This article is the last of a four-part series on meth in the gay and bi community. Read parts 1, 2 and 3.
General practitioner Nason Tan works with LGBTQ people, sex workers and intravenous drug users in Kuala Lumpur, Malaysia, a conservative, predominantly Muslim country whose colonial-era laws harshly punish queerness, sex-work and drug use. He estimates that 70% of his gay and bisexual private practice patients are either currently using meth or have done so in the last six months.
That’s more than Malaysia’s overall gay and bi population. A 2015 survey estimated that only 7% of gay and bi Malaysian men had ever used crystal meth before or during sex. But even so, when Tan opens up dating apps, many of the profiles openly seek “Chemfun, CF, Chem or Chill,” all euphemisms for chemsex, the use of meth and other euphoric stimulants for prolonged bouts of sex.
Some of Tan’s patients started using because they wanted incredible, uninhibited sex. Others first tried with friends, not really knowing what they were taking. When Tan questions his patients, most admit to wanting the same thing: an intimate long-term partner and emotionally connected sex.
But finding love and support in Kuala Lumpur isn’t the easiest for LGBTQ people. Tan calls the country’s laws on drugs, sexuality and gender identity “draconian.” Most medical facilities and rehabilitation clinics are run by heterosexuals or religious conservatives who disapprove of LGBTQ identities and know little about queer sexual health. Gay and bi meth users enter clinics fearful of scorn, familial outing or arrest; accessing medical care is even more difficult for the poor.
On top of all this, social conservatives sensationalize and politicize meth use to fuel stereotypes and stigma against the LGBTQ community, Tan says. It scores political points in the short term, but over the long term, it drives the queer community’s meth users further underground — far from the groups that want to help them.
Although Malaysia has seen an increasing presence of clinics, mental health professionals and non-government organizations (NGOs) that focus on meth use amongst gay and bi men, other parts of Asia, like Taiwan, have no such presences at all. Even in Malaysia, Tan says, it’s still too early to judge their overall impact. “We are all still at the infancy stage of planning, coordinating and collaborating amongst ourselves, faced with many local challenges ranging from the repressive socio-political climate to funding,” he says.
Helping meth users use more safely in the U.S.
In some ways, Malaysia isn’t so different from the United States and other Western countries, which largely treat meth use as a moral and criminal issue. While many Americans disparage meth users or urge them to quit, the American legal system penalizes meth use with arrests, fines, mandatory drug programs and prison time. American money spent on drug prevention, enforcement and incarceration has increased.
But this approach isn’t stopping people from using.
While the United States spends an estimated $2.4 billion on arrests, legal proceedings and trials, the National Institute on Drug Abuse says the number of new meth users has more or less remained consistent from 2007 to 2015, with an estimated increase of overall users from 440,000 in 2012 to 595,000 in 2013.
Part of the trouble is a punitive, one-size-fits-all approach to discouraging meth use, says longtime chemsex counselor David Stuart. As Stuart sees it, not every meth user belongs in a meth addiction program, because most programs (and anti-meth awareness campaigns) treat every user like an addict, regardless of how frequently they use or the consequences they’ve incurred.
A gay man who uses meth with sexual partners once every six weeks, for example, isn’t in the same boat as a high-risk heterosexual who injects daily, has hepatitis C and is homeless. If an outreach program treats them similarly, Stuart says, the former won’t seek help if he decides he wants to stop but cannot.
The occasional meth-using gay man doesn’t need a medical professional to tell him to quit, Stuart says. He needs to discuss how to communicate on hook-up apps, how to be authentic when meeting others and how to handle rejection and loneliness. He needs skills from supportive peers who have experienced what he’s going through — things he can’t get in traditional addiction settings. If he ends up as a daily user in an addiction clinic, Stuart says, the community has failed him.
Instead of waiting for users like this to worsen and end up at addiction programs, Stuart says, we need to engage them when they show up at sexual health clinics, bars, bathhouses, circuit parties and hook-up apps. Re-Charge, a three-month-old initiative from Housing Works and the Gay Men’s Health Crisis (GMHC) in New York City, takes this very approach, making their presence known at these places through posters, brochures, ads, in-person attendance and through online profiles.
While we can’t expect every health care provider to know about the nuanced needs of LGBTQ meth users, Stuart says, it’s far more possible for local organizations like Re-Charge to make providers aware of their services and to offer them as a resource to gay and bi men in their office.
Re-Charge’s key goal isn’t necessarily to get meth users to stop using, says Leon Setton, Assistant Director of Behavioral Health at GMHC.
