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New-Fill
on "Hold" ad Open-label for T-20
Unprotected
Sex Dangers: Barebacking
Pursuing
Pleasure Through The Use of Recreational Drugs: Hidden Dangers
HIV
Positive Women Have Higher Risks for Developing AIDS
Cigarette
Smoking
New-Fill
on “Hold” and Open-label for T-20
by Daniel
S. Berger, MD
New-Fill Use
Halted
Over the last several months countless numbers of HIV-positive individuals
have had their spirits lifted, their morale boosted and their self-confidence
improved. This was because a synthetic product called poly-lactic
acid under the trademark New-Fill became available for personal
use in the United States. New-Fill reversed many disfiguring facial
abnormalities for many individuals; facial lipoatrophy changes are
due in part to HIV drugs and HIV disease. Actually New-Fill has
proved safe through clinical trials outside the US and has been
shown to be effective for HIV-positive individuals with facial lipoatrophy.
As a result, many HIV-positive individuals sought out treatment
through a limited number of centers that were approved to administer
the product. The product’s sale and use was administrated by
DAAIR, a respectable buyers club based out of New York City. Further
detailed background information regarding New-Fill can be found
in my previous article from the September/October 2001 issue of
Positively Aware and on the www.AIDSInfosource.com web site.
After several months of smooth sailing with primarily trained plastic
surgeons, almost by surprise, the FDA interceded and halted its
use. A recent comment made by an unnamed HIV practitioner was “it
appears that the FDA managed to find a loop hole ‘vehicle’
by which to interfere with personal wishes of individuals who suffer
from the devastating facial side effects of antiretroviral therapy.”
Clearly it was the FDA themselves whose policy allows treatment
for personal use, given that a drug is approved outside the US.
The October 26 action of the FDA halted all further distribution
of New-Fill in the U.S.; therefore, the buying club DAAIR was in
effect ordered to not release any more product for shipment—this
included shipping New-Fill to those that had already initiated treatment
and were still in the process of having the 3-7 administrations
needed for New-Fill to be completely effective. DAAIR is guardedly
confident that it can fulfill all shipments of product for those
patients previously initiated into treatment with New-Fill prior
to October 26th; however, at this time they cannot ship product
to anyone who would have started the procedures post 10/26/01.
The FDA decision was made by a small group of Directors within the
FDA, from such areas as Personal Use and the Division of Compliance.
The FDA based their decision to halt distribution of New-Fill on
the technical terms of their guidelines of allowing availability.
Originally, New-Fill was allowed to be accessed by PWAs under the
“personal use guidelines.” These guidelines permit use
of drugs not yet approved here (but approved in other countries)
and for the treatment of one of several qualifying illnesses determined
by the FDA. Persons suffering from these illnesses (such as AIDS)
can import a drug into the U.S. for their individual personal use.
The FDA then decided, upon further examination, that since New-Fill
required the expertise of a trained physician and/or plastic surgeon
that it no longer should be considered a personal use drug. Moreover,
the FDA maintains that as New-Fill does not remain in full control
of the individual utilizing the product, it should be re-categorized
as a medical device.
The FDA does not allow for medical devices to be imported for personal
use—all medical devices must be approved prior to use. The
example the FDA gave was as follows: This situation would be similar
to an artificial heart that was available in Europe but not yet
approved for use in the U.S. The FDA would not allow anyone to import
that artificial heart and subsequently would not authorize any surgeon
to transplant said device—if that individual wants to access
that artificial heart they must travel to Europe and have the procedure
done there. The FDA did acknowledge that they would consider a treatment-IND
(Investigational New Drug) protocol for New-Fill (a clinical trial)—however,
this typically is itself a large administrative burden that can
take minimally 3-6 months to complete and is usually done by the
sponsoring pharmaceutical company.
Many medical specialists can state with confidence that New-Fill
indeed is not a “device.” Yes it requires someone to inject
the product, but linking this to heart transplant surgery is quite
a stretch. The product comes in a vial such as many other drugs
and is simply reconstituted with sterile water or saline, like other
drugs. It is drawn up in a syringe and injected. This does not require
any sophisticated or mechanical devices or apparatus.
