Series: Part 1 Of 8

THE METH MENACE

LONG BEACH - Scott pushes a plastic bag of crystal methamphetamine across
the wooden coffee table in his East Long Beach apartment.

"We call this a teenager," he says.

The bag contains a sixteenth of an ounce, the crystals inside sparkling
like rock candy.

But the drug is anything but sweet.

Crystal meth has tainted 20 of his 43 years. Already HIV-positive, Scott
says he may have infected others by having sex while high on meth. The drug
supercharges his sex drive, but warps his judgment. He rarely uses condoms
when he's high.

"There's this fatalistic approach, and all common sense is thrown out the
window," said Scott, who asked that only his middle name be used.

Health experts here and nationwide attribute the deadly combination of
methamphetamine and unsafe sex to a spike in new HIV cases among gay men.

Meth use, which has intensified over the past five years and replaced
cocaine as the most popular illegal stimulant in Long Beach, and the
nation, is widely abused among heterosexuals, too, but the high-risk sexual
behavior it triggers among gay men has presented a new front in the war on
AIDS.

From interviews with doctors, researchers, counselors and health
providers, the Press-Telegram has found:

More than half of HIV patients at Long Beach's two main treatment centers
use meth.

Men high on the drug are four times more likely to have unprotected sex.

The number of gay men in Los Angeles who use crystal meth tripled from 2001
to 2004.

Syphilis, hepatitis C and other STDs are increasing among meth users.

HIV-positive methamphetamine users are less likely to take their medication
properly, increasing the chance that the virus will mutate and become
resistant.

Drug treatment designed specifically for gays and lesbians is absent in
Long Beach.

"It's intense," says Dr. Rebecca Kuhn, an internist and HIV specialist at
St. Mary Medical Center's Comprehensive AIDS Resource Education Program and
Clinic, or CARE. "I would honestly and assuredly say meth has really been
the foundation here for increases in HIV."

Crystal meth lowers inhibition and boosts libido, a coupling that fosters
high-risk sexual behavior, reducing the likelihood of condom use and
increasing the risk of HIV infection.

In short, men who say they would normally never have unsafe sex are
smoking, snorting or injecting meth and having unprotected sex with
multiple partners.

An estimated 60 percent of HIV-infected patients at St. Mary Medical
Center's CARE program and 70 percent at the Long Beach Department of Health
and Human Services use the powerful stimulant, health experts say.

Health care providers face many obstacles. Funding is scarce. AIDS
awareness is often on the back burner.

Some say health officials in charge of treatment and prevention haven't
collaborated enough to form solutions.

A terrifying toll

There are about 80,000 gay men and women in Long Beach, according to the
Gay and Lesbian Center of Greater Long Beach. The drug is part of the
scene, but most steer clear.

"We have a disproportionate share of gays and lesbians living in Long
Beach, and that's because it's a wonderful place for gays to live," says
Andrew Signey, assistant director of the St. Mary CARE program. "And 90
percent are leading healthy, productive lives in this city just like
everyone else who lives here."

The meth epidemic isn't isolated to gay men. Meth abuse is common among
heterosexuals, too. Girls use it to diet, teenagers to party, students to
study, workers to stay awake.

Among straight people, however, meth hasn't been linked to sizable
outbreaks of HIV and other STDs.

"Heterosexual sex that happens (on meth) is high-intensity, but it's not
happening in bathhouses, in the contexts of a sexual culture," says Steven
Shoptaw, a UCLA researcher and psychologist, who has studied the drug
extensively.

Cathy Reback, director of the prevention division of the Van Ness Recovery
House in Los Angeles, has teamed with Shoptaw on some of the most
comprehensive research performed on methamphetamine abuse among gay men.

"The reason it's so intensified with gay men is there's a culture of
sexuality with gay men," Reback says. "There's a ready-made gay community
and a whole culture centered around sex."

Signey estimates that as many as 10 percent of the city's gay men use
crystal meth.