“We’re trying to build community,” he says, “to create a safe-space where people feel comfortable. We are providing linkages to PEP and PrEP and medical care, counseling and mental health care.”
Re-Charge also offers twice-per-week drop-in meetings where users can ask questions, find housing, jobs and medical resources or enter a rehabilitation program. It’s a more holistic approach that considers the full life needs of users rather than reducing them to their addiction.
Re-Charge’s approach falls under a health strategy known as “harm reduction,” an assumption that people will continue using harmful substances, but we can collectively reduce the personal and social harms associated with them. In the case of meth, it means giving people safer-sex strategies and medications to help reduce HIV transmissions during chemsex, advice on healthy eating and hydration and where to get clean needles for injecting.
Re-Charge is just one of many meth-related harm reduction proponents across the United States. Others include local groups like New York’s Lower East Side Harm Reduction Center, national groups like Impulse and websites like The Institute of Many and tweaker.org.
While conservative politicians, including Vice President Mike Pence, have opposed harm-reduction and needle-sharing programs as permissive, he reportedly saw their value after an unprecedented HIV epidemic broke out amongst intravenous drug users in his home state of Indiana.
Whenever someone criticizes harm-reduction programs as “enabling drug use,” Stuart asks what solutions they have to prevent a user from contracting or transmitting HIV. Usually, he says, their solution will be to tell the user to stop using drugs, which is no solution at all.
Creative community responses to meth are vital to meeting the drug’s challenges
For over a decade, Stuart has managed the chemsex support program at the 56 Dean Street sexual health clinic in London. In his conversations with clients, he has heard users admit “I get nervous taking my clothes off with a stranger,” “I feel anxious about what’s expected of me sexually in the bedroom,” “My online profile doesn’t authentically reflect me,” and “I was rejected online 18 times last weekend, and have been getting rejected like that every weekend for the last two years and it makes me feel like shit.”
Stuart felt grateful for their honesty, but also wondered why they were telling him instead of their lovers, best friends, families or the other men in gay social spaces. If the community could discuss these incredibly personal yet widespread issues together, he thought, it might help reduce the shame, stigma and isolation that compel people to use meth and other drugs in the first place.
So Stuart started the Dean Street Wellbeing Program to help cultivate community events to bolster these conversations. The program works in partnership with the Sextroverts, a sex-positive queer comedy group whose routines focus on sexual stigmas and moral judgments that complicate LGBTQ sex lives, sexual health and community; Let’s Talk About Gay Sex and Drugs, a cabaret-style variety show of spoken-word, poetry, drag and musical performances with the occasional striptease or stand-up set; A Change of Scene, a monthly gay men’s discussion group that focuses on rotating topics like body image, pornography, relationships, loneliness and app addiction; as well as film showings and theatrical performances, each with an interactive discussion portion afterwards.
Patrick Cash, the co-founder of Let’s Talk About Gay Sex and Drugs, says that hearing other people honestly share their experiences helps people overcome their shyness about these topics. He believes his events also build friend networks based on shared commonalities rather than just drugs and sex.
One of the Dean Street Wellbeing Program’s most provocative cultural events was gay fetish photographer Matt Spike’s exhibition of images showing gay men in leather and harnesses having group chemsex (pictured above). When Spike contacted Stuart to ask about the moral propriety of his photography, Stuart encouraged him to shoot 30 more, display them in an art gallery and invite the gay community to discuss them.
Stuart feels that creative community responses are vital to meeting meth’s challenges. “Let’s look at history,” he says. “Once upon a time, HIV was devastating our communities, and we didn’t just have a lot of doctors get up and say, ‘Misery, death, misery, death.’ That happened, of course. But what we did was we had theater, we had art, we had dances, we had marches down the street, we had funerals that played disco music — we reinvented how a community responds to a crisis.”
“[Meth and these frank conversations] can seem to undo decades of gay sexual liberation,” Stuart says. “It can seem like it’s gonna make the straights hate us all over again, but if the alternative is to not talk about it, silence equals death. I can’t have that myself. We have to talk about it, even if it’s unpleasant, even if it means we’re gonna argue with each other. Even if it means our opinions are gonna clash. We have to do it.”
“And so I ask my community to be brave,” he says. “Let’s look at it in the face bravely and let’s talk about it as a community and remember we are an extraordinary community that loves each other, that have come through dreadful times in the past, and we can do it, come together through this one as well.”
(Featured photo by svetikd for iStock)