New-Fill has been approved for use in France and Mexico. Safety
and effect studies performed satisfied the French requirements for
approval. Additionally, several studies reported the use among HIV-positive
individuals. Those reports were presented at the 2nd International
Workshop on Adverse Reactions and Lipodystrophy in HIV in Toronto
in September 2000 and the 8th European Conference on Clinical Aspects
and Treatment of HIV Infection in October 2001 in Athens.
As mentioned, DAAIR remains guardedly confident that it can fill
all necessary prescriptions for product to those that had initiated
treatment prior to 10/26/01. DAAIR is looking at various avenues
within FDA guidelines and is attempting further inspection of this
issue. If the FDA’s edict is left to stand, many affected persons
will be wronged and deprived of a procedure that can potentially
change their quality of life.
DAAIR is experiencing significant slowdown and problems. During
this writing plans are being set up for a meeting with the FDA.
In this meeting Martin Delaney of Project Inform, DAAIR management,
and I with other interested parties will hope to clear up some of
these issues. Additionally, clinical trials with New-Fill for a
“lipoatrophy associated HIV disease” indication are on
the discussion table. I will try to keep you all posted on the www.AIDSInfosource.com
website as well as in further issues of my column in Positively
Aware.
T-20, Trimeris/Roche Open Label
Trimeris and Roche teamed up to offer a new open label study for
the administration of T-20 to the most needy of HIV positive patients.
T-20 is a novel antiviral, first of a new class of fusion inhibitors
(blocks fusion of HIV to CD4 T cells). This was not an expanded
access program, but an open-label safety study and was severely
limited to 168 patients nationwide.
The program was initially announced on 11/07/01 and details of the
protocol and its operation posted on the Trimeris web site. Additionally
the companies announced that for “the letter distributed to
doctors concerning the initiation of the study, visit the following
websites: www.rocheusa.com or www.Trimeris.com.” However as
a physician who prescribes HIV medications, neither I nor the other
physicians in our clinic have ever received such a letter. We have
also spoken with several other community-based HIV physicians, none
of whom received any letter.
The wire news story announced that a phone line would open at 3
PM EST on November 27th for up to 56 physicians who would be allowed
to sign up as investigators and enroll three patients each. The
criteria for enrollment was CD4 T cell count <50 cells/mm3 and
viral load >10,000. First preference would be given to those
with a recent opportunistic event while on an anti-HIV regimen in
the last 90 days. However, I attempted to get through by telephone
to register, getting a busy signal and at times no response. I kept
trying. Finally getting a recorded message that stated, “We’re
sorry, enrollment is now full.” We were later told that the
program closed in less than 20 minutes of opening.
Alex Dusek, Director of Marketing at Trimeris stated that this was
their attempt to “serve the community in the most equitable
manner” and “seeking the advice of many other people.”
As much as we appreciate the efforts of Trimeris and Roche to increase
availability it remains that a majority of advanced patients were
not served.
If these were
the Rolling Stones tickets that were on a first come first serve
basis, I could understand handling it this way. However, unfortunately
the honest reality is that many individuals’ lives are at stake.
When protease inhibitors were in Phase III of development (1994)
a lottery system of patient chart numbers was set up through physicians’
offices and sponsoring pharmaceutical companies. Those programs
provided a fair chance for all patients to receive drug. In contrast,
the Trimeris/Roche program favored larger institutions that could
afford to place a dedicated employee on the phone that day and dial
as many times as needed to get connected. We were told that no comment
can be made as to whether several institutions or sites enrolled
more than 1 physician and potentially took up more than their share
of very few spaces.
Mr. Dusek of Trimeris reiterated that a complicated manufacturing
and production process limits supply. I encourage Trimeris to provide
wider availability for patients with limited treatment options.
During the recent years of development, T-20 access has been greatly
restricted. I hope that without too many delays Trimeris and Roche
will offer an expanded access program.
