CRYSTAL-METH USE IS ABOUT TO RACE OUT OF CONTROL

Last Sunday's raid of the Sound Factory, a Hell's Kitchen dance club,
where authorities charged the owner and two members of his staff with
promoting the sale of illegal drugs, highlights the fact that
crystal-methamphetamine use in New York City has been rising the past
five years, prompting a dangerous increase in unsafe sex practices and
many new cases of HIV infections. Despite this documented trend, the
city has not yet established crystal methamphetamine education and
treatment initiatives. It can't afford to wait.

In 1999, our research revealed that crystal-methamphetamine use was
beginning to grow rapidly and would inevitably be associated with new
HIV infections in New York City. This was especially true among men
having sex with men - the population where increased crystal use in
New York City began. Men used crystal to increase sexual pleasure, to
be more social, and even to treat undiagnosed attention deficit
disorders and depression.

To our great alarm, participants in our studies described forgetting
and choosing to forget to use condoms as they engaged in
crystal-fueled sexual marathons. Now crystal use is spreading to
adolescent and heterosexual populations in the city.

Not surprisingly, our latest data suggest that the proportion of HIV
infection associated with crystal-methamphetamine use is dramatically
rising. For example, in one study we found that crystal-meth-using
New York City men having sex with men were 2.9 times more likely to
become HIV infected through receptive anal intercourse. Our findings
echo earlier research among this population on the West Coast, which
has documented crystal-methamphetamine use to be between 5-25 percent.
Affected communities have begun to respond to the burgeoning
crystal-meth epidemic. In 1999, there was one crystal-meth anonymous
group at the Lesbian, Gay, Bisexual and Transgender Community Center
in New York City; today there are 12.

A cascade of disasters is accompanying the rise in crystal-meth use.
HIV-positive crystal users on HIV medications are missing more doses
and are likely contributing to the spread of drug-resistant strains of
HIV. Crystal users and other newly infected people oblivious to their
new HIV infections could rapidly spread the HIV-medication-resistant
virus. According to researchers at New York's Aaron Diamond AIDS
Research Center, some drug-resistant HIV may be mutating into
"super-spreader" varieties capable of infecting more people with fewer
numbers of exposures.

Thus, the combination of crystal use and the evolution and spread of
multi-drug-resistant viruses may be setting the stage for a far
greater epidemiological disaster by creating novel, super-spreading
varieties of HIV. Multi-drug-resistant HIV infections are more
difficult and expensive to treat - and more painful to endure.

New York City knows enough about the public health implications of
crystal-meth use and its history to draft an aggressive response. The
city should extend resources to train drug treatment programs to
provide detoxification to crystal-methamphetamine users. Surprisingly,
many New York City drug treatment programs do not have protocols for
treating crystal-meth addiction. Billboard, bus and subway advertising
campaigns would also help - adding to the pioneering efforts of Peter
Staley, founder of AIDSmeds.com, who has personally paid for public
health ads warning of crystal meth's dangers.

New York City must not wait for unequivocal proof showing the
association between crystal use and new HIV infections before mounting
a decisive and intelligent response to this growing epidemic. Existing
qualitative research and the reports of mental health and medical
professionals have supplied sufficient evidence to take action now. We
strongly urge the city to respond as creatively and compassionately to
the crystal problem as it has to syphilis, and to replicate its
current efforts to vaccinate gay and bisexual men for hepatitis.

As far as we can tell, the only impediment to launching a new campaign
is bureaucratic inertia - a malady much easier to overcome than a
devastating addiction to crystal methamphetamine.