‘It’s not the drug, it’s the structure’: Mixing Black, gay, HIV+ with meth in San Francisco

white-horse-bar, ‘It’s not the drug, it’s the structure’: Mixing Black, gay, HIV+ with meth in San Francisco, Local News & Views
Many bars and clubs in the Bay are havens for people facing racism, transphobia, homophobia or any discrimination.

by Sam Moore

“I use meth frequently. Like, I can say I’m a user. But I do the drug – I don’t let it do me.”

My close friend, who’s asked to be referred to in this story as “Ramon,” said this to me in my garage one night. He was sitting in the same spot where, on his 18th birthday nearly five years ago, he first got high off something.

“That was the night I smoked weed for the first time,” he said. “That’s what you’re supposed to do – how you’re supposed to be living life.” 

Ramon and I grew up together. We rode bikes around our neighborhood almost every day as kids, and got each other through our similarly horrible coming-out experiences in middle school. After high school ended, we’d smoke in the garage with friends most nights, sometimes until the sun came up. 

“I’m glad it started with that,” he said.  Hearing about his drug use since then, I feel more guilty than glad. Ramon is Black, gay and homeless; he’s been living in shelters and staying at friends’ houses since he was kicked out of his aunt’s apartment in February. She was already taking care of his grandmother, who has dementia, and couldn’t afford to house him any longer. 

He was first introduced to meth about two years ago, by older men at a gay bathhouse. There, he said, “it’s meth all day every day.” Since then, he hasn’t stopped. “Different guys give it to me,” he said. “Different guys everywhere. Everybody’s doing it – it’s crazy.” 

Ramon’s experiences are indicative of much larger phenomena: the covert prevalence of meth use in LGBT communities and the systems in place that keep the most vulnerable members of those groups at a higher risk of harm from the drug’s effects. 

In January, 55-year-old Timothy Dean was found dead in the West Hollywood apartment of Ed Buck, a prominent Democratic political donor. He was the second gay Black man in two years to be found dead there. The first was Gemmel Moore, 26, who died at Buck’s apartment in July of 2017. Both deaths were ruled as the result of methamphetamine overdose. 

“I’ve become addicted to drugs and the worst one at that,” Moore wrote in a journal entry several months before his death, ​first reportedby journalist Jasmyne Cannick. The entry reads: “Ed Buck is the one to thank. He gave me my first injection of crystal meth. It was very painful, but after all the troubles, I became addicted to the pain and fetish/fantasy.” 

In Moore’s last entry, he wrote, “If it didn’t hurt so bad, I’d kill myself but I’ll let Ed Buck do it for now.”

After Moore’s death, both Cannick and The WeHo Times reported on ​multiple accounts from young Black men of ​Buck paying to watch them inject dangerous amounts of crystal meth and pose in their underwear. Many of these men were homeless, HIV positive, and doing sex work in order to survive. Buck never faced any charges for the deaths of Timothy Dean or Gemmel Moore and has since been seen bringing more Black men inside his apartment. 

“A lot of white dudes fetishize it, getting Black men high,” Ramon said. “If I don’t have anything to do I can go for like three or four days without ever having to pay for it.”  

Meth use, though often overlooked, has been a prominent part of LGBT subculture and social life for decades. In 2003, the San Francisco Chronicle reported that more than 40 percent of gay men in San Francisco had tried crystal meth. With the rise of gay hookup apps like Grindr and Scruff, it became easier for meth users to meet and engage in “Chemsex,” or “Party N’ Play” (PNP). 

“Of the clients that I’m working with at the moment, I would say almost all of them, their primary drug of concern is meth,” said Alex Locust, the counselor-coordinator for People of Color Services at the Stonewall Project, a harm reduction-based treatment program for gay, bisexual and transgender men run by the San Francisco AIDs Foundation. 

“Meth provides a way to be uninhibited,” Locust said, “or lower your inhibitions to participate in certain sexual or kink-related activities that people might be interested in, but ashamed to pursue in a sober way.”

For those involved in the Chemsex scene, where sex parties and sexual encounters often go on for days without stopping, this is crucial. 

“On meth, sex goes on forever,” said Ramon. “For gay men, it makes us, just – woah. It could be horniness, it could be love, it could be passion – whatever you’re feeling at the moment, it’s all elevated. Which can be a bad thing.”

Traditionally, meth use was known within LGBT communities to predominantly affect white, cisgender gay men. This trend might be shifting, however, to include racial and gender minorities at higher rates. 

According to the U.S. Department of Health and Human Services, urban meth users are commonly transgender people and homeless youth. Additionally, data from the National Behavioral Health Survey shows that there was an increase in crystal meth use among gay and bisexual Black men between 2008 and 2014. The same data shows a decrease in use among gay and bisexual white men during those years. 

Kristen Marshall, the project manager of the DOPE Project, an overdose prevention program run by the Harm Reduction Coalition, isn’t convinced this is a recent phenomenon. 

“If that data is because we’re just now reaching queer communities of color to ask them those questions,” she said, “or if there’s been an actual increase, I don’t know. I think that queer people of color are at risk for the most harm associated with methamphetamine use, so I’m glad that attention is being put on it more widely. But I think meth has definitely been in that community and been used by that community for a very long time.”

Marshall said that when talking about people who use meth, it should be acknowledged if they are living at the intersections of marginalized identities. Those people – women, people of color, transgender people, sex workers, unhoused people or all of the above – are most likely to experience the harmful effects of drug use. 