Daniel S. Berger, M.D. is Medical Director of Northstar Healthcare
and Clinical Assistant Professor of Medicine at the University of
Illinois at Chicago and editor of AIDSInfosource (www.aidsinfosource.com)
He also serves as medical consultant for Positively Aware. For further
inquiries Dr. Berger can be reached at DSBergerMD@aol.com or (773)
296-2400.
Unprotected
Sex Dangers: BAREBACKING
by Gregory M. Sarlo, Psy-D Doctoral Licensed Clinical Psychotherapist
While on my
merry way of surfing the net for new information, I went into a
few chat rooms and visited a few web sites anonymously. I found
out that every Friday and Sunday night in San Francisco and in our
own home town in Chicago, somebody named Marshall and Mark host
a party for other gay men who share a similar sexual interest: No
condoms required. If I were to attend, admission is $8 dollars.
After paying the eight dollars, I would be handed literature stating
that this was a barebacking party, the house rules would read as
follows: It is assumed that all guests are HIV positive and made
the decision to attend this party. There would be no discussion
of status, illness, or medicine. Partygoers must also sign a statement
of their intention not to infect anyone with HIV, whether or not
they mean it. This relieves the host of any responsibility under
the new law that criminalizes HIV transmission.
Recently I discussed
this with someone who has attended such a party. He gave me the
low-down on what follows. After he signed in, he was instructed
to take off his clothes and stuff them into a bag labeled with his
first name and last initial, with a sense of trepidation, he proceeded
downstairs into a large bedroom occupied by dozens of men in various
positions of sexual activity. There were no condoms in sight.
Since its public
debut over three years ago, barebacking also called raw skin-to-skin
sex has been simultaneously condemned and sensationalized by the
media. The debate is stuck between two hyper-polarized camps, with
anti-barebackers screaming, Г’Dangerous Sex FiendsГ“, while barebackers
counter with Г’Condom NazisГ“. Meantime, a new sexual subculture has
emerged, organized around a new no-condoms creed. Driven underground
but swelling in numbers, this community flourishes in private houses
and especially on the Internet, where itsГ• members not all purported
to be HIV+ can fantasize, experiment, and connect with others, free
from the stigma attached to openly soliciting unsafe sex.
The notion that
the new drugs may be contributing to a climate of sexual dys-inhibition
became a media phenomenon last summer after Michelangelo SignorilesГ•s
article, Г’Bareback and RecklessГ“ which appeared in the July issue
of Out Magazine. Many have excused themselves by claiming HIV is
a manageable disease. The following month, the New England Journal
of Medicine published a letter suggesting that protease inhibitors
have altered the perception of perceived risk of contracting HIV
for many gay men. Twenty-six percent of the men surveyed reported
being less concerned about becoming HIV-positive because of the
new treatments. Fifteen percent had already had unprotected anal
sex because of their decreased concern.
Dramatic reductions
in viral load as a result of the new treatments could create new
rationales for unprotected sex. Wishful thinking may lead some men
to conclude that undetectable levels of the virus in their blood
is equivalent to being HIV negative. The new treatments have led
some men to conclude that the consequences of HIV infection for
themselves or their negative partners have been minimized. Michael,
webmaster of XtremeГ• Sex, a barebacking web site, says that now
HIV is merely a minor inconvenience and that is not the catastrophe
Г’negativesГ“ think it is.
Since the start
of the epidemic, individuals who are positive or negative were advised
correctly regarding the necessity of using condoms during intercourse.
This is also prudent if both partners are positive. . Some individuals
express that the dangers of re-infection arenГ•t actually proven
but better safe than sorry. Physicians explain the risks of re-exposure
to HIV; their disease can become complicated with resistant virus
and result in further progression. Further infections can also impose
trauma and immune stress.
