Last month the medical journal The Lancet published a news feature, describing an increasing number of London gay men who take methamphetamine (crystal meth), including a significant number who inject it, often at 'chill-outs' and sex parties. There are concerns that use of the drug is associated with unprotected sex, multiple partners and needle sharing, leading to transmission of HIV, hepatitis C and other sexually transmitted infections.
Concern about the drug is hardly new – it has been an issue in US gay communities since the 1990s. There have been anecdotal reports of use by UK gay men in recent years, with the issue being thoroughly examined by HIV treatment update three years ago.
And, more recently, some have linked alcohol and drug use to the unchanged rate of new HIV infections in UK gay men over the past decade, although there are no data that could support or refute such a claim.
But is there new evidence of increasing use of crystal meth by gay men in the UK? In order to inform the debate about the role that substance use work should play in HIV prevention, we clarify what we know and don’t know.
Use of specialist services
The data which suggest a recent upsurge in the use of crystal meth are based on the use of specialist clinics and services.
This kind of data must always be treated with caution – for example, a clinic might see more patients with a particular problem not because more people have the problem in the ‘real world’, but because of improved awareness of the clinic’s skills in dealing with that problem, either amongst health professionals or potential patients. Moreover, there are only a handful of specialist services for gay drug users in the country, seeing a limited number of individuals.
Nonetheless the data from Antidote are striking. This is a drug and alcohol project which works with lesbian, gay, bisexual and transgender (LGBT) people in London.
In 2006, just 5 of its 249 service users (2%) presented with methamphetamine use as their main problem. In 2010, 187 of 553 service users (34%) had meth as their main problem, with a further 78 people (14%) reporting its use in addition to another substance they had difficulties with.
Monty Moncrieff of Antidote told aidsmap.com that, although precise figures for 2011 and 2012 are not available, a similar trend has been seen in these years, with a large number of presentations from methamphetamine users, including some who inject.
Antidote has also an increasing number of men using GBL (gamma-Butyrolactone) and mephedrone. The immediate problems men present with may be psychosis associated with crystal meth or dependence on GBL, but self-esteem, intimacy, sexual identity and internalised homophobia are often underlying issues.
Antidote staff also work in two specialist London clinics, CODE and the Club Drug Clinic. Both will be publishing detailed service use data in the coming months. However, The Lancet reported that at the CODE clinic, the proportion of methamphetamine and mephedrone users who inject rose from 30% in 2011 to 70% in 2012.
National Treatment Agency data also show an increase but suggest that the overall scale of the problem is limited. These figures relate to people of all sexualities attending drug treatment services across England. In 2005, 32 people said they took methamphetamine; this went up to 131 in 2010 and 190 people in 2011.
More people reported using ecstasy (1983 people), mephedrone (1209), ketamine (1261), or GBL/GHB (285). And these figures are overshadowed by over 165,000 people who are treated for problems with opiates or crack cocaine.
NTA data show that 24% of methamphetamine users reported injecting the drug. Meth users are older than other club drug users – 42% in their thirties and 28% in their forties or older. Three-quarters of all people treated for club drugs are men.
Surveys of gay men
The service use data needs to be placed in the context of much larger surveys of diverse groups of gay and bisexual men.
The most recent cross-sectional survey of LGBT people, which asked specifically about the drug, found very low rates of crystal meth use. Of 4206 people recruited, mostly at Pride events between 2009 and 2011, only 34 (0.08%) reported using the drug.
The 2007 Gay Men’s Sex Survey found that 4.7% of the 6155 respondents had used methamphetamine in the past year, but this was higher at 7.8% in London. Moreover, 19.5% of HIV-positive Londoners reported using the drug.
There were clear associations with HIV status and risky sex. After statistical adjustment, men with diagnosed HIV were more likely to use meth (odds ratio 2.69), as were men who reported unprotected anal intercourse with a partner of a different HIV status (OR 1.39). Men with five or more sexual partners in the past year were more likely to use the drug (OR 2.66), as were men with 13 or more partners (OR 4.44).
Usage was higher in 2007 than in 2005, the only other year in which the survey has asked specifically about this drug.
In 2002 to 2005, a series of London surveys showed that percentage of gay men who had used crystal meth in the previous year varied according to where they were recruited – 12.6% at an HIV treatment clinic, 8.3% at sexual health clinics, and 19.5% at gyms.
Drug use in general
Last September, there were press reports that drug use is seven times higher amongst LGBT people, but the statistics used to make this comparison were problematic.
A more reliable comparison comes from a household survey which asked about sexuality, the British Crime Survey. Pooling data from 2007 to 2009, this shows that 13.3% of heterosexual men reported drug use in the previous year, compared to 38.2% of gay or bisexual men. The comparable figures for stimulant drug use are 5.9 and 29.0%.
Analysis of Gay Men’s Sex Survey data shows that drug use is particularly common amongst men in their 20s and 30s, London residents, those with more sexual partners and men with diagnosed HIV. Poly-drug use and relatively frequent use are common. A substantial minority of gay men who use illicit drugs are worried about their use.
In these respects, users of crystal meth are quite similar to gay male users of other drugs, although slightly older and more likely to report problems with their drug use.