DANCE OF DEATH: CRYSTAL METH FUELS HIV

The use of crystal methamphetamine has reached epidemic proportions among
gay and bisexual men, and Bay Area health officials are warning that the
mantra of HIV prevention - safe sex - has been drowned out by a raucous
scene of loud party music, cheap meth and reckless intercourse.

Health experts estimate that up to 40 percent of gay men in San Francisco
have tried crystal meth, a powerful form of what's commonly known as speed.
Even more alarming, a Health Department study last year found that at one
high- risk clinic, 25 percent to 30 percent of those with new HIV
infections reported crystal meth use in the previous six months.

At a meeting about crystal meth in Sacramento last month, the state's top
AIDS and HIV prevention officials came up with the smoking gun of all
statistics: Gay men in California who use speed are twice as likely to be
HIV- positive than gays who don't use it.

To be sure, the problem of methamphetamine use is not confined to gay and
bisexual men who like to party. Law enforcement officials say meth use has
spread to the suburbs, particularly among teens facing boredom, peer
pressure and undiagnosed psychological problems.

Yet nowhere is the meth concern greater than in the gay community and its
teeming subculture of partygoers who attend weekend-long events dominated
by alcohol, drugs, sex and ramped-up dance music. Dancers become one with
the pulsating beat, their bodies turned into wildly rhythmic instruments of
vibration.

Dr. Jeffrey Klausner, director of sexually transmitted disease prevention
and control for the San Francisco Department of Public Health, is convinced
of the dangers.

"We have all sorts of levels of evidence," he said, "and it's all pointing
in the same direction: The crystal meth epidemic is playing an important
role in increasing sexual risk behaviors, and that is leading to new HIV
and STD infections." San Francisco officials are planning a televised
hearing at 6 p.m. Wednesday on crystal meth use in the gay community. The
City Hall gathering will include public health authorities, recovery
program officials and members of the gay community.

There are various reasons why the demand for the drug has grown among the
Bay Area's gay community. It's cheap - $30 for a high of several days -
easy to get, and powerful. It increases sexual stamina and eases the pain
of depression or loneliness. Others find it makes them feel invulnerable -
if only for a night.

After cigarettes, alcohol and marijuana, speed is the most commonly used
drug in the gay party scene. Known also as "crissy," "tina," "tweak," and
"crank," crystal meth is a powdery substance that can be swallowed,
injected, snorted or smoked.

It appeals to men along any paths of life: lawyers to waiters, stockbrokers
to health-care workers - all have succumbed to the drug, a stimulant that
mimics the body's natural adrenaline. Derived in the early 1900s from
amphetamine, it was first prescribed, then made available over the counter,
in decongestants and bronchial inhalers.

Illicit makers quickly learned how to manufacture the drug cheaply and in
mass quantities. The chemical make-up of meth is similar to that of
amphetamine, but experts say meth has a stronger effect on the body's
central nervous system. Like amphetamine, it brings about heightened
activity, reduces hunger, and temporarily promotes a sense of well-being.

"It's the perfect drug for gay men," said Michael Siever, director of the
Stonewall Project, a speed recovery program for gay men at UC San
Francisco. "What else allows you to party all night long whether you're
dancing or having sex? . . . at least, at first - before it becomes a problem."

More and more, the dance is becoming a dance of death.

For when the music stops, there'll be more HIV-positive men than there
were, say, before the evening began. There'll be more meth users who've
found they've crossed into addiction - it's a tough drug to kick. More
immune systems of HIV-positive men will have been compromised, abused,
treated harshly. More doses of medicine will have been forgotten, or just
ignored.

The question is not, is crystal methamphetamine being used in the gay
community? The question, said Dr. Grant Colfax, director of HIV prevention
studies with the San Francisco Department of Public Health, is instead, can
the use of speed go much higher?

It could be said that Colfax belongs to an elite circle of health workers
who maintain the most knowledgeable insights into the sex habits of the gay
community and who track the progress of AIDS like a security guard on
maximum alert. And his chilling, current-day viewpoint is this: "We have a
dual epidemic - a speed epidemic and an HIV epidemic that are both increasing."

Klausner not only blames crystal meth for new HIV infections, but also for
the increase in syphilis and gonorrhea. According to Klausner, 25 percent
of gay and bisexual men testing positive for syphilis reported recent speed
use. In addition, HIV-negative gays who used meth were three times more
likely to have rectal gonorrhea than nonusers. The word, and the drug, have
spread coast to coast.