But despite
their doctorsГ• reservations, many HIV-positive people reject this
advice and donГ•t use condoms for positive-positive sex because they
have not seen the evidence or danger hit them in the face. Of course,
unprotected sex between people who are HIV-positive can be dangerous
for other reasons. Other sexually transmitted diseases can threaten
your health other ways. It has been shown that pus cells from other
STDГ•s are loaded and heavy with virus and HIV. Additionally, one
can become infected with Hepatitis C, of which currently there is
no existing effective treatment. Persons co-infected with HIV and
Hepatitis C are left with potentially having to face liver cancer
and cirrhosis, down the road.
It has been
difficult for many to have a quiet, rational discussion about this
topic. For many, barebacking pushes emotional buttons. The issue
is compounded lately by the sensationalizism and often misrepresentation.
It is no secret that barebacking is a sensitive and complex issue
that carries with it emotional baggage. While barebackers seem to
represent a distinct minority of gay men who have unprotected sex,
their reasons for doing so are irrational despite that many gay
men share the desire, consciously or not. It has been stated to
me that barebacking is the ultimate act and sharing virus with others
is a sexual Г’highГ“. One feels sorry for persons thinking this way:
why canГ•t they derive sexual pleasure in a way that is not medically
injurous? How can they believe that the ten years of medical hard
work and research will bail them out? One example patient in San
Francisco, who physicians published his case in the prestigious
New England Journal of Medicine, was not able to be bailed
out.
He failed every
possible cocktail available, since the newly infected HIV was resistant
to all available antivirals. How many barebackers are HIV-negative?
In the terminology of barebackers, there are gift givers, persons
who seek to infect others with HIV, and bug chasers, who want to
get infected and join the viral brotherhood of man. Naturally this
is the most ridiculous form of logic proposed by barebackers. One
client mentioned Г’In a way itГ•s a relief,Г“ he says, echoing a sentiment
heard too frequently from newly infected men. Г’I donГ•t want to wonder
anymore. That awful waiting is gone. So now, if I do find someone,
the relationship can be 100 percent real with nothing in the way.
ThatГ•s what I want: 100 percent natural, wholesome and real. Maybe
now that IГ•m HIV positive, I can finally have my life.Г“ These individuals
with these sentiments donГ•t understant the sadness, pain and side
effects that HIV positive individuals have to endure, day by day.
They donГ•t understand the dramatic consequences and change that
occurs in the struggle of individuals to survive with their HIV
status and remain healthy despite their HIV infection and damaged
immune systems. This is not a joke.
There are also
those who are HIV negative who are riding bareback who feel that
the protease inhibitors provide them with the impetus to ride bareback.
There are those who take on attitudes that post-infection they can
take on the new drugs and their life will be fine. Those individuals
appear to have no concern for the facts: the drug regimen can be
excruciating for some, they can be taking up to and over twenty
pills a day; the cost of the drugs is exorbitant; no one knows how
long the antivirals will be effective at controlling HIV or the
possible damage to the body over prolonged periods of time; there
are substantial number of individuals who cannot tolerate the drugs
and for some the drugs are ineffective; the virus can mutate around
the drug and create a strain of HIV that is drug resistant, and
further it is likely that there are drug resistant strains floating
among the community now. They fail to realize those patients who
are still getting sick, and some individuals are still dying, despite
all the technology. With these considerations, safer sex is more
important now than it was ever.
From a psychological
point of view, the man who stops at the neighborhood bar after work
to unwind feels more relaxed after a few drinks. Now he can laugh
or cry freely neither of which he could release without a drink.
Similarly, risky sex is a means of suppressing affect or emotion
and release of what is tightly controlled or suppressed.
When promiscuous
and risk taking sexual activity in our community is used as oneГ•s
only available means for release, the pursuit of sex increasingly
becomes governed by itself. Often gay men can become addicted to
the risk taking. In the case of barebacking, an individual can become
addicted to an intense level of excitement or risk which requires
varied and changing new sexual partners or objects that in turn,
will pay off in perpetual thrills. . So sexual behavior can start
out as being completely safe from mutual masturbation and accelerate
to more risky behaviors such as barebacking. This occurs when the
object is found as no longer exciting. At this point there becomes
an incessant search of higher levels of excitement and thrills.
