The experience of Latino gay men in San Francisco
Rafael M. Díaz
During the past 15 years, particularly within gay communities in the USA, there has been a dramatic and troubling increase in the use of (so-called) ‘club drugs’, including methamphetamine – hereafter crystal meth – a toxic and highly addictive stimulant with well-documented neuropsychological dysfunctions and psychiatric problems related to its use (Colfax and Guzman 2006; Díaz 2007; Fernandez et al. 2007; Rippeth et al. 2004; Wang et al. 2004). A comprehensive review of the literature on drug use among gay/bisexual men, published in 2001, reported prevalence rates of crystal meth use among gay men ranging from 5–25 per cent in different samples as well as increases in emergency room admissions and in the number of gay men seeking psychological and medical help for crystal meth-related problems (Halkitis et al. 2001). The most recent data on Latino gay men in San Francisco, derived from two different random samples (time/location sampling and respondent-driven sampling), show an increase in crystal meth use from 14 per cent in 2001 (Díaz 2006) to 19 per cent in 2004 (Ramirez-Valles et al. 2008).
The fact that crystal meth use appears as a powerful predictor of unprotected sexual practices and HIV seroconversion has led experts in the field refer to crystal meth use as the ‘second’ epidemic, and as ‘intertwining’ epidemics when referring to crystal meth use and HIV (Stall and Purcell 2000). However, while a strong correlation between crystal meth use and HIV risk is clearly documented, the reasons that explain such relationship are poorly understood. There is little understanding about how the use of crystal meth changes sexual behaviour, the subjective sexual experience of users or the context of sexual activity in ways that may increase the probability of HIV transmission. In addition, there is little analysis on how cultural norms and expectations (within US gay communities) regarding what constitutes ‘good’ or ‘great’ sex may pressure some gay men to consume stimulants, and in particular crystal meth, with potential detriment to their health and wellbeing.
Based on data from a study of drug using Latino gay men in San Francisco, this chapter presents a qualitative descriptive analysis of perceived sexual effects under the influence of crystal meth. The study involved men who self-identified as Latino/ Hispanic or by any Latin American nationality, whose self-identified sexual orientation was other than heterosexual, and who lived in the San Francisco Bay Area at the time of the study. As part of the inclusion criteria, men had to report current use of illicit drugs and the practice of unprotected anal intercourse at least once during the previous six months.
The study, sponsored by the US National Institute on Drug Abuse, was designed to provide a rich description (both qualitative and quantitative) of drug use among Latino gay men in the San Francisco Bay Area, with a particular focus on stimulant (crystal meth, cocaine and crack) use and its relation to HIV risk behaviour. The study was conducted in three different phases involving both qualitative and quantitative methods (see Díaz 2007 for more study details); this chapter reports findings only from the qualitative study.
Seventy drug-using Latino gay men (50 of them crystal meth users) who reported at least one instance of unprotected anal intercourse in the last six months were interviewed in a two-hour qualitative semi-structured interview. Beyond a detailed qualitative description of both drug use and sexual activity (including behaviour, social contexts and subjective meanings), the interview elicited narratives on specific episodes of drug use with and without sexual activity, and narratives on episodes of sex under the influence of drugs, with and without condom use. In this chapter, only qualitative data on ‘sexual effects’ are reported. Sexual effects of crystal meth were defined as any kind of sexual change subjectively experienced by the user while under the influence of crystal meth.
The qualitative interviews conducted during the first phase of the study were transcribed, coded and analysed in content with the aim of creating an exhaustive list of ‘sexual effects’ under the influence of crystal meth. I searched systematically for sexual effects of crystal meth on the interview transcriptions, particularly on text that was coded as the intersection of two different coding categories: ‘Effects of drug use’ and ‘Descriptions of sex and sexual activity’. Particular attention was paid to text that emerged within the narratives of sexual episodes and also text that was coded under ‘Perceived connections between sex and drugs’. The 20 different men quoted in this chapter are given fictitious names; a list of their demographic characteristics, including age, occupation, country of birth and HIV status is given after each name.
The majority of participants agreed that a major reason for using stimulants was to alleviate their exhaustion with work, forget their problems and find renewed energy to participate in social activities and nightlife. However, they also drew an emphatic distinction between the two powerful stimulants they were most familiar with: cocaine and crystal meth. When talking about cocaine, they emphasised the renewed energy for socialising with friends; when talking about crystal meth, all of them mentioned an unusually strong, increased and prolonged desire to have sex:
Cocaine is more for relaxing, for party, dancing. But crystal is for sex. To get nasty for hours and hours and hours.
(Gabriel, 37 years old, social worker, born in Puerto Rico, HIV+)
For some men, this sexual effect of crystal meth seemed to happen almost instantaneously, as if a ‘sex button’ was turned on and men felt sexually aroused very shortly after consuming the drug:
I said ‘Okay’ and I used it. I felt very, at that moment, I felt very, very, how can I say it … well, I was turned on, because of the drug I used … I got excited, I got sexually excited, I mean I got an instant erection. And it was something, well, that hadn’t ever happen to me before.
