Kerryn Drysdale: Championing collective responses in the intersection of health promotion and harm reduction for gay and bisexual men who use crystal methamphetamine

The common picture of the crystal methamphetamine user—whom politicians and media paint as the ‘ice addict’—is both familiar and dangerous. Often targets of wider ‘just say no’ campaigns on illicit drug use, the ice addict takes on a particular characterisation that links psychosis and mental instability with a clear trajectory of declining physical health. A quick Google image search of anti-ice campaigns globally reinforces this characterisation: images of before-and-after headshots reveal the supposed damage caused by the addictive qualities of the drug. An app, Ice Effex, even allows ‘users to apply the damaging effects of ICE use to their own face’ by digitally changing an uploaded photo of the user to reveal the impact of taking methamphetamine at three, six and twelve months.

Such depictions reinforce the notion that crystal methamphetamine is inherently dangerous and, what’s more, has deleterious health outcomes for the individual who chooses to use it.

The health risks associated with crystal methamphetamine have been well documented: there are risks of drug dependency, mental health issues, heart and other physical health factors, and increased transmission of blood-borne viruses such as HIV and hepatitis C. Of concern is the fact that Australian gay and bisexual men report higher rates of crystal methamphetamine use compared with the general population, with HIV-positive men more likely to use and inject crystal than their HIV-negative peers (Lea et al., 2016). This suggests that that there may be particular modes and patterns of use specific to this group of people. To date, though, little is known about the specific ways that gay and bisexual men use methamphetamine in Australia, and how particular forms and patterns of drug use relate to perceptions of risk and harm (Hopwood et al., 2016).

Consumed in the context of sexual encounters among men who have sex with men, crystal methamphetamine has been specifically associated with what is commonly referred to as ‘party and play’ situations in Australia and the USA, or ‘chemsex’ events in the UK. Indeed, crystal methamphetamine is by far the most common substance associated with drug-enhanced sexual activity in Australia (Lea et al., 2016), which suggests there are clear sexual health dimensions to crystal methamphetamine use among these men.

While the risks of such drug use are of concern in public health responses to the issue. The figure of the pathological drug-using individual is unhelpful because it creates inaccurate assumptions about crystal users and their practices that can impede effective health education, prevention and treatment. When we are asked to understand drug use as an isolated individualised event, any discussion of ‘addiction’ becomes untethered from the social and sexual contexts in which drug use occurs. Coupling an individualised focus on drug-taking decisions and presumptions of the ‘addictive’ pharmacological qualities of drug itself can result in a ‘rush to risk’ (Bryant et al., 2018) that elides any consideration of the collective pleasures and risk-reduction strategies that men actually employ to keep themselves safe from the drug’s potentially adverse effects.

One of the main gaps in the research we assessed is the issue that most crystal use is occasional and unproblematic and may not necessarily lead to harm. Consequently, those who use crystal methamphetamine in these ways simply do not see themselves represented in these depictions of the ‘ice addict’.

This dissociation has implications for the services that gay and bisexual men might use in relation to problematic drug use. For example, some harm reduction and health promotion material aimed at crystal users may appear irrelevant to them or may reproduce pathologised messages of danger, recklessness and harm, thereby reducing the chance of users accessing helpful service providers. By ignoring collective practices of care, health services miss opportunities to build on everyday practices of harm reduction and misunderstand or ignore the collective meanings of crystal use for those who use it. This might mean that those who use crystal for sex ignore messages about sexual and other health services available to them. Indeed, gay and bisexual men may benefit more from the combination of harm-reduction and sexual health programs. The social meanings that methamphetamine use carries and the ways in which the drug is used by gay and bisexual men warrant closer and more detailed study.