Unfortunately for many the quest for excitement at this point may
begin to dominate oneГ•s life. It may overshadow even strong ties
of enjoyment in the most enduring relationships. All other affects
become eclipsed in the endless pursuit of greater thrills. Only
the perpetual excitement suffices, and that hunger governs the quest
for new sexual partners and more riskier sex. Similarly like the
drug addict or alcoholic who has a near death experience before
ending up in treatment.
Nevertheless,
even within the barebacking community there seems to be guidelines,
but one questions these so called Г’guidelinesГ“. By no means can
any rationale professional endorse these behaviors, or pretend that
medically these precautions are effective. These so called guidelines
have included: not using poppers because they dilate blood vessels
in the body making it easy for transmission; always use plenty of
lubricant to help prevent small tears in tissue and Г’pulling out
earlyГ“ in the hopes of not transmitting HIV. Some ration the barebacking
experience to limit exposure; some use after-care by washing so
that you donГ•t trap bacteria and the virus; monitor health care
immunity, remember the more stressed, the influence of alcohol or
other drugs, fatigue, sleep deprivation, or being ill, increase
the chance of becoming infected. We encourage individuals to talk
with a professional in the medical field or discuss them with your
favorite psychologist in an effort to explore the underlying motivation
behind such behavior as barebacking. But, as this article has pointed
out, if there isnГ•t anything to fear, according to those who bareback,
then why the need to impose some of these so called precautions?
Are these individuals fooling themselves or are they the fools?
Take your pick.
Pursuing
Pleasure Through The Use of Recreational Drugs: Hidden Dangers
The weekend
is coming. You hear about a circuit party happening over the weekend.
Some of your friends are intending to go. ItГ•s been a hard week.
You are looking for an outlet to let go and to have some fun. The
image of hot men, muscles bulging beneath tight shirts and jeans,
bodies moving to the sounds of club music, excites you. Your mind
explores the possibilities- dancing, sweating, grinding all night
in a club filled with men. How can you pass up the opportunity?
You say Г’yesГ“to your friendsГ• invitation to join them.
In the past,
few people with HIV would entertain the possibility of attending
a party lasting all night, often across several weekend nights.
Recent medical advances in the treatment of HIV, however, have improved
the health status of people impacted by the disease. People with
HIV are living longer and better quality lives. PeopleГ•s time, energy,
and attention, previously focused on getting physically well, have
been freed to focus on other activities and pursuits, including
creating a more pleasant lifestyle. This often poses a dilemma for
people with HIV: how does one sustain his or her physical health
while participating more fully in the social and recreational activities
of the community? This conflict especially presents itself in decisions
to socialize at circuit parties.
Upon arriving
at the circuit party, your senses are filled with the sights, sounds,
and smells of the party. Some men are drinking, other men are using
recreational drugs to enhance their experiences and to heighten
their sensations. You are tired from the week. You do not want to
get intoxicated on alcohol, but some drugs to increase your energy
and to intensify your sensations sounds appealing. For $25, the
cost of 4-5 drinks, you can purchase some Ecstasy or Crystal to
get you through the night and into the party.
The use of
recreational drugs at dance bars and parties is not new to the gay
community. During a weekend night at a dance bar in the 1980Г•s,
it was not unusual to see men using Г’poppers,Г“ amyl nitrate or butyl
nitrite, to enhance sexual experience and pleasure. In the 1990Г•s.
there was a drop in the use of Г’poppersГ“ within the gay community.
Several factors contributed to this drop in the use. In 1991, butyl
nitrite, as well as other nitrites, were banned. The use of amyl
and butyl nitrites also have been associated with KaposiГ•s sarcoma
(KS). Early studies found that many people with HIV who developed
KS also used nitrites; the exact nature of this relationship, however,
is still under investigation (National Institute on Drug Abuse,
1999a).
