In the underworld of the so-called “Party and Play” scene (or PnP, as the meth-sex combo is often referred to in online personal ads), messages like the one above are rarely heard.

After a bump of crystal meth, a gay man who may harbor feelings of guilt or shame around sex is transformed into an uninhibited sexual dynamo, able to engage in hours or even days of guilt-free sex. To prolong the effects of meth and prevent an embarrassing inability to perform (known as “crystal dick”), those who PnP can easily purchase an illicit “party pack,” containing crystal, Viagra and Sustiva (the latter of which, an antiretroviral AIDS drug, is said to prolong the effects of both alcohol and meth).

As studies have shown, however, this euphoric, chemical self-confidence is frequently accompanied by an indifference to safe sex. According to studies released by the Centers for Disease Control and Prevention, men who have used crystal are four times more likely to engage in unsafe sex as those who have not, and more than twice as likely to test positive for HIV. Repeated studies conducted over the past five years in San Diego and across the country have shown that between 12 and 15 percent of gay and bisexual men have recently used meth. For HIV-positive men, that number is closer to 20 percent, and in some cases, even higher. Across the board, the highest rate of crystal use is among young gay men.

Though the meth epidemic is not unique to gay and bisexual men, what is unique among this population is the use of meth primarily to facilitate and enhance sex. News earlier this year that a gay meth user with a reported history of unsafe sex practices may have contracted a drug resistant strain of HIV has renewed GLBT leaders’ commitment to address the problem.

Though innovative anti-meth messages are starting to surface, they are virtually nonexistent in places where gay meth users hook up for sex – in bathhouses and on Internet message boards.

“If you go to those sites, you see lots of information on there about how to get to other porn sites, but there’s nothing [asking] ‘Are you having a problem with drugs?’” said Tom Wall, a marriage and family therapist intern who works with gay men recovering from meth addiction.

“If you look on these gay Web sites that are promoting sex, everybody is HIV-negative according to their profiles,” Wall noted. “I find that interesting.”

PnP in San Diego

Mike and Russ (who used only their first names to protect their anonymity) have hosted close to 30 sex parties in San Diego over the past two years. They occasionally advertise their gatherings on places such as Craigslist and gay message boards like adam4adam.com. The parties, which include food and non-alcoholic beverages, typically draw between 50 and 60 men.

Though Mike and Russ say they try to encourage safe sex by making sure condoms and lube are prominently displayed in the venues, safe sex is not mandatory.

“We provide and encourage condom and lube usage, though that is optional,” said Russ, a 39-year-old gay man with experience in the bathhouses. “Guys are going to be guys and they’re going to do what they do…. We’re at least providing a safe environment for this activity.”

Russ estimated that about 15 percent of attendees enhance their experience with meth, and that about 30 to 40 percent of the men engage in unprotected sex.

Though attendees are permitted to bring alcohol, Russ said they do not allow drug use to occur in the open – but that doesn’t stop people from using.

“We’re not naïve,” Russ said. “We’re aware that there are guys that possibly are under the influence of some substance. The only place that we draw the line is if their behavior, as a result, were to be disrespectful or aggressive toward others.

“We are not the police,” he said. “If a gentleman goes to the restroom, closes the door and perhaps is doing something, well, we’re not aware of it.”

Asked if he would be amenable to providing information about the dangers of meth use at his parties, Russ said he believes it is not the right venue to “espouse personal beliefs.”

“Condoms are placed all over the complex,” he said. “Guys know they’re there, and so they make a choice.

“I don’t think providing pamphlets and literature at our parties is the best way to do it….

“I’m pleased when I see somebody who typically barebacks putting a condom on. I take more pride in that than seeing somebody pick up a pamphlet, then throw it out before they get to their car.”

Bob Lewis, HIV programs director of Family Health Centers of San Diego, said their staff and trained volunteers have been visiting the bathhouses for the past five years to do HIV and STD prevention work. They visit each of the three bathhouses in San Diego, some as frequently as twice a month. However, they do not specifically provide education about meth use, unless asked for a referral.

