it pushes for same-sex marriage rights.
"There is anger at the opportunity this phenomenon is giving the rest of the world to associate the gay identity with promiscuous sex, with out-of-control behavior," Malpas said. "We don't need additional opportunities to be perceived negatively."
Kathleen Watt, who runs the Van Ness addiction-recovery center in Los Angeles, believes some major gay advocacy groups have tried to play down the epidemic.
"They're afraid people are going to say, 'Why should we put money into HIV treatment when these guys are knowingly going out and having sex and infecting other people?'" she said.
Matt Foreman, executive director of the National Gay and Lesbian Task Force, said some accounts of the gay meth problem had been "salacious" and "overjudgmental" - highlighting the role of promiscuous sex while underplaying the destructive addictiveness of meth for any user, gay or straight. He praised gay activists for taking the lead in fighting the epidemic.
Foreman and other gay-rights leaders also note that even in the hardest-hit communities, most gay men don't use meth. Estimates have ranged from 10 percent or 20 percent of all gay men, and as high as 40 percent in San Francisco - by any measure a problem that can't be wished away.
Smith is one of a growing number of young gay men in Atlanta who believe they contracted HIV after meth abuse and risky sex. But in metro Atlanta, which has the largest concentration of gays in the Deep South, AIDS groups have not yet started meth-specific education campaigns. The problem, however, has become a crisis, say some therapists and medical experts who treat gay men.And from the New York Blade (a gay newspaper--the ads may be offensive):
"They are taking outrageous risks," said John Ballew, an Atlanta therapist who says two-thirds of his clients are gay men. "It has really become associated with the fast-lane night life among certain gay men. My professional take on it is, the problem is just as bad as [in] New York or San Francisco or Los Angeles."
Meth use among gay men in Atlanta is "really, really insidious," said Michael Dubin, a counselor whose clients are all gay men. "From what I am hearing from friends and from clients, it is a lot more extensive than any of us would like to think, especially in the club scene. And it leads to people throwing caution to the wind — when they know better."
Dr. Sanjay Sharma, a psychiatrist at Grady Health System's infectious disease program, said the drug's use among gay men has become a serious health concern. "A lot of these substances, crystal meth in particular, are associated with euphoria and hypersexuality," he said. "And along with that, increased sexual risk-taking behaviors, and then an overall impaired judgment. That's not a good combination of effects."
Many gay men have never tried methamphetamine. Some have only experimented briefly with the drug. But a minority of gay men habitually abuse the drug during sexual encounters with multiple partners. For these men, meth use has become part of sex.
Meth, a psychostimulant that excites pleasure centers in the brain, makes users feel euphoric for hours. The drug impairs judgment, lowers inhibitions, keeps people awake for days, and can increase sexual arousal.
"They go from feeling like wallflowers to feeling like supermen," Ballew said. "Safer sex messages are just forgotten."
Meth is so linked with this subculture of gay men engaging in anonymous sex with strangers that men advertise either that they have the drug or want it during sex in personal ads and on the Internet. Their notices carry the phrase "PnP" for "party and play," a euphemism for crystal methamphetamine and sex.
"People will have what they call Tina sex parties," said Danny Sprouse, coordinator of HIV prevention and mental health services for gay and bisexual men at Positive Impact Inc., an Atlanta nonprofit that counsels people with HIV. "They may set up some rules at the beginning to say, 'You can only have safe sex.' So they'll have a lot of condoms available."
Or they may have Tina parties where condoms aren't even allowed, Sprouse said, "where they say, 'We're only going to have unsafe sex.' "
Even at condoms-only Tina parties, men don't always use protection as the drug kicks in and the night wears on, he said.
John, a 36-year-old gay man who lives in Midtown, said he wished he had never touched the stuff.
"On Tina, you make bad judgments about safe sex, about your life, about just about everything," he said.
John asked that his last name not be published. He has known since 1997 he is HIV-positive. He used meth for more than 18 months until he quit, with great difficulty, this Jan. 1, he said.
While on methamphetamine, he frequented all-night Atlanta sex clubs and often had anonymous, unprotected sex with men who also were high on the drug, he said.
"I think there's a possibility that I may have infected someone. I couldn't tell you who," John said. "And I have the feeling that the people that I did have unprotected sex with had already had unprotected sex with other people, so there's no way for them to know if it would have been me or someone else."
Planning for the First National Conference on Methamphetamine, HIV & Hepatitis, set for Aug. 19-20, began as a way to respond to a belief that increased meth use will lead to higher HIV and hepatitis rates, according to Luciano Colonna, executive director of the Harm Reduction Project, which hosts the conference.The article goes on to discuss--in somewhat cruder language than I care to quote--that because meth tends to cause impotence problems, they are mixing meth and Viagra.
"We were alarmed by the heath risks associated with the spread of methamphetamine," Colonna said. "But we were also very concerned at the lack of infrastructure in rural areas of the U.S. when it came to dealing with issues like HIV and hepatitis, and also just the basic fiscal toll and care toll that outbreaks for methamphetamine use could have on communities."
By gathering together groups that address meth use, Colonna said he hopes to create a better understanding of the "continuum of care" that includes treatment, prevention, harm reduction and law enforcement.
Several of the conference’s presentations discuss meth’s impact on gay men, including sessions on meth use and sexual risk for men who have sex with men, meth dependence and treatment among gay men and a "Tweaking Tips for Party Boys" discussion by Michael Siever, director of the Stonewall Project at the University of California, San Francisco.
Recent studies show that 15 percent to 17 percent of gay men used meth in the last three months and as many as 20 percent have used in the last year, according to Gordon Mansergh, a senior behavioral scientist at the Centers for Disease Control & Prevention who will take part in the conference.
Mansergh also said research drew links between men who have sex with men, meth use and unprotected sex.
"What we see in over a dozen studies is that meth users exhibit greater rates of unprotected anal sex than non meth users," he said.