Is Crystal Uncool? Gay Men’s Love Affair With Tina May Be O-Vah

by Scott Stiffler

EDGE Media Network Contributor

Tuesday February 17, 2009

As anyone who went clubbing or to one of those multi-party Circuit weekends in the late '90s or early '00s knows, Miss Tina (as crystal methamphetamine is known among its gay users) was an essential part of staying awake and having sex--plenty of sex, much of it unsafe.

But how much is tina use ebbing among the affluent gay men who were at the forefront of the epidemic--and, not incidentally, have been at the forefront of efforts to stop its rampant use? Anecdotal evidence points to programs that began with activist Peter Staley's bus and telephone-kiosk ads in New York City's Chelsea and Hell's Kitchen neighborhoods as making tina uncool (or at least less cool). But how effective have they been?

For those who track crystal meth usage among gay and bisexual men, once again, knowledge is power. But a lack of coordinated information as well reluctance on the part of state and federal funders to acknowledge the link between drug use and sexuality often hinders or dilutes their efforts.

Perry N. Halkitis, PhD, Professor of Applied Psychology and Public Health at New York University, is a prominent researcher into gay men's lives. His upcoming book, "Methamphetamine Addiction: Biological Foundations, Psychological Factors, and Social Consequences," will be released by the American Psychological Association Press on April 15.

All of the data that comes to Halkitis and other who are studying meth usage among urban gay men comes from other sources than national surveys. A lack of reliable data has complicated any tracking of what is generally acknowledged as an epidemic.

As it is, researchers attempting to identify emerging trends in order to create more effective prevention and treatment programs must cull their data from a patchwork of unrelated regional studies. A comprehensive national snapshot could easily be provided, says Halkitis, if the federal government would include a sexual orientation item to the National Drug Survey , which happens annually.

Whatever Halkitis can cull from recent surveys among New York City's (mostly white, and mostly professional) gay men is that meth use is trending downward among young men and Caucusions. That's the good news. The bad news is that, as tina use has become less acceptable among those populations, it has been trending upward sharply among gay urban African-American men.

Project Desire), a study completed in the summer of 2008, looked at meth use among 540 18- to 29-year-olds from throughout New York City (the five boroughs--that is, Queens, Brooklyn, the Bronx and Staten Island in addition to Manhattan). Still in the midst of crunching data, Halkitis notes that 70 percent of those surveyed were African-American--a demographic which, overall, has seen a sharp increase in use.

Among younger African-Americans, there's almost no meth use, Halkitis says: "It's not a drug gay men are using when they're young."

Reflecting anecdotal evidence from party producers and bar owners, getting drunk on alcohol (remember that?) and Ecstasy have become the inebriants of choice among the young, according to Halkitis. He emphasizes, however, that Project Desire's demographics represent "a potential entry point before they start using meth."

The challenge is to to target this specific age group and start intervening before they start using, he adds: "The window of opportunity to effect change closes by the time people are in their thirties, and it's too late."

Shocking Ads Get Results--to a Point

Halkitis traces the recent downward trend to the fact that young men are not beginning to use. Halkitis doesn't stint in his praise of social marketing campaigns like Staley's, which showed men during Pride weekend with a crack pipe in front of a home computer and other chilling images. Such campaigns can be effective, Halkhitis, "if done the right way."

Campaigns using ghoulish imagery, however, only "induces fear and panic, creating anxiety that can lead to the onset of drug use," Halkitis cautions. Accurate information that raises awareness, he adds, is more successful and has a more lasting effect than fear-inducing ads.

"There have been some positive developments in the last couple of years, in terms of an overall decrease in meth use," says Bill Stackhouse, PhD & Director of the Institute for Gay Men's Health. But some things continue to concern him.

An overall statistical decrease in usage--as well as men who are going into both formal and twelve-step recovery programs (such as AA, Narcotics Anonymous and Crystal Meth Anonymous) is significant, Stackhouse worries that those who seek help are largely residents of large urban areas.

Like Halkitis (whose research and statistical analysis he often uses in his own work), Stackhouse is an enthusiastic proponent of social marketing. But only when it's done effectively.

GMHC has received effective support from the New York City Department of Public Health for a number of years, in order to produce campaigns that stress prevention and meth's relation to sexual behavior. Stackhouse's next campaign, slated to debut this summer, involves the launching of a crystal meth website, with some social marketing used to promote it.

The site will focus on users or people who are contemplating use, their family and friends, professionals and policymakers. It will be a fully active website where people post personal experience and testimonials; it will also provide links to referrals and services.

Project Hope, a 2006-2007 study involving meth use among black gay men, confirmed anecdotal evidence that the drug was making significant inroads among a population that previously was relatively unscathed by meth abuse. Tina had been perceived as a drug for "Chelsea boys." No more.

Halkitis notes that the study indicated meth is a drug that's infiltrated the African American community. Compared to Ecstasy or even cocaine, meth delivers a huge effect at a low cost. "An African American man who is already experiencing stigma for being black, gay, and poor turns to this drug to cope," Halkitis says.

In the early stages of studies on the problem, there was much speculation that black men wouldn't be using this drug. But recent upswings and studies like Project Hope definitively prove that they have taken to tina in a big way.

"In the last six months, we've been hearing a lot of anecdotal evident that there is increasing use among men of color," Stackhouse says. "We've been hearing that particularly in Brooklyn the price is low."

For men of color, the intersection of meth use and unsafe sex is "a perfect storm. There's a very large percentage that have HIV, don't know, and are using crystal meth in their sexual experiences."

