[Editor’s note: Because meth use is illegal, all names of users have been limited to their first names only.]

On June 15, the Crystal Meth Working Group took out a full-page ad in The New York Times that read, “Gay Men and Crystal Meth: A Manifesto.” Here’s what it said:

“Let’s face it. There’s a problem, and we all need to deal with it.

Crystal meth poses a threat to many communities, both in this country and around the world. The U.N. says 35 million people use meth, making it the second most frequently used illicit drug behind marijuana. But while most meth use in the U.S. is among heterosexuals, here in New York City it’s largely a problem among gay men.

While most gay men have never used meth, approximately 15 percent have. By chemically blocking inhibitions, it leads many to take sexual risks, resulting in more infections of HIV, syphilis and other diseases.

We’ve watched as meth has worked its way into our lives as an ‘innocent’ party drug and then established itself as a serious threat to our health and prosperity. We’ve seen it cripple our friends and loved ones, destroy the lives of our youth and mentors, and corrode the spiritual fabric of our community.

Bottom line, meth is hurting gay men. How can we stand by and do nothing?

We know that the failed approaches of our nation’s ‘war on drugs’ won’t help. Addiction cannot be legislated away, and law enforcement is not the answer.

We know that treatment can work. Meth is highly addictive, and recovery is often difficult. While many will struggle, there is a growing army of gay men who have gotten off meth.

And most importantly, we know that love works. Yeah, that might sound corny to some. But love is what motivated gay men to care for one another when the AIDS epidemic hit 25 years ago. Love is what brought us together to fight America’s silence and apathy. Love made us insist on safe sex, dramatically reducing new HIV infections.

Love supports without judgment. It challenges self-destruction. It strengthens community.

And today, love is why one gay man will help another gay man quit using crystal meth.

So, here’s what we’re going to do.

We will take responsibility for our lives and for the health of our community. We will make informed choices about sex and partying, and urge our friends and lovers to do the same.

We will not be silent. We will talk to other gay men about the dangers of crystal meth. We will create honest prevention campaigns so that every gay man knows the real risks of meth use.

We will show compassion for those who are addicted. Meth is the problem, not those in its grasp. Addicts need treatment, not stigma. And if they’re in denial, they need to be challenged by those who love them.

We will fight for more money for drug treatment. We will advocate for treatment programs tailored to the needs of gay men.

And finally, we won’t let crystal meth destroy another generation of gay men. We will continue fighting the hatred that seeks to diminish our self-worth, our sexuality, and our relationships. We will continue to create and strengthen our political groups, our churches, our sports teams, our social clubs, and our families. We will lead by example, as we have done before.”

The manifesto was signed by a host of individuals, ranging from Larry Kramer to Andrew Sullivan, Junior Vasquez to Harvey Fierstein. Politicians such as state Senator Thomas Duane signed on. The executive directors of the National Gay and Lesbian Task Force (Matt Foreman), Broadway Cares/Equity Fight AIDS (Tom Viola) and the American Academy of HIV Medicine (Dr. Howard A. Grossman) all signed.

Members of the GLBT community here in San Diego are reaching out to meth users as well. There are CMA (Crystal Meth Anonymous) meetings in San Diego on Wednesdays, Thursdays and Sundays. The Center has just announced the formation of a new group, “So You Want to Get Off and Stay Off Meth,” that meets weekly. And Stepping Stone has been involved in addressing meth addiction for several years.

What’s surprising about the manifesto isn’t so much that a wide range of leaders in New York have voiced their concern with the rising meth use; what is surprising is that the manifesto appears to be promoting a departure from the traditional 12-step program and following the rising tide of addressing addiction through harm reduction.

Harm reduction comes out of the needle-exchange movement in London, and its purpose is to recognize that abstinence, while addressing a portion of the population, is not a solution for many users, regardless of the substance.

According to Tom Wall, a licensed marriage and family therapist who specializes in meth addiction treatment, the numbers surrounding alcohol abuse give some insight into this need for a “wider wingspan of options.”

“There are about 20 million confirmed alcoholics in the U.S.,” Wall says. “But only about 1.5 to 2 million are actually in 12-step treatments. That’s 90 percent or more still out there. The question is, then, what do we do to help that 90 percent who are not ready to commit to full abstinence?”

Three years ago, a group of leaders at Stepping Stone introduced the concept to San Diego.

Harm reduction is “as old as Adam and Eve and the discussion of the apple,” says Dr. Lionel Conner, a psychiatrist who has been working with harm reduction in London for more than 20 years. “While it’s true that the best way to prevent HIV transmission with regard to intravenous drugs is to eliminate IV drug use, we realized that wasn’t realistic. And so many cities started needle-exchange programs. By getting clean needles, we were reducing the number of transmissions.”

