Use of crystal methamphetamine is on the rise in London’s gay scene, putting men who have sex with men at higher risk of infections. Tony Kirby and Michelle Thornber-Dunwell report.
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), and also lesbians, and their heterosexual male and female friends often congregate at post-club parties known as chill-outs where drug-taking continues until drugs, money, energy, or all three run out. There are also many sex parties where MSM congregate at homes for group sex.
A wide selection of drugs are popular in the London scene, including ecstasy in both pill and powdered MDMA (3,4-methylenedioxy-methamphetamine) form, cocaine, ketamine, γ-butyrolactone (GBL), and speed. In 2009, use of another drug, mephedrone (part of the cathionone family), also exploded onto the club scene. More recently, methamphetamine (known as crystal meth or tina) has been growing in popularity but is regarded as more hardcore by many clubbers because it can lead to users binging for days at a time without sleep, and indulging in high-risk sexual practices as they smoke, snort, or inject the crystal, before suffering a heavy comedown.
Most MSM who use drugs in London take combinations of ecstasy, mephedrone, cocaine, GBL, and ketamine, in various doses and times during their partying cycle. Most do so reasonably safely, and the groups that tend to use these drugs don’t generally mix with people who use crystal meth, who generally attend their own chill-outs or sex parties and appear less often or for shorter periods in clubs, choosing instead to use crystal meth (often in combination with other drugs) with other users without shame or stigma.
Now, more of London’s MSM seem to be engaging in high-risk practices, including crystal meth use, putting them at risk of infection with HIV, hepatitis C (HCV), and a range of other bloodborne and sexually transmitted infections (STIs). This trend is concerning since, 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. Thus, around one in six of all new cases of HIV in MSM in the UK were diagnosed in this one London clinic.
Injection of crystal meth or mephedrone 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. While most so-called slammers inject the drugs dissolved in water, 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.
The drug clinics that are available are massively oversubscribed and struggling to cope. David Stuart manages the Antidote Substance Misuse Service at London Friend, a lesbian, gay, bisexual, and transgender health and wellbeing charity. This includes managing the UK National Health Service (NHS) partnership clinics: the Club Drug Clinic at Chelsea and Westminster Hospital (funded by the Central and North West London NHS Foundation Trust) and the CODE Clinic at 56 Dean Street (part of the Chelsea and Westminster NHS Foundation Trust), which treats MSM involved in the harder, higher-risk sex scene connected with drug use. “Users of crystal meth, GBL, and mephedrone represent 85% of the CODE Clinic’s consultations”, says Stuart. In 2011, 30% of the users of mephedrone and crystal meth visiting CODE were injecting these drugs. In 2012, this increased to 80%. Of these, 70% report needle sharing. “It’s a staggering and frightening increase”, says Stuart. “Lots of things are driving it, including the ease of finding the drugs themselves and the use of internet sites to find sex parties and drug dens where people can carry out this behaviour.” Stuart says that using these hardcore drugs helps MSM deal with shame and vulnerability issues many have about having gay sex.
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