“Because of the strong connection between sex and meth we see quite a bit of it in the bathhouse,” Lewis said. “There are folks that they encounter that are clearly high.”

Wall has worked with several bars to provide information about a crystal meth recovery group he facilitates, though bathhouse owners have been resistant to the idea, he said.

“The problem is the bathhouses won’t put any information up about the work that we’re doing,” Wall said. “I think we really need to target the bathhouses and these Web sites.”

By suggesting that information on the perils of meth use be provided at these venues, Wall made it clear that he is not condemning their existence.

“Sex is an important thing in our culture, our freedom around sex, but I think we’ve got to be able to have information in those places where people are going for sex,” he said, “even if it’s a link to other places where people can start getting information.”

Center board member Richard Britton, who also is co-owner of Numbers and The Flame, said the problem in combating meth use is that the user is often driven underground by the social stigma associated with the drug, as well as paranoia and social withdraw associated with meth use. Unlike alcoholism, which tends to develop more openly and over a longer period of time, meth addiction usually comes on shortly after a person’s first use and is harder to detect.

Britton said meth has caused a noticeable decline in business at local gay bars and clubs, his own included.

“The biggest thing that we’re seeing with crystal is [people] going from not using to being addicted in a very short amount of time,” Britton said. “I think that’s what’s hidden from our community. You’re not seeing the ravaging effects of crystal, because they drop off the face of the community.

“It’s starting to move underground,” Britton continued. “People aren’t putting up with it in public so they’re starting these underground parties where nobody’s there saying, ‘Don’t do it, it’s bad for you.’”

Community members were both shocked and saddened by the recent death of 31-year-old businessman John McCusker, the owner of Club Montage and ReBar, two successful local gay clubs. A toxicology report showed large amounts of oxycodone and amphetamines were present in McCusker’s system at the time of death, and the coroner’s report noted that McCusker had used methamphetamine a week prior.

Rich’s co-owner Bart Johnson said he had spoken to McCusker about his drug use prior to his death. Like McCusker, Johnson said he kept his 15-year battle with meth addiction to himself, preferring to suffer through his “private hell” alone.

Seven years go Johnson made the decision to stop using meth.

Like most users, what started out as an occasional weekend party favor progressed to a Saturday night staple. Johnson’s use soon spilled over into Friday and Sunday night, and, before long, he was using mid-week.

Johnson remembers the exact date and time of his first encounter with Tina. It was Labor Day of 1983. A friend offered him the drug.

“It’s that vivid,” Johnson said. “To put it in terms that I told my psychiatrist, it’s the first time I really ever felt normal…. Suddenly all those inhibitions and feelings about yourself go away. Everything that you thought was bad about yourself you completely forget and you step outside of yourself…. It’s bigger than God when you’re addicted to it.”

Crystal also helped Johnson mask his feelings about sex, making it easier to engage in sex at bathhouses and elsewhere. He believes it was while using crystal that he became HIV-positive.

“If the other person’s using at the same time, it’s no-holds-barred,” Johnson said. “That’s where people get in trouble with unprotected sex and completely crossing the line. That’s the furthest thing from your mind, to put a rubber on. You feel invincible and you’re completely out of touch with what’s going on.”

Jim Zians, project director for the Edge Research Project at UCSD, also noted this lack of perspective in his study participants.

“We have some people who use weekends and one or two days a week and they still consider themselves a light user,” he said.

To eliminate the meth problem among gay and bisexual men, Johnson believes that common issues of depression, shame, guilt or inadequacy must first be addressed.

“Be it child molestation, be it beating, a bad family or just something, we all feel that we’re inadequate in some way, either sexually, physically or emotionally,” he said.

Wall said most people, himself and other gay therapists included, carry a certain degree of internalized homophobia.