David Contois, project director of www.knowcrystal.org, worked with Steve Johnson, former Stepping Stone board chair, three years ago on the Stepping Stone campaign for harm reduction.

“Harm reduction is about acknowledging that people are on a continuum in their use,” Contois says. “Abstinence only reaches a small percentage of the population of users. Our message is targeted at a broad range of users who are in different stages of their use. What we try to do is say: ‘If you’re going to use, then drink water. If you’re going to use, then build downtime into that use schedule.’ We are not condoning drugs, we’re talking about things you can do to reduce the risks that users face.”

Wall sees harm reduction as a very real and powerful answer for a lot of people addicted to meth.

“The idea of harm reduction is to start where the user is and to do so in a compassionate, nonjudgmental way; finding out what the user’s goals are [and begin] working from there,” Wall says. “The idea is that some users are still going to use. The question, then, is, ‘How do we get them to use more responsibly?’”

Such has been the debate for years on reproductive education in schools. Abstinence is surely the best way for someone not to get pregnant. But the reality, say advocates of harm reduction, is that people are going to have sex. So how do we get them to minimize the spread of STDs, HIV and unwanted pregnancies?

Harm reduction in drug addiction works in the same way as the needle-exchange program: If the user isn’t going to quit, then the goal is to assist them in reducing the risks of their actions, both to themselves and to others.

And with studies showing that using meth once increases HIV infection by 75 percent and habitual use increases risk of infection by more than 400 percent, advocates are starting to look at harm reduction programs seriously.

Stephen, 35, is still a user, “but I’m on my way to stopping.”

“I can’t just up and quit,” says Stephen. “I’ve tried I don’t know how many times. But I am working on it.”

For Stephen it’s still a one-day-at-a-time approach. Stephen says he works hard to focus on proper nutrition and safer sex.

“I may not wake up and say, ‘Today is Tuesday, and I have been clean and sober for 45 days,’ but I can wake up and say: ‘Today is Tuesday, and I am closer to being clean and sober. And more than that, I am making better choices than I did on Monday.’”

And that, Wall says, is what we should be looking for.

“Abstinence is not something everyone can handle at any given time,” Wall says. “There has to be a way to meet the person where they are, and work with them toward that goal. That’s what I do in my practice. It’s a compassionate, nonjudgmental form of mental health.”

A recent film called Meth has been hitting the film circuits and played to a receptive audience at OUTFEST in Los Angeles on July 8. The film is a documentary by Todd Ahlberg that consists of a dozen or so men whose lives have been affected by using meth (see interview with Ahlberg on page 52).

On July 21, a group will be hosting a viewing of the film at Kung Food. Organizers intend to have a handful of computers available for people to visit the Web site www.knowcrystal.org.

The Web site is aptly subtitled “Crystal 101.” One of the most interesting elements of the Web site – aside from the “Perception vs. Reality” portion – is the “Tina Test.” The statistics and information revealed in this simple, 15-question quiz are remarkable.

“The goal is to get people to the site,” Wall says. “What I really think is great is that it has information for family and friends, too, including a step-by-step script, really, of how to confront a user.”

For Conner, who has been working with harm reduction in a wide range of areas, from heroin (needle exchange) to alcohol to meth, it’s the recent rise in using the harm reduction approach to meth users that is propelling discussions of harm reduction onto center stage in the areas of substance abuse.

Aqua. Alffy. Anny. Bache Knock. Bianca. Billy. Blizzard. Candy. Chalk. CR. Dizzy D. Epod. Glass. Go-ey. Ice. Jab. Juddha. Junk. Kibble. Lucille. Ned. Nose Candy. Phets. Pink. Rank. Rock. Rip. Sack. Scante. Scud. Shards. Sweetness. Swerve. Twiz. White Lady. Who-Ha. Yank. Zip.

There are more than 200 known names for crystal methamphetamine. And then there’s the most common, Tina.

There is a great deal of discussion happening around crystal methamphetamine right now, in particular within the GLBT community.

And for good reason, says Johnson.

He points out that syphilis rates among gay and bisexual men in San Diego have increased tenfold in the last seven years. Likewise, the Centers for Disease Control and Prevention has released studies showing that men who have sex with men and use meth are twice as likely to be HIV-infected or to test positive for gonorrhea as non-meth users.

Brad, 27, has used meth “on and off” for about 10 years. Growing up in Nebraska, Brad says it was not uncommon for his classmates to “party all summer.”

