It's about time, right?
We're almost 40 years into the epidemic
and still grappling
with how much it's interwoven
with substance use.
Decades of research and community
mobilization have ushered
in incredible advances
in HIV treatment and prevention.
But to end the HIV epidemic,
these advances need to reach
everyone who needs them,
including people who use drugs
like methamphetamine.
In the past decade,
researchers have seen higher
risk patterns of meth use
and meth-involved overdose increase
in multiple US populations.
At the same time,
researchers who study
HIV and substance use have found
an increasingly tight link
between meth use and poor HIV outcomes.
This is particularly true
among sexual and gender minorities.
One 2020 study estimates
people who regularly use meth account
for about one in three
new HIV transmissions
among sexual and gender minorities.
Dr. Grov and Dr. Carrico
are working on NIH funded research
to better understand how meth use
among gay and bisexual men
impacts HIV outcomes.
So, I'm wondering–
why are gay and bisexual men
who use meth a priority population
for HIV research?
The answer for that is you have to look at where
the case numbers are happening
and you let the epidemiological data
guide you.
And I'm seeing numbers and rates
of particularly methamphetamine
use increasing in our communities
at a time
when we've had PrEP for a decade,
and we're seeing a stubborn number
of HIV infections in the United States
that really isn't budging
in light of this
highly effective prevention tool.
This highly effective prevention tool,
PrEP, or pre-exposure prophylaxis,
refers to medication
that helps prevent
HIV in HIV-negative people.
So if the numbers aren't budging, despite this,
how do we end the HIV epidemic?
We can't end the HIV epidemic
without understanding the totality
of individual's lives.
Can we hear that again?
We can't end the HIV epidemic
without understanding
the totality of individuals lives.
And I think a lot of times we segregate
issues of substance
use from other aspects of HIV prevention
or for other aspects of health care.
And what this really underscores
to me is the extent
to which this holistic approach,
this really understanding human beings
and their full experience is what we need
to end the epidemic.
I realize how much of, like, drug use
and the addiction
was really rooted around the fears
of, like, connecting to people
and being myself
and I started to have friends
that cared about me for the first time,
and I started to care about myself
for the first time.
And I realized, like,
this doesn't have to be the
end of my story anymore.
The researchers I
spoke to explained
that HIV and meth use
are linked in several ways.
Meth can cause changes in the body
that may make it more vulnerable to HIV,
and it can also influence
sexual behavior in similar ways.
The way that substances impact HIV,
and I’m going to particularly focus on
methamphetamine, is behaviorally.
We see behavioral disinhibition
for people that are using meth.
If they're combining it with sex,
they're going to have probably more
partners, have more sex,
have sex for a longer period of time,
and condoms may be less likely to be used,
if they're being used at all.
I think drugs and sex,
especially for gay, bisexual,
and other men who have sex with men,
are a real cultural phenomenon
that people are mixing drugs
and sex for pleasure
often to enhance sexual pleasure.
When you come from a community
where having sex
with someone of the same
sex is a really fraught experience
that's looked down upon,
combining that with
something like meth can really
improve the experience as well
and help you not think
about the aspects of it
that might make you feel shame for doing it.
Crystal meth for me
has a lot to do with sexual, social,
emotional loneliness.
It satisfies
a lot of different aspects of my life
that continue to be at issue.
The question is,
how can we make sure
that those folks are kept
as safe as possible
within the context of that behavior?
I remember the first time I did crystal meth,
I felt sexy and I felt connected.
I've never done meth without having sex.
And sometimes that can lead to outcomes
they don't want, right?
Like, having different types of sex
or sex with multiple partners,
and other times it can lead to a fun night.
So, you know, it's really a wide array
of different kinds of experiences
that we see guys having
when they're partying and playing.
In this case,
“partying and playing,” or “chemsex,”
means using drugs as part of your sex life.
Gay and bisexual men
who party and play
report doing so for a variety of reasons.
Some say it makes them less inhibited
and increases pleasure,
or that they mix meth and sex
to address issues
in their sex life and self-esteem.
So, how risky is this?
The problem with risk is that—that's
a public health term, right?
And the minute that we put this risk
frame on the conversation,
it's alienating.
And it makes an individual think
that I am placing a judgment
on that behavior
by labeling it as a risk behavior.
And it wasn't just like,
“Hey, I'm doing drugs
and I'm not going to have a condom.”
It was like,
“I don't want to have a condom.”
This is like the barrier to me connecting,
the barrier to me being sexual.
And this is a person I always want to be
and there's no consequences in my mind.
People use meth
for a lot of different reasons,
and people who use meth
may have a lot of different goals
for their health and life –
from staying safer while using meth
to working towards long-term
recovery from meth addiction.
Was recovery the goal?
The goal was just not to die.
And I didn't know how to live.
People have all sorts of goals
with regard to their substance
use that we can help them meet.
There are all sorts of ways
that we can engage
clients and participants
in our research studies
in setting goals for behavior change
that really match their values
and goals in that moment
without demanding
that they be abstinent to even receive
the benefits of counseling.
Complexity is the rule
and not the exception
of the lives of the men we serve.
I think that at the root of my pain is pain.
But I know that the use of this
drug exacerbates a lot of things,
a lot of things that I’m aware of
and a lot of things
that I'm probably not aware of.
I don't think that kicking meth
is a solution to all my problems
and that everything will just be fine.
But I do think that it's one thing
that's for certain
that things will get better.
How do we talk about HIV
in a way that's inclusive of gay
and bisexual men
who are using drugs
or even experiencing addiction?
How can research
help us see the light
at the end of the tunnel
where those in need
are affirmed and validated
in health care spaces?
One way may be to close the research gap.
You know, let's get a clearer picture
of the totality of people's lives –
from HIV to substance use and beyond.
To learn more about substance use
and addiction research,
log on to nida.nih.gov.
If you or someone you care about wants help,
you can learn more by calling the National Helpline
at 1-800-662-HELP (4357)
or by visiting findtreatment.gov.