Do emerging drug use trends in parts of London’s gay scene risk creating a new health crisis? – DDN reports on the National Aids Trust’s call for urgent action.
Late last month NAT (the National Aids Trust) wrote to London councils calling for action to address the ‘recent and rapid rise’ in the use of crystal meth, mephedrone and GHB/GBL on London’s gay scene, particularly ‘in the context of high risk sex’ (see page 4 of magazine).
In a very short period this has become ‘one of the most pressing issues for gay men’s health’, the letter states, with the three drugs responsible for 85 per cent of all presentations to Antidote, the capital’s only LGBT drug support service, last year, compared to just 3 per cent in 2005.
‘The vast majority use these three drugs to facilitate sex’, the letter states, with further evidence of the connection between sexual health risk and problematic drug use in the rise in referrals to Antidote from sexual health clinics – up from 8 per cent of presentations in 2005 to 63 per cent in 2012.
Worryingly, the number of crystal meth and mephedrone users injecting the drugs in a sexual context leapt from 20 per cent in 2011 to 80 per cent in 2012, with 70 per cent of those injecting reporting sharing needles. Around 75 per cent of the men using Antidote’s services are HIV positive, with 60 per cent failing to adhere to their HIV treatment when under the influence of drugs.
‘We’d obviously known for many years that there was significant drug use on the gay scene,’ NAT’s director of policy and campaigns, Yusef Azad, tells DDN. ‘What has changed is the sort of drugs that are used and the context in which they’re used. We’d heard about crystal meth in the US and I recall asking health promoters in the UK about it and being told it wasn’t an issue here, but it became an issue and I’d guess about three to four years ago we first started hearing anecdotal reports of slamming [injecting], as it’s known.’
The overall prevalence of this sort of drug use remains unclear, and one priority is for more research, he stresses. ‘What is clear is that there is enough of this sort of drug use going on for it to be very problematic for the health of the individuals concerned. There have been a few deaths, and certainly a real transmission risk around HIV and hepatitis C. Maybe what we can say is that among some gay men who were engaged in risk activity, their risk is becoming even higher risk as a result of these changes in drug use and sexual behaviour.’
The letter also cites evidence from Chelsea and Westminster Hospital’s Club Drug Clinic and the 56 Dean Street sexual health clinic that reflect Antidote’s findings. ‘I think it shows there’s something of a health crisis, without wishing to be sensational, that we need to act on now – speedily, effectively and urgently,’ he says.
Does he feel that drug services are geared up to respond? ‘No,’ he states. ‘We held a roundtable in January on HIV and injecting drug use generally, but what was fascinating was how the gay men’s issue really shot up the agenda. One of the things that was clear is that traditional drug services – which we absolutely support and which have done amazing work – are used to opiate users, used to providing harm reduction with needle and syringe packs with citric acid for heroin use. They’re not necessarily trained in what harm reduction means for these new drugs, nor are they necessarily trained in discussing drug use in the context of gay men’s sexual behaviour, and sometimes quite sort of esoteric sexual behaviour.’
Gay men have reported drug workers being uncomfortable or embarrassed by the sexual context of the drug use, while service users could also be uncomfortable if they think the worker might be judgemental. Is training the answer?
‘We probably need a two-pronged approach, one of which is that generic drug services become much better at identifying the distinctives around the particular drug use we’re talking about, but also that they’re trained in terms of non-judgemental discussion, discussion of sexual risk and that they know whom to refer to in terms of service support. But we also need some new specialised services, and that of course is where there’s a question mark.’
Does NAT get the impression that this is something that’s limited to younger people? ‘I don’t think it is,’ he states. ‘If you look at the proportion of service users who are HIV positive, it’s 75 per cent at Antidote and knowing the age profile of people with HIV there will be some young men but there are certainly are men in their 30s, 40s and 50s. It’s not just young men early on the scene – many are very experienced on the gay scene and have moved on to these drugs from other club drugs.’
The letter has been sent to London local authorities – is it largely a London issue, or is there evidence of similar trends elsewhere? ‘If it’s a London issue then it is a national issue, because so many men come to London for clubbing and sex parties and so on,’ he says. ‘So far all the data seems to come from London, but that’s partly because the main services are in London and it’s the services that are gathering this information. There have been some requests for support from Brighton and Manchester, but there does not as yet seem to be the same levels of use of these drugs in the contexts described in our letter, which of course means we must use this window to prevent such problematic use spreading to other gay centres in the UK.’
With drug treatment, HIV prevention and sexual health services now under the public health remit of local authorities, there are opportunities to join up services and do things ‘differently and better’, NAT urges, and the letter calls for well-funded ‘open access, appropriate and tailored services’ to be commissioned as soon as possible. But with many drug services feeling they might not be seen as a priority in the new public health landscape, how confident is NAT that the money will be there?
‘We weren’t confident unless we did something, which is why we wrote the open letter. This is obviously a time of immense change – the good thing is that there’s a pretty decent national public health allocation, and sometimes new people can look at need freshly. We focused on councils taking on these responsibilities as an opportunity for innovation and to implement change, and we know from talking to them that a lot of councils are up for that, so I don’t think we should be by default pessimistic on this.’
Is the public health argument also just too strong to overlook? ‘We certainly think the public health argument is immensely important. We’re not claiming this is the majority of gay men – far from it – but if you have a group of gay men where there is very high drug and sexual risk taking, and very high HIV and hep C transmission rates, this has a ripple effect on the level of transmission in the whole gay community, because men in this group will have sex with other people as well.’
There are also, of course, the harmful impacts of crystal meth on mental and physical health generally. ‘Yes, we need to look at this holistically,’ he states. ‘We need to be worried about mortality again, about HIV, hep C and mental health and, in that context, equip drug services to deal with a very fast changing drug use scene and equip them to deal respectfully and with some degree of knowledge and appropriateness with gay men.
‘One of the things raised at the round table, given the rate that legal highs proliferate, is that maybe there should be some generic harm reduction advice even if you have no idea what it is that the person’s taking. The letter isn’t a criticism of drug services as such – it’s tough to keep up with these things.’