“A wake-up call”

In February 2005, officials from the New York Department of Health and Mental Hygiene called a news conference to report that a resident infected with a highly drug-resistant and "aggressive" strain of HIV had progressed to full-blown AIDS within just months of diagnosis, raising the spectre that a hard-to-treat variant of the virus could be spreading, particularly among promiscuous meth users.

Diagnosed with HIV in December 2004, health officials said the 46-year-old man – who used meth about once a month over the past five years, escalating to every weekend in 2004 – reported having unsafe anal sex with over 100 partners he met online and at Chelsea's notorious West Side Club bathhouse during the previous fall, including two occasions when he was the recipient of unprotected anal sex, which was not his usual practice.

While the department has yet to conclusively confirm whether or not their original prognosis was correct, it did highlight "disturbing behaviour patterns" revealed by its investigation into the patient's recent sexual history. "The social network surrounding this case indicates that unsafe, anonymous sex, along with the use of illicit drugs including crystal methamphetamine, remains common," it said.

"It's a wake-up call to men who have sex with men," said the department's Commissioner, Dr. Frieden, at the height of the scare, "particularly those who may use methamphetamine.

"Not only are we seeing syphilis and a rare sexually transmitted disease – lymphogranuloma venereum – among these men; now we've identified this strain of HIV that is difficult or impossible to treat, and which appears to progress rapidly to AIDS. This community successfully reduced its risk of HIV in the 1980s, and it must do so again to stop the devastation of HIV/AIDS and the spread of drug-resistant strains."

Dr. Frieden was accused by HIV agencies and activists of using scare tactics with the intention of shocking gay men into practising safe sex, while some community leaders expressed a vehemence of denial not seen since the early 1980s when the first cluster of AIDS victims were reported to be exclusively among MSM.

Awaiting the outcome of the ongoing investigation, Dr. James Braun, president of the Physicians Research Network – which represents clinicians who treat tens of thousands of HIV/AIDS patients – said that the transmission of a treatment-resistant strain of HIV was "a disaster waiting to happen, particularly in communities where safer sex is not practiced regularly, and in light of people using drugs like crystal meth", an opinion echoed by New York University psychologist Dr. Perry N. Halkitis – "This is what we were fearing all along" – and others who have long predicted the emergence of a supervirus resistant to the existing AIDS drugs.

"You can't have a core group of people having sex with large numbers of people without amplifying any sexually transmitted disease that enters the system. I don't have any doubt that a resurgent HIV epidemic will hit the gay population in the near future."
~ Gabriel Rotello [author of Sexual Ecology: AIDS and the Destiny of Gay Men]

Dr. Jeffrey D. Klausner, the director of sexually transmitted diseases for the San Francisco Department of Public Health, publicly stated his belief that meth, and not the HIV virus itself, was to blame for Patient Zero's rapid acceleration to full-blown AIDS, as the drug is known to drastically lower CD-4 cell counts.

With such an alarming picture emerging from the twilight world of meth-fueled sex, gay rights groups and HIV prevention workers expressed anguish and dismay that the 25 year fight against the disease appears to be lost.

Fearing that aggressive government intervention might ensue in light of the publicity surrounding the New York case and unless recklessly promiscuous gay men quickly change their behaviour, some are advocating a radical approach to the spread of crystal meth-induced unsafe sex; directly targeting those who knowingly engage in such behaviour and attempting to stop them before they can infect others. This could involve showing up uninvited at sex venues and confronting patrons head-on, or infiltrating web sites and thwarting liaisons that involve meth. "It makes a community stronger when we take care of ourselves," says Ana Oliveira, executive director at GMHC [Gay Men's Health Crisis], "and if that means that we have to be much more present and intervene with people who are doing this to themselves and others, then so be it."

"Gay men do not have the right to spread a debilitating and often fatal disease. A person who is HIV+ has no more right to unprotected intercourse than he has the right to put a bullet through another person's head."
~ Charles Kaiser [Historian and Author]

Others are sceptical of such an approach, which would have been unthinkable in the pre-meth AIDS era when gay men protested state efforts to close bathhouses and vigorously fought attempts to trace those infected with HIV. "That was the era when Jesse Helms and others were saying that gay people got what they deserved, and that the government shouldn't spend any money to help them," said David Evans, an HIV prevention advocate. "There was a time when people thought, Oh my god, they're going to put us in camps!"

"We don't want public health vigilantes going out and taking matters into their own hands, particularly if it means breaching the confidentially and civil rights of people with HIV. Frankly, I find it pretty scary."
~ Jon Givner [Director of the HIV Project at the Lambda Legal Defense and Education Fund]

Walter Armstrong, editor-in-chief of POZ magazine, suggested a more sensitive, interventionist-based approach involving gay organisations using traditional public health measures, such as more widespread screening and a partner-notification effort to track recently-infected meth users. "Why would it not be possible to get them together to communicate to each other, and then to their sex partners, that lives are being put at risk by reckless behaviour?" he wrote.

Walt Odets, a clinical psychologist, thinks such a move would smack of a witch hunt, preferring instead to identify the underlying causes of drug abuse and self-destructive behaviour, including the paradox of living in a society that rejects committed gay relationships while condemning gays for having sex outside those relationships. "Gay men," he said, "are using methamphetamines as an anti-depressant."

Ongoing adverse coverage of the role meth is playing in the lives of MSM risks igniting a backlash among New Yorkers fed up with the inconsiderate behaviour of abusers, not least from within the gay community itself. Wrote one embittered Chelsea resident in the New York Blade: "The WMD are in the back rooms, no pun intended, and guess what? I am sorry that I have already sent my year-end contribution to GMHC… The world is over-populated so a not fond farewell is wished to you all."

"It is just a sin when we know how [HIV] is transmitted from one person to another. [They] should be able to conduct themselves such that they don't catch it themselves, and certainly that they do not infect anybody else."
~ Michael Bloomerg [Mayor of New York City]

• Recent studies suggest that up to a quarter of new HIV infections in the US may be with drug-resistant strains – up from 13% ten years ago – with 8-20% resistant to one drug class, and 1-4% multidrug-resistant.