Common Sense About AIDS

Using poppers could increase risk of HIV infection

Expert answers all of your poppers questions

People have been using "poppers," the slang name for inhaled nitrates for decades as a way to enjoy a quick high during sexual activity. However, what most people don’t realize is that popper use is not safe and risk-free, despite what companies selling the items advertise on the Internet.

Popper use has been shown by numerous studies to be associated with HIV risk behaviors and HIV infection, says Hank Wilson, founder of the Committee to Monitor Poppers/Survive AIDS in San Francisco.

Also, people who use poppers and become infected with HIV are more susceptible to Kaposi’s sarcoma, and when people use poppers while on some erectile disfunction medications, it could kill them, he adds.

Here are some answers to your questions about poppers and HIV:

  • What exactly are poppers?

Poppers are a fluid that contains amyl, butyl, or isobutyl nitrate. They often are advertised as video head cleaners, incense, leather cleaners, and air fresheners, but they most commonly are used illegally as inhalants.

Traditionally, when the bottles were opened they made a popping sound, which is why they are called poppers.

Poppers are vasodilators, meaning they cause the heart to beat faster and send increased blood to the brain, creating a short, euphoric effect. "One of the physiological effects of nitrates is to relax muscle tissue, like the sphincter tissue, which facilitates painless anal intercourse," Wilson says.

In other words, men who have sex with men sometimes use poppers to make it easier for them to be the receiver in anal sex. "When more blood gets into the brain you get this feeling of a rush, and within seconds of inhaling, there’s a lightheadedness, a kind of euphoria for some people, and it’s very disinhibiting," he notes.

This makes it more likely that someone will engage in sex without bothering to use a condom, Wilson adds.

Poppers may enhance the experience of an orgasm, but they also can cause someone to lose their erection, he says.

  • Aren’t cocaine, methamphetamines, and other drugs used more commonly than poppers?

Studies of gay men who use substances have consistently shown that while alcohol and marijuana are the two substances most used by men who are at the greatest risk of HIV infection, poppers is the third most-used substance. Typically, more men report using poppers than use cocaine and the party drugs, and often the men who do use poppers are more likely to engage in the riskiest of sexual behavior.

  • Didn’t health officials decide in the 1980s that poppers aren’t the cause of AIDS?

Very early in the AIDS epidemic, doctors were seeing gay patients who had similar disease symptoms and many of them had used poppers, so some people thought that poppers might be causing the immune problems. However, these theories were quickly debunked when the public health community determined that a virus was causing AIDS.

Now, researchers know poppers do not cause AIDS, but they also know that popper use is linked to unsafe sex practices and HIV infection, Wilson says.

  • What are the dangers of using poppers?

What is known is that poppers can cause death if they are combined with Viagra or similar drugs because they both lower a person’s blood pressure, Wilson says. And if used repeatedly, they can cause major headaches, he notes.

"Poppers can cause a bad headache that lasts for a day," Wilson says. "The reason is that when the blood vessels expand, even when dilated, that includes the vessels in the head, and so some people experience excruciating headaches that last for a day."

Since poppers are flammable, they can burn users or explode and seriously hurt someone, and they can reduce oxygen in the blood and turn feet and hands blue. "If a popper is spilled on your lip or nose or if you drop the bottle on your skin, you can have a serious burn," Wilson says. "If you use a popper near a candle or lighter it can explode."

Sometimes, poppers cause impotence right at the time a person wants to have an orgasm, and there are studies that show that popper use appears to make it easier for a person who has HIV to develop Kaposi’s sarcoma.

But one of the most alarming risks is that poppers can make it more likely that someone will become HIV infected during sex. While this has not been proven beyond a doubt, enough researchers believe that poppers can increase the risk of infection in several ways:

1. Poppers might lower a person’s immune response, making it easier for the virus to win that first battle over infection.

2. Poppers make it easier to have anal sex, so a person might have more anal sex, which leads to more tearing in the rectum; and this could make it easier to become infected.

3. Poppers cause the blood to concentrate in the rectal area, and this also makes infection easier.

4. Poppers cause a person to lose inhibitions and so someone using poppers might be less likely to have a partner wear a condom.

  • Poppers are offered at all the best parties — how does someone avoid them?

"A lot of people are introduced to poppers nonverbally," Wilson says. "One person — maybe a hot partner — pulls out a bottle, takes a sniff, and hands it to you, and no words are exchanged."

This makes it exciting to the person whose been offered the drug, and it is tempting to go ahead and take a sniff without asking first what’s in the little brown bottle, Wilson says.

"I was introduced to poppers exactly like this," Wilson says. "I had a person who was sniffing this thing and then handed it to me, and so what did I do? I used it, even though I didn’t know what it was."

Wilson, who has had very close friends die from AIDS, now teaches other people how to say "no" to popper use.

However, if a person knows that by going to a certain club or party they might be offered poppers, they can come up with ways to say "no" before they even arrive. For example, they could say that they’ve just taken a pill that they think is Viagra and can’t use poppers this night. Or they could say that poppers give them headaches, or they could just smile and pass it on.

  • Some web sites say that poppers are safe, why shouldn’t these be believed?

Mos of the information about poppers that can be found on-line is written by the major companies that make and sell poppers for recreational use. That information is not written by scientists or doctors and is mostly false.

Here are some fallacies about poppers as well as the facts:

— Fiction: One web site says, "There is a large body of data that appears to demonstrate that these products are perfectly safe."

— Fact: Scientific evidence does not find poppers to be safe; on the contrary, much of the scientific data available show how poppers can increase HIV risk and cause other health problems.

— Fiction: Poppers are perfectly legal.

— Fact: Poppers were banned by the U.S. Congress more than a decade ago, and while they can be sold as cleaners and for non-inhalant uses, it is not legal to use them as an inhalant drug.

— Fiction: There’s little reason not to use poppers to enhance one’s sex life.

— Fact: Poppers are dangerous in a variety of ways, and while they may give people a momentary feeling of euphoria, many people would agree that when weighing the risks against the benefits that they simply are not worth the risk.

• If poppers aren’t safe, why don’t doctors talk about it?

Most clinicians are too busy to ask their patients about their sex lives and substance use, and even those who do ask sometimes forget to mention poppers. Outside the gay and bisexual communities, poppers are less common; and some doctors may have heard that poppers were banned years ago and aren’t aware it’s still very easy to buy and use them.