Other drugs
have emerged at bars and clubs to replace Г’poppers.Г“ These drugs,
often referred to collectively as Г’club drugs,Г“ include MDMA (3,4
methylenediozymethamphetamine) or Ecstasy, methamphetamine or Crystal,
and GHB (gamma-hydroxybutyrate) or Liquid Ecstasy. Each of these
synthetically-produced drugs have powerful effects on the central
nervous system, increasing physical energy, enhancing sexual performance,
heightening sensitivity to stimulation, and promoting a sense of
euphoria. The effects of these drugs, which can last up to 24 hours,
can be appealing to people seeking to re-engage or to more fully
participate in the gay community, especially socially and sexually.
However, these drugs also can have immediate and longer-term effects
on peopleГ•s health. Additionally there are many potential drug interactions
with protease inhibitors and other antiretroviral agents that can
pose added risks.
More about
MDMA (3,4 methylenediozymethamphetamine) or Ecstasy:
MDMA is also
known as Ecstasy, X, X-TC, Adam, Clarity, LoverГ•s Speed, Stacy,
and Beans. This is a synthetic drug that combines properties of
mescaline (an hallucinogen) and methamphetamine (a stimulant). For
between $7 and $30 a tablet, capsule, or powder containing MDMA
could be purchased. If you were to orally ingest, snort or smoke
the MDMA, you may experience the following:
Shortly after
taking MDMA, you may experience a sense of euphoria or an intense
rush followed by an abundance of energy, a heightened sensitivity
to stimulation, greater mental and emotional clarity, an enhanced
sense of pleasure, an increase in self-confidence, and a sense of
acceptance and closeness to others. These effects may last up to
24 hours, although they more typically last between 4 to 8 hours.
So you may think-
Г’WhatГ•s the problem?Г“ Г’This sounds great!Г“ However, in addition
to, or instead of these pleasant and positive experiences, you may
have the following unpleasant and negative experiences:
You may react
psychologically to the MDMA with depression, anxiety or panic attacks,
paranoia, irrational thoughts or behaviors, and violent thoughts
or behaviors. You may find it difficult to remember what you saw,
read, or heard, to reason and think clearly, and to sustain your
attention to what you are doing. You also may experience physical
symptoms including a sense of hyper-excitability, increased heart
rate and blood pressure, nausea and vomiting, lack of appetite,
insomnia, chills and sweating, faintness, and tremors. These symptoms
may persist between 1 day and 14 days. Recent studies also implicate
the use of MDMA with long-lasting depletion of brain serotonin levels-the
neurotransmitter substance that regulates aggression, mood, sexual
activity, sleep, and sensitivity to pain. With a high potential
for abuse, it may be difficult for some people to stop using the
drug even when they have the desire to stop (Bolla, McCann, & Ricaurte,
1999; Hatzidimitriou, McCann, & Ricaurte, 1999; McCann, Mertl, Eligulashvili,
& Ricaurte, 1999; McCann, Szabo, Scheffel, Dannals, & Ricaurte,
1999).
More about
Methamphetamine:
Methamphetamine
is also known as Ice, Crystal, Crank, Fire, and Glass. This is a
synthetically-produced stimulant that chemically closely resembles
amphetamine but with more powerful effects. For about $10 to $25,
a powder or crystal containing methamphetamine can be purchased.
If you were to orally ingest, snort, or smoke methamphetamine you
may have the following experiences:
Within 3 minutes
to 20 minutes, depending upon how you consumed the methamphetamine,
you would experience an intense rush or flash followed by an increase
in activity and decrease in fatigue, a general sense of well-being
and euphoria, a decrease in appetite, and an increase in libido.
While similar to the effects of cocaine, the stimulant effects of
methamphetamine are more prolonged. Its effects can last up to 24
hours, although they generally last between 6 to 8 hours.
Again, you may
think that these effects are appealing and desirable. As with MDMA,
you may experience undesirable and negative effects in addition
to or instead of the more desirable and positive effects. These
may include the following:
Psychologically
you may feel anxious, confused, agitated, intensely angry, and out-of-control.