“People use drugs, and are at the risk for the harms related to drug use, oftentimes because of a severe lack of access to resources,” Marshall said. “The racist war on drugs has caused the street drug supply to be very inconsistent and very unpredictable. It’s not that people are just doing too much meth; that’s too simple – it’s that people are engaging with a drug supply where your dose of meth one day could look drastically different from the next, depending on the supply you’re engaging with.” 

latisha-nixon-gemmel-moore-ed-buck-la-times, ‘It’s not the drug, it’s the structure’: Mixing Black, gay, HIV+ with meth in San Francisco, Local News & Views
Gemmel Moore’s mother LaTisha Nixon mourns the loss of her son to meth and racism. Women, people of color, transgender people, sex workers, unhoused people – all are most likely to experience the harmful effects of drug use.  -Photo: LA Times

This differs from the experiences of meth users who aren’t affected by racism, gendered violence, or housing insecurity. 

“I think that white gay men,” Marshall said, “specifically cis, white gay men who participate in the party ‘n play scene have access to a lot of resources. That means access to very good drugs, which means this is a different conversation for them. They’re safer, oftentimes. What’s happening to them is usually happening inside, in protected houses. Whereas many queer people of color don’t benefit from that system of protection.”

It’s easy to see how the effects of meth could be appealing to vulnerable communities. It keeps users awake, which could help a homeless person stay safe during nights, when conditions outside are most dangerous. Sex workers, like the ones hired by Ed Buck, are sometimes paid substantially more to use meth with or in front of their clients. For many, the high from meth also provides a temporary respite from the stress of societal factors like racism, homophobia and transphobia. 

“We have clients who are experiencing homelessness,” Locust said. “If they go to sleep at night, they might get attacked or have all their stuff stolen. So sometimes people use meth in order to stay awake. To me, it seems like if you call someone who’s in that situation an addict, it’s really ignoring the systemic issues that they’re facing, and erases their autonomy.” 

Marshall said that clients often come into her workplace after not having slept for days at a time. “I’ll bring it up to them,” she said, “and they’ll say, ‘yeah, because I keep getting assaulted,’ or ‘my stuff keeps getting stolen.’ Unhoused people who are really vulnerable, in particular women and trans folks, use meth to stay awake, because when you’re awake nobody can sneak up on you and assault you. Meth keeps you awake, which keeps you vigilant.” 

Some people, Marshall said, use meth to treat mental health issues such as ADHD. “For some folks, the way their brain chemistry works, meth makes them feel stable,” she said. “It treats ADD and ADHD by basically reconfiguring the chemistry in the brain to help people slow down and focus. Adderall is just methamphetamine, but in a formula the FDA finds acceptable.” 

Ramon, who was diagnosed with ADHD as a child, often uses meth for this reason. “Because I have ADHD,” he said, “meth feels more mellow. I feel ‘up,’ but a good up. Meth is like the fun version of Adderall.” 

Of course, this doesn’t come without a price. “The correlation between meth and HIV is so real,” he said, “and I’m a product of that correlation. You get sloppy with it, and you forget about things, and then it’s like, oh, I’m HIV positive.”

Ramon received his diagnosis in July, placing him at an intersection familiar to many like him: that of meth use and the transmission of dangerous communicable diseases. 

“Unhoused people who are really vulnerable, in particular women and trans folks, use meth to stay awake, because when you’re awake nobody can sneak up on you and assault you.”

“Using meth lowers your inhibitions and impedes cognitive functioning,” Locust said, “so users often find themselves doing things that they wouldn’t do if they were sober. You might not have the same regard for the risks of HIV when high. Sharing needles can increase that risk, and a lot of party ‘n play culture is also closely associated with barebacking, or having condomless sex.”

Ramon would often have sex with men who he knew were HIV positive, “because I trusted they were on their meds,” he said. “But anything can send your viral load up. Depression, anger, a cold, anything.” 

He’s on those meds now, an antiretroviral therapy regimen which prevents the HIV virus in his blood from making copies of itself. According to an ​infosheet published by the U.S. Department of Health and Human Services, eventually this treatment reduces people’s viral HIV loads to levels undetectable by a viral load test. Once someone’s viral load is undetectable, they have virtually no risk of transmitting HIV through sex. 

“I’m on the road to being undetectable,” Ramon said, pulling a box of small pills out of his backpack to show me. When I asked if the medicine had any side effects, he said, “They’re slim to none compared to things that it stops from happening. Before I started the meds, I felt so sore everywhere. I wasn’t able to dance too well. I was crying all the time – I cried more this year than I have my entire life.”

The stigmas surrounding meth and HIV, Locust said, often make people feel like they aren’t able to seek help. Traditional approaches to substance use treatment usually aren’t as effective for marginalized people, and backlash from their communities can lead to isolation. 

“I had to duck out of the community for a while because of it,” Ramon said, “because people kept asking questions.”

According to Locust, this is why working to end the stigmas surrounding meth use is so important: “We should be having conversations with medical providers,” he said, “and with policy makers who have the power to create resources or implement programmatic changes. We need to help them view people who use drugs as people first, and not as addicts.”

These changes could include overdose prevention sites, more access to safe and sterile drug equipment, a reduction in “abstinence-only” drug treatment, and resources that would enable vulnerable communities to use drugs more responsibly or not at all. 

“My hope is that the more we talk about it,” Marshall said, “the more we understand that the reasons harm happens is not because of the drug. The drug is the result of structural violence and a lack of access to resources. That’s what we should focus on, because focusing on the drug itself is a waste of our time.”

Since we spoke in my garage, Ramon’s treatment has successfully brought his viral HIV load to an undetectable level. He’s living at a shelter in West Hollywood and spending more time with his community. Currently, he has no plans to reduce his meth use. 

“It’s not about dwelling on it,” he said. “It’s about comforting each other through it. That’s all life is, is mind over matter. At the end of the day, I’m gonna be the happy gay boy that I wanna be.”

Sam Moore, a San Francisco State University journalism student, is an intern with the Bay View. He can be reached at samoore2015@gmail.com.