Understanding Crystal Meth and the Links to HIV: Essen9als DAVID FAWCETT PHD, LCSW AUSTIN, TEXAS AUGUST 2016 Objec9ves § Iden%fy epidemiological trends of meth use and the impact on HIV/AIDS both in Texas and the US. § Understand the unique physiological and psychological impact of meth and the resul%ng high-risk sex and prolonged period of recovery. § Apply this understanding to outreach/ case management with co-occurring s%mulant abuse and HIV/AIDS. Sex - Drug Connec9on  Combines synthe%c amphetamines with high-risk sex ◦ Party and Play (PNP) ◦ Chemsex ◦ Methsex ◦ Facilitated by social media Sex-Drug Connec9on  Most common: • Methamphetamine • Cocaine or Crack Cocaine • Ketamine • Ecstasy • GHB • Amyl nitrate Sex – Drug Connec9on • Longer periods of con%nuous sexual intercourse • Careless in choice of partner • Not using condoms • Increased sexual desire   “it pushed my personal boundaries and changed preferences of the type of sex (rough, more adventurous, etc.)”  “I was a sex maniac on the drug…” The Problem • Methamphetamine use is up na%onally •  2010 -> 2013: 353,000 -> 595,000 current users •  h\ps://www.drugabuse.gov/publica%ons/drugfacts/na%onwide-trends • Methamphetamine use is increasing among young adults (aged 18 to 26), par%cularly among MSM • Methamphetamines: six %mes more likely among MSM (15 % of gay/bisexual/ 2% heterosexual). •  IAS 2016. CDC. Laura Kann PhD, Emily O’Malley Olsen MSPH, Tim McManus MS, and Stephanie Zaza MD The Problem – Local Jurisdic9ons § The propor%on of methamphetamine items seized and analyzed by NFLIS laboratories in Texas increased from 19% of all drugs in 2012 to 24% in 2013. § Methamphetamine is now the second most frequently iden%fied drug reported among analyzed items in Texas, exceeded only by marijuana/cannabis. §  h\ps://www.drugabuse.gov/sites/default/files/texas2014a.pdf § In New York City meth overdoses increased 160% from 2013 to 2014. § NYC Health Department The Problem – United States § NY meth use doubled in 3 years, also up in both LA and SF §  2014 CDC Na%onal HIV Behavior Surveillance § “1 in 4 gay men in LA consistently use meth.” §  Cathy Reback PhD (UCLA and Friends Ins%tute) § Ten years ago meth was a phenomenon of affluent, gay, urban, white men – no longer. §  2016 - Gay Men of African Descent (Brooklyn counseling center) §  20% - 40% of clients use meth §  6 of 10 African-American MSM predicted to be HIV-posi%ve by the age of 40. The Problem – Trans Community • 20% of Transwomen use meth • Santos GM, et.al. (2014) Alcohol and substance use among transgender women in San Francisco: prevalence and associa%on with human immunodeficiency virus infec%on. Drug Alcohol Rev. 2014 May;33. (3):287-95. doi: 10.1111/dar. 12116. Epub 2014 Mar 14. • Injec%on drug use was 34% among MTF transgender individuals and18% among FTM transgender individuals. • (1999, 2000) San Francisco study by Dr. Kris%n Clements at the San Francisco Department of Public Health AIDS Office. • Increased HIV risk through injec%on drug use • 8% new infec%ons from IDU The Problem - Interna9onal • An%dote, UK's only LGBT drug and alcohol support service: •  >60% of clients injected drugs in last year. •  Double the number in 2010. •  Nine years ago, fewer than 1 per cent were injec%ng drugs. • University of NSW’s 2015 Sydney Gay Community Periodic Survey •  2,846 men •  10.2% HIV-nega%ve men used meth prior 6 months •  >30% used meth prior 6 months • Philippines, Thailand, Singapore •  Capital crime; vigilante groups