You also may experience psychotic-like symptoms such as severe mood
disturbances, paranoia, auditory and visual hallucinations, and
delusions. You may have difficulties remembering and thoughts of
homicide and suicide. Physically, you may experience an increase
in respiration, hyperthermia, cardiovascular and neurological damage,
difficulties sleeping, and weight loss. These symptoms may persist
for some time. Recent studies suggest that long-term exposure to
even low levels of methamphetamine can damage dopamine-producing
and serotonin-containing cells in the brain (National Institute
on Drug Abuse, 1999b). Methamphetamine has a high potential for
abuse, similar to MDMA.
More about
Gamma-hydroxybutyrate (GHB):
GHB is also
known as Grievous Bodily Harm, G, Liquid Ecstasy, and Georgia Home
Boy. This is a synthetic drug that acts as a central nervous system
depressant with intoxicating, sedative, and euphoric properties.
In addition, itГ•s growth hormone-releasing effects may build muscles
in chronic users. The drug can be easily purchased in clear liquid,
white powder, tablet, or capsule form. If you were to orally ingest,
snort, or smoke this drug, you may have the following experiences:
Within 20 minutes
of taking the drug, you may experience a reduction in anxiety, an
increased sense of calmness and relaxation, an increase in sleepiness,
and enhanced sexual performance. These effects generally last about
4 hours. Extended use of the drug may promote the building of muscles.
As with most
of the Г’club drugs,Г“ GHB has several negative side effects in addition
to or instead of the more positive effects. These may include the
following:
As a central
nervous system depressant, GHB can slow breathing and heart rate
to dangerous levels. Overdose of GHB can occur quickly producing
drowsiness, nausea, vomiting, headache, loss of consciousness, loss
of reflexes, impaired breathing, and ultimately death. Since GHB
often is used in combination with alcohol, the potential for overdose
is high (National Institute on Drug Abuse, 1999c).
The Appeal
of Club Drugs
Sexual activity
is integral to the gay community. Besides providing pleasure and
release, sexual activity is a way to connect physically and emotionally
with others. The bars always have been used by the gay community
as a place to socialize and to meet others, including sexual partners.
The bathhouses also have been used to connect with others, especially
physically and sexually. Circuit parties have emerged as new forums
for people to Г’partyГ“ for hours or days. In the pursuit for ways
to enhance sexual pleasure and satisfaction, recreational drugs,
particularly MDMA or Ecstasy, Methamphetamine or Crystal, and GHB,
may be appealing. These drugs may offer people sustained physical
energy, increased sensitivity to physical sensations, and reductions
in behavioral inhibitions. These drugs are relatively accessible
to people since sources selling these drugs are easy to find and
the cost to purchase these drugs is low. However, these, as well
as other Г’club drugs,Г“ have the potential to create physical and
psychological problems.