For Brad, “It’s the sex, stupid.”

“I grew up in a town where being gay was big-time wrong,” says Brad. “I was told in a lot of ways that being gay was going to send me straight to hell. And when I came out, people said, ‘OK, you can be gay, but you just can’t have sex.’ There was a lot of guilt involved in having sex with another guy.”

This is not uncommon, Conner says.

“There is a certain element of shame that gay men are made to feel when they are having consensual sex with another man,” Conner explains. “This shame is an obstacle to a healthy sexual encounter. For many meth users, the drug takes away the inhibitions that we have learned and allows them free and sexual encounters.”

The downside, says Conner, is that inhibition reduction also means reducing plain common sense.

“While it can be a positive experience to have uninhibited sex – sex that is not fraught with years of oppression – it also takes away common sense: negotiating safer sex, discussions on HIV and STD issues,” says Conner. “And that leads to a much larger issue as a society. Make no mistake, meth is a disinhibitor and makes people engage in activities they might not otherwise [engage in]. This is where the risk of physical damage and HIV is, well, frightening.”

But for Brad, and millions like him, having sexual experiences that don’t come with the “Nebraska guilt squad” is a fair trade-off. Brad is HIV positive.

“It may sound stupid to some people,” argues Brad, “but I can live with being [HIV] positive if I can at least have sex.”

Brad is one of many who are open about their use. From Brad’s perspective, he has done his cost-benefit analysis: “I’m sure not giving up Tina. She’s the only bright spot I’ve got.” Brad is referring to the fact that he is unemployed, had his car repossessed, has been arrested twice for possession and has trouble making rent.

What Brad has seen and experienced firsthand is a change in the quality of the drugs today.

“When I was in Nebraska, we could get some pretty good stuff,” Brad recalls. “But the glass I get here in San Diego is way better than anything I could get back home.”

More than 12 million Americans have experimented with meth and as many as 1.5 to 2 million are regular users. According to some studies, as many as 500,000 of those are in California. Law enforcement officers have proclaimed meth use to be the number-one drug battle today.

Paul, 32, used meth for about six years. And before him, his parents used. Paul’s dad, a Vietnam veteran, “brought the habit home with him.”

“My parents were always doing [meth],” Paul says. “There was always an eight ball around. I guess it’s like cigarettes. We were told, ‘You can’t do that until you are old enough to make a decision.’ I was like, ‘Well, who the hell is making decisions around here now?’”

For Paul, it was an escape. “My parents lived miserable lives, and it was the only time I saw them happy. Man, they would go on a binge that would last for weeks. I figured, well, no matter how miserable life is, at least I’ll have great moments with Tina. I used for five or six years at home, instead of going to college. My wake-up call came when I woke up to find a dozen policemen with guns in my face.”

One of the problems, says law enforcement, is the simplicity of meth’s formula and the availability of all the components that go into producing the drug. All of the products used to manufacture the formula are commercially available anywhere in the U.S.

“I draw an analogy,” says Conner, “with dog bites. Most people think of dobermans or pit bulls as the cause of most dog bites. The fact is it’s cocker spaniels. And the reason is because more people have access to cocker spaniels. And more people think cocker spaniels are friendly. You wouldn’t walk up to pet a pit bull, but you would a spaniel.”

Kevin, 38, used to be a corporate attorney. He had his license revoked when he showed up to court “cranking once too often.”

“My clients used to pay me in meth,” Kevin says. “There was great poetic justice at the time to walk into court, get a guy off [from allegations of possession or distribution of meth] for some technicality, while the whole time I was cranked,” he said.

Kevin stopped using meth about two years ago and is working as a massage therapist.

“It was so easy to come into,” says Kevin of meth. “I mean, you didn’t need to go into some dark alley to some anonymous dealer to get it.”

Availability is one of the leading issues in battling meth distribution. Unlike many drugs, more meth is distributed through people – often friends – who know each other than through anonymous drug dealers.

This is in large part due to the simplicity of the ingredients. One of the most common ingredients is the simple nonprescription cold pill or cold and sinus syrup. In response to the availability of ingredients like these, Target, Wal-Mart and Rite-Aid, among others, have put these behind the pharmacy counter. Stores like Ralphs and Albertsons limit the number you can purchase at any given time.

The active ingredient in those pills and syrups are pseudophedrine, a chemical derivative of amphetamines. The “pseudo” is extracted and cooked with other common chemicals, such as ammonia or iodine. This can be accomplished with little more than a school chemistry set. It seems simple enough.