“A lot of people are conflicted about expressing themselves in a gay manner in our society and crystal helps them get a sense of control over this internalized homophobia,” said Wall, who is open about his own past meth use.

However, Wall said, meth use can push the shame further inside, making it harder to deal with.

The rush and the high caused by meth are believed to be the result of a release of high levels of the neurotransmitter dopamine into areas of the brain that regulate pleasure. Researchers have reported that as much as 50 percent of the brain’s dopamine-producing cells could be damaged after prolonged exposure to even low levels of the drug.

After being diagnosed with adult attention deficit disorder, Johnson was put on a combination of medications to stabilize his mood and stave off depression.

Cheryl Houk, executive director of Stepping Stone, a residential recovery facility serving the San Diego GLBT community, noted meth’s effect on normal brain function. Between 50 and 60 percent of clients accessing Stepping Stone’s services report meth as their drug of choice.

“Many folks need to be on an anti-depressant for the rest of their lives,” Houk said. “Their ability to have a feel-good experience is greatly diminished without medication – and may be permanently damaged.”

Chronic users will routinely develop signs of psychosis, believing they are being videotaped, recorded or followed.

Meth can cause serious physical problems in other ways.

“Crystal meth sucks the calcium out of the body and so this is why a lot of people get osteoporosis,” Wall said. “That’s how they lose their teeth.”

Wall leads a support group for gay and bisexual men recovering from meth addiction called Lifestyles in Transition.

“Research is showing that the best treatment for crystal meth addicts is a cognitive behavioral approach [that] helps people identify high-risk environments, warning signs of relapse, and develop alternative coping mechanisms,” said Wall of the “smart recovery” model he employs.

Citing research conducted by Van Ness Recovery House in Los Angeles, Wall noted a dismally low recovery rate for meth addiction – 10 percent.

In his practice, he eschews the 12-step tenet that people are powerless over their addictions.

“What I’m seeing in my practice is that 12-step meetings don’t work for a lot of people,” he said. “If you tell somebody that you’re powerless, they start believing that they are. The individual has the ability and the power inside of them, but a lot of times they forget that.”

To help his clients stay on track, Wall has developed a contract clients enter into with themselves. Among its stipulations, the contract includes a list of alternative behaviors to follow when tempted to use: phone numbers of friends they can call when tempted to use; and a commitment to stop and write about what they were feeling when they felt the urge to use.

“If they do end up using, later they can look back at this list when they’re in therapy and say, ‘OK, what was going on with me? I was in a lot of pain because my boyfriend broke up with me or I was feeling really lonely and one way for me not to feel lonely is to go out and have sex.

“The biggest thing that I hear with men is, ‘I didn’t think about all the after-effects; I didn’t think about the come-down,’” Wall said. “The contract helps move them into a conscious awareness of what they’re doing.”

Calvin, a gay man in his 30s in recovery for meth addiction, said the contract and Wall’s group have helped him in his recovery.

“The most helpful exercise for me was when I sat down and did a pros and cons,” he said. “The pros were one or two items and under cons I listed at least 50 different things. Every time you get the urge and the desire to do it, you just sit down and go through the logic.”

Zians uses a similar method with participants in the Edge study, all of which are HIV-positive gay or bisexual meth users.

Each participant is given an initial interview. Rather than tell the person how they should behave, Zians said, the interviewer will ask them what they value, then point out behaviors that are at odds with those professed values.

“The motivation comes from inside themselves based on the discrepancy between what they value and what they’re doing,” Zians said. “They always have intentions of not infecting anyone else and they don’t know how they end up in a situation where they’ve had all this unsafe sex and they haven’t identified their own HIV status….

“People don’t realize that their moment-to-moment behaviors actually lead to their future,” Zians said.

About 60 percent of Wall’s clients combine sex and meth, he said. Though the PnP euphemism may save men from having to state their meth use online, Wall doesn’t tolerate the hedging language with his clients.

