Gay Men, Sex(uality) and Crystal Meth Use

Drugs are people substitutes, people are drug substitutes¹

As a counsellor I prefer the term “drug use” rather than “addiction.” For many, addiction implies “bad behaviour” and can foster stigma and disempowerment for drug using individuals. One of the main characteristics of counselling is acceptance without judgment, especially when talking about sex with drugs. People use drugs for a reason, often to meet unfulfilled needs. Crystal meth was the most used illicit drug in the gay community during the 90s and early 2000s. While I am not an addictions specialist, about half of the gay men I see for therapy have current or past history of crystal meth problems. A common reason for gay men to use crystal meth relates to social and sexual inhibition and lack of connection to people.

Aspects of gay male subculture are dominated by sex. Within any medium size community, gay men can find sex within 10 minutes via phone apps. While such “hook-ups” frequently result in sexual release, they often do not meet their emotional needs. Many gay men struggle and cope with feelings of being different, or may have experienced various forms of abuse, and therefore question if they are lovable. Crystal may temporarily help users feel free of judgment, facilitate emotional connection with others and provide great pleasure with sexual partners.Crystal can also partially fulfill one’s sexual needs or fantasies, (i.e. engaging in “pig sex”), that otherwise might never be explored due to internal and/or external inhibitions. With reflection and support, these men often identify their desire for connectedness as the most important aspect of being high. Many report that without crystal, sex is boring because they are inhibited and cannot emotionally connect.

Crystal meth is not the problem but the symptom: the symptom of being unable to be free and spontaneous and therefore cannot connect with others. Thus, the primary goal of therapy is not to stop crystal use, but rather to assist the person in acquiring the skills needed to have uninhibited, drug-free and meaningful sex while feeling more connected with partners. This approach may require the therapist to be sexually open and sensitive to these topics in order to assist gay men to more intimately explore their sexual feelings and needs. As counsellors we need to lay the foundations of a nurturing therapeutic relationship that refrains from labels and judgments that disempower a person.  It seems with gay men and crystal use that, truly “drugs are people substitutes,” and with support, ideally “people can become drug substitutes.”

BillColeman

Author: Bill Coleman, counsellor

Biography: Most of Bill’s career has been working with criminals, primarily sexual criminals. He also works in the area of sexual health. Much of his work here has been with gay men at BC Centre for Disease Control, and many years in private practice.  He has also written for the LGBT newspaper, Xtra, on gay men and health. www.bcoleman.ca

¹  (Blachly, 1970) Seduction: A Conceptual Model in the Drug Dependencies and Other Contagious Ills, Paul H. Blachly, M.D., 1970, Charles C. Thomas, Springfield, Illinois.

**Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC

Rehabilitating Our Approach to Gay Men Who Use Drugs

Much of the writing on HIV prevention is loaded with punitive clichés about gay men that highlight psychological deficits, lack of self control, and prevention fatigue. Perhaps the most repeated one since the onset of the epidemic suggests that the majority of gay men are into drugs and couldn’t care less about becoming infected while enjoying their substances.

While these clichés have persisted throughout the epidemic, a closer look at statistics shows a more nuanced portrait of gay men. The Sex Now survey (Canada’s largest survey of gay and bisexual men) showed that the vast majority of gay men report no risk for HIV in the previous year (70 percent) nor did most report any use of party drugs over the same time period (85 percent), not even once.

One issue of concern emerging from the Sex Now survey, however, is that gay men who do use drugs are nearly twice as likely to report HIV risk. Other researchers have also demonstrated this relationship. But concluding that “drugs = uncontrolled gay men = risky sex ”, and that health professionals should focus their efforts on eradicating drug use among gay men to prevent HIV, ignores the complexity of gay men’s lives and the reasons they engage in both risky sex and substance use. For example, a recent UK study looking into the narratives of gay men who use drugs suggests that only a small minority were unable to control their behaviour when doing drugs. For others, risky sex was a decision made independently of drug use, while others enjoyed their sex lives and substances without any HIV risk.

Moreover, the explanation for higher sexual risk among drug using gay men may not actually reside in drug use itself. In Sex Now, gay men who reported drug use were also likely to report an array of other psychosocial difficulties such as depression, anxiety, suicidality, experiences of violence and homophobia and episodes of binge drinking. All these factors are known in the HIV literature to increase one’s vulnerability to HIV.

Finally, it is important to consider how public health and community agencies have generally responded to the prevention needs of drug using gay men. A recent review of prevention activities in BC demonstrated that the gay drug-using population is largely ignored by prevention. Initiatives that have been implemented have tended to focus on warning gay men against the danger of mixing drugs and sex, while doing very little to empower more informed decisions. Again, this strategy does not attend to gay men’s needs – most men are familiar with the danger of drugs with sex. Fear-based campaigns ignore the co-occurring factors and health problems gay men may be experiencing in conjunction with drug use. A strategy that focuses on educating solely on the risks of drugs reinforces the cliché that gay men cannot make rational decisions.

Rather than blaming gay men, we need a more positive approach to sex and drug research that examines gay men’s experiences with substances beyond a statistical correlation with risky sex. This research needs to take into account the burden of other health issues in this sub-population. We should demand targeted health promotion initiatives that reflect gay men’s real needs and work to reduce the bias of the public health field which appears to have issues with both gay sex and substance use.

olivier ferlatte

Author: Olivier Ferlatte, Research Education Director at the Community-Based Research Centre for Gay Men’s Health, Vancouver.

**Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC