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NY should step up crystal meth curbs
  Newsday, Sept 23, 2004
Patrick Moore, author of "Beyond Shame: Reclaiming the Abandoned History of Radical Gay Sexuality," is writing a memoir focusing on crystal meth use.
September 22, 2004
For once, New York is not at the forefront of a cultural trend. New York is blessedly late to the party when it comes to the crystal methamphetamine epidemic that originated in California 10 years ago, migrated to the rural Midwest and is now afflicting the East Coast.
New York may want to take advantage of its timing to get an advance look at the future of the crisis by examining how it has already manifested itself in Los Angeles.
In California, the party is already over. The Los Angeles Times recently reported that researchers believe that crystal is being used not only by gay men but also by a wide range of people as a way to show up at work and make it through the day. As Richard Rawson of UCLA says, "There is too much meth out there to explain this away as a party drug."
For public health reasons, New York has focused thus far on the impact of crystal meth on the gay community. And it is true that crystal has been a major factor in rising HIV rates for gay men.
But New York has the relative luxury of utilizing effective prevention programs that have proved effective in Los Angeles for risk reduction among gay men. Rather than reinventing the wheel, New York could quickly implement these programs to deal with the immediate risk of HIV and begin to focus on meth's projected course into the broader population.
Crystal use among gay men is understandable. Gay men who lived through the first decades of the AIDS crisis carry with them an incredible weight of sexual shame and untreated grief. Rituals such as marches, funerals and volunteering have largely stopped, but the emotional devastation remains. Crystal offers a way to hook into a primal sexuality that negates all thought.
As for younger gay men, they are largely disconnected from the history of the AIDS crisis because of a generational disconnect in the gay community. Though they watch neutered versions of themselves on television, young gay men do not have many opportunities to discuss the reality of their sexual desires and are left with seeing sex as either monogamous marriage or shameful promiscuity.
Be that as it may, effective HIV outreach programs for gay men using crystal already exist in Los Angeles. The straightforward message of condom use that many AIDS organizations currently broadcast is overly simplistic.
Nearly 25 years into the AIDS crisis, gay men are well aware that condoms prevent HIV transmission. More specific, explicit information is needed.
For example, oral sex is widely considered to be low-risk behavior. But men on crystal often have mouth sores from grinding their teeth, and oral transmission of HIV is more likely for them. That's a level of information not provided in the generalized prevention campaigns in New York.
Also, the men at risk are not hanging out at the gay and lesbian community center. They're at the sex clubs - and New York has busily been shutting down these businesses that represent excellent educational forums.
In Los Angeles, outreach programs use a stringent ethics policy: Outreach workers are strictly prohibited from sexual behavior in venues where they've worked (or might work in the future) because blurring the line between participant and educator can lead to disaster. Also, the same workers staff the same club week after week, so that patrons can develop a level of trust and be encouraged to discuss difficult issues. Finally, HIV prevention workers are cross-trained in drug counseling (a rarity in outreach programs) so that they can provide a message truly targeted to their clients.
These programs exist and could be quickly implemented in New York. If they were, New York would be able to deal not only with the risk crystal represents to gay men but also to plan for the near future. In California, crystal use is spreading far beyond the stereotype of gay party boys; the drug is taking hold among lawyers, construction workers, media executives and factory workers of all genders and sexual preferences.
That is a future New York does not want.
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