“They’ll say, ‘…and then I partied.’ I say, ‘Are you talking about crystal? Be direct.’

“It’s really important as a human being when you make any change to claim it,” Wall said. “To release that shame, you talk about it.”

Wall is currently developing a Web site where people in recovery can log on 24 hours a day if they’re feeling the urge to use.

“With any type of behavior change, you have got to develop a large support group around you,” he said.

Despite the persistent problem with meth addiction, many feel the response from community leaders and HIV/AIDS service providers to date has been woefully inadequate.

Part of the problem has been an unwillingness of community members to discuss the issue. Because meth use is not always readily apparent, it also becomes harder to engage users and the community in a constructive dialogue.

In New York City, recovering meth addict Peter Staley took it upon himself to get the conversation started. Staley spent $6,000 out of his own pocket to buy ads stating “BUY CRYSTAL, GET HIV FREE.” Based on the response, the New York City Council pitched in money to pay for more ads. In San Francisco bars, when people lift their drinks from coasters, many are confronted with the telling statement, “Crystal Mess.”

Two years ago, San Diego activists David Contois and Steve Johnson helped raise close to $80,000 for a methamphetamine education and intervention program targeting gay and bisexual men in San Diego. Implemented in conjunction with Stepping Stone and The Center, the campaign used print ads, posters, brochures, billboards and bus shelter ads to spread its harm reduction-based message.

The harm reduction model seeks to meet the user at whatever stage and comfort level they are at. For those who are not ready or willing to quit, they are asked to reduce their meth intake and gradually introduce healthier lifestyle choices, such as safe sex, with the goal of eliminating their use entirely.

This approach has not proven popular with everyone, drawing criticism from both the recovery community and public funding sources that believe anything short of complete abstinence is condoning drug use.

However, harm reduction has been in place for years, said Steve Johnson, noting that the use of condoms to contain the spread of HIV is itself harm reduction.

“Anybody in their right mind in this day and age – except for those who are on the fringe in the right [wing] – know that that is a valid public health message, that it is proven that it helps reduce the spread of HIV/AIDS,” he said. “So why then would you not use the same approach when you address the complexities of addiction and HIV?

“The health agencies in this town haven’t made that connection – and if they have, they certainly haven’t let anyone know about it,” he said.

Contois, who is chair of the San Diego HIV Funding Collaborative, said that during his four years with the group, they have not had one proposal from an HIV or AIDS service provider in San Diego County concerning crystal meth.

“A lead agency for meth prevention does not exist,” Contois said, “particularly with expertise around gay men’s health issues.

“We proved there’s funding out there two years ago.”

However, Houk said Stepping Stone has worked to revive a harm reduction strategy within the organization.

Lewis also said Family Health Centers is employing the harm reduction model in its prevention and outreach efforts.

“We’re ready, willing and able to tell people to stop using drugs,” Lewis said, “but to expect people to take that one big step to not using drugs is not realistic. It’s a series of smaller steps.”

Still, people like Staley are skeptical of harm reduction’s reluctance to point an accusatory finger.

“A culture of harm reduction, where the community is stifled from being able to stigmatize the drug, is very dangerous,” he told The Associated Press.

Dr. Delores Jacobs, chief executive officer of The Center, said she believes it is not harm reduction, but the GLBT community itself that is a barrier to funding.

“Harm reduction is an acceptable part of the continuum of care,” Jacobs said. “It’s not the fact that the intervention is harm reduction that’s problematic. The government is not excited about giving our community money currently.”

Aside from Stepping Stone’s harm reduction campaign, which was discontinued due to a lack of public and private funds, Wall said he feels there has been little education around the meth problem in San Diego.

“We have to look at what other cities are doing and what is working there,” Wall said. “We do a fairly good job as a community to rally around somebody when they’ve hit rock bottom, when they have lost their job, lost their home or lost true relationships,” but not before that point.