Yves-Michel Fontaine, coordinator of substance abuse counseling and
education at the Gay Men's Health Crisis in New York, said: "We are seeing
more cases of crystal meth use than in the past. We're definitely concerned
about it, as are the gay men who are coming in for counseling."

In California, a statewide study found that among the gay and bisexual men
tested in 2001 and 2002 at publicly funded clinics, 7.1 percent of meth
users were HIV positive, compared to 3.7 percent of those who didn't use meth.

Of the total 63,098 gay and bisexual men who were tested, 10.5 percent, or
6,637 men, reported meth use.

Researchers found that condom use - considered the most effective barrier
against HIV - was lower among gay men who use speed.

For receptive anal intercourse - the riskiest form of sex - officials found
that 39.2 percent of gay non-meth users "always" use a condom, compared to
24. 6 percent for meth users.

Consider one sure-fire indicator of the presence of crystal meth: the
number of people asking for help getting off it. Say you seek help in San
Francisco - anywhere in San Francisco. Your name goes on the bottom of a
long waiting list. You have to wait at least a full month.

Three crystal meth treatment programs operate exclusively for gay and
bisexual men in San Francisco. Meanwhile, Narcotics Anonymous chapters,
complete with their time-tested 12 steps, are sprouting up in this city, as
well as in Seattle, Palm Springs, Atlanta, Philadelphia and New York.

Experts have shown that heavy methamphetamine users, those who do two to
four grams a week, can suffer serious brain damage. Heavy meth use has been
shown to be the equivalent of 40 years of aging, affecting movement and memory.

Although speed creates a sense of euphoria, it is actually knocking out the
brain's ability to produce dopamine, which is how the brain naturally
creates the sensation of pleasure. The addict then becomes desperate for
his fix because the drug offers a sense of well-being.

"People are using the drug to feel better," said Dr. Nora Volkow, the new
director of the National Institute on Drug Abuse, "but they are literally
selling their soul to the devil."

While the effects of infrequent use of methamphetamine are unknown, experts
say the good news is that studies show that heavy users who quit regained
some of the brain's ability to produce dopamine.

A San Francisco Department of Public Health study, published in February,
of gay and bisexual men who frequented late-night dance clubs, parks after
hours, sex clubs, and adult bookstores found the incidence of recreational
drug use extremely high:

- -- More than three-fourths of the 350 men in the street-based survey
reported use of noninjection drugs. Half said they had tried
methamphetamine in the previous three months.

- -- Three-quarters of the men said they had had unprotected anal intercourse
in the same time period.

- -- Nearly one-third of the men surveyed either said they already had HIV or
tested positive for the first time, which indicates they possibly had
transmitted HIV to casual sex partners while using drugs.

The study's authors concluded that the late-night party set is clearly
contributing to the rise in HIV infections and there is "urgent need" for
heightened HIV prevention outreach at these venues.

"We're continuing to see guys who have been HIV-negative for years start
using speed," Colfax said, and subsequently contract the AIDS virus.

Crystal meth is anathema to safe sex. It leads to rougher sex and
uninhibited, risky sex; condoms are failing, or men simply aren't using them.

Men on speed say that meth tends to make them "instant bottoms" - the
receptive position in anal sex - because the drug induces temporary
erectile dysfunction.

"We're trying to de-link substance use from risk behavior, to get guys to
be safer while using substances," Colfax said. "People use it and they're
not able to assess their risk behavior. We have a lot of work to do."

Colfax concedes that not all men become addicts, but says even the
occasional or weekend user puts himself at serious risk for contracting
HIV. He wants the full array of programs - treatment, counseling,
prevention - tailor-made to the occasional user. Members of that audience
fall below the drug-dependency radar, Colfax said, and walk around
believing they're risk- free.

But the pitfalls of addiction lie just around the corner.

"Guys start with weekend use and it accelerates," said Board of Supervisors
President Tom Ammiano, who is co-sponsoring the crystal meth hearing
Wednesday with Supervisor Bevan Dufty.

Both Ammiano and Dufty are gay and said they're now hearing of incidents in
which men can't function at work because they're still under the influence
of meth from their weekend parties.

