Jay Dagenhart pulls no punches when discussing how he contracted HIV. 'It was crystal,' the 38-year-old says of his five years of abusing methamphetamine, a highly addictive stimulant popular for its high-energy rush and enhancement of sexual activity.
'I went to bathhouses. I barebacked. I sold my body in my addiction. The reason I am HIV-positive today is because of what I did while high on crystal,' laments Dagenhart, who became a national face of the meth epidemic after discussing his experiences on The Oprah Winfrey Show in November 2005 and again in March of this year. But long before then, Dagenhart says, it bothered him that the facts behind how meth use was fueling HIV infections were treated as a dirty little secret that no one ever addressed. 'We weren't talking about it like we are now,' he says. 'We weren't talking about how people were seroconverting on this--like I did. We weren't talking about how people's lives were being taken over by this--like mine was. After I stopped using and got my life back on track, I felt like I needed to start some of those conversations.'
Turning the Tables
Getting harm-reduction messages back into the heads of drug users and warning nonusers of meth's dangers became Dagenhart's mission in life'and are the goals of crystal meth task forces that are forming in several U.S. cities. In November 2004, Dagenhart and Mike DiPilla founded the Philadelphia Crystal Meth Task Force, and Dagenhart served as its president until this past spring. Similar task forces have formed in major U.S. cities--including Atlanta; Chicago; New York City; Palm Springs, Calif.; Philadelphia; and Washington, D.C.--to help fight the rising use of the drug, particularly among gay and bisexual men.
A key component of these groups' early efforts is addressing the links between meth use and HIV, including the adverse health effects the stimulant can have on HIVers, says Dan Carlson, cofounder of New York City's Crystal Meth Working Group. 'The more people binge,' he warns, 'the more they don't take care of themselves. They don't eat. They don't sleep. They don't do any of the things they need to do to stay healthy.'
That includes failing to adhere to antiretroviral drug regimens, experts caution. HIVers must maintain nearly perfect drug adherence for their meds to remain effective. Missing even a few doses--which is easy to do during a meth-fueled weekend of sex and partying, Carlson says--can lead to treatment failure and the development of a drug-resistant infection.
HIVers also may engage in unprotected sex--often with multiple partners they've met online or at bathhouses and sex clubs--while high on the drug, Dagenhart says, exposing others to the virus and putting themselves at risk for infection with multiple strains of HIV. If they've developed drug-resistant infections, they can pass those along to others as well.
How Bad Is It?
Studies have shown that meth use is becoming more commonplace--particularly among urban gay and bisexual men. In Chicago, 11% of gay men who were surveyed reported meth use within the prior year; one quarter of those who were surveyed in New York City used the drug during the prior six months. An informal survey of gay and bisexual men in Philadelphia that was conducted by the Philadelphia Crystal Meth Task Force revealed that about 20% of the men currently use meth, 40% had used it in the past, and 70% have friends who use the drug.
More alarming still, some studies have provided data indicating that gay men who use meth are significantly more likely to engage in risky sexual behavior--and are as much as three times more likely to be HIV-positive than nonusers. 'Barebacking [having sex without a condom] was my agenda' while high on meth, Dagenhart says of why HIV rates are soaring among drug users. 'It's more erotic, more of an adrenaline rush. Meth pushes the idea of safer sex right out of your brain.'
But despite these obvious risks, safer-sex messages either fail to resonate with meth users or are quickly forgotten during drug-fueled sexual encounters, says Dagenhart. 'Take me, for example,' he notes. 'I had all the information. I knew all of the reasons why I should be having safer sex. But while you're doing the drug, you just don't care.' DiPilla, who says he also contracted HIV through unprotected sex while using crystal meth, agrees: 'When I was high, you could talk about safer sex to my face and I would blow you off.'
Working on the Problem
Instead of just handing out condoms and urging people to practice safer sex, Dagenhart and other activists also are focusing on the root causes of meth abuse. For HIVers, they say, meth-induced feelings of well-being and acceptance can provide a temporary escape from the difficult realities of living with the disease. In addition to its libido-increasing effects, meth also can counter feelings of isolation, depression, shame, and low self-esteem that gay men may experience because of their sexual orientation. Crafting healthy solutions to these psychosocial problems could help allay the negative feelings that lead many men and HIVers to turn to the drug in the first place or to keep going back for more, community leaders say.
'We also have to come up with new models to teach gay men how to get involved with their communities and create new ways for them to be loving, healthy, responsible men, as opposed to the catty, vicious, self-hating people we too often see,' Dagenhart urges. 'And too many young gay men are still being mentored in gay communities on their knees or backs. This has to stop. There have to be better ways to 'be gay' than just drugs and sex.'