ealth officials are very concerned with the increasing association between methamphetamine use and the spread of HIV. A study conducted last year by the San Francisco Health Department revealed that around 30% of the individuals who recently became HIV positive have used methamphetamine in the last 6 months.

“It’s the perfect party drug,” says Michael Siever, director of the Stonewall Project, a program in San Francisco that deals with safety issues among methamphetamine gay users. “For 30 dollars you can get a bag that keeps you high for several days” he adds.

Methamphetamine is derived from amphetamine, and it was first synthesized by a German chemist in 1887. During World War II the drug was used among soldiers to improve their performance in combat. In the 1960s its use significantly increased in the United States until it finally became a schedule II drug in 1970, due its limited medical use (initially limited to nasal decongestants as bronchial inhalers) and its huge potential for abuse.

The drug, also known as meth, speed and crystal, among other names, is a cheap and unrefined mix of different chemical compounds available over the counter. It can be smoked, inhaled, swallowed or injected and its effects can last for days. The drug has been manufactured in “mom and pop” labs all over the country for years.

A powerful stimulant of the central nervous system, methamphetamine works by inducing the release of high levels of dopamine, a neurotransmitter associated with our natural reward system. But meth also seems to destroy the cells carrying dopamine and serotonin, another transmitter. Animal studies have shown that high doses of methamphetamine destroy the nerve connections between neurons.

The connection between gay men and methamphetamine use is substantial. According to health experts, while in other populations the incidence of meth use is between 5% and 10%, in the gay community 40% of individuals have used the drug, reported The San Francisco Chronicle (1). Another significant connection is between meth use and HIV status, as demonstrated by a statewide study at publicly funded clinics conducted in California in 2001 and 2002 by the San Francisco Health Department. Of a total of 63,098 gay and bisexual men tested for HIV infection, 7.1% were HIV positive individuals who had used methamphetamine, while only 3.7% were HIV positive and had not used methamphetamine. Michael Siever does not believe that the increasing use of speed and the HIV epidemic are just coincidental. “This increase is a trend in both directions”, he says. Dr. Grant Colfax, director of HIV prevention studies at the San Francisco Department of Public Health, also believes that we are facing a dual epidemic.

For an increasing number of HIV positive gay men, the pleasure of uninhibited and rougher sex experienced under the effect of speed is a necessary break to the common apathy and depression seen in HIV positive individuals. The drug increases sexual stamina, gives a general feeling of well-being and for some, makes them feel stronger and full of energy. But because methamphetamine can also cause erectile problems, users tend to mix it with Viagra. The result of this recipe can be a two-day uninterrupted party of intense sexual activity. On the day after, chances are that more men became HIV infected.

In a study (2) conducted by the Department of Psychiatry at the University of California, and the Department of Veterans Affairs Medical Center, both located in San Diego, California, researchers have found that 80% of 25 HIV-infected methamphetamine-using men who have sex with men reported engaging in marathon sex while under the effects of methamphetamine. During marathon sex sessions, 93% of participants reported engaging in receptive anal sex without a condom. This unsafe behavior represents a great threat to prevention efforts for stopping HIV spread.

Michael Siever believes that “there is a reluctance to acknowledge that drug treatment is also a form of HIV prevention”. But he also points out that there is an urgent need for programs that reduce the harm caused by methamphetamine use.

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