What does this mean for those of us tasked with research in this field, and how do we go about conducting in-depth, meaningful and relevant research on these practices? To tackle this issue, the Centre for Social Research in Health at UNSW Sydneypartnered with the Australian Research Centre for Sex, Health and Society at La Trobe University in Melbourne, ACON in Sydney, Thorne Harbour Health in Melbourne, the South Australia Mobilisation + Empowerment for Sexual Health in Adelaide, and the West Australian AIDS Council in Perth. In our NHMRC-funded research project, Crystal, Pleasures and Sex between Men, we are examining gay and bisexual men’s crystal methamphetamine use in four cities in Australia, with the aim of developing a detailed understanding of the ways in which crystal is used by gay and bisexual men, the pleasures and risks associated with its use, and the strategies these men employ to reduce risk.

In particular, the concept of ‘sex-based sociality’ underpins the research design, data collection and analysis; that is, we examine the ways that drug-taking practices can shape sexual activity in networks of gay and bisexual men through the particular meanings gay communities and their members attach to sex and drugs. Acknowledging the complex intertwining of drugs, sexuality and sociality in its identities, practices, relations and meanings can provide opportunities to develop innovative and creative reconsiderations of current institutional and programmatic responses to gay men’s drug use in the context of sexual activity.

We still have a lot of data to analyse as we head into the third and final year of this study: so far 88 interviews have been undertaken with gay and bisexual men in Sydney, Melbourne, Adelaide and Perth, as well as telephone interviews with 35 key informants working in the health policy, sexual health, harm reduction and blood-borne virus prevention fields. Within the diversity of contexts and patterns of drug use gay and bisexual men revealed, one thing is clear: crystal methamphetamine use takes place in social and sexual contexts as a group or collective rather than as an individual activity. It is within these groups or collectivities that specific pleasures and risks occur and are meaningful and pleasurable for the men who engage in these activities.

For more information on the project, please see: https://csrh.arts.unsw.edu.au/research/projects/crystal-pleasure-and-sex-between-men/

If you would like to find out more about our research, please contact Kerryn Drysdale at k.drysdale@unsw.edu.au. Our first report,‘Sunshine on a rainy day’: Crystal methamphetamine use among gay and bisexual men in Perth, looks at the specific networks, practices and risk-reducing strategies in one of these cities (Hopwood, Drysdale, & Treloar, 2018).

 

The project team is led by Prof. Carla Treloar and includes Prof. Gary Dowsett, Dr Max Hopwood, Prof. Martin Holt, Dr Toby Lea, Prof. Peter Aggleton, A/Prof. Joanne Bryant, Dr Kerryn Drysdale, Mr Brent Mackie, Mr Colin Batrouney and Dr Helen Calabretto.

 

References:

Bryant J, Hopwood M, Dowsett GW, Aggleton P, Holt M, Lea T, Drysdale K and Treloar, C. (2018) The       rush to risk when interrogating the relationship between methamphetamine use and sexual         practice among gay and bisexual men. International Journal of Drug Policy55: 242-248.

Hopwood M, Cama E and Treloar C. (2016) Methamphetamine use among men who have sex with men in Australia: a literature review. Sydney: Centre for Social Research in Health, UNSW Sydney.

Hopwood M, Drysdale K and Treloar C. (2018) ‘Sunshine on a rainy day’: Crystal methamphetamine use among gay and bisexual men in Perth. Sydney: Centre for Social Research in Health, UNSW Australia.

Lea T, Mao L, Hopwood M, Prestage G, Zablotska I, de Wit J and Holt M. (2016) Methamphetamine         use among gay and bisexual men in Australia: trends in recent and regular use from the Gay      Community Periodic Surveys. International Journal of Drug Policy29: 66-72.

 

Kerryn Drysdale is a Research Fellow at the Centre for Social Research in Health, located within UNSW Arts and Social Sciences. Her disciplinary background is in cultural studies, with a particular focus on LGBTIQ social scenes, identities and practices. Kerryn’s current area of research lies at the intersection of social inquiry and public health, particularly in the experiences and expressions of health and wellbeing among same-sex attracted and sex/gender diverse people, people who use drugs, and people living with or affected by HIV and/or viral hepatitis. Kerryn is also interested in community-led approaches to harm reduction and urban LGBTIQ night-time economic reform.