Understanding Crystal Meth and the Links to HIV

63 Pages·2016·3.5 MB·English

Understanding Crystal Meth and the
Links to HIV:
Essen9als
DAVID FAWCETT PHD, LCSW
AUSTIN, TEXAS
AUGUST 2016
Objec9ves
§ Iden%fy epidemiological trends of meth use and the impact
on HIV/AIDS both in Texas and the US.
§ Understand the unique physiological and psychological
impact of meth and the resul%ng high-risk sex and
prolonged period of recovery.
§ Apply this understanding to outreach/ case management
with co-occurring s%mulant abuse and HIV/AIDS.
Sex
- Drug Connec9on
 Combines synthe%c amphetamines with high-risk sex
◦ Party and Play (PNP)
◦ Chemsex
◦ Methsex
◦ Facilitated by social media
Sex-Drug Connec9on
 Most common:
• Methamphetamine
• Cocaine or Crack
Cocaine
• Ketamine
• Ecstasy
• GHB
• Amyl nitrate
Sex – Drug Connec9on
• Longer periods of con%nuous sexual intercourse
• Careless in choice of partner
• Not using condoms
• Increased sexual desire
  “it pushed my personal boundaries and changed
preferences of the type of sex (rough, more
adventurous, etc.)”
 “I was a sex maniac on the drug…”
The Problem
• Methamphetamine use is up na%onally
•  2010 -> 2013: 353,000 -> 595,000 current users
•  h\ps://www.drugabuse.gov/publica%ons/drugfacts/na%onwide-trends
• Methamphetamine use is increasing among young adults (aged 18 to 26),
par%cularly among MSM
• Methamphetamines: six %mes more likely among MSM (15 % of gay/bisexual/ 2%
heterosexual).
•  IAS 2016. CDC. Laura Kann PhD, Emily O’Malley Olsen MSPH, Tim McManus MS, and Stephanie Zaza MD
The Problem – Local Jurisdic9ons
§ The propor%on of methamphetamine items seized and analyzed by NFLIS
laboratories in Texas increased from 19% of all drugs in 2012 to 24% in 2013.
§ Methamphetamine is now the second most frequently iden%fied drug reported
among analyzed items in Texas, exceeded only by marijuana/cannabis.
§  h\ps://www.drugabuse.gov/sites/default/files/texas2014a.pdf
§ In New York City meth overdoses increased 160% from 2013 to 2014.
§ NYC Health Department
The Problem – United States
§ NY meth use doubled in 3 years, also up in both LA and SF
§  2014 CDC Na%onal HIV Behavior Surveillance
§ “1 in 4 gay men in LA consistently use meth.”
§  Cathy Reback PhD (UCLA and Friends Ins%tute)
§ Ten years ago meth was a phenomenon of affluent, gay, urban, white men – no longer.
§  2016 - Gay Men of African Descent (Brooklyn counseling center)
§  20% - 40% of clients use meth
§  6 of 10 African-American MSM predicted to be HIV-posi%ve by the age of 40.
The Problem – Trans Community
• 20% of Transwomen use meth
• Santos GM, et.al. (2014) Alcohol and substance use among transgender women in San Francisco: prevalence and
associa%on with human immunodeficiency virus infec%on. Drug Alcohol Rev. 2014 May;33. (3):287-95. doi: 10.1111/dar.
12116. Epub 2014 Mar 14.
• Injec%on drug use was 34% among MTF transgender individuals
and18% among FTM transgender individuals.
• (1999, 2000) San Francisco study by Dr. Kris%n Clements at the San Francisco Department of Public Health AIDS Office.
• Increased HIV risk through injec%on drug use
• 8% new infec%ons from IDU
The Problem - Interna9onal
• An%dote, UK's only LGBT drug and alcohol support service:
•  >60% of clients injected drugs in last year.
•  Double the number in 2010.
•  Nine years ago, fewer than 1 per cent were injec%ng drugs.
• University of NSW’s 2015 Sydney Gay Community Periodic Survey
•  2,846 men
•  10.2% HIV-nega%ve men used meth prior 6 months
•  >30% used meth prior 6 months
• Philippines, Thailand, Singapore
•  Capital crime; vigilante groups