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‘Tina’ Leading Down a High Risk Path for MSM
Feature article, Michigan HIV & STD News, Summer 2005 Issue
Patrick Curry was on the fast track. At a very young age
he was vice president of a company and doing well. But he needed help to keep up
with the pace of his bi-coastal business travel. His drug use got “kicked up a
notch” when he started using crystal methamphetamine, referred to as ‘Tina’
among gay men.
If you’ve been following the national news lately, you’ve
read similar stories. But Patrick Curry doesn’t live in LA or NYC or even
Chicago. He lives in metro Detroit. His meth habit started when he lived on the
east coast several years ago, but he had no problem making connections with
dealers right here in urban and suburban Michigan.
Authorities are well aware there is a serious rural meth
problem in Michigan. Public health, law enforcement and social services
professionals – as well as legislators – packed a conference held in Kalamazoo
in June to learn about the raging meth epidemic in west Michigan.
The rural meth epidemic, which involves individuals creating
their own meth, is primarily heterosexual. It is particularly devastating
because of the many ways it affects an entire community.
The real impact of meth use on STDs and HIV infection in
Michigan has yet to show in data. There are indicators, however, that meth will
have impact on HIV & STD infections here.
A parallel problem is emerging in Michigan – as it has in
urban areas across the country – meth use and addiction by men who have sex with
men (MSM) in urban and suburban areas.
A new Michigan law restricting cold medicine sales that will take effect in
December is not going to faze the dealers in metro areas who supply the gay
‘Tina’ addicts. Their source is not rural Michigan brew-your-own labs. ‘Tina’ is
coming from out-of-state ‘super labs’ and Mexico, according to several sources.
For meth users making a connection is as easy as checking in
on gay.com or AOL chat rooms “late at night when all of the tweakers are awake”
to set up a delivery to your front door, according to Curry. That’s exactly what
he was able to do two years ago when he moved to the Detroit area.
Between 2002 when he first started visiting the Detroit area
and 2003 when he moved, Curry said the use of cystal meth by gay men in metro
Detroit had seriously increased. ‘Tina’ can now be found in Detroit bathhouses
and clubs and it fuels the circuit parties here just as in other urban areas.
Parties that can last for days with no sleep require more than a few cups of
java. Crystal meth will keep you awake for days.
Available at these gatherings it is the quintessential
prescription for high risk behavior: large groups of MSM with meth induced high
energy, increased sexual desire and enjoyment sensation for sex plus loss of
inhibitions, added to the increased sexual stamina from Viagra or its
equivalent. This means “barebacking [unprotected sex] and lots of it with
multiple partners,” said Curry.
Men aware of the risks of HIV and STDs, who previously had
used protection and limited their partners, are throwing caution to the wind
under the influence of ‘Tina.’ Some men have reported embarrassment over
behaviors they engaged in while high on meth used with erectile sustaining drugs
like Viagra. Everyone agrees meth use leads to high risk sexual behavior for MSM.
And there is HIV risk from injecting meth for those who do not have a supply of
clean syringes.
While large urban areas on the coasts and Chicago have
recognized the meth use problem among their MSM population, according to Curry
professional support agencies in northern metro Detroit were clueless when he
sought help. And according to several sources, this gay recreational use has
been growing in the past couple of years in the Grand Rapids area as well as
greater Detroit.
MDCH-DHWDC-HAPIS has been on the alert, seeing what has been
happening in other states. A few months ago as part of the HIV/AIDS Prevention
and Intervention Section’s continued partnership with the MDCH Office of Drug
Control Policy (ODCP), Brenda Stoneburner gave a presentation on methamphetamine
at the Michigan HIV/AIDS Council (MHAC) meeting. And “MHAC members were
encouraged to get involved in meth efforts in their own communities,” said HAPIS
Manager and MHAC Chair Debra Szwejda.
HAPIS has also been looking into gathering data on meth use
here. “We have made changes in our data reporting system for prevention
providers to better track methamphetamine use among those who are accessing our
system, and we will be sharing this data with ODCP in order to assist them with
tracking,” said Szwejda.
Between the Lines (BTL) reported on the HIV – meth connection
in February. That article referred to a 2004 survey the Midwest AIDS Prevention
Project (MAPP) participated in, which indicated a rise in meth use by MSM since
its previous survey in 1997. MAPP CEO Craig Covey recently pointed out use has
probably increased since that survey.
“MAPP is actively seeking funds from various sources to
create initial programming in the metro Detroit area,” said Covey, “targeting
MSM for meth education and prevention.” A social marketing campaign is one part
of what MAPP is planning.
HAPIS requested that MAPP get involved with the Statewide
Methamphetamine Task Force. “This helps assure the link between HIV and other
STDS, primarily among gay men, has a voice at the table and is being addressed
in the context of and in partnership with these larger efforts,” said Szwejda.
However, the statewide Meth Task Force at present is focused
primarily on the rural problem. MAPP has been a lonely voice at the recent
meetings for this growing MSM epidemic. At the Kalamazoo conference very little
was said about gay men, and nothing in reference to MSM meth use in Michigan.
The UCLA Integrated Substance Abuse Programs Associate
Director, Richard Rawson, Ph.D gave an excellent presentation in Kalamazoo about
the signs, symptoms and effects on the body of methamphetamine. He also talked
about treatment that has been successful at his clinic – which has been seeing
meth addicts for about eight years.
