Rafael M. Díaz, Ph.D. Andrea L. Heckert, M.P.H.

1. Welcome to the Acción Mutua web-seminarFabulous Effects, Disastrous Consequences: Methamphetamine use among Latino gay men in San Francisco

2. Acción Mutua is a capacity building assistance (CBA) program of AIDS Project Los Angeles in collaboration with the César E. Chávez Institute of San Francisco State University • Funded by the Centers for Disease Control and Prevention

3. Fabulous Effects, Disastrous ConsequencesMethamphetamine use among Latino gay men in San Francisco Rafael M. Díaz, Ph.D. Andrea L. Heckert, M.P.H. César E. Chávez Institute ~ San Francisco State University Funded by NIDA Grant 5 R01 DA12566 We thank Jason Chang, Jorge Sánchez, Héctor Carrillo, Andrea Williams, Edward Bein and the Henne Group for their contributions to the design, implementation and analysis of the study.

4. Four Important Points • In the Latino gay community, sexual risk, and crystal meth use are deeply intertwined • The experienced effects of crystal meth are perceived as fabulous • The consequences/life impact are disastrous 4. However, opportunities for intervention are multiple

5. Presentation Outline • Details of study • Reasons for stimulant use • Crystal meth vs. cocaine • Sexual Effects • Fabulous and not so fabulous • Negative life impact • HIV risk • Opportunities for intervention

6. Sample Characteristics N = 300 (male, non-heterosexual, Latino, stimulant user in last 6 months) • 30 years Median age • 70% Some college or more • 38% Unemployed • 50% Immigrant (including Puerto Rico) • 21% Mostly Spanish-speaking with friends • 23% HIV-positive (self-report)

7. Self-reported substance use in the past six months among all screened by venue type(screener data)

8. Demographic characteristicsof crystal meth and cocaine users Most frequently used stimulant (MFS)

9. Reasons for most frequently used stimulant

10. Reasons for most frequently used stimulant “Cocaine is more for relaxing, for party, dancing. But crystal is for sex -- to get nasty for hours and hours and hours….”

11. Reasons for stimulant useENERGY “You feel, like, invincible. I mean, you are like, you have so much energy, you can do anything you want, you know? Like, if you wanna do this around the house, or garden, or painting, or whatever, you get high — I can paint a whole living room, you know, which I have. [Laughs] Or you can have a hard-on that goes for six hours…” “It gives me the energy, it gives me the stamina to finish all these projects, it also gives me a feeling of being able to stay up with my friends and partying.” “We each did a line of crystal because I was feeling sleepy. I was yawning. It wasn’t that I didn’t want to go out, I think I was physically just exhausted from the week. It was just long, and so that kind of gave me a boost of energy. “I started doing it because I was working hard and when the weekend came around I was too tired. So, I thought, I need something that will keep me awake and kind of alive to, to , to enjoy the evening. And that was initially my motivation to do it…” “When you have AIDS, you feel like you’re slowing down and you’re losing all your senses, ok? And speed brings them all back and it makes me feel like I’m 16, 17… When you’re 16 or 17 years old you feel like you are invincible.

12. Reasons for stimulant useSexual Enhancement “I felt like it rushed to my brain, I felt my skin get hot and I felt the desire to have sex with whoever was around…” “Sex is better, much better... I go for like nine hours. It’s more passionate.” “Theintensity, it makes me feel incredibly well. Yes, the focusing on the sex , the focusing means unity in all that time when you are having sex..when I’m having sex under those circumstances there’s nothing else to think about…”

13. Reasons for stimulant useSocial Connection “I just start, like, expressing myself a little bit more, you know, or like just, I get more talkative, you know, it makes you chit-chatty. So I start just chit-chatting and running around and just, you know, it makes me, gives me a little bit more like a little pep in my step to, like, do what I want to do.” “I guess I’m shy, so I use drugs to kind of remove that, so I can meet people…” “It brings in companionship - with crystal I’m able to get, you know, I fit into this circle of gay men.” “I can feel more part of a group … because, you know, we’re all together. We’re all on it. So you can relate better sometimes.”

14. Reasons for stimulant useCoping with stress [Speed], like, makes me worry less about things. I stop thinking about my family, about my debts in Mexico, about the 15 of us who live together, about work, about the pressure…” “I started recreational use [crystal] at that point, 21, 22. I did that for a while and used it then for similar reasons, escaping the realities of graduating college and can't find a job kind of a thing.” “There’s no loneliness. There’s no other worries. There’s just that focusing in that particular moment.”