Considering
Your Personal Use of Club Drugs
Acquiring information
about the effects of Г’club drugsГ“ is important to making informed
decisions about personal use of these drugs. It also is important
to review honestly how these drugs play a role in your life. There
are several barriers, however, to reviewing personal use of Г’club
drugs.Г“ No one intends to use Г’club drugsГ“ or any other drug in
order to create problems for himself or herself. Instead, however,
most people pursue drug use to capture the positive effects and
to avoid the negative effects of these drugs. Unlike other drugs
which may be used daily and/or in non-social situations, people
usually restrict their use of Г’club drugsГ“ to weekends and special
parties. People may develop a false sense that these drugs are Г’safeГ“
since they tend to be used infrequency within a social context and
without immediate financial, social, or career consequences. While
many people do not often discuss the Г’lowsГ“ associated with their
use, it is also accurate that people have had negative physical
and psychological immediate reactions to these drugs and long-term
consequences resulting from frequent use of these drugs. Additionally,
many individuals are taking antiretroviral agents such as protease
inhibitors that are known to have possible negative drug interactions
and may therefore pose added harm or risk. To sustain your physical
and mental health, it is important to look at your use of recreational
drugs. To get a sense as to whether you may be experiencing some
problems with your use of Г’club drugs,Г“ you may want to use one
of the available screening tools for possible problems with drug
use. The CAGE is one widely used screening tool initially used to
screen for alcohol-related problems but modified to screen for other
drug-related problems. There are four questions to answer on the
CAGE:
- Have you
thought about Cutting down the amount and/or the frequency with
which you use Г’club drugs?Г“
- Has /have
your partner, friends and /or family been annoyed with you because
of your use of Г’club drugs?Г“
- Have you
felt Guilty about the your use of Г’club drugs?Г“
- Have you
spent extended periods of time high or recovering from the effects
of Г’club drugs ?Г“
If you responded
Г’yesГ“ to any of these questions, you probably want to look more
closely at your use of Г’club drugs,Г“ including the frequency with
which you use them, the effects these drugs have upon your physical
and psychological health, and the reasons you use them (e.g., what
you are seeking through your use of these drugs). Your physician,
psychologist, or counselor can help you deterimine whether you are
developing a problem with Г’club drugs.Г“
Even if you
responded Г’noГ“ to these questions, you may want to look more closely
at your use of these drugs, asking yourself some of the following
questions: Do these drugs really get you what youГ•re looking for?
Does the immediate pleasure you may get from using these drugs outweigh
the potential risk these drugs pose to your health?
References
Bolla, K.I.,
McCann, U.D., and Ricaurte, G.A. (1998). Memory impairment in abstinent
MDMA (Г’ecstasyГ“) users. Neurology, 51, 1532-1537.
Hatzidimitriou,
G., McCann, U.D., and Ricuarte, G.A. (1999). Altered serotonin innervation
patterns in the forebrain of monkeys treated with MDMA seven years
previously: Factors influencing abnormal recovery. Journal of Neuroscience,
191, 5096-5107.
McCann, U.D.,
Mertl, M., Eligulashvili, V., and Ricaurte, G.A. (1999). Cognitive
performance in 3,4-methylenediozymethamphetamine (MDMA, Г’ecstasyГ“)
users: A contolled study. Psychopharmacology, 143, 417-425.
McCann, U.D.,
Szabo, Z., Scheffel, U., Dannals, R.F., and Ricaurte, G.A. (1999).
Positron emission tomographic evidence of toxic effects of MDMA
(Г’ecstasyГ“) on brain serotonin neurons in human beings. As reported
in, R. Mattias, Г’EcstasyГ“damages the brain and impairs memory in
humans. NIDA Notes, 14, (4), 1-5.
National Institute
on Drug Abuse (1999a, November). Infofax: Inhalants. Rockville,
Maryland: Author.
National Institute
on Drug Abuse (1999b, August). Research Report Series: Methamphetamine
Abuse and Addiction. Rockville, Maryland: Author.
National Institute
on Drug Abuse (1999c, December). Community Drug Alert Bulletin:
Club Drugs. Rockville, Maryland: Author.
HIV
Positive Women Have Higher Risks for Developing AIDS
Researchers
from JohnГ•s Hopkins have demonstrated that HIV-positive women with
similar viral loads of males appear to have half the CD4 T cell
counts of their male counterparts. Women may not be equal in HIV
progression due to hormonal, biologic or anatomical differences.
Other researchers in Switzerland and Italy have reported similar
results. It may be inferred that HIV+ women should be treated more
aggressively and earlier.
Cigarette
Smoking
A New study
has revealed that smoking may be an additional health risk for HIV
infected patients. The study published in the American Journal of
Respiratory and Critical Care Medicine demonstrated that HIV-positive
individuals who smoke have depressed levels of CD8-lymphocytes in
the bronchial lavage fluid which may play a role in fighting HIV.
Smokers were also shown to have lower levels of interleukin-1 in
the bronchial fluid, important at fighting bacterial infections.
The study may suggest and explain how HIV-positive smokers are more
at risk for respiratory and lung infections such as bronchitis and
pneumonia.
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