The gay community in the United States was recently put on alert when health officials announced that a gay man in New York City had contracted a new, drug-resistant strain of HIV. Activists have been warning for years that the virus that causes AIDS could mutate into a so-called virulent form.
Experts now say the New York case may be similar to a couple of infections in Canada that have responded well to drug therapy. But the fact remains that gay men across America are still being infected with HIV at an alarming rate. And health officials are disturbed that many of the behavioral changes that helped to curb the epidemic in the 1990s are being reversed - because of drug abuse, youth and complacency.
Urban gay men who use illegal drugs have been increasingly turning to methamphetamine, which is known as crystal meth. "I had so much more energy," recalls Jeff, 37, a gay man who lives in New York and who tried the popular club drug a few years ago when he was into the city's club scene. "I didn't feel tired 12 hours later. I didn't feel tired 24 hours later. 36 hours later, I was still ready to go and have fun."
Public health officials say methamphetamine abuse has been on the rise in the United States for the past few years, and that homosexual and heterosexual communities have both been affected. Among gay men, however, the drug has been linked to compulsive and reckless sexual behavior. The activity could include dozens of sexual encounters in a single night that do not involve the use of condoms and which unavoidably contribute to the spread of HIV.
"Men are having compulsive sex in ways that they weren't before," says Dawn Harbatkin, medical director of the Callen-Lorde Community Health Center, which serves New York City's gay and lesbian community. "We'll see men who have had a hundred partners in a weekend, who are bleeding from sex, who continue to have sex, and it's completely related to their crystal use."
Dr. Harbatikin says the availability of prescription drugs for erectile dysfunction has also encouraged the use of crystal meth. "Where crystal used to make it so that men couldn't have an erection, [making] it more difficult for them to have sex," she says, "Viagra's really taken care of that problem."
According to the U.S. government's Centers for Disease Control and Prevention, the number of new HIV infections among gay men in the United States is no longer declining. In some cities, the number has actually gone up. While the infection rate today is not nearly as bad as it was in the 1980s, experts admit that some members of the gay community have become complacent about the safe-sex practices that were so instrumental in bringing the HIV infection rate down in the 1990s.
Most agree that crystal meth is the primary reason gay men have become reckless. But they caution that drug abuse is not the only explanation for this behavior. Terje Anderson, executive director of the National Association of People With AIDS, points to a sense of youthful invincibility among gay men in their 20s who cannot remember the early years of the AIDS crisis. They can't recall a time when no medication existed to help people with H-I-V.
Mr. Anderson also says some men have simply gotten tired of always having to think about wearing a condom. "Think about a diet, quitting smoking, think about anything that people try to do to keep themselves healthier," he says. "Understand how hard it is for people to maintain a lifetime commitment to that. And it's very difficult to do it with something that is as personal and as visceral as sex, as love, as relationships."
In the wake of the announcement about the drug-resistant strain of HIV in New York, some people working to curb the AIDS epidemic started suggesting that radical measures may be necessary - for example, visiting bath houses where sex parties often take place and confronting gay men who are using crystal meth and having unprotected sex.
Perry Halkitis, a psychologist at New York University who has studied the connection between drug abuse and reckless sexual behavior, says that approach is too simplistic. "Unsafe sex and drug use just don't happen in a vacuum," he notes. "There are factors in a person's life that lead them to these behaviors, such as depression and loneliness and low levels of self esteem that contribute to why men take risks."
According to a study conducted by the University of San Francisco, depression is 17% more prevalent among gay men than it is among American men in general. That same study found that depression is often associated with the experience of growing up gay in a culture that marginalizes, and often scorns, homosexuality.
Perry Halkitis says it is important for health care professionals to understand the connection between depression and the spread of HIV. But he also urges gay men to re-evaluate their role models.
"The gay community needs to take a real close look at itself and recognize that the men who are idealized and revered in the community -- those with the buff bodies who are using meth or who are dancing at clubs all weekend long -- are not the ideal we should be going after," Professor Halkitis says. "There's a responsibility on the part of gay men -- and I include myself in that -- who are not engaged in that lifestyle to stand forward and say 'Hey, look, there's another ideal here: financial stability, great careers, no use of drugs.'"
Along those lines, Perry Halkitis points to the ideal of family. But that, he says, can be a hard ideal to sell when the nation is engaged in a volatile debate over whether committed homosexual relationships should be legally recognized as families.