CITY SAYS METH USE IS AT 'HIGH PLATEAU'

The City Hopes To Curb Meth Use Among Gay Men With Its "Resist Meth" Campaign.

Despite some data suggesting that methamphetamine use among gay men
has declined in recent years, a city panel tasked with addressing
what health officials consider "the other epidemic" after HIV
maintains that usage remains at a "high plateau." The Mayor's Task
Force on Crystal Methamphetamine came to the conclusion in an April
consensus report.

Little noticed at the time it was issued, the report concluded that
13 percent of the city's estimated 54,000 gay and bisexual male
residents use meth. Out of 5,524 gay and bi men who inject drugs, the
task force concluded that 54 percent are speed users. Taken together,
the numbers suggest that 10,003 gay men in San Francisco are meth users.

Overall, the task force estimated that 46,000 residents use meth. The
task force came to its decision after reviewing data from a dozen
studies, and usage could range anywhere from once a day to once in
the past year. "With most drugs you are looking at single digit
percentages, not 13 percent," said task force member Michael Siever,
Ph.D., manager of the Stonewall Project, a meth-focused substance use
program that recently merged with the San Francisco AIDS Foundation.
"Crystal has been and continues to be a major issue in San
Francisco's gay community. It still remains high, no matter how you
slice the numbers." The task force estimated that only 3 percent of
gay meth users use the drug on a daily basis, while 73 percent use it
once a month or less. Seventeen percent of gay and bi who inject meth
do so at least once a day, while 21 percent inject meth once a month
or less, concluded the task force. "The conclusion of the consensus
meeting was that we are at a high plateau and have been for a while.

There are some fluctuations but there is still a very high rate of
use even with whatever recent dips there have been," said Siever. "A
high plateau means to me meth use has been very significant among gay
men and has been for some time." Siever noted though that even if
roughly 20 percent of the city's men who have sex with men use meth,
80 percent do not. "The reality is the vast majority of folks don't
do drugs, period," said Siever. The task force's conclusion is 3
percentage points higher than data collected by the Stop AIDS Project
suggested two years ago. Only 10 percent of the 809 men the agency
surveyed in 2005 reported using crystal in the last six months, down
from 18 percent of the 1,305 men asked in 2003 as part of the
agency's street surveys. A study using Stop AIDS Project data through
June 2006, published last month in the Journal of Drug and Alcohol
Dependence , reported that overall, the use of methamphetamine was
lower in early 2006 compared to late 2003. Usage among HIV-negative
MSM dropped from 14.7 to 9 percent, while usage among HIV positive
men fell to 19.9 percent last year from 28 percent in late 2003. Even
more encouraging is that usage of the drug during sex also declined,
said the study.

The study's authors, who included Stop AIDS education manager
Jennifer Hecht and health department epidemiologists H. Fisher
Raymond and Willi McFarland, noted that speed use has been found to
be associated with HIV seroconversion and is thought to account for a
"large proportion" of infections in San Francisco. The city estimates
it will record 800 to 1,000 new HIV infections this year. The number
of negative men using speed during sex fell from 11.8 percent in 2003
to 6.6 percent in early 2006. Among positive men, the number fell
from 24.8 percent in 2003 to 17.4 percent in early 2006. The study
authors also reviewed drug-related visits to San Francisco General
Hospital's emergency room. While visits for marijuana, alcohol,
cocaine, and ecstasy use all increased, meth-related visits showed a
"slight decrease" from the first half of 2004 to early 2006. The
numbers dropped from 371 to 299. "The downward trend of
methamphetamine use among HIV-negative MSM is particularly noteworthy
given the attention that has focused on this issue over the last few
years," states the study. The Stonewall Project launched in 1998 and
in 2002 its http://www.tweaker.org Web site debuted.

In 2005 Stop AIDS launched its own "Crystal Clear" campaign, and in
April that year Mayor Gavin Newsom formed his crystal task force at
the urging of Supervisor Bevan Dufty, who held several hearings at
City Hall on the drug's impact. "While our data do not prove that the
intensified prevention efforts are causing a decrease in
methamphetamine use, they are encouraging and merit confirmation in
other data," conclude the study's authors. The authors are currently
crunching data collected over the last 12 months to see if meth use
has continued to decline.

According to the health department's July monthly STD report,
meth-related hospital visits for men through June of 2007 numbered
213, down from 245 during the same period last year. Steven Tierney,
a co-chair of the task force and deputy director of programs at SFAF,
said despite the consensus report's conclusions, he remains
optimistic about the course of the city's meth epidemic. "The news is
good. Meth use appears to be continuing to go down," said Tierney,
who said more data is needed though to confirm the trend. "Before
people get all excited about meth, we need to do a little more
investigation of what we are discovering." Studies have found that
cocaine use among gay men is on the rise in San Francisco, suggesting
that meth has lost some of its cachet as a fun party drug. According
to McFarland, cocaine was slightly up, but statistically level from
the second half of 2003 through the first half of 2006. Usage went
from 13.6 percent in 2003 to 14.5 percent last year. While cocaine
use has not been tied to unsafe sex and HIV infections, as has speed,
Tierney said he is still concerned that cocaine may impair people's
judgment. "The impact of cocaine on sexual risk would be in the same
school as alcohol. If a person has a safety plan for himself around
sexual behavior, sometimes you are not in the same capacity to stick
to your plan. So that is the situation," he said. City urges
resistance to meth The city's latest effort to reduce crystal use is
an ad campaign and Web site urging gay men to "Resist Meth." An
outgrowth of the task force's recommendations, the campaign uses
stark black, red and white imagery recalling Soviet-era poster
realism. The message is intended to reach not only meth users
struggling to quit the drug, but also those gay men who have never
tried it but may find themselves in a situation where they are
offered the drug. Since its unveiling in June, more than 5,355 people
have visited http://www.resistmeth.org and 75 people have "joined the
resistance" at the online site. The health department is spending
$195,000 on the campaign, which also includes the translation of
tweaker.org into Spanish. "Meth has actually created a little bit of
a front for a lot of us to come together and join forces.