Brian Alexander, who has lived in Long Beach for six years and is familiar
with the gay party scene around Broadway in Belmont Heights and Bluff
Heights, says that's an understatement.

"You can't swing a dead cat around there and not hit about 10 people who
are either selling or using," he says.

A recent report by Reback and Shoptaw shows that as the use of crystal meth
increases, so does the risk of being infected with HIV. Participants in the
study, all Los Angeles County residents, were divided into four groups:
recreational users; chronic users, or "weekend warriors"; those in
outpatient treatment; and those who have checked in for residential care.

The study shows 25 percent of recreational users and 40 percent of chronic
users were infected with HIV. The number was 60 percent for the group who
checked into outpatient treatment. And by the time people entered
residential care for crystal meth abuse, 86 percent were HIV-positive.

"The more involved gay men are with meth, the more likely they are to be
HIV-positive," Shoptaw says.

Unchained esteem

The primary attraction to the drug for many is obvious: sex.

"What happens is the sex that (users) have is so heightened that the sex
they have off it is not good anymore," Kuhn says. "And the only way to have
that sex again is with crystal meth."

Todd Stevens, an HIV education specialist, leads a support group run out of
the Redgate Memorial Recovery Center in downtown Long Beach for recovering
crystal meth addicts.

Stevens says there's something rooted in the gay male identity that
compounds the drug's psychological pull. Addiction is just a byproduct of
the root of the problem.

"A vast majority of our lives, we were marginalized, not accepted and
didn't accept ourselves," he says. "It's a way of letting go of all that."

Many gay men spent some time in the closet, he continued, which contributes
to depression, self-loathing and low self-esteem.

"Crystal really takes that away," he says. "It allows them to be free of
bonds."

Stevens estimates that 80 percent of men he treats suffered physical,
mental or sexual abuse as children, or had family members that used drugs.

"It's hard to see past that when you don't know any better," he says.

Scott, who relapsed about a year ago after five years of sobriety, can
attest to that. At first, the drug made him feel a confidence and ease for
which he had always longed.

"I felt like I was God," Scott says. "All the things that were wrong with
me weren't wrong anymore."

The drug taps into the sort of feelings of sexual freedom and cultural
belonging that many gay men have been seeking for decades, ideas that have
embodied the gay civil rights movement, Shoptaw says.

"The kind of sex that happens gets tangled up with gay culture ... gay
liberation, all the stuff that gay men have been working hard to pull
together for 30 years," he says.

Clouding judgment

Mark, who spoke on condition that his last name be withheld, says that
scars from the '80s, when AIDS swept through his peer group, are still
reminders of the casualties of that era.

"In 1984, it was like a light went out in the world...," the 44-year-old
real estate portfolio manager says. "It was 10 or 11 years of just total
darkness, and all of this self-loathing and feeling like somehow, this was
a universal punishment on people with gender-specific sexual orientation."

With the advent of protease inhibitors, the cocktail of drugs that slow
AIDS infection, the panic surrounding AIDS has been somewhat quelled.

"The way that pharmaceutical companies have marketed the medication in the
gay media gives the impression that the virus isn't that bad," Signey says,
referring to ads of healthy, athletic men. "In the meantime, it has made it
seem like something you can take a pill for, but this is not something that
a pill makes disappear. The life these people lead while on medications is
really difficult. These are not easy drugs to tolerate."

Plus, they require 95 percent adherence, something that doctors say is
almost impossible when using crystal meth. Missing pills can cause the
virus to mutate, increasing the danger that patients will become resistant
to their medications.

"A high percentage (of patients) are not adhering," Kuhn says. "Among
heroin addicts, I have found the adherence factor to be much better than
with crystal meth. With crystal meth, they go on a run, and it's rare that
they take their medications faithfully."

Paul Duncan, 51, who used meth on and off for about 20 years, lost all
sense of time.

"When I'm high, the last thing I'm thinking about is taking my meds," he
says. "You're just not focused on anything. Your mind is racing. Your heart
is pounding. You're just looking for that party."

