10 year history serving the Substance Use needs of London’s LGBT(Q) community

1. New Trends in Substance Use/Club Drugs (Novel Psychoactive Substances) And LGBT Trends 10 year history serving the Substance Use needs of London’s LGBT(Q) community 8,000 contacts, 700+ people in treatment each year

12. UKDPC: Drugs and diversity 2010

13. From “Huggy” to Hardcore”

15. This is not the Trainspotting generation • Crack Heroin, not used for a laugh • Normalised use; greater ambivalence • Abstinence an un-popular goal. M.I. techniques more relevant than ever • Online purchasing • On-line “Hooking up” • Sexualised use • Drug services, GU services, A&E Dept’s letting users down

16. “Tina” “Club Drugs” are Problematic Drugs

17. LGBT REASONS for DOING DRUGS • HIV issues, both real and stigmatised • Exclusion from family, social groups or workplace • Trauma from bullying at school • Homophobia/Transphobia (internalised and social) • Other trauma such as illness or abuse • Difficult “Coming Out” experiences • Lack of role models/lifestyle aspirations • Loneliness, Isolation

18. More Reasons…. • Habit. “Everyone does it” • Social anxiety. • Intimacy anxiety. • Sexual performance anxiety. • Body anxiety. Body Dismorphia LGBT and non-LGBT share many of these • Mental health. Emotional dysfunction. • Avoidance\numbing of other issues that ought to be addressed, including HIV and other health issues. • As a coping mechanism, learnt from peers or adults. • Lifestyle choice • Physical dependence.

19. Normalised Drug/Alcohol useon our Bar and Club Scene

20. 24 HOUR SAUNAS…

21. The most harmful drug use by Gay men is almost exclusively to facilitate Sex. WHY?

22. The popularity of BareBacking

23. LGBT reasons for drug use Shame/judgment Sexual SHAME HIV FEAR/STIGMA Bullying/Rejection • Gay sex = • Sin • Disease • rejection

24. Some religious Gay Men communities My little sister

25. Managing Social Networking

33. HELP A CLIENT WRITE A BOUNDARIED “Hooking-Up” PROFILE • Films • http://www.davidstuart.org/film • http://www.treasureislandblog.com/news/release/real-raw-slammed-the-trailer/#

34. “HIV prevention” includessexually active HIV+ people. • Are you confident disclosing your status? • Do you feel confident & sexy, or diseased and unclean? • Are you comfortable discussing HIV with friends/lovers? • Do you use Bareback sites to avoid the HIV topic? • Do you want support in writing your online profiles/setting boundaries on line? • Do you care about your health and others… even when high? • Unsafe sex may be fine… but sharing needles? Is compulsive sexual behaviour a result of HIV+ men being out of work, benefit dependent, low self-esteemed, lonely, needing affirmation, not at ease with their status?

35. “Crystal, GBL and bareback.com help me avoid having that awkward and distressing HIV conversation”

36. Crystal Methamphetamine, Crystal, Tina. • 3, 4 + day “benders” of speedy, unboundaried chaotic sexual marathons. • Effects managed with GBL use. • Repetitive GUM presentations. • Increased HIV/Hep C infections. • Drug-induced psychosis very common. • High likelihood of psychological dependence.

37. Mephedrone (Miauw Miauw) • £30 to £50 per gram • Snorted, dabbed, swallowed, injected • A cathenone, derived from Khat, or pseudo-ephedrine • Used for dancing, sex • Myth that it’s a “safe alternative to Meth

38. Chelsea and Westminster HIV stimulant survey • One month audit of crystal Methamphetamine use • 418 patientsreported crystal use in last year • 78% physical harm • 61% psychological harm • 56% unprotected sex as a result of crystal use • 25% non-compliant with anti-retroviral treatment due to crystal use

39. MANY more people now injecting..

40. ANTIDOTE STATS • Of the Crystal Meth and Mephedrone users at Antidote; • 95% are using to facilitate sex • 80% are injecting • 70% report having shared needles to inject-sometimes with erotic intention • Prefer to use “Bareback” sites to find sexual partners • Report an average of 5-10 sexual partners per “episode” • 75% are HIV positive; of these, • 60% report being non-compliant with ARV’s while “high” • 90% attribute their diagnosis to the use of drugs and alcohol • Of the HIV Negative clients, more than half have had • one or more courses of PEP in the last year

44. QUESTIONS TO ASK • “Do you use Party Drugs for sex?” • (and if so…) “Tina, Mephedrone or G? (Ketamine?)” • “Are you taking G every day?” (and if so.. It can be dangerous to stop without medical advice) • “How long do you stay awake for?” • “Have you had any bad experiences?” (eg; paranoia) • “Do you sometimes regret the choices you make when high?” • When did you last have sober sex? • “What’s your non-sexual/non-clubbing social life like?” • “Are you slamming (injecting) ?” • Do you want to talk to someone about being safer with drugs?

45. MOTIVATIONAL INTERVIEWING Role Play

46. CASE STUDIES

47. REASONS for DOING DRUGS • HIV issues, both real and stigmatised • Exclusion from family, social groups or workplace • Trauma from bullying at school • Homophobia/Transphobia (internalised and social) • Other trauma such as illness or abuse • Difficult “Coming Out” experiences • Lack of role models/lifestyle aspirations • Loneliness, Isolation

48. More Reasons…. • Habit. “Everyone does it” • Social anxiety. • Intimacy anxiety. • Sexual performance anxiety. • Body anxiety Body dismorphia • Mental health. Emotional dysfunction. • Avoidance\numbing of other issues that ought to be addressed, including HIV and other health issues. • As a coping mechanism, learnt from peers or adults. • Lifestyle choice • Physical dependence.

49. WHAT WE DO (ANTIDOTE) • Identifying “Contemplation” or “Action” • Setting Goals • Recognising Triggers • (Places, situations, people, • emotional states, stress, sexual arousal..) • List of Pro’s and Con’s • Managing Cravings • Recognise and anticipate triggers/associated situations • Acupuncture, breathing, meditation • Remove yourself from situation “Time Out” • Delay, Distract, Decide

50. What we do… • Make a list • Saying “no” confidently/setting boundaries • Anticipating certain invitations/situations • Encouraging other interests • Communication skills. • Honesty/support from appropriate friends/family • Harm Reduction • Referrals • Listening is Support