Medical Journal to Gays: 'Lets Not Have A Kiki' - The Lancet on Gays & Crystal Meth

It's not often that Rentist delves into high-brow medical journals these days (who has the time?) but this article in the Lancet was a page-turning start to the year. With the catchy title, 'High-risk drug practices tighten grip on London gay scene', it made uncomfortable reading. Concentrate - here comes the science part...

The report describes how the combustible combination of the hedonistic elements of London's gay scene and ever-so-slightly terrifying & addictive crystal meth is leading to an explosion in Hep C and undiagnosed STDs including our old friend, HIV. You can read the article in full here - like many things in the gay world, it might take a few attempts to see it through to the end. You might want to stop half way through for a breather/cry. But it's worth it.

Obviously Rentist is not yet a 190-year old peer-reviewed scientific journal of worldwide repute. But the article gave pause for thought...

London's 24-hour gay scene is world famous, with clubbing that goes on all weekend and beyond. Many of London's drug-using men who have sex with men (MSM)... often congregate at post-club parties known as chill-outs where drug-taking continues until drugs, money, energy, or all three run out.

First up, the term 'MSM' - yes it's tricky to come up with something that isn't perjorative or too exclusive, but seriously. For years, our people have been renowned and bullied for our creative streak; one of us must have a better idea for a group name? We can surely all agree that the act of men having sex with men is not the delicious chocolate and candy coated peanut treat this label suggests.

The article continues, pointing out that recreational use of drugs such as ecstasy, mephedrone, cocaine, GBL, and ketamine is rife across the scene. Change is afoot, though, and the use of crystal meth is increasing amongst groups who had previously not tangled with it.

Injection of crystal meth... to get a bigger rush or high—known as slamming—is also increasing, taking place at sex parties or chill-outs where many people often share equipment without sterilising it... Some are withdrawing their blood with a needle, adding either crystal meth or mephedrone to that blood, and then re-injecting it into themselves or someone else. Users can then be high for days, reinjecting and having sex with multiple partners without protection. The result is a perfect storm for transmission of both HIV and HCV, as a well a catalogue of ensuing mental health problems. A slamming community, largely hidden to the rest of the gay scene, exists behind closed doors in London.

Rentist is a firm believer that the use of recreational drugs is not going to go away; as more eloquent people have argued in a more compelling fashion, prohibition has not worked. Drugs are prevalent in London and particularly on the gay scene. Just like drinking, responsible use can be fun, or at least make going to the Joiners again into a tolerable experience. But come on gays, crystal meth? Are you sure? According to the lazy researcher's best friend, crystal meth is more addictive than coke, causes severe depression during withdrawal, and may lead to "meth mouth" (a more palatable way of saying "losing your teeth abnormally quickly"). There's a fairly clear distinction between recreational drugs, and drugs which are highly likely to cause devestating addiction and serious health problems. Like heroin, it seems the potential benefits of crystal meth are outweighed by the inevitable downsides. This is possibly the only time Rentist will stand shoulderpad-to-shoulderpad with Nancy Reagan and ask that you 'Just Say No'.

Drugs aside, the bigger risk here is the spread of Hepatitis C, HIV and other STDs to the wider MSM community.

The increased risk of [Hep C] infection comes from a melting pot of risk factors including party drugs and HIV-positive men relaxing safe sex practices in the era of successful antiretroviral treatment. They can also have a number of other STIs such as gonorrhoea, syphilis, and chlamydia... These other STIs break down the mucosal barrier in the rectum and make it easier to contract HCV sexually. “It's not just people engaging in the highest risk practices like injecting recreational drugs and fisting who are getting acute hepatitis C infections”, says Devitt. “Around 60% of new HCV cases are in those who don't inject. They can smoke crystal meth or snort mephedrone, or other drugs, sharing straws or notes while doing so, and also catch it through unprotected sex.

Which, to be clear, is a bad thing. And even worse:

In 2011, there was a record high 3010 new HIV infections in MSM in the UK, of which 1296 were in London. At the 56 Dean Street Clinic in Soho, London, 511 new cases of HIV were diagnosed, with most (482) in MSM.

Maths isn't the gayest subject, so let's just break this down. Around one sixth of all new cases of HIV in the UK diagnosed in 2011 were in a clinic we have all walked or staggered past, and where some of us have even been tested (after accidentally demanding a clap test from the long-suffering staff of the TV production offices next door).

The reports from over-subscribed clinics are not good. Crystal meth use is spreading; needle use has increased from 30% of users in 2011 to over 80% of users in 2012; and needle-sharing makes up a terrifying proportion of this. Users engage in barebacking, with a reported - possibly boastful - claim of up to five sexual partners per 'episode'. Dr Bowden-Jones, a consultant psychiatrist from the Club Drug Clinic (not to be confused with Club Tropicana), said:

Injecting these drugs for some MSM seems to have become sexualised, which is very unusual. We are trying to understand why. The meaning of an HIV diagnosis in this context is also important. People will sometimes say ‘well I knew everyone in the room had HIV’, but when asked about hepatitis C, they say ‘well I didn't think about that’. We have a mixture of people [who are] HIV and/or HCV positive and negative people injecting and sharing needles, potentially creating a public health disaster. Tackling the complex relationship between drug use and sexual behaviour is a key part of the clinic's work with MSM.

Which says it all really. What is it that causes the rise in destructive drug use? Why do we have unprotected sex with strangers? It's a bit 'no shit Sherlock' to start positing the notion that this is a cry for help. But is it self-hatred, sado-masochism, the excitement of engaging in high-stakes gambles with your health, difficult relations with wider society, or do we just think it's great material for anecdotes amongst friends? Rentist's long-running series of 'London Sex Distasters' is fairly guilty of all of the above. But the warning siren has been sounded by the writers of the Lancet's article.

Risk carries an element of thrill with it, but comes with a side order of responsibility. It's easy to think you are immune from the dangers we all face, but it's less palatable to think that you could very easily infect someone else, or introduce them to a drug which they can't use quite so recreationally. The lessons are simple: don't mess about with drugs you know to be extremely dangerous. Don't have unprotected sex with strangers. Get tested regularly. The alternative is that the Lancet will be writing a lot more about us in the future...