Elizabeth Eastlund, substance abuser mental health coordinator at CARE,
says that about 30 percent of patients she sees use meth for reasons aside
from sex. Some, she says, rely on it to cope with side effects from AIDS
medications, such as fatigue and depression.

"I think people are also just tired," she says. "We're kind of coming from
the perspective of working with people who are already positive and have
spent years and years practicing safe sex. They just get tired, tired of
thinking about it each and every day."

Sneaking up

Methamphetamine was first synthesized in Japan in 1919. It appeared in the
United States in the 1930s and by the 1950s was readily available in tablet
form as Dexedrine and Methadrine. During World War II, it was widely used
by soldiers to increase energy and stamina. In 1970, it was declared
illegal when the Controlled Substances Act was passed.

No one knows exactly when the drug first appeared in Long Beach, but Signey
says it saw its first spike in 1984, when a cluster of students in San
Diego began manufacturing it out of ether, drain cleaner and the interior
sponges of nasal inhalers. It slowed for several years, but then resurfaced
in the mid-'90s, emerging as an alternative to crack cocaine.

"It's a lot cheaper, it's easier to get and the high from it lasts a lot
longer," says Lee Kochems, an anthropologist at the Cal State Long Beach
Center for Behavioral Research and Services.

Kuhn says that 10 percent to 20 percent of her patients were using meth
when she first started working at CARE in 1999.

"Then, a year and a half ago, something shifted," Kuhn says. "There was a
huge surge of crystal meth into the community. To me, it seemed like an
explosion."

Now, more than half of Kuhn's 300 patients are using, she says.

The drug's resurgence in the '90s corresponded with the rise of the
Internet, which has been called the "bathhouse of the new millennium."

But it wasn't until a syphilis outbreak in 2000 that city health officials
began to recognize the scope of the problem, says Nettie DeAugustine,
preventive health bureau manager at the Long Beach Health Department.

It was when disease-intervention specialists began interviewing people with
syphilis that the first signs of a link between that disease and crystal
meth became apparent.

"Perhaps we should have looked at signals closer, earlier," she says. "But
I don't think we had enough information to do that. There were other things
we were focusing on at that time."

It was around the same time, in 1999, that CARE program workers also began
noticing a trend in high-risk sexual behaviors associated with crystal meth
and an increase in STDs, Signey says.

"I don't think anyone realized the addictiveness of it in those early
days," Signey says. "It just kind of seemed to sneak up."

And numbers have risen steadily in the last two years. Those who wish to
meet others who want to use meth and have sex cruise online chat rooms and
look for PNP, short for "Party and Play," code for sex and drugs.

The drug is often coupled with other "party drugs," such as the
hallucinogenic stimulant Ecstasy, the anabolic GHB and the tranquilizer
ketamine. And because impotence is a common side effect of prolonged meth
use, it has also given rise to a surge in medications for erectile
dysfunction, such as Viagra and Cialis, among gay men.

"It's a wicked triad: crystal methamphetamine, Viagra and the Internet,"
Kuhn says.

Over the past decade, meth has become so embedded in Long Beach's gay
community that some say it takes more energy to avoid it than to seek it
out. Certain Long Beach bars, beachfronts and parking lots have become
gathering spots that center around the drug. At virtually any hour of the
day, men can be found sitting in their cars, standing on corners, or
driving slowly, cruising, looking to get high and find someone to sleep
with, or both.

Duncan says he can immediately spot a meth addict.

"They're fidgety," he says. "Their bodies are going 30 miles an hour. Their
mouth is going constantly. They're sweating."

Police say they're aware of the problem, but are limited by a tight budget.

"We've had to slim down several units throughout the organization," Long
Beach Police Chief Anthony Batts says. "Our core mission is putting
officers in black and white ... and the narcotics unit is smaller. The
reality is we have to prioritize what we're able to address during this
budget crisis."

