CRYSTAL CLEAR & DEADLY

Health Officials Say HIV Prevention Is 'Broken' As Crystal Meth Stirs A New
Wave Of Infections

NEW YORK - It's a freezing Wednesday night in Manhattan, and the crowd of
about 300 at the town-hall meeting falls silent as Bruce Kellerhouse begins
to speak about a potent new strain of medically resistant HIV. The strain
is carried by one gay crystal methamphetamine user here who had hundreds of
unsafe sexual encounters.

"This case evokes a powerful set of feelings about ourselves," said
Kellerhouse. He's one of the founders of HIV Forum, a small activist group
determined to stop the rise of HIV infections among gay men through crystal
meth abuse and high-risk sex. "For me, it evokes fear and loss. For others,
it evokes feelings about discrimination, homophobia, stigma and drug
addiction."

The meeting, organized by HIV Forum, has brought gay leaders and medical
experts together to discuss the case with the city's gay community. Doctors
are still uncertain whether the new strain is a single case, the first of a
cluster of cases, or the precursor of a deadly new wave of HIV.

But Kellerhouse is utterly certain about one thing.

"HIV prevention is broken, and we must be the ones to fix it."

Getting high on crystal meth, which can be snorted, smoked or injected,
impairs judgment and enhances sex. But if crystal use and "barebacking" --
unprotected anal sex -- is so dangerous, why would anyone do it?

New York University professor Perry Halkitis, in his study "Methamphetamine
Use Among Gay Men in New York City," puts it this way: For gay men "who
want the escapism and adventurism of prolonged sex and multiple partners
.. meth is the quintessential gay drug."

Montreal songwriter Rufus Wainwright calls crystal meth addiction "the gay
hell." Wainwright knows -- he was strung out on meth and spent a month
detoxing and undergoing therapy at a rehab clinic.

Wainwright told one interviewer about being "with 20 naked people in my
apartment and me in my bathrobe playing Cigarettes and Chocolate Milk," his
powerful song about meth addiction.

"If you walk down to Chelsea (a gay neighbourhood in New York), every
second billboard on the street is about the dangers of crystal meth. It is
like speed, but the effect it seems to have on gay men is that decades of
anxiety about sex and fear of disease just goes away and you are just off
to the races."

Wainwright told about having lost weekends, and violent fantasies. "At one
point, I can't remember whether it was in the act of sex or just before,
this single thought came into my head: the ultimate orgasm is death. And I
knew that was where I was heading."

In gay slang, it's known as "ordering in" -- arranging sexual encounters
through Internet personal ads that mention "raw" sex or "PnP" -- "Party and
Play." Typically, a PnP event begins with a roomful of strangers handing in
their clothes and doing a "bump" of crystal meth. What usually follows is
hours of unprotected sex with multiple partners.

Because going on crystal meth binges causes temporary impotence in many men
- -- some take Viagara to get aroused -- users are more likely to be "bottom"
or receptive partners in unsafe anal sex, greatly increasing the risk of
contracting HIV.

Peter Staley, an HIV Forum activist and a recovering crystal meth addict,
spent about $6,000 of his own money in January, 2004 on a provocative
poster campaign linking crystal meth and HIV.

"Huge Sale," the poster trumpets, "Buy Crystal -- Get HIV Free!" It shows
an athletic man with a "six-pack" abdomen and a disco ball for a head. The
poster, which was plastered on phone booths, also shows a "trendy
accessory" -- a glass meth pipe.

Crystal meth, also known as "Tina" after a character on Dynasty, is
manufactured using common household products such as iodine and drain
cleaner. And it's cheap -- $100 in materials can produce $1,000 worth of
the drug.

At the March 3 forum, health officials stressed that the New York City man
remains the only known case of the so-called HIV "super-strain." Dr. Thomas
Frieden, the city's health commissioner, defended his department's decision
to go public in February.

"We did not make this announcement to increase fear," Dr. Frieden said,
adding that it could be weeks or months before they know if others are
infected with the strain of multi-drug resistant HIV. "We made this
announcement because we felt we had a responsibility."

He said the decision to speak out was made when the health department
concluded that the case might be "a harbinger of increasing drug
resistance." Dr. Frieden said media reports about the case may have
prevented other infections. "I think our going public with it made it less
likely that it will be widely disseminated."

The crowd also learned new details about the infected man, who is in his
40s. He was a meth user, but never injected the drug. Over the past five
years, he took the drug about once a month. During that time he was a top
during anal and oral sex.

Last year, his meth use escalated to every weekend and he had an October
sex encounter where he was the bottom. If he was infected then, it would
mean that he rapidly progressed from being HIV-positive to having AIDS, a
diagnosis he received in January. It typically takes years to go from being
HIV-positive to having AIDS.