It was saying going back to the concept of community.

We the people come together and want you to join us to resist this
thing," said Antonio Aquilar, a gay Latino man who was a member of
the campaign's community advisory group. Aquilar, 40, has spent the
last two years working with gay Latino meth users through a project
sponsored by the Cesar Chavez Institute at San Francisco State
University. He said the advisory group members all had various points
of view on the need for another meth campaign. "My hope was just
start the dialogue.

With gay Latino men there is no language to talk about it. So much
stigma, fear, and misinformation," said Aquilar. "The sign doesn't
say anything stigmatizing about anyone or anything.

It leaves it open so people can read into it whatever they want." In
addition to the ads and posters, 40,000 pamphlets called a
"methifesto" and duplicating the Web site's message have been
distributed. Under the heading "Resistance is not futile," the
campaign proclaims that "Meth doesn't have to be part of being gay.
It doesn't have to be a rite of passage." At the same time the
campaign acknowledges that some gay men "can use meth occasionally
without it becoming a problem." It includes advice for meth users on
how to protect themselves from STDs and HIV - one suggestion for men
who bottom tells them to insert a female condom in their rectum prior
to getting high on the drug. It also advises HIV-positive men to be
honest about their meth use with their doctors because crystal can
cause negative interactions with HIV medications. The site also
debunks myths that meth increases T-cells or boosts users' immune
systems. Tracey Packer, the city's interim HIV prevention director,
said the campaign purposefully tries not to sound preachy so it will
not be dismissed. "We need to be realistic about people's behaviors
and give them the information they need to reduce their risk," she
said. "If you don't speak to people within the reality they live in
they won't listen." She also said the campaign is not meant to
compete with other efforts already being undertaken in the city. "The
most effective messages are delivered in lots of different ways," she
said. "It is not meant to compete but to complement." Packer said the
Resist Meth message seems to be resonating with people. "I think that
meth in the community can be very stressful.

Just the effect it can have on individuals in a community creates a
level of tension," said Packer. "The responses are suggesting relief.

People are saying let's take some power over a drug that could be
harming us." Siever gave high marks to the campaign's design, but he
questioned if it was producing any real dialogue on meth use among
gay men. Most people he has spoken to about the campaign said by
trying to reach various target audiences, the campaign's messaging is
muddled. "By its very nature the slogan sounds a little like Nancy
Reagan's 'Just Say No' with cooler graphics and coolers words,
maybe," said Siever. "What I found most interesting is I don't get
the sense from folks I talked to that it prompted much discussion. I
dont know if people are oversaturated with crystal meth messages or
what." Others have said the campaign strikes a chord.

One recovering meth addict wrote in an e-mail that the Web site gives
him encouragement to stay clean. "Meth seduced me then left me all
alone ill and broken, but somehow my will to live was stronger than
meth. I promised myself first and foremost that I'd never touch it again.

Somehow, I've kept that promise for 2 years now, but am always
looking for reinforcement. Thank you for CARING enough to build this
site," wrote the San Francisco resident. Another person wrote, "Other
campaigns can seem patronizing and unrealistic. This campaign with
its political art, sexy style, and strongly directed message, appeals
to our humanity to resist something that we know is killing so many
of us." Back in February the city paid $15,000 for a billboard in the
Castro to gather input on what kind of meth campaign gay men wanted
to see. According to John Leonard, senior vice president of Better
World Advertising, which created the campaign, more than 110 people
responded to the billboard.

Replies included suggestions and ideas for the ads as well as
personal stories, artwork, and songs. "We got a huge range of
responses to the billboard from people who said you should lock up
users and dealers and throw away the key to people who said legalize
it and forget about it," he said. "By and large if there was any
common theme it was that the community needs to come together to deal
with this." Leonard said the ad shop's task was to create "something
positive that could help mobilize the community and avoid
stigmatizing users. That posed a real challenge, but I feel the
campaign is succeeding in speaking to all these different audiences
with a strong message and just the right tone." Better World drew on
the revolutionary and wartime mobilization posters of the 20th
century as inspiration for the campaign, said Leonard. "The image is
meant to be sort of iconic and to evoke and appeal to a community
ethic but people also look at this guy's face and see various things.

Some think he is using meth and struggling with it; others see him as
someone who is in recovery and moved past meth," said Leonard. "I
think because the campaign is so stark and simple it allows for
people to interpret in it a lot of different ways, which I think is a
strength." Dufty, who had criticized the expenditure on the
billboard, complimented the final outcome, though he did express
discontent with the more guerilla-type aspects of the campaign, such
as chalk drawings that appeared in the Castro. The sidewalk images
will disappear over time if not washed away first. I am a fan of the
Resist Meth campaign.

I have had a number of people who wrote to me saying how striking the
graphic images are and the brochure is good," said Dufty. "I struggle
with this sometimes.

I understand an edgy marketing approach reaches a younger audience.
Certainly, that is a group we want to engage with on meth use."