|
Article Excerpt
Crystal methamphetamine [d-methamphetamine hydrochloride] and its attendant dangers and pleasures have received considerable attention in the Sydney gay community and mainstream press since around 1998. Much of this discussion has been alarmist and of doubtful informative value (e.g., Dow, 2003). This has mirrored much of the popular discussion about the drug among gay communities on the West Coast of the United States, notably San Francisco and Los Angeles (e.g., Heredia, 2003). At the same time, some social and epidemiological research has argued that methamphetamine is implicated in unsafe sexual practices and HIV transmission among gay men (see Clatts et al., 2001). Other dissenting opinions in the Sydney gay community suggest that crystal is manageable in much the same ways as other party drugs, and they caution against singling it out for particular attention in the context of a wider policy commitment to harm reduction by such service and education agencies as community-based AIDS councils.
This article argues that both these positions tend to obscure the particular effects of the drug and the ways in which some individuals' management strategies work and others fail. Despite the considerable popular and scientific interest in the drug, there is little research available that addresses how and why people use crystal. Until now there has been no qualitative research on Australian gay men's use of crystal.
This article aims to make a start in addressing this gap through an ethnographic approach to crystal use among some gay men in Sydney. As attested and demonstrated by various researchers, ethnography is well suited for understanding hidden or hard to reach populations (Adler, 1990; Bourgois, 1999; Koester, 1996; Maher, 1997; Moore, 1993).
The Illicit Drug Reporting System (IDRS) has noted an increase in both use and availability of methamphetamine since 1998 (Topp et al., 2002). The IDRS distinguishes between three forms of methamphetamine in Sydney: a powder form known as "speed"; an oily yellow substance known as "base"; and a crystalline substance known as "crystal meth," "crystal," less frequently "ice," or sometimes "tina" among gay men. In a sample of party drug users (recruited from dance culture and gay and lesbian media) the IDRS reports that over one-quarter had used crystal methamphetamine (called "ice" by the authors) in the six months prior to interview and around 7% had at sometime injected it (Topp et al., 2002). I concur with Clatts et al. (2001) that attempting to reconcile chemical descriptions of drugs with street names is very difficult. Sydney gay men distinguish clearly among various forms of amphetamine, including crystal, and use them in different ways and contexts. Thus whether the substances are pharmacologically different or not, they have different effects related to these contexts. I have followed the nominal lead of my participants on this count.
A number of surveys of Australian gay men have pointed to higher levels of illicit drug use, particularly party drug use, than in the general population. They have also found that gay men are more likely to inject drugs than members of the general population. In one study of Melbourne, Sydney and Brisbane gay men recruited through advertisements in the gay press, 78.3% of the Sydney cohort (n=733) had used an illicit drug in the six months prior to interview, half (54.8%) had used a "party drug" (psychostimulant or hallucinogen), and 10% had injected drugs in that period (Knox et al., 1999). These figures contrast with a general population household sample of mixed gender (and presumably sexuality), where the prevalence of any illicit drug use was 16.9% in the 12 months prior to interview and 6.3% for party drugs (AIHW, 2003). Despite the differences in sampling techniques and the lack of data on sexuality in the national sample, these differences are indicative. Knox et al. (1999) also found higher rates of HIV infection among men who had injected, leading them to speculate that injecting drug use may form part of an HIV positive subculture. Grierson et al. (2002) lend support to this notion with the finding that 25.8% (n=898) of a national sample of HIV positive people (79.4% of whom were gay men) had ever injected an illicit drug, while half that number reported having done so in the 12 months prior to interview. This finding is replicated in another sample of HIV positive people (82.3% gay men, n = 425) drawn from Sydney and Melbourne, where 14.2% report injecting drugs in the six months prior to interview (NCHSR, 2002).
A number of researchers have suggested that illicit drug use is normative among gay men in Australian cities (Knox et al., 1999; Ireland et al., 1999; Southgate and Hopwood, 2001). Knox et al. found that very few men (50/1438) had ever used heroin. Given the IDRS reports of the virtual disappearance of amphetamine in favor of methamphetamine in recent years (Topp et al., 2002), it is reasonable to conclude that a significant proportion of injecting occurring among Australian gay men, both HIV positive and HIV negative, involves methamphetamine.
The use of methamphetamine is reportedly associated with a number of potential harms (Degenhardt and Topp, 2003), including psychiatric problems such as psychosis and violent episodes (Buffenstein et al., 1999; Volkow et al., 2001; Yui et al., 2001; Kalechstein et al., 2000), addiction and neurological and cognitive impairment (Simon et al., 2002) and social and financial problems (Wermuth, 2000; Klee and Morris, 1997; Joe-Laidler and Morgan, 1997). Drug injection is also associated with various potential harms including HIV and hepatitis C infection and various skin and wound infections (CDC, 2001; Murphy et al., 2001; Molitor et al., 1999).
While researchers suggest caution in relation to self-report of hepatitis C (HCV) seropositivity, as respondents often confuse the different hepatides (Van de Ven et al., 1999), some picture can nonetheless be gleaned from existing survey data on gay men. In a national sample of HIV positive individuals, 13.9% reported they had been diagnosed with hepatitis C (Grierson et al., 2002). In a national survey of homosexually active men, 11.3% of HIV positive individuals reported co-infection with HCV (Van de Ven et al., 1999).
