It’s hard to get people to practice safe sex. It’s even harder to convince methamphetamine users to do so. Researchers at UCSD are trying to influence the behavior of gay men who use meth and have HIV. It’s a challenge. KPBS Health Reporter Kenny Goldberg has the story.
It’s around 9 p.m. outside a nightclub in Hillcrest. People fill the outdoor tables as they wait for the music to start inside. There’s a vibrant club scene here in the heart of San Diego’s gay community. And methamphetamine plays a big part in it.
Recent surveys reveal about 14 percent of gay men who frequent these clubs say they’ve used meth within the past six months. So why is meth so popular?
Bobby: It’s crazy, it’s just like, you know, the more of the drug that you do, the more sexual your appetite grows, it gets bigger and bigger.
Bobby, not his real name, lives in Hillcrest. He started using meth last year, when some friends turned him on to it. Bobby says it was weekends only, at first. Then he began to use during the week, too.
Bobby has HIV. He says there’s a distinct possibility he’s infected other people.
Bobby: A lot of times when I was high, and with other people that were high, I didn’t ask their status, I didn’t even talk about it, didn’t even use a condom, we just had sex and you know, that’s not good, but you know, when you’re high you don’t even think about stuff like that.
One study reveals up to 84 percent of gay men who use meth have un-protected sex when they’re high. That’s really playing with fire, because gay men in general are at much greater risk of HIV infection than any other group.
Researchers at UCSD are working with men like Bobby. They’re testing what’s called a behavioral intervention to see if they can get gay meth users who have HIV to practice safe sex.
Dr. Jim Zians is project director for the Edge study. Zians says a lot of the study participants are ambivalent about their behavior.
Zians: On the one hand, they care very much about their health, they don’t want to infect other people with HIV and AIDS, they want to take good care of themselves, but on the other hand, they really like meth, and they realize this is a drug that’s difficult to fight.
Three-hundred-and-fifty men in the Edge study were randomly assigned to two groups. One group received instruction on diet and exercise. The other got the behavioral intervention.
The intervention group received eight one-on-one sessions with a counselor.
Zians says it’s tough to get people who aren’t motivated to change their behavior to actually change. He says counselors get them to focus on their values, and what’s important to them.
Zians: And then we look for discrepancies between what they say they care about, and what they value, and what they’re actually doing.
The counselors remind men that their values and their unsafe behavior are at cross purposes. They’re encouraged to try and resolve the conflicts.
Zians: And what happens when people start focusing on things that they care about, is they start resolving this ambivalence by making a decision to change.
All of the men in the study provided detailed information about their behavior over a one-year period. At the beginning, they reported using condoms about 15 percent of the time. At four months, both groups showed improvement. At one year, men who received the information on diet and exercise stopped improving, and actually regressed.
Men in the intervention group forged ahead. In the end, those who got the brief counseling sessions had much higher condom use than the others. But, they still had unprotected sex about 75 percent of the time.
Kenny and Zians: The thing I don’t understand is, people know it’s unsafe, and yet they do it anyway. Why?...It sounds like it’s easy, gosh, using condoms is easy. Getting off meth is easy. Having meth not control your behavior, should be easy. And obviously, it’s not.
Just ask Bobby. These days, he tries to use meth only once a week.
Bobby says if he had known how meth would foul up his life. . .
Bobby: I probably wouldn’t have even started using crystal, had I would have known, you know, all of effects and everything that go along with it.
Bobby says he wants to quit meth all together before his next birthday.
UCSD has launched a new Edge study. Researchers want to find out whether they can get men like Bobby to lower their risk behaviors even more.
Kenny Goldberg, KPBS News.
