Rafael M. Díaz, Ph.D.

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. César E. Chávez Institute ~ San Francisco State University Funded by NIDA Grant 5 R01 DA12566

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 • Introduction • Study Main Findings • Prevalence of Meth use • Reasons for stimulant use • Negative life impact • Differences between Meth and Cocaine use • Sexual Effects (fabulous and not so fabulous) • HIV risk • Socio-cultural Contexts of Meth Use • Intervention Development

6. Prevalence 2001

7. Prevalence 2005

8. 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)

9. How Common is Drug Use among Latino Gay Men? • Drug use is common among those screened for the study. • Close to half of those screened had used some substance in the past six months. • Drug use is most common among those screened over the phone or internet. • More than eight out of ten of those screened over the phone or internet used some substance in the past 6 months. • Two thirds of those screened over the phone or internet had used Crystal Meth in the past 6 months.

10. Why do Latino Gay Men use Stimulants? • Energy • Sexual enhancement • Social connection • Coping with stress • Focus/productivity

11. 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. Sexual 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.”

13. Social Connection “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.”

14. Coping 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…” “There’s no loneliness. There’s no other worries. There’s just that focusing in that particular moment.”

15. How does stimulant use affect other aspects of life? Crystal Meth users report a significantly higher negative impact onlife compared to cocaine users (>50% reported the following aspects being negatively affected). Ability to think clearly Relationship with friends Finances Social connection Mental health Stress level Physical health Self Esteem

16. Proof of Addictive Properties of Crystal Meth • More LGM use crystal meth on a weekly basis compared to cocaine (42% vs 24%) despite perceptions of greater negative impact on life • Weekly crystal meth users report more negative impact on life compared to monthly users.

17. How are Crystal Meth Users Different? • Compared to Cocaine users, Crystal Meth users are more likely to be : • born in the US (58% vs 41%) • speak mostly English with friends (61% vs 41%) • unemployed (44% vs 30%) • HIV Positive (27% vs 12%)

18. Different Stimulants for Different Occasions • Cocaine is used more for social connection • Crystal Meth is used more for sexual enhancement “Cocaine is more for relaxing, for party, dancing. But crystal is for sex -- to get nasty for hours and hours and hours….”

19. What are the “Fabulous” 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 “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.”

20. What are the “Disastrous” Sexual Consequences? 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.” 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.”

21. How does Crystal Meth affect HIV Risk? • Overall, Crystal Meth users report the highest rate of UAI in the past six months (72%) of any Latino sub group studied • Crystal Meth users report higher rates of UAI in the last 6 months while under the influence than cocaine users (53% vs 32%) • Both weekly and monthly users report high rates of UAI in the last six months (56% and 46% ) compared to less than monthly users (23%) • Crystal Meth users seem to accurately perceive their HIV risk in relation to their behavior “I 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.”

22. The Social-cultural Contexts of Crystal Meth • 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.

23. Social Isolation Predicts Spiraling Down Social 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.……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.” 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.”

24. What are Users’ Strengths? • Awareness of Negative Consequences • Ambivalence about use (contemplation stage of change) • People that care about them • Evidence of “Intra-ventions”

25. Opportunity for Inter(intra)vention • Intra-ventions: “prevention activities that are conducted by and sustained through ongoing actions of members of communities at risk”. • Friedman et al, 2004, p.250 • Promoting Intra-ventions in Social Network (helping friends help)

26. A social network intervention to reduce negative impact of Crystal Meth in Latino MSMA program of the César E. Chávez Institute/SFSUFunded by the Universitywide AIDS Research Program

27. Three Successful Recruitment Questions Are you concerned about the negative impact that crystal meth (aka speed, Tina) is having on our communities? Are you, your partners or friends being affected by crystal meth? Would you like to do something about it, but aren’t sure what or how?

28. 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

29. Overview of the One Day Intervention Welcome/ brief overview / Introductions with fun ice breaker Group open discussion: Impact of meth on you and your loved ones Meth 101 – a functional approach Confronting negative attitudes against meth users Mapping methamphetamine use in social networks Difficult conversations: motivational interviewing skills Role plays of difficult conversations Appropriate referrals to treatment: resources and skills Integrative summary: lessons learned Ritual: personal commitment to reduce the negative impact of crystal meth on our community

30. Perceived Impact“After participating in this retreat, I feel….” • I received support for my concerns about crystal meth 52% Strongly Agree ; 48% Agree • More aware of community resources for referrals 56% Strongly Agree; 40% Agree • More committed to alleviate the negative consequences of meth use 68% Strongly Agree; 28% Agree • I enjoyed my participation in this retreat 80% Strongly Agree; 16% Agree • My participation in this retreat was definitelyworthmy time 88% Strongly Agree; 8% Agree • I would recommend this retreat to people I know 88% Strongly Agree; 8% Agree

31. iGracias ~ Thank You! Questions & Answers

32. Thanks for Your Participation For more information or to learn how to receive CBA services, contact us at: 213.201.1345 www.accionmutua.org