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Crystal methamphetamine use poses sexual health risks in women and men
Study finds male heterosexual drug users engage in risky sex
Call it "crystal," "tina," or "crank," use of crystal methamphetamine is cutting across all socioeconomic and sexual boundaries. How does that affect your family planning facility? A new report reveals that risky sexual behavior under the influence of the drug, which has been reported in men who have sex with men (MSM), also is turning up among heterosexual men.1
Researchers in five California counties found that heterosexual men who reported recent methamphetamine use were much more likely to have casual or anonymous sex, anal sex, and sex for money or drugs with female partners than those who did not use the addictive stimulant.1
Long reported as a predominant drug problem in the Western United States, methamphetamine abuse now has become a substantial drug problem in other areas of the country as well, according to the National Institute on Drug Abuse (NIDA) in Bethesda, MD.2 Once associated with white, male blue-collar workers, methamphetamine now is being used by more diverse population groups that change over time and differ by geographic area.2 Case in point: Crystal meth use has been noted among patients attending Planned Parenthood of Central and Northern Arizona in Phoenix, says agency spokeswoman Melissa Fink.
Methamphetamine use makes many users feel hypersexual and uninhibited.3 This loss of inhibition puts users at risk for sexually transmitted diseases (STDs) and, in the case of heterosexual women, unplanned pregnancies.4 For many women, the drug often is seen as the answer to the conflicting demands that come with the role of "super mom" — work, child care, cooking, cleaning, and companionship.4
Public health officials are concerned about the relationship between crystal meth use and new HIV infections. Researchers at the Centers for Disease Control and Prevention, the University of California San Francisco, and the San Francisco Department of Public Health showed that crystal meth users were three times more likely to get HIV-infected than nonusers.5 Among those who reported crystal meth use during sex, the likelihood was nearly four times as high, investigators found.5
To combat the problem in San Francisco, Mayor Gavin Newsom and Supervisor Bevan Dufty appointed a citywide Crystal Meth Task Force in 2005. Responses from the task force should be forthcoming, says Jeffrey Klausner, MD, MPH, director of the STD Prevention and Control Services at the San Francisco Department of Public Health.
The task force already has considered the use of meth broadly, that is, in groups outside of gay men and other men who have sex with men including transgender people, women, youth, and vulnerable groups, such as the homeless and mentally ill, reports Klausner. The task force's upcoming recommendations will be aimed at the breadth of the using and at-risk population but remain prioritized among those populations most affected, he notes.
"That response should emphasize prevention and treatment over criminalization and enhanced enforcement," states Klausner. "It is a public health problem, not one of public safety; thus, it requires a response framed in public health."
Understand the problem
According to NIDA, amphetamines are the most potent of the stimulant drugs in increasing dopamine levels, more than three times that of cocaine.2 Since crystal methamphetamine can be synthesized from over-the-counter ingredients, the drug has been easy to access. Law enforcement officials have battled the rise of home-based methamphetamine labs as well as illicit drug importation from Mexico.3
NIDA reports show indicators of methamphetamine abuse have persisted at high levels in the Western United States, including Honolulu, Seattle, San Francisco, Los Angeles, and San Diego, and have increased in several areas through 2003-2004, including Colorado, Phoenix, Atlanta, and Minneapolis/St. Paul.2 In Minneapolis/St. Paul, primary treatment admissions for methamphetamine as a percent of illicit drug treatment admissions increased from 10.6% to 18.7% from 2001 to 2004; while in Atlanta, primary methamphetamine admissions represented nearly 11% of the illicit drug treatment admissions in the first half of 2004, compared to 6.7% and 6.9% in 2002 and 2003.2
Meet the challenge
How can reproductive health providers address the crystal methamphetamine crisis? AIDS Project Los Angeles (APLA) has instituted a Crystal CLEAR support program for friends and family members concerned for a loved one in their life who is using the drug.
APLA began its crystal methamphetamine program to address the increasing evidence that users of the drug may be at a higher risk for STDs and HIV, explains Justin Burke, APLA communications manager. The program creates and coordinates free community forums and two sets of training: one for crystal users, and one for their friends and sexual partners.
The program is designed to meet the needs of users and their social affiliates, because the drug too often leads to social isolation, he notes. The affiliates' support group provides education and prevention through facilitated group discussion and expert presentations, as well as through role play and similar group activities, says Burke. One of the primary techniques explored in the group is motivational interviewing, which is a nonconfrontational and supportive approach to communication.
Members of the affiliates' group meet for four two-hour sessions over the course of a month. APLA also offers a monthly follow-up meeting for affiliates who have completed all four sessions and have received the Social Affiliate Certificate issued by APLA. The follow-up meeting provides an opportunity for the group to share feedback and best practices based on their experiences in applying motivational interviewing techniques with the user in their life, says Burke.
"Our affiliates' support group is based on a harm reduction model; in other words, we acknowledge use of the drug and provide information and tips that help the user's loved ones identify problematic behaviors that the user may want to change," he states. "We teach them skills that will help promote the physical, sexual, and mental health of the user until the user is ready to access treatment."
Launched in last August, the affiliates support group has been positively received by clients, reports Burke. Although the group is open to anyone, male or female, HIV-positive or negative, the target population remains gay and bisexual men, so there have been some growing pains as APLA attempts to reach people from all backgrounds, he states.
"We have had several success stories, as well as growth in participation, as we come together to deal with the devastation caused by crystal meth," says Burke.
In San Francisco, major efforts at integrating substance use services and STD/HIV prevention have been made over the past year and a half, reports Klausner. Progress has been made, not as quickly as most would like, but the direction is clear, he states.
"Trainings have occurred for both types of providers: STD/HIV training for substance use providers, and substance use training — in particular meth — for STD/HIV care providers," says Klausner. "They have all been very well received, extremely well attended, and clearly met an important gap in provider capacity."