IS HIV-METH LINK CLEAR?

Experts Note Users Are More Apt To Have Unprotected Sex

But Toronto Health Agencies Say It's Too Early To Blame Meth For Our
High HIV Rate

Using explicit ads and dire warnings, public health officials and
AIDS agencies across the United States are sounding the alarm on a
link between crystal methamphetamine use and HIV transmission, but
their counterparts in Toronto are refusing to follow suit.

U.S. experts point to evidence that suggests the use of crystal meth
- -- a highly addictive drug, popular among gay men, that boosts sexual
arousal and erases inhibitions -- makes a person much more likely to
have unprotected sex and contract HIV.

But to health officials in Toronto, where the drug is still in its
introductory phase, the links to risky sex and HIV remain unproven.
Their stance is drawing a lot of sharp criticism.

"It sounds like they're burying their heads in the sand," says Dr.
Jeffrey Klausner, director of sexually transmitted diseases
prevention and control for San Francisco's Department of Public
Health. "They need to just look around to every major urban area in
the U.S., from San Francisco to Atlanta to Miami to Los Angeles, and
the direct effects meth has had on continued transmission of HIV. I
think it's extremely unlikely Toronto would be shielded from those effects."

The latest U.S. Centers for Disease Control and Prevention study of
people getting tested for HIV showed that meth users in that city
were three times more likely to have the virus that causes AIDS.

San Francisco's HIV infection rate went up between 1999 and 2002, but
has since levelled off. Meth is "fuelling the continued high number
of HIV infections," Klausner contends.

Toronto has seen a similar trend, with the number of new infections
rising by about half to a high of 614 in 2002. Last year, the number
had dropped slightly to 563.But Toronto's associate medical officer
of health, Dr. Rita Shahin, says it's too early to blame meth for the
city's high HIV infection rate. "The jury is still out as to whether
crystal meth is leading to riskier behaviour than other drugs," she
says. "I've seen evidence on both sides. So I haven't taken a
position one way or the other."

"There's not been enough studies of crystal use among gay men to say
that definitively," echoes John Maxwell of the AIDS Committee of
Toronto (ACT). "We don't know if it's any more risky than using any
other substance."

He pointed to research from Vancouver suggesting young gay men on
meth were no more likely to have unprotected sex than those using
other drugs. "Maybe we're being overly cautious, but we want to make
sure we know what's going on in our city," he says.

As a result, Toronto has no large-scale awareness campaign warning of
a link, like those in major U.S. cities.

Andrea Stevens-Lavigne, director of health promotion at the Centre
for Addiction and Mental Health, says agency resources must go toward
issues "that have the broadest impact." In the general population,
meth use is still quite low in Toronto, she says.

Among street youth and gay men, however, the rise has been recent,
and fast. There are now websites in Toronto where men advertise their
desire to "party n' play," which means sex with drugs, usually
crystal meth. The ads sometimes declare whether condoms are to be used or not.

The debate has been raging in the gay community for months.

ACT has responded by starting a new task force on how to tackle the
issue. During the city's Pride festivities, it issued a pocket
information card on the safer use of meth. For instance, since meth
suppresses appetite and fatigue, the card recommended eating protein
shakes and napping. "We may find it difficult to practise safer sex
on meth," it noted on the back.

That's a far cry from the in-your-face posters and advertisements
seen in the U.S. of late. One shows what appears to be a dead man,
his vacant eyes still open: "Men on crystal are much more likely to
have unprotected sex and get gonorrhea, syphilis, herpes and HIV," it reads.

Greg Downer wants to see a similar approach here. "In a few years, I
don't want us to say, 'Why didn't we do more?'"

Downer was a volunteer outreach worker for ACT, until he was asked in
April to take a leave of absence, he says, because he accused ACT of
downplaying the link to HIV in a letter to the media. "ACT does a lot
of great work," Downer says, "but on this issue, I was hoping they
would be more proactive." ACT would not comment on Downer's leave.

A recovering meth addict, Downer once went to bathhouses to educate
others about safer sex. But after becoming hooked, he went there for
sex, sometimes staying for 48 hours straight.

"It's just a lot riskier than any other drug," he says. "I've seen
significantly more people on it who don't have a problem having unsafe sex."

One current meth user, a member of the meth task force, says risky
sex is caused by a person's predilections. "People are going to have
unsafe sex regardless of whether they're high," says David, who asked
that his last name not be used.

But long-time New York City AIDS activist and former crystal addict
Peter Staley disagrees. He points to "binges" of often unprotected sex.

ACT's stance is "the height of irresponsibility," says Staley,
founder of the Crystal Meth Working Group. "Questioning the link
between crystal and HIV is ridiculous, if you've been there (and)
seen what it does," he says. "It's the perfect Petri dish of disease
transmission."

Last year, Staley used his own money to finance the first anti-meth
campaign in New York's gay community. The ads caused a stir,
deadpanning: "Buy Crystal Meth, Get HIV Free!"

The city responded quickly. Its public health department allocated
$300,000 for ads like Staley's and issued a health bulletin outlining
the links to HIV and decreased condom usage.

The Canadian AIDS Society, a coalition of 123 community AIDS
organizations -- including ACT -- also issued a fact sheet last year.
It says: "One of the biggest health risks from using crystal meth is
the increased chance of HIV infection through unprotected and uninhibited sex."

Though use of the drug is by no means isolated to the gay community,
ACT's harm reduction co-ordinator, Nick Boyce, says gay men might use
meth to party, to deal with loneliness, or to boost their confidence
in meeting other men. Scaring them with aggressive warnings, Boyce
says, is ineffective. "It just stigmatizes people and makes it harder
to have an honest discussion about it."

U.S. experts counter they're stigmatizing the drug, not the people
taking it. And being aggressive is essential, given how entrenched
meth has become there, they say. In San Francisco, the health
department is even rewarding users to stay off the drug for 90 days
with merchandise, like clothing and radios, worth about $400.

Says Klausner: "It's a drastic problem requiring innovative measures."