Frieden acknowledges that more data is needed to link drug with HIV infections increase
The city health department has joined efforts to combat the use of crystal among gay men and what public health experts believe is the drug’s contribution to the increase in HIV infections in gay men who use crystal.
“The bottom line is that crystal meth is a dangerous drug,” said Dr. Thomas R. Frieden, commissioner of the city’s Department of Health and Mental Hygiene, at an April 20 meeting with reporters. “It also increases HIV risk and we are seeing it increasingly in New York City.”
The city will spend $300,000 to fund an anti-crystal education campaign and to produce a one-day conference in June that will educate healthcare providers about the drug. The campaign should be up and running soon.
“We’re looking to get it out as soon as possible, hopefully within the next few months,” said Brett Larson, director of the Office of Gay and Lesbian Health and the health department’s point man on crystal. “We’re hoping to get it out by early summer.”
The health department is increasing its efforts to gather data about the crystal problem in New York City. That includes asking people about their drug use, including crystal, when they get an HIV test in the city’s sexually transmitted diseases (STD) clinics.
Understanding the link between crystal and HIV, assuming there is one, has become more important as some in the gay community question if that link exists.
The May 2004 issue of Genre, a national gay magazine, featured a news analysis piece that, while not dismissing crystal’s harm, suggested that some recent responses to the drug were more sensational than based on facts.
On April 20, Frieden was asked about any evidence that tied HIV to crystal and he conceded that data was lacking.
“We have some information, not as much as we like,” Frieden said. “This is why I was very careful to say clearly drugs are a problem. Crystal meth is a dangerous drug. There are other dangerous drugs.”
A number of West Coast studies have linked crystal use to higher rates of sexually transmitted diseases and HIV among gay men. In New York City, six studies from the Center for HIV-AIDS Educational Studies and Training have tied meth to unsafe sex among gay men. As yet, the city health department has only anecdotal data on such a link.
“We know it’s a problem from our STD clinics. We know it’s a problem from what patients are telling us who have had recent unprotected sex,” Frieden said.
Steve Rubin, deputy director in the department’s Bureau of Sexually Transmitted Disease Control, said the agency would have 2004 data in early 2005 and that “I know the numbers are large right now.”
Frieden said that crystal’s harm was evident in other ways. Reports on crystal overdoses made to New York City’s poison control center have risen from none three years ago to more than two dozen in each of the past two years.
“Those have clustered in lower Manhattan among young, white males for the most part,” he said. “We know that there is a great risk of it getting much worse and we know that at present it is at levels that are large enough to be of concern.”
Crystal can be particularly damaging to the health of people who are already HIV-positive. “Among people who are already HIV-infected, crystal also increases risk,” Frieden said. “It reduces the likelihood that people will take medications…It has some dangerous interactions with HIV medications. It may increase HIV viral activity. It ccelerates HIV dementia and other health problems related to HIV.”
One controversial aspect of the city’s response may be that an internal health department task force on crystal includes participation from the city’s police department.
“We’ve involved the police department in our crystal meth task force,” Frieden said. He is not advocating that the police arrest crystal users, however, only dealers.
“My comments about legal intervention were related to large- scale production and the approach is, from a public health standpoint, if you increase the price, price means both the cost and difficulty in getting the drug, you will decrease utilization,” Frieden said.
Activists who have been pressing AIDS groups and the city to respond to crystal use among gay men approved of the city’s actions.
“It’s a start, it sounds like a good start,” said Dan Carlson who, along with Bruce Kellerhouse, produced a series of town meetings on gay men, HIV, crystal and other topics. “It sounds like the health department is listening to the community and responding. That’s very promising…I think the $300,000, if well spent, can be very, very impactful because I believe a little education with this drug will go a long way.”
Peter Staley, a longtime AIDS activist who has spent $5,000 of his own money to place anti-crystal ads on Verizon phone booths along Eighth Avenue in Chelsea, also welcomed the city’s actions. “I come from the Act Up days when fighting Koch’s and Dinkins’ health departments was like screaming at a stone wall,” Staley said. “In that light, what the health department has done over the past two months, I’d give them a B plus. These are good first steps.
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