GMHC Testimony at NYC Council Oversight Hearing on Strategies
to Address the Crystal Meth Crisis
April 22, 2004
Good afternoon. My name is Ana Oliveira and I am the Executive
Director of Gay Men's Health Crisis (GMHC) here in New York City.
GMHC was founded 23 years ago as an indigenous response by the gay
community to the HIV and AIDS epidemics. Throughout the years the
agency grew and responded to the expansion of the epidemic in New
York City. Today we provide comprehensive HIV services to 15,000
clients — 1 out of 5 New Yorkers living with HIV/AIDS —
and prevention education and counseling to thousands of those at
risk of contracting the virus. Approximately one fifth of our clients
readily acknowledge challenges with chemical dependency and addition
when contacting us, and many more reveal such difficulties during
their care plan. The issue we are discussing today is particularly
important to GMHC.
The crystal meth crisis is important to all of us. Crystal meth
is a dangerous and addictive drug, and there are numerous studies
and ample anecdotal evidence demonstrating the link between crystal
meth use and HIV and syphilis transmission. Studies are showing
that methamphetamine use among gay men is strongly associated with
sexual behaviors that increase the risk of the transmission of HIV
and other sexually transmitted infections. In one study of over
1200 gay men in San Francisco, it was found that the men who had
used methamphetamine were twice as likely to be HIV positive.
As an indication of the importance of this issue to our clients,
our LGBT communities, and our city, the GMHC Board of Directors
recently formed a task force on crystal meth, syphilis, and HIV
prevention. The task force is completing its work and will be making
recommendations for follow-up action.
The methamphetamine epidemic is of growing concern to us in New
York City. Indeed, methamphetamine use is a global problem. With
an estimated 35 million users, methamphetamine is the second most
popular illegal substance in the world. Here in the United States,
the epidemic grew in the last few years, moving eastward, from Hawaii
to the West Coast, through the Midwest, and is now putting down
roots in Philadelphia, Washington, Atlanta, Miami and New York.
Here in New York, public awareness of crystal meth has increased
greatly in the last six months. While the focus on a crystal meth
crisis in New York City is currently located in the community of
men who have sex with men, where it is estimated that 10–20%
of these men are using the drug, crystal meth addiction and use
has been found in all populations in the USA. It is important to
ground our response in an understanding of crystal meth in this
larger context, while at the same time responding to the crisis
in front of us. Understanding and responding to the specific impact
of crystal meth on men who have sex with men is critically important.
It will save their lives and help us prevent its expansion into
other networks.
The second aspect of the larger context in which we should view
and respond to crystal meth use is the broad issue of alcohol and
substance use and their relationship to HIV and AIDS. As we all
know, New York City is one of the nation's centers of illicit drug
use and drug distribution. Furthermore, drug use has always been
a key factor in HIV transmission, as well as transmission of hepatitis
C. As we talk about the "new" epidemic of methamphetamine use among
our communities, we have to acknowledge that the epidemics of heroin,
crack and other illicit drugs have already cut a path of devastation
through our neighborhoods. This devastation includes contributing
to the disproportionately high rates of HIV infection that constitute
a state of emergency in communities of color.
When we talk about crystal meth use, we must do so also in the
context of these multiple drug epidemics, as the lives of drug users,
no matter what drug holds them in addiction, are equally precious.
Our response to these epidemics can either help to fight or fuel
the transmission of HIV and hepatitis C. They can either help drug
users reclaim their lives or destroy them and the lives of their
families, friends and loved ones.
Placing crystal meth use in a larger context will also help us
avoid the mistake of narrowly viewing the crystal meth crisis in
New York as a "gay problem." There is no question that crystal
meth use and its link to HIV transmission is a serious problem affecting
men who have sex with men in New York City. There is no question
that the city as a whole and LGBT communities must mobilize to confront
this issue as we are. But as the patterns of crystal meth use in
other parts of the country show, this is clearly not a problem restricted
to men who have sex with men. There are reports already of crystal
meth use among other populations here in our city, including lesbians
and heterosexual women. If we myopically focus our attention to
crystal meth use among men who have sex with men, a year from now
there likely will be another hearing on the citywide crisis of crystal
meth use.
We should also view crystal meth use as part of the larger issues
of HIV prevention among men who have sex with men and the overall
health of men who have sex with men. Our response must be a part
of a comprehensive approach to HIV prevention and substance use
that address the varied needs of all segments of the population
of men who have sex with men, from the West Village, to Chelsea,
to Central and East Harlem, to the South Bronx, and throughout the
city.
