For those of us on the front lines fighting the HIV/AIDS pandemic, news this past month that public health officials have identified a drug-resistant strain of HIV that may cause the rapid onset of AIDS confirmed one of our biggest fears. Several days later, local health officials announced that one individual tested for HIV in San Diego County may be infected with the strain. Appropriately, AIDS prevention professionals and gay community groups have begun to debate how best to respond. Unfortunately, others, both within and outside the gay community, have instead chosen to demonize gay and bisexual men for their behavior, adding to the ongoing stigma that has fueled the HIV epidemic.

Lost in most of the debate so far is the fundamental role that crystal methamphetamine addiction plays in feeding the resurgent wave of HIV infections and unsafe sexual behavior. Organizations and leaders in the gay community and AIDS community dealing with HIV prevention and substance abuse have failed to adequately address their responsibility and role in preventing crystal-meth addiction and HIV transmission.

For those who are gay, homophobia and stigma feed their drug use. Rapidly, addiction sets in and sexual risk-taking becomes common. Data collected at publicly funded clinics in California between 2001 and 2002 showed that gay or bisexual men who use crystal meth were twice as likely to test positive for HIV. Other studies show that condom use was lower among men who used meth.

From 2001 to 2003, I was the board chair of a local residential drug and alcohol recovery agency primarily serving the gay, lesbian, bisexual and transgender community. On average, 66 percent of the individuals entering the residential treatment program were addicted to crystal. Once they began their journey out of addiction, many learned that they were also HIV infected.

Recognizing the need to act, I joined with several friends to create a crystal meth outreach and education campaign targeting gay and bisexual men. Our effort raised more than $80,000 in private donations to place billboards, bus shelter ads, posters, brochures and print ads in publications and venues reaching gay and bisexual men. Our goal – to begin a community debate and raise awareness of the issue – was successful. In response to the discussions that occurred throughout the community, a number of people entered treatment. Lacking additional private or public resources, or leadership from community stakeholders, the campaign ended more than two years ago.

An urgent, coordinated and sustained response is required. New leadership from the county of San Diego is needed to address the urgency of this unfolding problem. Chief Administrative Officer Walt Ekard should direct health officials to establish a joint-community public health task force to examine how new interventions and resources can best be directed to address this growing threat. Outside stakeholders, including those who don’t have a financial stake in HIV or drug-prevention funds, should be members, and the task force should be asked to issue a report within six months. County leaders should take the recommendations of this working group and set clear expectations for measuring success. Funds should be reprioritized to ensure the implementation of the recommendations. Similar efforts were begun in 2003 by the State Office of AIDS.

Elected officials at the federal and state levels also have important roles to play. Restricting access to pseudoephedrine, a key ingredient of crystal meth, is one important step. Legislation is expected to be introduced at the federal and state levels. As currently proposed, these bills would limit the quantity a person could purchase in a 30-day period and require it be stocked behind a pharmacy counter. Similar legislation in Oklahoma resulted in a reduction of meth lab seizures by 80 percent in its first year.

Finally, the identification of a drug-resistant and powerful strain of HIV must be a wake-up call, demanding leadership from the gay community and public officials. Solutions should focus on fighting the disease of addiction and recognizing its role in spreading HIV, rather than demonizing those who it impacts. Together, we can meet this new challenge while treating those dealing with addiction and HIV with respect and dignity.