Fridae

It's cheap, and a little goes a long way - the high lasts much longer than cocaine. It can make you feel giddy, euphoric and confident. When it comes time to fuck, you can go all night, and then some.

"Crystal methamphetamine is described as the hyper-sexual drug," says Perry Halkitis, M.S., Ph.D, professor at New York University, and co-director of the Center for HIV Educational Studies and Training (CHEST). "It makes you horny."

But like all drugs - and erections - what goes up, must come down.

As HIV rates continue to climb among gay and bisexual men, studies point to a clear connection between crystal, unsafe sex, and HIV risk. While high, you might be more likely to bareback, have multiple sex partners, have rougher, more aggressive sex, and bottom - all risky behaviours.

"I have patients who are ripped up beyond belief, with multiple anal tears. The answer explaining what happened is usually, 'I don't know, I was partying,'" says Stephen E. Goldstone, M.D., F.A.C.S., medical director of GayHealth.com. "If they can have that much damage done to them they certainly aren't thinking about protection."

Dr. Goldstone was once called to the emergency room because a patient with an intermittent crystal problem had an abscess (or boil) the size of an orange. "It would be impossible to tolerate the pain associated with that without being high all the time," Dr. Goldstone says. "You can't manage a crystal habit or maintain judgment on it."

Moreover, crystal is ranked among the most popular drugs among HIV-positive men in several cities including New York, Miami, and San Francisco. While mainstream communities (like Jackson County, Arkansas) are finding a spike in addiction, gay and bisexual men are hit with a double whammy - an increase in addiction and HIV.

"Crystal can suppress the part of your immune system that is responsible for actually blocking HIV," says Antonio Urbina, M.D., Assistant Professor of Medicine at New York Medical College. For HIV-positive men, there are potentially fatal drug interactions between crystal and protease inhibitors, especially Norvir, says Dr. Urbina. Because Norvir and crystal share a common pathway, crystal may be three to ten times more potent in people taking Norvir.

This is not a reason to stop taking your HIV medications, Dr. Urbina says, which will only increase the likelihood that you will develop resistance to medications. While Dr. Urbina says abstinence is the only way to go with crystal, if you can't stop at this moment, strongly consider doing a much smaller amount. The combination, however, can be deadly.

"We may also see more HIV-associated dementia for men with HIV," Dr. Urbina says. Crystal and HIV have overlapping toxicity that may cause irreversible damage to the brain.

Methemphatamine may actually increase viral replication in the brain, says Dr. Halkitis, who has worked on several studies regarding club drugs and HIV. "Also, a lot of men with HIV who are using meth, are not adhering to medication regimens." This puts HIV-negative men at greater risk for catching a drug resistant strain of the virus.

Unfortunately, not much is getting done to combat this growing problem. The most notable action in New York City were ads (that some say came too late) purchased by Peter Staley, who spent US$6,000 of his own money for posters that were donned in Chelsea in March that said: "Huge Sale, Buy Crystal, Get HIV Free!"

"Those ads will only work for people who haven't tried crystal," says Donald McVinney, director of training at the Harm Reduction Coalition in New York City.

"There is a certain doom about the message that if you do crystal you will bareback and you will get HIV. That isn't always true," he says. One way to reduce risk, McVinney says, is to limit use to the weekends. The Web site Tweaker.org offers more than 20 tips about risk reduction.

Others say you can't harm reduce crystal-it is just too psychologically and physically addictive to limit or control. "Abstinence has to be the goal, but harm reduction can lead the way," says Dr. Halkitis, adding that more research is urgently needed to develop treatment options for people who want to kick crystal. Currently, the only game in town is the 12-step program, Crystal Meth Anonymous (see a link below).