An Interview With Daniel Berger, M.D.
By Gus Cairns
Crystal meth (methamphetamine) use is "wreaking havoc" in the gay community in the United States, says a prominent gay doctor. Dr. Daniel Berger, writing in Positively Aware newsletter, has called for an urgent high-profile campaign to fight the epidemic of crystal abuse.
Berger says that crystal use is reversing a decade of advances in HIV treatment and is instrumental in gay men contracting HIV at a younger age, as has been seen recently in the U.S.
This phenomenon has not so far been seen in the U.K., where the average age at HIV diagnosis is in the mid-30s, compared with the mid-20s in the U.S., but Berger's words sound a stark warning.
"Methamphetamine is slowly weakening the moral fiber and cohesiveness of our community," he says. It also reverses health gains seen in HIV-positive patients.
"As an HIV physician, it has been very unnerving to watch patients who have finally become medically stable develop psychological breakdowns and medical complications."
A common scenario, says Berger, is seeing patients with "promising, sophisticated occupations and livelihoods" lose their jobs, become burdened with debt, become clinically depressed, lose weight and appear to be undergoing HIV-related wasting or drug-related lipodystrophy. After unsuccessful therapy for wasting, physicians eventually discover that the symptoms are crystal-related.
"Some experts believe that as much as 20 percent of the gay population has used crystal in the last three months," he continues. "However, most everyone lies about their abuse."
HIV-positive men are particularly vulnerable, he says, with a recent study finding that 60 percent of people participating in a crystal-addiction recovery program were HIV-positive. All were in their mid-30s and most were college educated.
Crystal, writes Berger, has an unfortunate image in the community of being a drug you can do and still "handle" the normal stresses of life, in contrast to the image of crack or cocaine. "The irony is that individuals on the drug have a false feeling that they are intelligent and 'making sense,' when in truth they are often incoherent and out of touch with reality."
This is echoed in a separate article for the Seattle Treatment Education Project by Susan Kingston. She says, "Commonly shared beliefs among users can contribute to harm. Many see methamphetamine as more "functional" than heroin or cocaine. Users see themselves as "getting things done," including purposeful activities such as work and home maintenance as well as sex."
But the price, Kingston adds, is a gathering rate of psychological breakdown and paranoia. She recounts that working with meth users involves having to work midweek (because at other times users are always high or crashing) and knowing how to work with paranoid delusions such as the conviction that the user is being followed.
Berger finishes his article with a call for action: "We were once a force that dealt with the HIV epidemic with muscle and vigor. Community leaders should launch another concerted effort with AIDS service organizations to fight the current destructive road we are traveling on."