What people don’t know, and what Conner calls the “Spaniel Factor,” is that the process of making meth is the dangerous part. For every pound of meth, five pounds of toxic waste are produced. The process is also quite unstable. By themselves, the ingredients seem harmless enough. But in combination, the chemicals can cause explosions that take out entire homes, hotels or child care centers (just a short list of the kinds of places California law enforcement officers have found meth labs).

Amid all this data, what can we do? That all depends, says Conner, on what your desired outcome is.

Statistics show that less than 10 percent of all admissions for treatment related to meth are voluntary. More than 90 percent are court-ordered. Studies show that for men, it is the threat of incarceration; for women, often there is an issue involving child custody.

There are a variety of traditional 12-step program options in San Diego, both residential and nonresidential. Twelve-step groups do not charge fees or dues. According to the guidelines, “The only requirement for membership is the desire to stop using drugs.”

The Live and Let Live Alano Club is likely the most well-known nonresidential program (known for its Alcoholics Anonymous program), with meetings for those in recovery available at any time, day or night. Specific to meth addiction are the aforementioned CMA meetings.

Ian, 39, is in recovery.

“I stopped cold turkey,” Ian says. “It was the most difficult day of my life. I had lost my job, my 401K, my partner, almost all of my family. And what had I gained? Nothing that hadn’t come at a price, I can tell you that.”

For Ian, though, avoiding meth isn’t easy. “It’s everywhere you go, even in the most innocent of places,” he says. “And it’s so easy to spot. You look up and see some guys who are in their own world. Most people would think, ‘Wherever they are, that’s where I want to be.’ But I know where they are. And the point is that it’s not where they are at that moment, it’s where they are going to be in 48 or 72 hours when the paranoia and the exhaustion and the depression kick in.”

The most well-known program in San Diego’s GLBT community is at Stepping Stone, a nonprofit alcohol and drug recovery program which relies mostly on the 12-step process. Stepping Stone also has a 28-bed facility for long-term residential needs, and provides programs under Proposition 36 for first- and second-time nonviolent drug offenders to seek treatment.

For many harm-reduction advocates dealing with drug addiction and recovery, the time has come in San Diego for a wider approach to users.

For all the statistics and numbers one has, Conner says, there are every bit as many real people being affected by methamphetamines.

“When people think of those affected by meth, they think of the users,” Conner explains. “And that’s quite true, really. But there are also a lot of families and friends who have lost loved ones – not literally, in terms of having passed away, but lost the relationships they had with those individuals.”

Ian describes his mother as a strong woman. “She was the reason I had to quit, really. I could see it in her face. The pain.”

Ian’s mom, Susan, says it was really more about being a mirror to her son.

“If he says he quit because of me, then I will accept that,” says Susan. “But if there was any pain he perceived, it was merely a reflection of the pain he was experiencing. For every high he had, and you could always tell when he was using and when he wasn’t, there were a hundred lows. As a mother, all I could do was quietly point those out.”

But for every Ian, say Conner, Wall and Contois, there are nine Stephens. And that, says Conner, is why the treatment community is embracing harm reduction.

“No one promotes the use of meth except users and dealers,” Conner says. “Our goal is to get people moving toward a day when they no longer believe they have the need to use. A day when they understand that they can connect with others in such a way that fills their life in as satisfying [a] way as they perceive their relationships to be when they are using.”

There are as many reasons why people use as there are users. And while many of the stories have common threads – social euphoria, enhanced sexual experiences, declining health and loss of friends – the decision to use, and to stop using, is singular to the individual.

Thursdays, 7:00-8:30 p.m.

“So You Want to Get Off and Stay Off Meth”

The Center’s Health Services

2313 El Cajon Blvd., (619) 260-6380

This group is for meth users with less than one year of sobriety. HIV-positive individuals who have used meth are also encouraged to attend. The group is facilitated by Dr. Michael Majeski, and donations will be accepted. An intake appointment is required and can be scheduled by calling Michelle Morrison at (619) 260-6380 ext. 105.

Wednesdays, 5:45 p.m.

“Crystal Clear”

The Live and Let Live Alano Club, in the “small room”

1730 Monroe Ave., San Diego, (619) 298-8008

Associated with Crystal Meth Anonymous

Thursdays, 7:00-8:00 p.m.

“Two Tweaker Speakers”

Center for Social Support and Education (CSSE)

3960 Park Blvd., Suite H, San Diego, (619) 574-8015

Associated with Crystal Meth Anonymous

Sundays, 7:00-8:00pm

“Unspun”

University Christian Church of San Diego, in the chapel

3900 Cleveland Ave., San Diego, (619) 295-4146

Associated with Crystal Meth Anonymous