“With harm reduction, when we step in earlier, people don’t have to lose all those things.”

Houk agreed that the decline in government funding for HIV prevention over the past few years has further impacted the problem.

“Our government likes to have measurement outcomes, and you cannot measure prevention when the person never got into a facility and used, but you stopped them from ever using,” she said.

According the County Health and Human Services Agency, Family Health Centers of San Diego receives more than twice the amount of HIV prevention and education funding as other service providers in the region – slightly more than $800,000. The Center receives around $175,000, which includes efforts geared towards African-Americans and Asian Pacific Islanders. The overall county budget for HIV prevention is $2,049,445, which is being reduced to $2,005,398 July 1.

Given the tenuous state of government funding for the GLBT community, Lewis cautioned against the backlash that could ensue by painting the problem as unique to the gay community.

“That could be detrimental,” he said.

However, Wall said the issue is one that the community needs to own and address with vigor.

“It’s an issue that we have to not hide from out of fear of the larger culture and what they’re going to say,” he said.

The Center, in conjunction with the county and other service providers, is conducting a forum on crystal methamphetamine from 6:30 to 8:00 p.m., Monday, May 23, at The Center.

The evening will consist of a one-hour presentation by Dr. Neva Chauppette, a Los Angeles-based psychologist with a background in substance abuse, followed by a 30-minute question and answer period.

“A lot of people are saying, “I don’t feel like I know enough about this,’” Jacobs said of the county-sponsored forum.

Asked if she felt the community’s response to the problem has been adequate, Jacobs said, “Absolutely not…. Can we do better? Absolutely.”

Jacobs concedes that the issue has been treated like the elephant in the living room for far too long.

“I think the special truth in our community is that we’re very reluctant to judge, to infringe or talk about people’s private or personal behavior in what a lot of people would call a judgmental way,” Jacobs said. “It’s not unlike HIV 20 years ago. Any time we’re not information seeking and we’re not together as a community the silence itself begins to become a part of the problem.”

In addition to a recent pledge by the San Diego LGBT Community Leadership Council to address meth use, Britton said local GLBT bar owners will be meeting this month to discuss establishing a zero-tolerance policy towards meth use in their clubs.

“It’s not just the user that’s being affected,” Britton said. “It’s becoming a big burden in our community and it’s draining resources.”

Houk decried what she sees as a lack of ads geared toward the first time user.

“What we need to do is find some more public announcements that really take up a lot of space on the page – frankly, because people are dying, people have been dying all along here.

“Once they get in these doors they’ve already created a pretty big problem for themselves.”

Breaking the silence around meth use will require a concerted effort that includes the help of those who can serve as mentors to people struggling with meth addiction.

“We have to find people who have had success stories, real stories of people in the community, and share those stories,” Wall said.

“I know a lot of people who still use. I don’t associate with them, but I’ll see them out and they know the work that I’m doing now. They’re like, ‘Wow, here’s somebody who’s done it.’ I think we need more people who have gone through the recovery process so people can use them as leaders or mentors.

“It saddens me that we’re not really looking at how to kind of love and support and have compassion for people in our community that are really struggling,” he said.

Bart Johnson suggested that more visible acknowledgments of the problem might help start a dialogue.

“I’ve noticed those Lance Armstrong bracelets everywhere,” he said. “Maybe somebody should put out a white bracelet that says I’m going to live clean … and get people to make a commitment to live clean – or sell them at Pride, get the message out there…. You’re making a statement that, ‘I’ve faced my demons and maybe I can help some other people.’”

Though Johnson’s road to reestablishing a sense of normalcy and peace of mind has been a long one, he is happy to have put forth the effort.

“I can go out and be at a club and drink water or Coke and dance and have a far better time than I ever had when I was drinking and drugging,” Johnson said. “There is something bigger and better beyond all of that. How people get there is for them to decide. At some point alcohol and drugs will either kill you or you’ll step up to the plate and quit using.”