Fatal attraction

For most users, crystal meth begins as a recreational drug, a few lines or
hits in a bar bathroom or a friend's apartment, followed by a feverish
weekend of partying.

The attraction is clear: a euphoric high, wild partying and seemingly
endless sex.

Soon though, it starts spiraling out of control.

As an IV drips into his arm, Duncan talks about his most recent health
setback - cytomegalic inclusion disease, caused by the cytomegalovirus,
commonly known as CMV.

Five years ago, CMV infected his lungs. This time, it's attacking his
intestines.

After repeated vomiting and severe fatigue, he checked himself into the
hospital, where he stayed for several days. Now he's being treated at home.

"I'm nervous," he says from his living room couch, scratching his leg with
the IV cord. "But I'm really thankful that this time I'm sober. I took care
of it before it got critical."

Doctors are keeping close tabs on Duncan during his six-week treatment.
Every day, his roommate, Kevin Hayes, attaches Duncan's IV drip, releasing
480 milligrams of the medication Ganciclovir into his arm, and then cleans
and changes the tubing.

The movie "Resident Evil" flashes on the television. The apartment is
comfortable: plush couches, a soft blue rug, oil lamps and nature paintings
on the wall.

But moments of true comfort are rare occurrences for Duncan, who, over the
years, has also suffered pneumonia, severe abscesses and most recently,
neuropathy, which causes numbness and painful tingling in his feet. He's
also waiting on tests to find out whether a growing lesion on the shaft of
his penis is cancerous.

^iIt's been a rough two months," he says.

His AIDS cocktail regimen is made up of six pills a day: two Reyataz, one
Norvir, one Viread, one Epivir and one Bactrium.

"At one point, I was taking 78 pills a day," Duncan says. "It was
confusing. I had to keep track of them. I was vomiting all the time. I
would take them and throw them back up."

Duncan was diagnosed with full-blown AIDS in 1985 and started using crystal
meth three years later. He's uncertain as to what extent his 17 years of
drug use have contributed to his health problems. But he wonders out loud
whether things would be different if he hadn't been spotty for years about
taking his medications.

Siren song

Scott, too, wonders how his life would have been without the drug.

"Oh, to be 25 again and do it over," he says wistfully.

The 43-year-old addict steals uneasy glances at the front door and window.
He had spent the night before writhing ecstatically on the living room
carpet after injecting two syringes full of crystal meth, his largest dose
in more than 20 years of using.

Nearly 16 hours later, the drug's effects still consume him. He chatters
rapidly and chews the inside of his cheek. He pets his cat with brisk,
circular strokes.

"It's your heart," he explains, tapping his chest. "It's being all amped."

He lifts his arms and flexes his muscles.

"It's like a really good orgasm," he says.

He scratches his nose, then the cat. Outside, a motorcycle engine revs and
he again glances nervously at the door.

The apartment is thick with meth smoke and chemical-smelling fumes.
Lethargic fish swim in slow circles inside an aquarium. Beside two Gatorade
bottles and a container of Viagra, a plate on the coffee table holds a
blackened pipe, a red straw, a syringe and a plastic bag containing about
$80 in meth, enough to last anywhere from a few hours to several days.

Scott says the drug is like an abusive partner he wants to leave, but can't.

The high is dazzling, euphoric, but the crash sends Scott spiraling into
paranoid depths so low he'd rather be dead. He ignores the phone. He
mistakes his cat scratching inside the litter box for gunshots. He sweats
and shakes.

It's no surprise that he struggles to keep his travel industry job. His
credit card bills are higher than he is.

Five years after Scott tried meth for the first time, he started losing jobs.

"I became a big, sad, shame ball," he says. "The more bad things I would
do, the more horrible I would feel and the more bad things I would have to
do. ... I went from being Mr. Wonderful to being a social pariah."

It's since been an arduous, uphill battle for him to get clean.

"I'm getting so disgusted with myself," Scott says. "I'm hoping I'll be
able to stop soon."