Syphilis has made a major comeback among MSM in America – several years after rates had declined so low that a strategy had been formulated to eliminate the STI by 2005.

For the seventh year in a row, the rate of secondary and primary syphillis infection across the US between 2006 and 2007 increased by 14%, to 11,181, with MSM comprising approximately 64% of cases compared to only 5% of all reported cases in 1999. Syphilis rates are up to 4.9 times higher among crystal users, while men who use meth and Viagra together are 6.1 times more likely to have syphilis than those who used neither drug. Syphilis sores and other STDs increase the chances of HIV sero-conversion two to five-fold and can cause bigger than usual drops in CD4-cell counts and greater increases in viral loads in those infected with the virus, according to a report in the journal AIDS.

In New York City, syphillis rates soared 62% in 2007, almost exclusively among MSM. Two-thirds of New York-based MSM infected with both syphilis and HIV are known to engage in unsafe sex. With the risk of syphilis spreading via bisexual men into mainstream society, several cities including Los Angeles have aimed syphilis campaigns on web sites and billboards at heterosexuals, despite the surge in syphilis and HIV transmission since 1998 being linked to the rapid spread of crystal meth among MSM, which continues to go largely ignored and unchallenged.

Official rates of syphilis and HIV infection in countries where crystal meth usage among MSM is rife clearly do not tell the whole story. 

A sizeable minority of gay men actively seek out and indulge in behaviours destructive to themselves and others. Anecdotal evidence strongly points to crystal meth being embraced by such individuals, despite knowledge of where using the drug can lead, and who are least likely of all MSM to voluntarily take an HIV test. In Australia, it is estimated that 70% of MSM meth users never get tested, while in London, a 2005 study reported that more than five times as many HIV+ men with multiple sexual partners use crystal than HIV- men. Some users simply don't recognise the symptoms of seroconverting as their systems are too wasted and ravaged by meth.

"I think many gay men have this kind of built-in self-
destruct button. After years of sexual frustration and really low-grade discrimination, it stores up somewhere and some drugs can really release that…"
~ Rufus Wainwright [Singer / Songwriter]

Gay journalist David Evans, writing in POZ magazine, suggests that around 5% of HIV+ gay men keep a particular community's "viral wildfire" burning, and that the 95% of HIV+ gay men who fall outside of these "hot spots" typically have little effect on driving the epidemic. "It's long been known that some contribute much more to the spread of HIV than others," he says. "Ignoring that fact hampers our ability to slow HIV/STD transmission," he says.

However, crystal is considerably exacerbating the numbers of otherwise responsible, self-respecting gay men who are linking up with the 5% core group, many of whom are rapidly seroconverting. A case in point is New York's "Patient Zero", [see "A wake-up call"] who suddenly found himself pulled into the high-risk "twilight world" of meth, saunas, sex parties and internet hook-ups. "If community-based prevention, including condom and clean needle distribution, can be said to be a failure, it is precisely because it has failed to adequately reach this crucial 5%," says Evans. "Science has advanced us a long way from the old notion that everyone is equally at risk and responsible, but prevention has yet to catch up."

This nucleus of risk-taking individuals are also among those most likely to resort to injecting, or "slamming", crystal meth. "Slammers are a special breed among us," wrote Christopher Murray in New York Blade in April, "who push the envelope of what is acceptable among gay men, and who may help us understand the outer limits of behaviour that symbolises tensions that all of us share." During his research, one slammer told Murray that, in his opinion, "the prevalence of injecting meth is in direct relation to where gay culture is at," implying that the intense feelings of being an outsider – combined with the difficulty many gay men experience accessing intimacy – are instantly overridden by shooting meth, an act which merely "confirms the uniqueness of the loner mystique."

Clearly, HIV transmission figures don't take into account how STDs are being indiscriminately passed on within this subgroup, and to those who overlap within it.

Falling outside of the reach of research and studies conducted to determine the extent of risky sexual behaviours, despite being key players in the virus' spread – particularly via men who occasionally stray or crossover into their world, or those who also have sex outside of the core group – some regard HIV as a self-fulfilling prophesy and openly profess to having a "death wish", and a few are even vocal in their intent to bareback regardless and "to take as many others as possible down with me" [sic].

"People with HIV alone do have the power to stop new infections," asserts David Evans, "and not only through facing fears of disclosure and always protecting sex partners, as profoundly important as those are. The personal responsibility that is increasingly focused on all HIVers also offers the chance for our community to be leaders once again in prevention. Failing to do so, we risk being scape-goated – lumped together by an AIDS-weary, moralistic nation as reckless infectors… The ugly truth is that our epidemic is still driven by sexual promiscuity and drug addiction. As this news gets louder and more public, you needn't be psychic or paranoid to predict Jerry Falwell and James Dobson giving impassioned speeches, run hourly on Fox news, to criminalise gay sex in the interests of national secuirty.

"Failing to reach – and reach out to – the most despised and irresponsible among us will lead to retribution against all HIVers."

Craig Hayworth, the Director of Services at Callen-Lorde in New York City, acknowledges the frighteningly intensive role crystal meth is playing in the dramatic increase in HIV infections. "Much of the evidence is anecdotal," he told HX magazine last year, "but we know that almost 75% of our patients newly-infected with HIV say crystal meth use played a part in their engaging in unsafe sex." A 2003 survey by New York City's Department of Health and Mental Hygiene found that only 45% of men who had sex with men reported using condoms.

"Few of us would ever admit it, but many HIVers consider the virus a gift certificate – a pass to unlimited pleasure. Some think they've earned the right to unprotected sex."
~ River Huston [POZ magazine]