NEW YORK – It's a Friday evening, traditional kickoff time for the party scene in New York's gay community, but the 75 men packed into a small room at a gay health center aren't in a partying mood.
Through a humbling 12-step program modeled after Alcoholics Anonymous (search), they are battling to kick their addiction to methamphetamine (search), and in doing so escape an epidemic that is roiling urban gay communities nationwide with disease, despair, embarrassment and anger.
Meth is an equal-opportunity menace — many thousands of men and women, gay and straight, have fallen prey to it in rural villages, placid suburbs and city slums. But gay leaders in New York, California and elsewhere bluntly acknowledge that their communities have distinctive problems with the drug, and an unavoidable responsibility to combat it.
"Years from now we'll look back, as gay men, and be pretty despondent that we popularized and glamorized this drug," said Dan Carlson, an ex-addict who has become one of New York's leading anti-meth campaigners.
"I'm not anti-partying or anti-sex," he said. "But how can we fight for our rights as a sexual minority if we don't establish what's right and wrong in our community, and look out for each other."
Crystal meth (search) — which can be snorted, smoked or injected — has been a popular gay party drug on the West Coast for more than a decade, and in New York since the late 1990s. In many cities, however, gay activists and health officials were not quick to confront the fact that the drug, by curbing inhibitions and boosting energy, encourages unsafe multi-partner sex and thus increases the risk of HIV transmission.
In New York, alarm over meth intensified in February, when health officials reported a rare strain of highly resistant, rapidly progressing HIV in a gay man who regularly engaged in meth-fueled sex parties. But the tide began turning against the drug a year earlier, when gay activists held the first of several forums on the epidemic and an ex-addict named Peter Staley circulated posters with an eye-catching message: "Buy Crystal. Get HIV Free."
Staley, a bond trader-turned-AIDS activist, is guardedly optimistic that the forums and ad campaigns are helping stigmatize the drug.
"A year and a half ago, this was a whispered-about epidemic," he said. "If it came up, it was someone bragging about their wild weekend on meth, and no one had the courage to say, 'What the hell are you laughing about?'
"That's completely changed," Staley said. "When gay men ask a friend about it now, they're as likely to hear, 'That stuff destroys lives,' as they are to hear, 'Oh, you should try this; it's amazing."'
One indicator that the anti-meth message is spreading is a surge of addicts seeking help at Crystal Meth Anonymous (search) and other recovery programs.
Meth Anonymous started in New York six years ago with one weekly meeting, attended by a half-dozen men. It now offers 24 meetings a week, attended by anywhere from a dozen to more than 100 people.
Some of the men at the recent Friday meeting, clearly on edge, were just beginning their attempt to quit; others had been off meth for two years, yet still embraced the intensive group support in trying to stay sober.
The evening's speaker, a former flight attendant celebrating one year off meth, riveted the audience with a wrenching account of his unhappy youth, his descent into prolonged addiction, his years as a hustler getting paid for sex even as he contracted HIV and other diseases. "Darkness" was how he described his life at the nadir.
Afterward, two 38-year-old former addicts detailed their battles to quit meth two years ago.
Matthew, an Ohio native who now does freelance legal work, progressed over five years from using meth every few months to every weekend, struggling with his career, his relationships and a drinking problem. "I couldn't have felt any worse, depression-wise," he said. "There I was, 36 years old, without a game plan."
Frank, an advertising executive, started using meth at work, sometimes with his boss, eventually escalating to almost daily use. He got into the meth party scene, often engaged in unsafe sex and considers himself lucky not to have contracted HIV.
"For years, every time I had sex, I was on crystal," he said. "I had a lot of fun, and then it slowly, surely turned into not being fun. It was taking over my life."
The spiritual, abstinence-only philosophy of Meth Anonymous works for some men, but repels others. Some counselors espouse an alternative known as "harm reduction," cautioning users about meth's risks while encouraging addicts who can't quit to avoid overdoses, take care of their health and — to the extent possible — engage in safe sex even while high.
The Stonewall Project in San Francisco is one such program, inviting meth users to "deal with their crystal issues without any stipulations or guilt-laden finger pointing."
Staley, though agreeing that all avenues of treatment should be explored, is among the skeptics of the Stonewall approach.
"A culture of harm reduction, where the community is stifled from being able to stigmatize the drug, is very dangerous," he said.
Jean Malpas, a gay psychotherapist in New York, has been handling meth-related cases for four years; they now comprise half his practice. He won't condemn harm reduction, but says he has yet to encounter anyone who can use meth recreationally without developing an addiction.
"The behaviors associated with it are so strong," he said. "At some point, when Friday night comes along, they don't know what else to do."
Malpas believes the frankness of the anti-meth awareness campaigns has been invaluable in deglamorizing the drug, yet he sees potential pitfalls. "We don't want to create a split — the good and bad, the users and nonusers," he said. "It's important to build bridges, not divide."
Increased publicity about the gay meth epidemic comes at an awkward time for the national gay-rights movement as it pushes for same-sex marriage rights.