Having established, I hope, the importance of viewing crystal meth
in a larger context, I want to shift to the issues of treatment
and law enforcement.
For us at GMHC, addiction, whether it is to methamphetamine, heroin,
cocaine or other drugs, is primarily a medical issue and should
be handled as such by addiction specialists with the proper clinical
training and with appropriate peer-based interventions. At GMHC,
our Substance Use Counseling and Education program sees men who
are using methamphetamine. We offer our services to those who want
to stop or reduce their use or minimize the harm associated with
their crystal habit. Our colleagues at the LGBT Community Center
and the Center for Motivation and Change offer some of the only
other programs specifically designed for gay men with addiction
to methamphetamine in the city.
The methamphetamine epidemic poses particular challenges for drug
treatment programs. There are few drug treatment programs targeted
at methamphetamine users and the gay men who are currently the most
frequent users of this drug in New York City. As we respond to
the epidemic of methamphetamine use, we need to ensure the availability
of drug treatment slots that utilize a comprehensive approach, including
abstinence and harm-reduction related models.
We need the city and the state to support an increase in methamphetamine
treatment programs specifically for gay and bisexual men that include
relapse prevention services and needle exchange, among the continuum
of care for drug users. In addition, because there are few proven
behavioral and biomedical interventions that have been successful
with users of methamphetamine, a drug associated with very high
rates of relapse, we need the city and the state to support an aggressive
program of research to expand the clinical approaches to dealing
with this drug.
The rise in the use of crystal meth and increased awareness of
the multiple damages associated with crystal meth use, have led
to inevitable calls for a stronger law enforcement response, including
crack downs that largely affect users. While we do not support
the legalization of drugs, we believe overly harsh penalties associated
with drug use and possession deprive users of access to appropriate
treatment or drive them away from treatment. For example, in New
York State, the Rockefeller Drug Laws, which are among the harshest
mandatory minimum sentencing laws in the nation, require judges
to give drug offenders mandatory minimum sentences regardless of
the offender's background, role in the offense, or threat to society.
Additionally, the Rockefeller Drug Laws have had a disproportionate
impact on people of color.
Furthermore, these laws restrict the ability of judges to divert
appropriate offenders into treatment. By sending drug users to
prison where they have little access to treatment or prevention
methods for HIV and hepatitis C, such as clean needles and condoms,
we expose users to greater risk of these diseases than they may
face outside the correctional system. We also increase the risk
of transmission to others after the inmates' release, and nothing
is done about their substance use problems.
We need to repeal the Rockefeller Drug Laws in New York State.
Before I conclude my remarks, I want to highlight and commend the
various efforts over the past six months to increase public awareness
of the crystal meth crisis. These include media attention, community
forums, ad campaigns, the formation of task forces and working groups,
and, indeed, today's hearing. These efforts must be strengthened
and must be continued. We urge the city to increase its support
for public information campaigns and community mobilization efforts.
This should include information for the general population as well
as targeted campaigns.
Gay Men's Health Crisis is requesting additional funds for the
implementation of a vigorous and comprehensive response to the crystal
meth crisis, including the specific elements outlined in my testimony.
It is critical that these funds not be taken from funding that is
already limited for existing substance use or HIV-related programs
including those for HIV treatment and prevention. Crystal meth funds
should also not be taken from any future funds that are designated
for substance use treatment or HIV-related programs.
The multiple epidemics of drug use in New York City are not new,
but I hope we can all offer a new commitment today towards fighting
these epidemics, no matter which drug we are talking about. In
an increasingly conservative climate, both fiscally and politically,
progressive drug policies and an expansion of services may not be
popular things to support. The temptation might be to respond just
to the tip of the iceberg by issuing strong pronouncements and perhaps
mounting one or two public education campaigns about the dangers
of crystal meth, but leave our communities bereft of the services
they need and with public policies that exacerbate drug use, and
the transmission of HIV, hepatitis C, and other sexually transmitted
infections. This would be a disservice to all New Yorkers.
Let's not repeat the past. Twenty Three years ago we responded
to the AIDS epidemic as a gay disease and in doing so created a
stigma for the community and pervasive denial to all. What was indeed
a crisis became a plague. Today we cannot afford to make the same
mistake. I urge you to marshal the necessary resources to address
the crisis at hand in the community of men who have sex with men,
while, simultaneously preventing its expansion into other communities,
including communities of color.
Thank you. I will take any questions that you may have.
© 2003 Gay Men's Health Crisis
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