There are special issues for treatment of methamphetamine
addicts. With mental states ranging from paranoid to psychotic, their behavior
can put others at risk. Their brains have been physically altered by the drug
and full recovery takes 6 months to two years, Rawson said. He said treatment
needs to be behavior based, not cognitive based, since memory, cognition and
reasoning are seriously impaired by meth. Rawson also emphasized the importance
of positive reinforcement for treatment. The most important thing in the
beginning of treatment is to keep them coming back.
The Lancet (4.2.05) reported on a study at Rawson’s UCLA
clinic. One of the researchers, Steve Shoptaw said that the treatment program
specifically for gay men targeting drug use is also showing improvement at
reducing sexual behavior. “It’s important, because by the time gay men show up
at the clinic door, three out of five are HIV positive,” he said.
Rawson’s real take home message to the audience in Kalamazoo
was, by the time you see treatment admissions for meth addiction, you’ve already
had a methamphetamine problem for seven years.
Curry said he was not able to find a treatment program in
Michigan that could deal with his meth addiction, so this spring he went out of
state, where he graduated from a 28-day program in 16 days and was sent home
with a 20-day relapse prevention plan.
The BTL article referred to Dawn Farm in Ypsilanti as being a
“gay-friendly” treatment center. They are indeed treating gay and lesbian
clients and are also prepared to treat meth addiction. Several of the Dawn Farm
staff attended the Kalamazoo conference.
Curry and his friend Jason Sommers arrived at the MAPP office
in Ferndale early this summer seeking assistance in setting up a support group
for ‘Tina’ addicts. Sommers and his partner had decided to quit meth at the same
time Curry was entering treatment. Sommers, having lost his job due to his
addiction, was without the means to get into a treatment program. So, he and his
partner went ‘cold turkey’ and were guided by Curry and the resources he brought
back from his treatment at the Pride Institute.
“We are very interested in helping facilitate programs and
support groups for persons seeking recovery from meth adiction or use,” said
Covey. MAPP working collaboratively Affirmations in Ferndale to develop a
12-step program specifically for meth addiction.
Curry and Sommers shared the materials for the Methamphetamines Anonymous
support group they want to start to help individuals stay on their path of
recovery. At the conference in Kalamazoo Rawson talked about the importance of
support groups, especially for recovering meth addicts due to the long time for
the brain to recovery completely from the drug’s damage*.
Prevention for this drug, which is more addictive than any
other recreational drug according to Rawson, is obviously preferable to
treatment. And Rawson thinks Michigan has a real opportunity now to prevent the
epidemic proportions of meth seen other states. Curry sees a real need for a new
meth prevention campaign targeting gay men in Michigan’s urban areas. Given the
risks, meth prevention for MSM is HIV prevention.
Metro area professionals need education said Curry. This
includes mental health and social work as well as medical professionals. Both he
and Sommers said that having to educate their own counselors, just talking about
meth brought on ‘flash backs’ and the desire to use again for them. Someone else
needs to provide this meth 101 they said.
There are also issues for professionals serving meth addicts,
where education is needed. Counselors and hospital emergency room staff
may see ‘tweakers,’ meth users in the tweaking stage, which follows the meth
high. These individuals present behaviors that can be violent and also can be
mistaken for psychiatric disorders and misdiagnosed.
So a conference, like the one held in Kalamazoo, oriented to
the professionals who may work with urban MSM is still needed for Michigan. This
conference should include HIV case managers said Curry. ‘Tina’ is not just a
problem for prevention; it is also a problem for care.
Depression resulting from HIV infection leads some PLWH/As to meth use. MAPP’s
Mark Peterson has noted meth use among clients he has seen statewide through the
POP (Prevention Options for Positives) program.
Meth addiction can lead to serious antiretroviral adherence
problems. People high on meth forget to take their meds.
In addition to the altered brain chemistry, there are many
physical effects of addiction. One is ‘meth mouth,’ serious tooth decay, a
result of the loss of saliva in the mouth and acids over time wearing away at
both teeth and gums. Government funded dental programs will see increased
expenses because of this problem.
The methamphetamine problem is a Michigan HIV/STD problem. To
become involved, contact the Michigan Statewide Methamphetamine Task Force
Chair, Nancy Becker Bennett
(beckern@michigan.gov ) to find out what’s going on in your area.
For more information on the problem, see Resources below. See
the Calendar (pg11) for a new support group for MSM in meth recovery.
Look for a report on the 1st National Conference on
Methamphetamine, HIV and Hepatitis, held in August in Salt Lake City, on the
Michigan HIV News website:
www.mihivnews.com/in_the_news.htm.
Methamphetamine Resources
PowerPoint presentations from the First National Conference on
Methamphetamine, HIV and Hepatitis
http://www.harmredux.org/conferencemedia.html
Report from IAS Conference: Use of crystal methamphetamine boosts risk of
transmitting drug-resistant HIV
http://www.aidsmap.com/en/news/7967A7D8-8DB3-43A0-8AF1-4D9BC26640CB.asp
The Meth Epidemic - Inside America’s New Drug Crisis
Newsweek, August 8, 2005
http://biz.yahoo.com/prnews/050731/nysu010.html?.v=20
America’s Most Dangerous Drug
http://www.msnbc.msn.com/id/8770112/site/newsweek/
Street Drugs, Methamphetamine, State of Michigan Initiatives
Brenda Stoneburner’s PowerPoint presentation to MHAC, November 10, 2004
http://www.mihivnews.com/mhac/MHAC_B_Stoneburner.pdf
Methamphetamine Abuse, HIV Infection Cause Changes in Brain Structure
http://www.nih.gov/news/pr/aug2005/nida-11.htm
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