Another study by Halkitis, Project Pump, also backs up anecdotal assertions that meth use has decreased among Caucasians while increasing sharply among minority populations. Completed in 2006, the study surveyed 311 men from New York City gyms who were asked about their meth use over the past six months.

Overall, 24 percent indicated usage; 28 percent of black men reported using; 30 percent of Latino men; but only 15 percent of white men.

"Meth was going to stay confined to white middle class men based on their experience from the drug on the West Coast," Halkitis says. But the Project Pump results confirmed Halkitis' instinct that "New York City is different. While somewhat segregated, races tend to interact much more than in other cities. So we were arguing it was going to appear in the black community."

Disparity of usage among racial lines wasn't the only surprise that came from Project Pump's results.

"The city, which funded the study, thought we'd find behaviors like no unsafe sex or drug use because they go to the gym," Halkitis reports. Instead, he and his peers had to explain this conundrum to dumfounded officials, who couldn't' wrap their heads around the concept of men getting buff so they could further enjoy the benefits of sex while high.

"They were actually shocked to find out that some gay men go to the gym because they want a certain body and want to act a certain way," Halkitis says. That public health officials may have been scandalized by behavior that is understood as a way of life among the gay community would be amusing--were it not so problematic in terms of properly funding prevention and treatment.

Sex, Meth, & Harm Reduction

Halkitis points out, with palpable dismay, that public health officials and government-funded efforts may actually have hampered curtailing meth use among gay men. Why? Because they fail to acknowledge the link between drugs and sex. Basically, they don't acknowledge the fact that sex on tina is, well, great. It's just the day after the day after--the proverbial Suicide Tuesday--that presents the valley after the mountain.

"When you study the health of gay men, you cannot talk about it separate from sex." he says. "Trying to compartmentalize these things is short sighted." The studies of Halkitis and others consistently reinforces a fact widely acknowledged by those involved in day-to-day outreach and prevention efforts.

"When you speak to gay men, they cite sexual reasons for their use of the drug," he says."Is it a desire for a certain kind of sex that is a precursor for meth use? For some men, it is. The desire for fantastical sex can be achieved more readily when they are high."

A blissful ignorance of the relationship between meth use and gay sex is bad enough. But equally confounding is the fact that many programs which purport to help users quit rely solely on the 12 Step, all-or-nothing approach, which many find a turn-off.

Is 'Harm Reduction' the Answer?

There is a general consensus among those working with gay men that harm reduction, not abstinence, is a far more effective technique. "Harm reduction" is a controversial umbrella term for programs that don't tell the user to quit entirely. Instead, they encourage cutting back or limiting to certain times or experiences and not using at other times; or at least using less.

Harm reduction, its proponents believe, engages users in an ongoing dialogue on their own level that ultimately facilitates more healthy behavior. Michael Siever, a strong advocate of harm reduction, stresses the ultimately positive impact that comes from accepting the fact that

"There will always be people who do drugs, and there are things we can do to minimize the harms caused by their drug use," says Siever, founder of the San Francisco AIDS Foundation's Stonewall Project and founder of a website dedicated to educating LGBT crystal users about harm reduction.

For nearly 11 years, theStonewall Project, founded by Siever and funded by the San Francisco Department of Public Health, has provided LGBT harm reduction counseling. "We're here to help people at whatever stage they're at." says Siever. "Our motto is 'You don't have to be clean and sober to come in here or even want to be.' Most places, historically, won't take someone until they say they're ready to quit. We try to help people before things get so bad."

Those methods of help include encouraging users to reduce the drug's harmful effects by using less often, altering their method of intake (from injecting to snorting or smoking, drinking liquids, and consuming solids on a regular basis. Over time, these behaviors become habits. "There are methods of helping reduce the harm event when people are not ready to stop using the drug," Siever says.

That approach often yields better long-term results than abstinence only programs: "Ninety percent of the guys we work with eventually come to the conclusion that they need to stay away from this drug," Siever reports.

Lasting change, Stackhouse says, comes from encouraging casual meth users to contemplate how it's impacting their lives. "They may choose to limit or stop their use," he says.

For those who transition from weekend partying to going to the extreme level of use where it becomes an addictive dependence, Miss Tina can indeed be a bitch. Halkitis says there's merit to programs that "meet people where they are and don't pass judgment or demand immediate abstinence."

But he also believes that there's a smarter approach, "which is one that addresses the link that exist between meth use and sex." He praises the work that Thomas Patterson is doing at the University of California-San Diego, using successful methods gleaned from HIV prevention programs to address meth use in heterosexuals and gay men.

"I think that's the smartest approach in terms of all of those talk therapy models," Halkitis says. "When you acknowledge that desire for fantastical sex, you also address the desire to use meth to have that kind of sex. The folks in San Diego have shown some real promise with this approach."

A realistic sense of meth's power over users--whether it's the lure of the high or the heightened quality of the sex--may be the key to engaging gay men to acknowledge the toll that the drug takes on their bodies and minds. No matter the treatment or prevention methodology, Siever emphasizes the paramount importance of being "very evenhanded and realistic about the pros and cons of crystal meth. People wouldn't do the drug if it wasn't fun. I think it's important to acknowledge that, be realistic about it, and talk about it."

Scott Stiffler is a New York City based writer and comedian who has performed stand-up, improv, and sketch comedy. His show, "Sammy's at The Palace. . .at Don't Tell Mama"---a spoof of Liza Minnelli's 2008 NYC performance at The Palace Theatre, recently had a NYC run. He must eat twice his weight in fish every day, or he becomes radioactive.