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Club Drugs and HIV: The Agony and the Ecstasy
With: Perry Halkitis, PhD
People take street drugs to escape from the realities of their lives. But when they come down in the middle of the night, or the next morning, their problems are still there waiting for them. And statistics show that people who take club drugs like methamphetamine, also known as crystal, may wake up to a brand new problem: HIV infection.
Club drugs like methamphetamine release people from their inhibitions, leading some otherwise sexually responsible men, women and teenagers to engage in risky sexual behavior. For people with HIV, club drug use can interfere with their ability to stick to their drug schedule—and may make the virus replicate faster in their bodies. Below, Perry Halkitis, PhD, a chair of the department of applied psychology at New York University, discusses the relationship between club drugs and HIV infection.
What is the state of the HIV epidemic today?We've seen a worsening of the HIV epidemic in the last several years. Infection rates were stable during the 1990s, but in the last few years there's been a spike in new HIV transmissions across the population, especially among gay and bisexual men. In this population, there was a 14 percent increase in new HIV infections between 1999 and 2001.
What has lead to this increase?First of all, there's a fatigue around HIV in the gay population and in the general population. People feel that the HIV epidemic is over, and they're more complacent about safer sex practices. They think there's a cure and, as a result, people are not being as safe or as responsible in their sexual behavior.
Number two, prevention efforts haven't evolved as people have become sophisticated about HIV. So "Use a condom every time" campaigns, which worked fine in the early 1980s and the mid-1980s, are no longer effective.
We're also seeing a complex interaction between sexual risk-taking and drug use in the gay population and also in the straight population. We're seeing this in particular with a subset of drugs known as "club drugs" because of their association with dance clubs and bars.
Are people still going to clubs to do these drugs?Twenty years ago, these substances were used a lot in dance club situations. Our research shows very clearly that people do them at home, they do them with their friends, they do them in the park—they do them wherever they need to do them. Some people have suggested that maybe a better label for them would be "party drugs" because these are the drugs that people do to have wild and inhibited sex, to go dancing, or to do both of those things in combination.
Which drugs are contributing to increase HIV risk?We're talking about methamphetamine, also known colloquially as "crystal." We're talking about MDMA, which is known commonly as "ecstasy." We're talking about ketamine, Rohypnol and we're still talking about cocaine, to some extent. Most importantly, we need to think about not just each of these drugs in isolation, but these drugs being used in combination with each other, and in combination with alcohol and prescription drugs such as Viagra.
Which drugs are the most worrisome and why?Perhaps the most worrisome is methamphetamine. This is a psychostimulant and a form of speed. Crystal is a hypersexual drug. It's a hugely disinhibiting drug. We know, and it's been clearly documented, that people who are using this substance have sex without rational thinking, they have multiple partnerings, they just let go. They feel like they're on top of the world, so nothing is a problem and any logical thinking around safer sex practices gets wiped away.
Methamphetamine is also a problem because it's a highly addictive drug from a psychological perspective, so people have a very difficult time coming off of it because the cravings are so intense.
Does the way methamphetamine is administered affect HIV risk?Absolutely. When a person first starts using it, methamphetamine is usually snorted. Eventually chronic users begin to smoke it because it is a more effective way of ingesting the drug; it gives a better and a longer and a faster high.
Eventually, people who are dependent on the substance become injectors of methamphetamine. They inject it in their veins or muscles because it creates a much quicker and more intense high. So transmission through injection and the sharing of needles and the sharing of works creates another route of HIV transmission that is linked to methamphetamine use.
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