ABSTRACT

During the past 15 years, particularly within gay communities in the USA, there has been a dramatic and troubling increase in the use of (so-called) ‘club drugs’, including methamphetamine – hereafter crystal meth – a toxic and highly addictive stimulant with well-documented neuropsychological dysfunctions and psychiatric problems related to its use (Colfax and Guzman 2006; Díaz 2007; Fernandez et al. 2007; Rippeth et al. 2004; Wang et al. 2004). A comprehensive review of the literature on drug use among gay/bisexual men, published in 2001, reported prevalence rates of crystal meth use among gay men ranging from 5-25 per cent in different samples as well as increases in emergency room admissions and in the number of gay men seeking psychological and medical help for crystal meth-related problems (Halkitis et al. 2001). The most recent data on Latino gay men in San Francisco, derived from two different random samples (time/location sampling and respondent-driven sampling), show an increase in crystal meth use from 14 per cent in 2001 (Díaz 2006) to 19 per cent in 2004 (Ramirez-Valles et al. 2008). The fact that crystal meth use appears as a powerful predictor of unprotected sexual practices and HIV seroconversion has led experts in the field refer to crystal meth use as the ‘second’ epidemic, and as ‘intertwining’ epidemics when referring to crystal meth use and HIV (Stall and Purcell 2000). However, while a strong correlation between crystal meth use and HIV risk is clearly documented, the reasons that explain such relationship are poorly understood. There is little understanding about how the use of crystal meth changes sexual behaviour, the subjective sexual experience of users or the context of sexual activity in ways that may increase the probability of HIV transmission. In addition, there is little analysis on how cultural norms and expectations (within US gay communities) regarding what constitutes ‘good’ or ‘great’ sex may pressure some gay men to consume stimulants, and in particular crystal meth, with potential detriment to their health and wellbeing. Based on data from a study of drug using Latino gay men in San Francisco, this chapter presents a qualitative descriptive analysis of perceived sexual effects under the influence of crystal meth. The study involved men who self-identified as Latino/ Hispanic or by any Latin American nationality, whose self-identified sexual orientation was other than heterosexual, and who lived in the San Francisco Bay Area at the time of the study. As part of the inclusion criteria, men had to report current use of illicit drugs and the practice of unprotected anal intercourse at least once during the previous six months.