Dr. Frieden declined to discuss results from the health department's
efforts to find the man's sex partners who may be infected with the virus.
"As soon as we have information that we are reasonably confident is valid,
we will release it," he said. "I will not give any information on an
ongoing investigation."

There are four classes of drugs used to treat HIV. The new strain is
resista nt to all of the drugs in two of those four classes with
susceptibility to some drugs in the other two classes. The man is being
treated with drugs from the latter two classes.

The case has focused attention on the growing role of crystal meth in the
spread of unsafe sex. Dr. Moupali Das-Douglas, a special assistant to Dr.
Frieden, told the crowd that the case was a "wake-up call" to gay men, meth
users, AIDS groups and health-care providers.

Kellerhouse and his friend Dan Carlson founded HIV Forum in the summer of
2003. "It was a response to what we perceived as more and more men taking
more and more risks in their sexual behaviour," Carlson explained.

Soon that perception was back by some frightening statistics -- about 20
per cent of gay men in New York City had used crystal meth and HIV
infections were on the rise among gay men for the first time since 1997.

Since then, study after study has underscored the scope of the problem. A
recent study of N.Y.C. gays shows that those with HIV are twice as likely
to have tried crystal meth than those who test negative. Men high on
crystal meth are four times more likely to engage in unprotected sex as
those who aren't using the drug, according to the Centers for Disease
Control and Prevention.

In a study of 1,600 men who have sex with men, conducted in 2003-2004 by
the Los Angeles County public-health agency, 13 per cent said they had used
crystal meth in the previous year. Those respondents were twice as likely
to report having had unprotected sex, and four times as likely to report
being HIV-positive.

On its website, HIV Forum raises the question of a resurgence of the HIV
epidemic among gay men, and runs some scary numbers: "new HIV infections
are up 18 per cent in three years; syphilis infections are up 1,200 per
cent in four years; crystal methamphetamine use is implicated in one-third
of new HIV infections."

Some experts suggest that the combination of casual sex hookups arranged
via the Internet, drug addiction, and a visible culture of barebacking
among gay men will make HIV and other sexually transmitted diseases
unstoppable.

Many young gay men are less concerned about safe sex since the coming of
retroviral cocktails in the late 1990s made HIV a chronic but treatable
disease. In a speech that progressed into a furious diatribe, Larry Kramer,
a celebrated AIDS activist, lashed out about the state of HIV prevention at
an HIV Forum meeting in late 2003.

"More and more I am filled with dread," Kramer began. "That is my truth
that I bring to you today. Larry is scared. Do you see what I see? I don't
think so. Most gay people I see appear to me to act as if they're bored to
death. Too much time on your hands, my mother would say. Hell, if you have
time to get hooked on crystal and do your endless rounds of sex-seeking,
you have too much time on your hands. Ah, you say, aren't we to have a
little fun? Can't I get stoned and try barebacking one last time? ARE YOU
OUT OF YOUR F------MIND! At this moment in our history, no, you cannot. You
kids want to die? Because that's what I sometimes think. Well, then, die.

"You cannot continue to allow yourselves and each other to act and live
like this! And by the way, when are you going to realize that for the rest
of your lives, probably for the rest of life on Earth, you are never going
to be able to have sex with another person without a condom! Never! Every
time you even so much as consider this I want you to hear my voice
screaming like crazy in your ears. STOP! DON'T! NEVER! NO WAY, JOSE! ... As
I understand it, more and more new viruses and mutant viruses and partial
viruses that are not understood are floating around. Are you ready for that
one?

"We're living in pigshit and it's up to each one of us to figure out how to
get out of it. Crystal meth is not an answer. You must know that by now. It
takes hard work to behave like an adult. It takes discipline. You want it
to be simple. It isn't simple. Yes, it is. Grow up. Behave responsibly.
Fight for your rights. Take care of yourself and each other. These are the
answers. It takes courage to live. Are you living? Not so I can see it. Gay
people are all but invisible to me now. I wish you weren't. But you are.
And I look real hard.

"I love being gay. I love gay people. I think we're better than other
people. I really do. I think we're smarter and more talented and more aware
and I do, I do, I totally do. I really do think all of these things. And I
try very hard to remember all this.

"But I am finding that I am not so proud of being gay anymore. It's come
over me slowly. As much as I love being gay and I love gay people I'm not
proud of us right now."

At the March meeting, Kellerhouse spoke movingly about "generating a new
dialogue about HIV transmission." This dialogue could be "a powerful
preventive tool," as well as a necessary "social lubricant" that "connects
the shared experiences of each other."

Too often, he said, the gay community has not spoken openly about issues
and ideas because of shame, guilt or fear. Kellerhouse noted that the HIV
Forum meetings are known for igniting "passion, emotion and controversy."

Then he paused for a moment. "That's OK, because anything would be better
than silence."

Bruce Ward writes for the Weekly.