Although the risk of sexual transmission of HCV is generally regarded as small, and debate continues on this issue, some literature that addresses HCV transmission among gay men supports the view that sexual transmission is possible. It suggests that transmission may be more likely to occur in unprotected anal sex than in vaginal, more likely to occur from the insertive partner in anal sex to the receptive partner, and more likely to occur in individuals infected with HIV due to the fact that HCV viral load is elevated in co-infected individuals (Bodsworth et al., 1996; Brook, 2002; Eyster et al., 1994; Fletcher, 2003; Filippini et al., 2001; Giuliani et al., 1997; Ndimbie et al., 1995, 1996; Nerurkar, 1998; Rooney and Gilson, 1998; Terrault, 2002).
Various studies in the United States report that gay methamphetamine users often take the drug in sexual contexts in order to enhance sexual pleasure (Halkitis et al., 2001; Semple et al., 2002, 2003). The use of drugs for sex among Australian gay men has been noted by at least three studies. Lewis and Ross (1995) outline sex and drug use practices at gay dance parties. Ireland et al. (1999) provide a useful distinction between the use of Ecstasy for "soft" sexual practice and the use of amphetamines, especially when injected, for "hard" sexual practices that include anal intercourse, esoteric practices, and multiple and extended sexual sessions. Kippax et al. (1998) have associated the use of recreational drugs for sex with cultures of sexual adventurism and increased risk of HIV infection.
Among the many studies that have looked at the question of HIV sexual risk in the context of illicit drug use, only a small number have specifically examined the use of crystal methamphetamine. Notably, these studies all associate crystal use with increased sexual risk taking (Bull et al., 2002; Frosch et al., 1996; Halkitis et al., 2001; Molitor et al., 1998; Paul et al., 1993, 1994; Reback and Grella, 1999; Shoptaw et al., 1998, 2002; Stall et al., 2001). In Sydney there has been a steady rise in the proportion of gay men having unprotected sex with casual partners between 1996 and 2002 (Hull et al., 2003) and an increase in the number of HIV infections (NCHECR, 2003).
Only one study has specifically explored the practices and social contexts of Australian gay men's drug use (Southgate and Hopwood, 2001). Crystal methamphetamine is covered, but only in non-specific fashion, as data were gathered in 1997-1998, before the drug became widely available and popular. However, other findings are relevant. The authors argue that Sydney gay men have developed various strategies for managing drug use and reducing associated potential harms. They specifically point to three aspects of this: the normalization of drug use in the Sydney gay community; the existence of "folk pharmacologies" that allow the circulation of harm-reduction knowledge; social networks and particular individuals within those networks that facilitate the flow of folk pharmacologies. Southgate and Hopwood (1999) argue elsewhere that drug use does not directly produce an increase in sexual risk taking among their sample of "non-problematic" drug users, but they do acknowledge that "coming down" off drugs is associated with sexual risk for some.
These studies have been unable to offer any detail about crystal use among gay men. This paper reports ethnographically on some of the social and cultural characteristics of Sydney gay men's crystal use and associated practices and their meanings, at both individual and social levels.
Methodology and sample
Many researchers in the illicit drugs field use ethnography as a way to put meat on the bones of statistical or epidemiological findings, doing this through the use of participant observation (Bourgois, 1999). Others use participant observation in very circumscribed forms (e.g., Power, 2002). Frequently participant observation seems a vague term, as the fieldwork involves only tenuous social connection to the worlds being studied. This is not to deny that direct observation of field situations is a valuable experience for all researchers, especially for those unaccustomed to direct contact with study participants. However, such practice is not necessarily ethnographic fieldwork, and it does not constitute, on its own, ethnography. The latter, according to Agar (2002), contains epistemological implications as well as suggesting certain methods. Thus in addition to extended time spent in the field developing ongoing relationships with participants, ethnography also theoretically reflects on culture and social structures and the effect of these on the production of meaning (Ortner, 1999). Additionally, over the past two decades, anthropology has moved toward more reflexive field engagements and writing processes (Clifford and Marcus, 1986). A small but excellent body of research in the drugs field has taken up the challenge to produce more theoretical and reflexive texts (e.g., Bourgois, 2000; Fitzgerald et al., 1999; Fraser et al., 2004; Vitellone, 2003a, 2003b). This notwithstanding, most social science research in the drugs field is limited in its theoretical engagement (Bourgois, 1999).
Fieldwork for this project commenced in April 2000 and concluded in September 2002. In mid-2000 I leased a small apartment in the center of one of Sydney's street drug markets, Kings Cross. I had read Philippe Bourgois's (1995) ethnography of the East Harlem drug scene, and, like much ethnographic fieldwork, moving to another place and getting to know the locals seemed a reasonable approach. In the end it did not produce the kind of entry to the field I had hoped for. Some of the barriers were related to doing anthropology "at home," insofar as I was not sufficiently different from other residents in the area whose relationship to the drug scene was structurally mediated by factors such as class. I found that I came to occupy a social space within the local milieu that was very difficult to reach beyond. The most significant difficulty, aside from structural barriers, arose from the transience of the drug scene. Drug users and dealers would commonly pass through the area, do business, sometimes use drugs, and return to their residences, often in distant suburbs. Located as a resident with a sampling frame to match, I missed the opportunity to...
|
