Jay Dagenhart became infected with HIV while addicted to meth. His addiction also led him to “losing just about every job that I had during my addiction, being gay-bashed, having a gun pulled on me, declaring bankruptcy, and finally becoming homeless; all because of my crystal meth addiction.”

His was the most riveting presentation heard at a session on crystal methamphetamine at the spring meeting of the National Coalition for LGBT Health in Washington, D.C., on March 14.

Dagenhart and a group of other recovering addicts formed the Philadelphia Crystal Meth Task Force. “We are tired of pushing this under the rug and not discussing it, so we are going to talk about it in very bold ways, to change the conversation,” he said.

The goal is to change community values so that using crystal and having unprotected sex or being up all night dancing is seen as inappropriate behavior. “We are saying, ‘Do you realize how addictive this is?’”

It is based on a model developed in New York City.

Dagenhart recently went to a bathhouse in Philadelphia. When he disclosed his HIV status to men there, the first five turned and walked away, “The only person who was willing to have sex with me was the crystal meth addict,” Dagenhart said. “This is no mystery. The drug dealers in our community are setting up shop in bathhouses. They check into a room, they bring their supply, and they can feed their sexual addiction, which stems from their crystal meth addiction.”

“They can sell large quantities of the drug without fear of getting caught because who from the DEA or police are going to come into the bathhouse – walk around in a towel with the fear of playing grab-ass – and crack down on the drug problem within our community. As gay men we sexualize everything; we shake hands with our penis. If we can learn to educate one another and bring the problem into the light we might have a little more success in dealing with it.”

Some 15 percent of HIV-positive and negative gay men had used meth during their most recent sexual encounter, third only to alcohol and marijuana, according to a 2004 survey conducted in San Francisco, said Gordon Mansergh. The CDC researcher summarized some of the key findings presented at a two-day meeting on gay men and crystal meth use that the Centers for Disease Control and Prevention (CDC) held in mid-January.

Meth users in San Francisco were “1.7 times more likely to test positive for gonorrhea, nearly two times more likely to have chlamydia, and nearly five times more likely to have syphilis.”

In New York City, HIV-positive men were nearly three times more likely to report meth use during their most recent anal sex encounter.

When pressed as to why meth, which is only one of many substances of abuse, is getting all of the attention, Mansergh acknowledged, “It’s the drug de jour, in some ways. Meth is something that we’ve seen an increased wave coming in the last 10 to 15 years. It becomes a community consciousness because of the movement… because of the rapid increase, but also because of the rapid devastation. One of the recommendations coming out of the conference in January is that we don’t focus exclusively on meth, that we focus on all substance abuse, because of the issue of somebody moving to another substance.” That report will be released shortly.

“I think the risks around alcohol abuse are better known. I wonder how many young gay men may get in over their heads before they realize what their risks are with meth,” said David Haltiwanger with the Chase-Brexton Clinic in Baltimore.

“Part of what we need to do is re-brand crystal meth so that it is not considered another innocent party drug, but a much more dangerous drug. There are casual drug users who would never touch heroin; it has a brand that they are not going to go near.” Part of the solution is to “move crystal across that line so that people don’t think of it as something that you can casually pick up and put down.”

“How come, when you interview straight men, they don’t put enhancing sex as one of the top reasons for using meth?” asked Barbara Warren with the New York City LGBT Center. “I think that has got less to do with whether or not they use it for sex and a heck of a lot more with the cultural and political context that gay men live in versus straight men. I think that the reason that this behavior is still such a challenge to gay and bisexual men is linked to the absolute hostility and demonization of gay sexuality in our society. Using a drug like this and engaging in these kinds of behaviors is a way to kind of forget that.”

Warren urged “compassion for the struggle that lots of folks in our community are undergoing around the political context that we are dealing with right now,” as well as the “25 years of dealing with an epidemic that… impedes your freedom of expression around your sexuality…. The challenge is to maintain compassion within our own community and not let this issue vilify or demonize men who have sex with men.”

“We need to understand the social context within which people in our community are using crystal meth, and the meaning that people are assigning to that use,” added David Acosta, coordinator of HIV/AIDS prevention programs for the city of Philadelphia.

“Not everyone is using it to have lots of wild sex…. If you are a youth who is homeless and trading sex for survival, crystal meth might keep you from feeling hungry and needing a place to sleep…. It’s really important for us to tone down the rhetoric and put it into perspective.”

Treatment specialist Phil McCabe noted that many people continue to use meth as a self-medication for depression, and one of the physical symptoms of stopping meth use is long-term depression as the body recovers. He does not believe the community is prepared to deal with that. While the focus today is on prevention, “we have to balance that with treatment” to help people stop using meth.