15. Sexual Effects • Prolonged Sexual Arousal • Sexual Disinhibition • Sexual Dissatisfaction • Negative Side Effects • Physical • Social • Isolating Sexual Contexts

16. Sexual Effects Prolonged Arousal “I wanted to do it again. I remembered what it was to have sex with that person for 4 or 5 hours and I wanted to do it again… I wanted to be having that kind of sex, that prolonged sex all night long or all afternoon long..” Disinhibition “I become even more hardcore. Sexual risks and inhibitions are totally gone. I become empowered in feeling, like, I can take on the world or anyone that fucks with me. It can be an euphoric rush. You can feel it in your ass, in your balls, where it heats them up all of a sudden. It did help me explore my ass at one point when I refused to even think I had an ass.” Dissatisfaction “On crystal meth you don’t satisfy, you know, it’s just like that need, you know, that urge for sex that you never satisfy.” “I am running around looking for ass, or I’m not running around, just looking at ass. And I start like getting all like built up like , you know, sexual energy, but really like sexual, like tension…”

17. Sexual Effects Negative physical effects “I couldn’t get nobody, and I couldn’t get an erection any more, I was so sore that, I kept playing with myself at home, and I rubbed it so sore, it became raw, that’s how bad it was. It didn’t feel good afterward.” Negative social effects “I get horny, you know, and I just want to bust a nut. I don’t want no fucking hi’s no bye’s, no conversation. I want to go in there, I want to bust a nut. I’m going to leave you know. I don’t want no relationship, I don’t want no fucking friendly conversation. I don’t want breakfast, I don’t want dinner. I don’t want nothing, you know. All I want to do is give my cock a wash after I’m done.”

18. Isolating Sexual ContextsSocial Isolation/Paranoia “I think I’m becoming paranoid. I’m finding that I’m even less trusting of people. It has to do with the people that I’m associating with now, that come with it. There’s a lot of people out there, a lot of guys that are on that phone line looking for crystal. They’re looking for drugs and they’re basically what we call crack whores. They are out there and they are attractive and they’re willing to have sex and they’ll meet your sexual needs but they’ll show up with no money and no drugs. I think that it also brings in... it’s just bringing in drug addicts, people that I don’t know, strangers off the street. And I’m finding that I’m changing my locks on my doors, I’m hiding things when I have strangers over, I’m becoming paranoid and it’s with good reason because a lot of these guys don’t give a damn about me or my property.”

19. In SummaryThe functional role of crystal meth in the lives of Latino gay men • Meeting sexual expectations and norms in the gay community • Homophobia, sexual discomfort and disinhibition • Focused, in the present moment, sex • Masculinity scripts / sexual objectification • Anti-exhaustion, anti-depressant • However, the promise of power, youthfulness, and social connection is short-lived and false.

20. Perceived negative impact of most frequently used stimulant(Any negative)

21. Impact of Frequency of Use # of negative items with ≥ 50% Frequency of use

22. Frequency of stimulant use in the sample

23. HIV Risk “When I do speed or recreational drugs, it leads me to not use condoms. It gives you a false sense of what your are doing, like, you know, say you do it with somebody and you’re in a close environment, it makes you relax with that person. It lets all your fears go away and so you don’t use condoms and maybe the sex, the sex is a little rougher and a little more dangerous…” “When I do crystal, because of the higher sex drive that it arouses within me, I’m more apt to have unsafe sex when I’m on that particular drug. The few times I have slipped up has been primarily because of that drug.”

24. Sexual risk in the last 6 months by most frequently used stimulant

25. Sexual risk in the last 6 months by frequency of stimulant use

26. Perceived HIV Risk & Actual Reported Risk Behavior

27. High HIV risk among intermittent users(“recreational users”)

28. Opportunities for Intervention • Social Marketing Message: “Is it worth it?” • Social Network Intra-ventions (helping friends help) • 3. Culturally sensitive substance abuse treatment

29. iGracias ~ Thank You! Questions & Answers

30. Thanks for your participation • For more information or to learn how to receive CBA services, contact us at: • 213.201.1345 • www.accionmutua.org

31. Social Isolation / Loss “I enjoyed doing them but at same time I was in another world... living in a world where at times you lose all shame, you lose friends, family, you lose... everything. Sometimes I wouldn't even make a phone call, all I cared about was getting high and that was it.”

33. Promoting Intra-ventions Working with concerned partners and friends • Functional knowledge • Decrease stigmatizing attitudes • Increase motivation to help • Skills in “difficult conversations” • Opportunities to practice skills • On-going support • Referral skills • Commitment to reduce negative impact of crystal