Some gay and bisexual men use crystal methamphetamine because they like it — or at least they like it at first. They say they like the energy, the parties and the new people they meet. Many report a feeling of overwhelming self-confidence, a loss of unwanted inhibitions and a sense of complete liberation.

Most men say meth enhances sexual pleasure. They say it gives them permission to do things sexually they might not otherwise do, or approach men they might not otherwise approach. Many men who are HIV-positive say meth makes them feel less sick. It helps them get through the day, and it allows them — at least for a while — to forget they have HIV.

The other thing most of these men say is that they really care about their health. (This is important, and will be addressed later).

The use of crystal methamphetamine (often referred to as “meth”) has exploded in Southern California. San Diego has become a major hub for crystal meth, particularly since the manufacture and distribution of the drug has shifted from small labs in people’s homes to larger operations (mostly in Mexico), and is now transported through San Diego County.

It seems meth has found a home among our community. The social culture of bars, clubs, baths, “back-street” parties and after hours is perhaps unintentionally in sync with the biorhythm of the meth user.

From a public health point of view, high rates of meth use among gay and bisexual men can create health complications that are fourfold. First, gay and bisexual men are already at high risk for HIV infection, due to high HIV/AIDS rates among men who have sex with other men (MSMs). Meth unfortunately has infiltrated a community already overwhelmed with this epidemic. In San Diego County the HIV/AIDS epidemic is particularly brutal. While MSMs make up 45 percent of all cumulative AIDS cases in the U.S. since 1981, they comprise 75 percent of all cumulative AIDS cases in San Diego County.

Second, research demonstrates a strong relationship between meth use and unprotected sex. At a California State Office of AIDS meeting in Sacramento last April, data presented showed that gay and bisexual men in California who use meth have twice the rate of new HIV infections as those who do not use meth.

Other recent studies continue to pinpoint meth’s role in facilitating new HIV infections. High-risk sexual behaviors most associated with meth use include higher rates of multiple sex partners, higher rates of casual and anonymous sex and higher rates of all-day and all-night, prolonged sexual activity, often called “sexual marathons.” In addition, meth users have lower rates of overall condom use and higher rates of STD infections.

Third, meth is extremely addictive. As one’s meth use progresses, one’s life begins to unravel through loss of employment, family estrangement, loss of friends, financial problems, legal problems, and, finally, serious health problems. Eventually many of these people require a professional drug treatment program, as attempting to quit meth on one’s own may be beyond their reach. Stepping Stone reports that approximately 75 percent of males seeking drug and alcohol treatment have a history of meth use. Community leaders at Stepping Stone and The Center recently began a social marketing campaign addressing meth use in the GLBT community. The response has been good and there is currently a waiting list to get into the recovery program at Stepping Stone.

Perhaps most alarming is that meth use via needle injection has skyrocketed. Though most meth users start out snorting or smoking meth, continued use progresses into injection use in 32 to 40 percent of all meth users. Among gay and bisexual men who use meth, local research data show exorbitant rates of injection meth use. Of the 211 men in UCSD’s Edge Research Project, which studies HIV-positive meth users, 42.2 percent had injected meth within two months prior to starting the study. Of these men, 28.4 percent preferred injecting meth over other modes of use.

And yet, as ironic as it sounds, gay and bisexual men who use meth still care about their health — there is ample data that demonstrates this.

The contradiction is very complicated and there is a lot to comprehend. Let’s think outside the box for a moment and envision a more commonplace example. Many people who care about their health still take health risks. People drive too fast, they don’t always eat right, they don’t get enough sleep and many put off regular exercise. Does this mean these people have a total disregard for their health? Of course not. And, like it or not, contradictions between one’s health concerns and one’s health behaviors remain a part of the human experience. With regard to meth users, the contradiction may appear more drastic and frightening, but the human processes remain the same.

Examples of meth users showing great concern for their health are clearly evident in The Edge Research Project, a one-year study of gay and bisexual men who are HIV-positive and actively use meth. When talking with these men it is very apparent that, though they are active meth users, they do indeed care about their health.

All of these men struggle with HIV issues, and a significant number of them have had their share of medical emergencies and other health problems. Worries and concerns about becoming ill are common. The men make inquiries as to the latest information about new medical treatments and they seek answers to their long list of health questions. Almost all of these men talk endlessly of their desire not to infect others with HIV.

Of the 211 men who are currently part of The Edge Research Study, more than 70 percent saw a physician for HIV care two months before joining the study. In addition, almost 60 percent of the sample were under the care of a psychiatrist, psychologist or counselor for mental health issues at the time they joined the study.

Most people deal with their apparent contradiction between health concerns and risk behaviors in a kind of incremental fashion. For example, people don’t always speed; rather they moderate their driving as a function of weather conditions and traffic volume. People don’t always eat poorly; they pick and choose when to splurge on junk foods. People may short themselves of sleep, but very often they attempt to make up for it on the weekend.

This general, more incremental approach to health behaviors is often referred to by researchers and public health officials as “harm reduction.” Simply stated, harm reduction refers to minimal, incremental changes in behavior in order to achieve a greater health benefit. For harm reduction to be effective, these incremental changes must be deemed “reasonable” and “achievable.” Many people who use meth are not yet ready, willing or able to commit to drug abstinence. For many of these people harm reduction choices are the only true alternative — and these choices may lead to life-saving behaviors.

Though a comparison to driving, diet, sleep and exercise may appear trivial, the logic is the same. Of course people can make life-altering changes in behavior. They can enter structured programs. They can go on a popular diet program or they can hire an expensive fitness trainer. The same is true of meth users. There are special programs available.

However, as in the general areas of human experience, people often change behavior in a more incremental fashion; they more gradually reduce harm. Of course, no one is recommending that meth users continue to use meth — far from it. But in the real world, adults make these decisions for themselves.

Meth users who choose to continue using meth can adopt more incremental changes to their behavior and maximize improved health benefits. Examples of incremental health changes include the following options:

• Use a lower dose of meth.

• Use meth less often.

• Eat something when high, even if you are not hungry (small, frequent snacks).

• Drink lots of fluids (water, juices).

• Take a good multiple vitamin.

• Stay physically fit by exercising (not while you are high, but after you have rested).

• Practice safer sex. Use condoms.

• Get plenty of sleep.

• Do not drive when you are high.

• Maintain good hygiene. Bathe and wear clean clothes.

• Keep meth out of your workplace (do not let meth affect the quality of your work or risk your employment).

• Find and keep a group of trusting friends who care about you.

• Get more information and support.

You can also seek referrals on the Stepping Stone website at www.steppingstonesd.org or call them at (619) 295-3995. HIV-positive men may call UCSD’s The Edge Research Project at (619) 543-5086. Participants who are eligible are paid $255 for their research participation.