SF Meth Use at "High Plateau"

http://ebar.com/news/article.php?sec=news&article=2069
City says meth use is at 'high plateau'

Published 08/09/2007

by Matthew S. Bajko
Bay Area Reporter (San Francisco, CA)

The city hopes to curb meth use among gay men with its "Resist Meth" campaign.

m.bajko [at] ebar.com

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."

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