"There is anger at the opportunity this phenomenon is giving the rest of the world to associate the gay identity with promiscuous sex, with out-of-control behavior," Malpas said. "We don't need additional opportunities to be perceived negatively."
Kathleen Watt, who runs the Van Ness addiction-recovery center in Los Angeles, believes some major gay advocacy groups have tried to play down the epidemic.
"They don't want to talk about it," she said. "They're afraid people are going to say, 'Why should we put money into HIV treatment when these guys are knowingly going out and having sex and infecting other people?"'
Matt Foreman, executive director of the National Gay and Lesbian Task Force, said some accounts of the gay meth problem had been "salacious" and "overjudgmental" — highlighting the role of promiscuous sex while underplaying the destructive addictiveness of meth for any user, gay or straight. He praised gay activists for taking the lead in fighting the epidemic, while noting that the debate is complicated because "sexual freedom has been a value of our community."
Foreman and other gay-rights leaders also note that even in the hardest-hit communities, most gay men don't use meth. Estimates have ranged from 10 percent or 20 percent of all gay men, and as high as 40 percent in San Francisco — by any measure a problem that can't be wished away.
"It would be irresponsible for us to look at a challenge and throw our hands up and walk away from it," said Winnie Stachelberg of the Human Rights Campaign, the largest national gay advocacy group.
Perry Halkitis, a New York University psychologist specializing in the study of HIV/AIDS and drugs, says the root cause of meth addiction for many gays is not sex or partying, but deeper problems of isolation and low self-esteem, particularly if they are HIV positive.
"Users are often experiencing mental health problems," he said. "You have this really vicious cycle — HIV, meth, depression."
Experts say many men in this category are experiencing "safe-sex fatigue" — they are tired of using condoms, believe medication can contain their HIV, and are emboldened by meth to forget their difficulties and engage in unprotected sex.
"Meth was the drug that would turn your head off and allow you to have the sex you thought you were missing out on," Kathleen Watt said. "There's not enough people talking about having a healthy sex life without meth, getting away from anonymous bathhouse sex."
At the Callen-Lorde health center, which serves New York's gay community, the staff wrestles constantly with cases involving meth and unsafe sex.
"Safer sex is not everybody's idea of a good time," said Callen-Lorde's executive director, Jay Laudato. "It diminishes trust; it sets a fearful expectation for your life. When you're high, you decide not to make the healthy choice — you think, 'Why should I?"'
The resulting addictions are often disastrous, Laudato said — men lose their jobs, their friends and, because of one alarming side effect of meth, even their teeth.
It's so frightening to see people lose everything and still value this drug," he said. "They'll say, 'Crystal is the only good thing in my life."'
The current prevention campaigning tries to promote the concept of healthy, meth-free sex. Peter Staley's latest ads, for example, feature posters of buff male models, accompanied by the slogan, "Crystal Free and Sexy."
New York City's health department contributed $300,000 last year to support the activists' education campaigns. More money is coming this year.
"When gay men saw their peers' lives destroyed, it was like another HIV/AIDS plague," said Brett Larson, director of the city's office of lesbian and gay health. "This was something they weren't going to tolerate. The community has done an incredible job getting the word out."
One of the celebrities who enlisted in the campaign is John Cameron Mitchell, director and star of the hit film "Hedwig and the Angry Inch." He has hosted a forum addressing meth's role in increasing HIV transmissions.
"I've seen a lot of friends wasting away — they start to look like a ghost and can't even see it," he said. "What we need are intelligent scare tactics, to convince people the drug is uncool."
Such messages may not sway hard-core users, Mitchell said, but should be targeted at gays who might be tempted to sample meth, particularly newcomers to big cities.
"You have a lot of young gay men coming into the city — they were the nerds in high school, the wallflower, the ugly kid," he said. "They feel the city is the place to be sexy, to be a star, and they get a false burst of confidence with a drug like this."
Health officials and activists hope to expand access to treatment programs for meth users and develop better techniques for combatting an addiction that is considered extremely tough to break. Treatment experts say any effective program needs counselors who understand the specific issues faced by gay men.
"Some of these guys need support around the clock — when they're online, wanting to go out and hook up," said Watt. "You have to be able to support them from 10 at night to 4 in the morning."
Internet gay sex sites are a particular concern to anti-meth activists. Staley said at least one major site has been cooperative, displaying health messages amid the dating profiles. Other sites have been slow to help, and personal ads hinting at sex-and-meth parties still appear, though less often than a year ago, he said.
In California, West Hollywood Mayor John Duran has been discussing anti-meth strategies with other players in the gay sex industry — including pornographic filmmakers and sex club operators.
"We're at a crossroads on the meth epidemic," said Duran, who is gay and HIV-positive. "We've reached the point where enough people in the gay community have lost enough friends that it's reached a level of urgency.
"We didn't come through the AIDS epidemic, and the battles over gays in the military and gay marriage, to end up here, a community filled with drug addicts," he said. "We've fought too long and too hard to let this drug take us down."