Cranked up

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In the early 2000s, crystal meth abuse became so rampant in San Francisco that city officials formed the Crystal Methamphetamine Task Force in 2005. A correlated increase in HIV transmission led the task force to focus on the gay men’s party circuit, targeting that community with education campaigns on the drug’s effects, safer usage, and safe sex tips.

But while the party boys got the attention, the drug appears to now be taking an increased toll on women. Has focusing on men meant that women users aren’t getting enough information on reducing harm?

Jennifer Lorvick is part of a team at the Research Triangle Institute, a nonprofit based in North Carolina that has an office in San Francisco, that is now studying women meth users in the Tenderloin. She agrees that the majority of users in the city are gay men, pointing to the alarming results of studies done between 2002 and 2005 showing a related increase in syphilis transmission as well as HIV among male meth users. Meth use still seems to be on the rise, increasing faster among women than men.

Lorvick’s group is researching meth use, sexual risk, HIV, and other sexually transmitted infections in about 300 people in one of the poorest cross-sections, women at "street level" in the Tenderloin. The study "isn’t representative of clubbers, students or middle-class users," she cautions. With more than half of the project completed, she’s finding "lots of unprotected sex, trading sex for drugs or money. A lot of sex risk and a fair bit of STD infection."
One red flag is the city’s most recent monthly STD report, available at the Department of Public Health’s Web site. Meth is the only drug included in the statistics. Comparing the first half of 2009 with the first half of 2008, meth-related visits to the SF General Hospital’s emergency department jumped 11 percent for men, and spiked a whopping 38 percent for women.

While that’s a staggering jump, activists note that it’s just one isolated indicator, albeit one that should warrant a closer look at the problem. Gay rights advocate Michael Petrelis found that the stats lump together all kinds of visits, whether an accidental overdose, a user seeking to start detox, or a physical or mental injury. Michael Siever, currently a co-chair on the meth task force and a director of the Stonewall Project, said the physicians’ reporting methods need to be standardized. "These numbers ebb and flow," he said. "We need a long term view for trends."

Dr. Dawn Harbatkin, medical director of Lyon-Martin Health Services, a San Francisco clinic started in 1979 specifically to serve lesbians, says that in a bad economy societies experience "an overall increase in substance use, not just meth specifically." Siever concurs: "In bad times, the use of alcohol and all other drugs goes up. If you’re out of work, you have more time for meth. It’s a kind of common wisdom."
It’s not terribly surprising then, that there would be some increase in ER visits this year. But 38 percent is a huge jump for women. "Incarceration, hospitalization, and treatment is the same for women and men around the state," Hilary McQuie, regional director of the Oakland-based Harm Reduction Coalition, said of meth-related statistics across California. "In San Francisco, it was a party drug. Now it’s starting to even out" between men’s and women’s usage.
Lorvick said that nationwide, women make up about a third of the users of other substances like alcohol and heroin — but half of meth users. "There are a lot of women users — 50 percent. I don’t think people know that." She says that it was prescribed to women in the 1950s to help them remain slender, supposedly happier, and to get more done.
The study also found that African American women had higher rates of HIV and other STDs, even when not engaging in riskier behaviors. The researchers urged that free, voluntary, accessible, STD screening and treatment be provided to all meth-using women.
It may be time for the city’s meth task force to focus on HIV prevention and safer use for women as well as men. The Stonewall Project runs the information-packed Web site tweaker.org, which is oriented to gay and bi men.

But gay and bi men aren’t the only ones reading: "Meth use by women has been an issue for quite a while. I wasn’t expecting so many e-mails and responses from women," Siever said. "It doesn’t get as much attention, with less HIV transmission."
When Siever and his task force co-chair, Sup. Bevan Dufty, were asked about resources for women meth users, they mentioned treatment and counseling centers like the Iris Center, New Leaf, and Walden House. But as far as outreach and HIV prevention, there doesn’t seem to be an equivalent to tweaker.org for women who need information.

Furthermore, resources shouldn’t be solely for those who are ready to quit. Harbatkin of Lyon-Martin points out that it’s challenging to get women and transgender individuals into treatment.
For starters, Siever recommends having the city’s health departments track use more extensively. But he concedes, "Obviously, that’s not enough."