Fabulous Effects, Disastrous Consequences Stimulant use among Latino gay men in San Francisco

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Fabulous Effects, Disastrous ConsequencesStimul
ant use among Latino gay men in San Francisco

• Rafael M. Díaz, Ph.D.

César E. Chávez Institute San Francisco State
University Funded by NIDA Grant 5 R01 DA12566
We thank Jorge Sanchez, Héctor Carrillo, Andrea
Williams, Edward Bein and the Henne Group for
their contributions to the design and
implementation of the study.
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Introductory Remarks

• To effectively address the issues raised by
  crystal meth use, we need to understand
• The social and cultural context of use
• The subjective experience of users (reasons,
  effects, and consequences)
• The functional roles of crystal meth in gay
  communities at this particular time in history

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Sample Characteristics
N 300 (male, non-heterosexual, Latino,
stimulant user in last 6 months)

• 30 years Median age
• 70 Some college or more
• 38 Unemployed
• 50 Immigrant (including Puerto Rico)
• 21 Mostly Spanish-speaking with friends
• 23 HIV-positive (self-report)

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Self-reported substance use in the past six
months among all screened by venue type (screener
data)
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Reasons for most frequently used stimulant
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Reasons for most frequently used stimulant
(continued)
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Fabulous effects
I feel like invincible, you have so much energy,
you can do anythingyou can have a hard-on that
goes for six hours, you know what I mean?
That particular drug crystal seems to attach
itself to a certain side of the brain that kind
of like stimulates Endorphin production, or
somehow negates emotional, mental and physical
pain.
With crystal I find that I am no longer pudgy
and plump. I feel that Im a little bit more
physically attractive because Im not overweight.
When you have AIDS, you feel like you're slowing
down and you're losing all your senses, ok? And
speed brings them all back and it makes me feel
like I am 16, 17.
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Perceived sexual effects of most frequently used
stimulant
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Sexual enhancement
I felt like it rushed to my brain, I felt my
skin get hot and I felt the desire to have sex
with whoever was around
Sex is better, much better... I go for like nine
hours. Its more passionate.
The intensity, it makes me feel incredibly well.
Yes, the focusing on the sex , the focusing
means unity in all that time when you are having
sex..when Im having sex under those
circumstances theres nothing else to think
about
I become even more hardcore. Sexual risks and
inhibitions are totally gone. I become empowered
in feeling, like, I can take on the world or
anyone that fucked with me. It can be an euphoric
rush. You can feel it in your ass, in your
balls, where it heats them up all of a sudden. It
did help me explore my ass at one point when I
refused to even think I had an ass.
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Assessment of negative impact
I would like to know how your use of most
frequent stimulant (MFS) has impacted your life
in the last year. Please tell me whether this
drug has had a positive or negative influence, or
no influence at all, in the following aspects of
your life, during the last year How has your
use of (MFS) impacted/influenced

• Your physical health?
• Not at all
• Positively
• Negatively
• Both positively negatively
• Dont know
• Decline to answer

• Your mental health?
• Not at all
• Positively
• Negatively
• Both positively negatively
• Dont know
• Decline to answer

• Your relationship with family?
• Not at all
• Positively
• Negatively
• Both positively negatively
• Dont know
• Decline to answer

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Perceived negative impact of most frequently used
stimulant (Any negative)
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Perceived negative impact of stimulantby
frequency of use (Any negative)
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Frequency of stimulant use in the sample
X2 10.13, p lt.01
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Negative impact in last year by drug type and
frequency of use (Negative Impact Scale 0-14 ?
.90)
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Sexual risk in the last 6 months by most
frequently used stimulant
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Sexual risk in the last 6 months by most
frequently used stimulant
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Sexual risk by drug type and frequency of use
(Sexual Risk Scale 0-8 ? .78)
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Social isolation
I enjoyed doing them but at same time I was in
another world... living in a world where at times
you lose all shame, you lose friends, family, you
lose... everything. Sometimes I wouldn't even
make a phone call, all I cared about was getting
high and that was it.
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Progressive isolation in last year by drug type
and frequency of use (Progressive Isolation
Scale 0-3 ? .71)
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Conclusions

• In comparison to Cocaine, Crystal Meth
• more frequently used for sexual reasons
• more powerful sexual effects
• more sexual risk
• more negative life impact.
• There is a strong relation between frequency of
  use and negative life impact Progressive
  isolation is a possible mediator.
• 3. However, increased frequency does not seem
  to explain why Crystal Meth has more negative
  life impact than Cocaine.
• 4. Sexual risk at relatively low frequency of
  Crystal Meth use.
• 5. Community awareness of both fabulous
  effects and negative consequences suggests
  readiness for intervention and prevention.

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(No Transcript)
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Opportunities for Intervention
1. Social Marketing Is it worth it?
2. Helping concerned friends help
3. Culturally sensitive substance abuse treatment
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Reasons for most frequently used stimulant
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Reasons for most frequently used stimulant
(continued)
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Energy

I started doing it cocaine because I was
working hard and when the weekend came around I
was too tired and I said, I dont want to party.
I dont want to even hang out. I was too
tired. So, I thought, I need something that will
keep me awake and kind of alive to, to, to enjoy
the evening. And that was initially my
motivation to do it..
I needed to work many hours, sometimes twenty
hours a day or more, sometimes I wouldn't sleep.
So I would use cocaine to get by and get through
work. I would finish one job and go to another
one, perhaps I had errands to run so I couldn't
sleep and would resort to the cocaine. I would
go back to work and maybe not sleep for two or
three days, but that wasn't for the fun of it, it
was for work. In that case, I did take advantage
of the drug it did serve a purpose for me.
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Sexual Risk
It definitely puts you in a mindset where you
feel safe enough to go somewhere where you
shouldnt normally go, whether youre, youre
going to be the bottom or youre going to be the
top or youre going to be dominant, youre going
to be this or youre going to have sex with
different men all night at a sex club.
I got real high and I got really horny, so horny
that it was out of control. It was very out of
control. Its like I could have fucked forever
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Sexual dissatisfaction/risk
With drugs you start degenerating and you no
longer are satisfied with one personyou want
another and you want more and you want them all
at the same time. So I do see a relationship,
drugs do lead to becoming infected with diseases,
kind of the mindset you fall into when youre
doing speed. That, oh, its okay because hes
probably positive and Im probably positive,
and some people think that and probably dont
even know if they are. So, its just kind of a
cop-out to make it okay.
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Paranoia
I think Im becoming paranoid. Im finding that
Im even less trusting of people. It has to do
with the people that Im associating with now,
that come with it. Theres a lot of people out
there, a lot of guys that are on that phone line
looking for crystal. Theyre looking for drugs
and theyre basically what we call crack whores.
They are out there and they are attractive and
theyre willing to have sex and theyll meet your
sexual needs but theyll show up with no money
and no drugs. I think that it also brings in...
its just bringing in drug addicts, people that I
dont know, strangers off the street. And Im
finding that Im changing my locks on my doors,
Im hiding things when I have strangers over, Im
becoming paranoid and its with good reason
because a lot of these guys dont give a damn
about me or my property.