Transcript Crystal Methamphetamine Use among MSM in Los Angeles County: A Situational Assessment

Crystal Methamphetamine Use
among MSM in Los Angeles
County: A Situational Assessment
Jane Rohde, MPH
Planning and Research Division
Office of AIDS Programs and Policy
Summit on Methamphetamine Abatement and Treatment
October 29, 2005
What We Know about Crystal Meth
• Associated with a feeling of euphoria
 Often used to initiate and enhance sexual
encounters1,2
• Results in decreased inhibitions
 Users typically have more sexual partners than nonusers3
 Highly associated with risky sexual behaviors such
as decreased use of condoms, anal sex, fisting and
prolonged sexual activity3,4,5,6
 Gay and bisexual men who use meth have a
greater prevalence of HIV infection than MSM who
do not use the drug3,7
1Halkitis
et al. (2001), 2Reback (1997), 3Molitor et al.(1998), 4Purcell et al (2001),
5Reback et al. (1999), 6Shoptaw et al (1998), 7Chesney et al. (1998).
2
Background
Los Angeles County Risk Assessment Survey
(CRAS)
• Survey Questions
 Demographics
 Drug and sexual risk behaviors
 Perceptions about sex, drug use and condoms
 Service utilization
• Eligibility Criteria
 Clients receiving HIV prevention services from
agencies funded by health department
 12 years of age or older
 Not previously surveyed in 2004
3
Substance Use among CRAS
Respondents (n = 5,046)
Alcohol
Tobacco
Marijuana
Crystal Methamphetamine
Crack Cocaine
Other Opiate
Cocaine (not crack)
Club Drugs (Special K, Ecstasy, GHB)
Heroin
Speedball
Inhalant
Other Amphetamine
LSD/Acid
Other Drugs
Source: Janson, M. 2004 CRAS Data (weighted)
71%
59%
39%
17%
16%
13%
12%
11%
11%
7%
6%
3%
2%
2%
4
CRAS Respondent Drug Use by BRG
100
n= 578
90
AOD
80
Crystal
Percent
70
Crack
60
Cocaine
50
Heroin
37.4%
40
Club Drugs
30
20
18.4%
11.8%
10
0
MSM
IDU (non-MSM)
Source: Janson, M. 2004 CRAS Data (weighted)
WSR
5
CRAS Meth Users by BRG
n= 856
n
%
308
36.0
MSM
158
18.5
MSM/IDU
102
11.9
MSM/W
48
5.6
WSR
128
15.0
F/IDU
94
11.0
HM/IDU
50
5.8
Undetermined
276
32.2
MSM
Numbers may not equal 100% due to rounding and missing data
Source: Janson, M. 2004 CRAS Data (weighted)
6
Limitations
• Data captured are cross-sectional
• Service providers are targeting a high-risk
population
7
Objectives
• Gather information on current strategies and
interventions in LAC
• Identify existing gaps in HIV prevention and
substance abuse education among MSM
from the perspective of experts in the field
• Gain a deeper understanding of the issues
surrounding crystal meth use in LAC
8
Objectives (Cont’d)
• Determine to what extent meth use is
perceived as a community norm and how
this affects acceptance and use of the drug
• Gather information for the local community
to make informed decisions about the kinds
of interventions needed
9
Methods
• “Key informants” identified as having
expertise in HIV/AIDS/substance abuse field
and work with MSM
• 26 “key informant” interviews conducted
(March – July 2005)
 Direct providers of services
 Researchers in the field
 Indirect providers
10
Findings
•Why users use meth
Accessibility and acceptability help make crystal the
“perfect drug for the perfect group at the perfect time.”
•Who uses crystal
“Meth is not just another party drug, but an elixir that
temporarily assuages a long record of affliction. For this
reason, it is the perfect gay drug.”
• HIV and meth use
“…meth disorganizes behavior sufficiently so that people
who are HIV infected already are out there having a lot of
sex, passing the virus.”
11
Findings (Cont’d)
• The sexual experience and meth
“There aren’t enough people who are willing to have the
conversations that they need to have regarding sexual
identity and practices.”
• Sexual addiction
“The bottom line is there is such thing as an obsessive
compulsive sexual behavior that is bringing wreckage to
your life. Gay or straight.”
• Relapse
“The compulsivity is so substantial that I have to put a
geographic wedge between them and the hood and
remove them across town to literally get them out of there.”
12
Issues/Challenges
• Role of internet in facilitating sexual encounters
• Need for creation of a healthy sexual space
“I would say the biggest barrier is we have an
emotionally shut down community.”
“We don’t expect people to stop having sex. This is like
a harm reduction model to some degree where we
really work to define what is healthy for them, what is
healthy non-destructive behavior.”
• Scattered efforts and lack of collaboration or
knowledge about existing programs in LAC
• Lack of communication between doctors and
pharmacists
13
Issues/Challenges (Cont’d)
• Importance of changing community norms
around meth use
• Community dialogue is crucial
“I think community dialogue works. We need to expose
people to how to talk about this topic and teach them how to
do this.”
• Need to create trust in the community to
encourage open dialogue
“Anyone doing work around public health stuff needs to be
asking drug and alcohol questions. If we aren’t talking
about it everywhere … then we aren’t doing our job. If
sexual health and risk taking isn’t talked about either, then
we’re missing it. Until we’re finding some of these things
out from these people, we won’t know how to
14
address this problem.”
Recommendations
• Convene a crystal meth working group
• Collaborate with other urban areas
• Increase number of in-patient treatment
beds in drug and sexual addiction facilities
 Treatment facilities should be sensitive to issues
affecting MSM
“It is unacceptable and unethical to ask gay men
to hang their sexual identities at the door.”
15
Recommendations (Cont’d)
• Conduct more comprehensive trainings
covering meth use, sexual orientation and
sexual addiction




Private physicians (CMEs)
Pharmacists
HIV counselors and outreach workers
Drug treatment center staff
16
Recommendations (Cont’d)
• Develop a continuum of interventions targeting
the user at multiple stages of use
 Social marketing campaign
• Driven by direct research in the field
• MSM population has been inundated with the HIV/safe
sex message
• Variety of messages – also target ‘recreational users’
• Identify a key community leader to function as a
spokesperson
• Fear campaigns won’t work
“My sense is you cannot talk about the negative consequences
without acknowledging all the good things men are experiencing
on this drug. Here’s just another campaign that’s telling you,
Here is your brain fried on drugs – which is an old story.”
17
Recommendations (Cont’d)
• Create a website that is Los Angeles County
focused
• Use the internet creatively for possible
interventions
• Create resources for peers and friends of
users
• Identify alternative funders to support and
fund interventions
18
Recommendations (Cont’d)
• Identify increased funding sources for
research surrounding crystal meth
 Need for analysis and dissemination of existing
local data
 Use of ethnography to determine how an
individual’s meth use affects ability to define and
negotiate safety and risk
 Need more specific data on women and meth use
19
Resources
• “A Key to Methamphetamine Related
Literature,” NY State Department of Health
• National Library of Medicine’s PubMed
database:
http://www.nyhealth.gov/diseases/aids/harm_reduction/cr
ystalmeth/docs/methamphetamine_index_0_9_5.pdf
20
Thank You
To all the participants interviewed who
generously volunteered their time and
candidly shared their thoughts around this
timely and important issue
21
Contact Information:
Jane Rohde, CDC Specialist
Planning and Research Division
Office of AIDS Programs and Policy
600 South Commonwealth Avenue, 2nd Floor
Los Angeles, California 90005
Phone: 213-351-8018
Fax: 213-381-8023
E-mail: [email protected]