"There's a tremendous amount of denial around speed use," Ammiano said.
"It's pernicious. We're also hearing stories of people failing in rehab
after eight, nine tries. It's very brutal."

Abstaining from speed doesn't induce the severe withdrawals or vomiting
associated with heroin, but those who stop taking meth often face
depression, agitation and intense cravings for the drug.

What's more, experts say, speed's strong association with sex and partying
make it all the harder to kick.

The police have stepped up narcotics enforcement at late-night dance clubs
and on the Internet to staunch the wave of speed flowing into the party
scene. But in San Francisco, possession of methamphetamine is only a
misdemeanor - a frustration to police who want to mandate that people get
treatment.

All one has to do to find speed is log onto several Web sites, where speed
is traded using code words. In the clubs, men exchange what are known as
"bumps," or snorts, on the dance floor or in rest room stalls.

"It's extremely prevalent," said Capt. Tim Hettrich, head of the San
Francisco Police Department's vice unit. "We're trying to kick a- as much
as we can. We go out to the clubs and make a buy. That's one guy. Once
others see that happen - we're dead in the water for that club for the rest
of the night. We're trying to get the major suppliers."

San Francisco prosecutor Liz Aguilar-Tarchi, who leads the district
attorney's narcotics unit, says the problem is exacerbated by sex club and
dance club owners who turn their backs on drug use.

"How can it be that the club owners' security does not know?" she says.
"They are aware. 'Culpable' is a strong word. I haven't seen any evidence
they are involved, but they sort of shut one eye to it."

Club Scene

Prosecutor Jim Hammer, who is gay, said the solution is not incarceration,
but getting more people into treatment programs early on.

At a late-night dance club, he pointed out to a friend that there was no
line for alcohol. "You could get a beer without standing in line," Hammer
recalled. "Yet when you walked out on the dance floor, people were
obviously on something. I think it's a terrible tragedy, especially for the
younger people coming out."

Gay dance party promoter Don Spradlin said he had gone to great lengths to
keep drugs out of his events, which include the annual Gay Pride dance
party in City Hall and the Halloween Hell Ball in October.

But invariably the drugs get in, past the pat downs of security guards,
past the roving eyes of bouncers with flashlights. So Spradlin also posts
health pamphlets and provides plenty of condoms at the club.

"I get irritated that the gay clubs get singled out," he said. "Club owners
have made extraordinary efforts to keep drugs out. Their licenses are
threatened. I'm very anti-crystal. It's sad. I hate it."

Spradlin, 56, a gay man, said health officials and the gay community must
address issues of self-esteem and addictive behavior. The
"use-a-condom-every- time" message of the 1980s doesn't work anymore, he said.

The danger of crystal meth has been kept under cover, most agreed, by its
cloak of shame. Gay men have stopped talking about condoms, and crystal
meth use among friends is kept quiet.

A forum on the subject last fall at the Gay, Lesbian, Bisexual and
Transgender Community Center was sparsely attended, much to the regret of
outreach workers.

"It's unraveling our community," said Jed Herman, a Stop AIDS Project
worker who has heard of meth's destructive toll on not only the user but
also on lovers, friends and families. "I don't know what the answer is. The
obvious problem is getting people in the door who are clearly at high risk
for HIV transmission."

Herman said the Stop AIDS Project's Crissy campaign, which encouraged men
to get help if they thought they had a problem, quickly ran out of money.
One of the dangers of crystal that hasn't been broadcast widely is that
mixing it with Viagra can raise heart rate and blood pressure and lead to
death. Men on speed commonly use Viagra to counteract the erectile problems
caused by meth.

"Any amphetamine - cocaine, crystal - mixed with Viagra increases your risk
for heart attack," said Fontaine of the New York Gay Men's Health Crisis.

Dufty, the supervisor, is hoping the City Hall hearing will further
discussion to combat speed addiction. "To the untrained eye, it's
invisible," Dufty said. But it's also widespread.

"It's a currency that's being traded like dollar bills all around our
community. It's impacting people in their 20s, 30s, 40s and 50s. I've heard
lesbians talk about crystal use. I recognize people are going to make their
own choices. But we have a responsibility to make it an informed choice. As
community leaders and friends, we have to speak loudly about the clear and
present danger of crystal meth."

Tomorrow: Portrait of a meth addict