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Is HIV-meth link clear?
Eexperts note users are more apt to have unprotected sex
But Toronto health agencies say it's too early to blame meth for our high HIV rate
By Andrew Chung, Toronto Star
July 7, 2005
Using explicit ads and dire warnings, public health officials and AIDS agencies across the United States are sounding the alarm on a link between crystal methamphetamine use and HIV transmission, but their counterparts in Toronto are refusing to follow suit.
U.S. experts point to evidence that suggests the use of crystal meth — a highly addictive drug, popular among gay men, that boosts sexual arousal and erases inhibitions — makes a person much more likely to have unprotected sex and contract HIV.
But to health officials in Toronto, where the drug is still in its introductory phase, the links to risky sex and HIV remain unproven. Their stance is drawing a lot of sharp criticism.
"It sounds like they're burying their heads in the sand," says Dr. Jeffrey Klausner, director of sexually transmitted diseases prevention and control for San Francisco's Department of Public Health. "They need to just look around to every major urban area in the U.S., from San Francisco to Atlanta to Miami to Los Angeles, and the direct effects meth has had on continued transmission of HIV. I think it's extremely unlikely Toronto would be shielded from those effects."
The latest U.S. Centers for Disease Control and Prevention study of people getting tested for HIV showed that meth users in that city were three times more likely to have the virus that causes AIDS.
San Francisco's HIV infection rate went up between 1999 and 2002, but has since levelled off. Meth is "fuelling the continued high number of HIV infections," Klausner contends.
Toronto has seen a similar trend, with the number of new infections rising by about half to a high of 614 in 2002. Last year, the number had dropped slightly to 563.But Toronto's associate medical officer of health, Dr. Rita Shahin, says it's too early to blame meth for the city's high HIV infection rate. "The jury is still out as to whether crystal meth is leading to riskier behaviour than other drugs," she says. "I've seen evidence on both sides. So I haven't taken a position one way or the other."
"There's not been enough studies of crystal use among gay men to say that definitively," echoes John Maxwell of the AIDS Committee of Toronto (ACT). "We don't know if it's any more risky than using any other substance."
He pointed to research from Vancouver suggesting young gay men on meth were no more likely to have unprotected sex than those using other drugs. "Maybe we're being overly cautious, but we want to make sure we know what's going on in our city," he says.
As a result, Toronto has no large-scale awareness campaign warning of a link, like those in major U.S. cities.
Andrea Stevens-Lavigne, director of health promotion at the Centre for Addiction and Mental Health, says agency resources must go toward issues "that have the broadest impact." In the general population, meth use is still quite low in Toronto, she says.
Among street youth and gay men, however, the rise has been recent, and fast. There are now websites in Toronto where men advertise their desire to "party n' play," which means sex with drugs, usually crystal meth. The ads sometimes declare whether condoms are to be used or not.
The debate has been raging in the gay community for months.
ACT has responded by starting a new task force on how to tackle the issue. During the city's Pride festivities, it issued a pocket information card on the safer use of meth. For instance, since meth suppresses appetite and fatigue, the card recommended eating protein shakes and napping. "We may find it difficult to practise safer sex on meth," it noted on the back.
That's a far cry from the in-your-face posters and advertisements seen in the U.S. of late. One shows what appears to be a dead man, his vacant eyes still open: "Men on crystal are much more likely to have unprotected sex and get gonorrhea, syphilis, herpes and HIV," it reads.
Greg Downer wants to see a similar approach here. "In a few years, I don't want us to say, `Why didn't we do more?'"
Downer was a volunteer outreach worker for ACT, until he was asked in April to take a leave of absence, he says, because he accused ACT of downplaying the link to HIV in a letter to the media. "ACT does a lot of great work," Downer says, "but on this issue, I was hoping they would be more proactive." ACT would not comment on Downer's leave.
A recovering meth addict, Downer once went to bathhouses to educate others about safer sex. But after becoming hooked, he went there for sex, sometimes staying for 48 hours straight.
"It's just a lot riskier than any other drug," he says. "I've seen significantly more people on it who don't have a problem having unsafe sex."
One current meth user, a member of the meth task force, says risky sex is caused by a person's predilections. "People are going to have unsafe sex regardless of whether they're high," says David, who asked that his last name not be used.
But long-time New York City AIDS activist and former crystal addict Peter Staley disagrees. He points to "binges" of often unprotected sex.
ACT's stance is "the height of irresponsibility," says Staley, founder of the Crystal Meth Working Group. "Questioning the link between crystal and HIV is ridiculous, if you've been there (and) seen what it does," he says. "It's the perfect Petri dish of disease transmission."
Last year, Staley used his own money to finance the first anti-meth campaign in New York's gay community. The ads caused a stir, deadpanning: "Buy Crystal Meth, Get HIV Free!"
The city responded quickly. Its public health department allocated $300,000 for ads like Staley's and issued a health bulletin outlining the links to HIV and decreased condom usage.
The Canadian AIDS Society, a coalition of 123 community AIDS organizations — including ACT — also issued a fact sheet last year. It says: "One of the biggest health risks from using crystal meth is the increased chance of HIV infection through unprotected and uninhibited sex."
Though use of the drug is by no means isolated to the gay community, ACT's harm reduction co-ordinator, Nick Boyce, says gay men might use meth to party, to deal with loneliness, or to boost their confidence in meeting other men. Scaring them with aggressive warnings, Boyce says, is ineffective. "It just stigmatizes people and makes it harder to have an honest discussion about it."
U.S. experts counter they're stigmatizing the drug, not the people taking it. And being aggressive is essential, given how entrenched meth has become there, they say. In San Francisco, the health department is even rewarding users to stay off the drug for 90 days with merchandise, like clothing and radios, worth about $400.
Says Klausner: "It's a drastic problem requiring innovative measures."