(Fernando, 26 years old, construction worker, born in Mexico, HIV-)
Even though many men described feeling euphoric with the increased energy and stimulating effects of the drug, increased sexual arousal appeared to be the most common and predominant subjective experience of crystal meth users:
If I take that drug, nine times out of ten it’s going to incite an emotion in me, and I’m going to go out and actively seek some sexual partners … My mood didn’t really change, but I think my, yeah, somewhere in there it activated, you know, the horny button, somewhere in there. But my mood was still the same. It was more of a mental thing … Like my mind wanted, you know, that dick or that you know, sexual contact. My emotions were still the same. I felt fine.
(Roberto, 33 years old, hairstylist, born in the USA, HIV-)
The sexual arousal was accompanied by a strong sensation of body heat, including a heating up of the skin, genitals and anus, the relevant body parts for sexual activity:
I felt like it rushed to my brain, I felt my skin get hot and I felt the desire to have sex with whoever was around.
(Raul, 35 years old, cosmetologist, born in Mexico, HIV+)
Depending on the product and quality it can be a euphoric rush. You can feel it in your ass, in your balls, where it heats them up all of a sudden. That’s also when you shoot it up, you can feel it that way. Or if it’s quality stuff, you feel your asshole get hot and like on fire. Or your balls kind of get that way, depending on what you’re focused on.
(Angel, 40 years old, unemployed (on disability government assistance), born in the USA, HIV+)
By the same token, while men truly enjoyed the pleasures of strong sexual arousal, the fact that the arousal was unusually prolonged in time, and not diminished after orgasm, often resulted in some degree of tension and discomfort. Men reported still being sexually aroused right after having sex, or when tired after a night filled with sexual activity. Many men spoke of being so sexually hungry that they had to masturbate several times in an attempt to find sexual satisfaction:
I got up and ate something. I went back to sleep, I felt bad. I had a horrible hangover, but I still was aroused … I was tired but aroused at the same time, I mean, every thought seemed to turn into wanting to have sex … Sexually, physically, I mean extremely euphoric: I want to keep having sex, I want to do this, I want to do that, I’m telling you I was extremely sexually aroused. I masturbated three times that day.
(Fernando)
It is perhaps no surprise that for many, such prolonged states of arousal were often experienced as tension and dissatisfaction:
I am running around looking for ass, or I’m not running around, just looking at ass. And I start like getting all like built up like you know, sexual energy, but not really like sexual, like tension.
(Armando, 27 years old, shipping and receiving clerk, born in the USA, HIV-)
It was hours and hours of wanting to be satisfied but not being able to be.
(Roberto)
On crystal meth you don’t satisfy, you know, it’s just like that need, you know, that urge for sex that you never satisfy.
(Rodolfo, 39 years old, hairstylist, born in Nicaragua, HIV+)
With drugs you start degenerating and you no longer are satisfied with one person … you want another and you want more and you want them all at the same time.
(Raul)
Makes me very interested in performing sexual activities, very interested. I just don’t know why I walk around with all of this hunger, physical hunger. And I don’t usually act on it. I mean I’ll, I’ll go home and think about stuff and masturbate.
(Luis, 36 years old, legal assistant, born in the USA, HIV-)
Men described sex as being more intense, more passionate and more focused, as evidence by the following interaction between the interviewer and Martin (35 years old, health worker, born in Central America (specific country not disclosed), HIV negative) as well as in the subsequent quote from Ismael:
INTERVIEWER: Did you feel the effects of the drugs while you were having sex?
MARTIN: Oh yeah.
INTERVIEWER: What did you feel?
MARTIN: I felt very good. I enjoyed it and I felt like a very nice sensation in your body. You feel very good. Everything pretty much feels like … in a different motion. The sensation is … lasts longer and you feel more passionate, more connected and more sexual. You feel very good about what you’re doing. The intensity, it makes me feel incredibly well. Yes, the focusing on the sex, the focusing means unity in all that time when you are having sex … when I’m having sex under those circumstances there’s nothing else to think about.
(Ismael, 40 years old, unemployed, on disability government assistance, born in Mexico, HIV+)
But more often than not, when sex was described as better or ‘incredible’, the description was qualified in terms of the length and/or frequency of sexual activity:
It’s more passionate. It’s more … [pause] … longer! It’s like eight hours of sex!
(Alberto, 39 years old, unemployed, on disability government assistance, born in the USA, HIV+)
I told my roommate, ‘Hey listen, I did this and that, and I felt good. I have never tried that … It’s incredible, you can have sex for a long time’ … I wanted to do it again. I remembered what it was to have sex with that person for 4 or 5 hours and I wanted to do it again … I wanted to be having that kind of sex, that prolonged sex all night long or all afternoon long.
(Fernando)
I feel like invincible, you have so much energy, you can do anything…you can have a hard-on that goes for six hours, you know what I mean?
(Rodrigo, 44 years old, restaurant waiter, born in Cuba, HIV+)
When I had sex, I would have sex three times at night, three times in the day, I will keep having sex during the day and … there would be no limit.
(Miguel, 43 years old, unemployed, on temporary general government assistance, born in Mexico, HIV+)
Thus, even though it was generally agreed that sex was experienced so much more intensely when under the influence of crystal meth, it was not clear from the narratives whether sex was actually better, more pleasurable or simply that it lasted longer, or could be had more often under a state of prolonged arousal.
Study participants generally agreed that they felt sexually uninhibited when under the influence of crystal meth. Disinhibition, however, meant different things for different men. Meanings of disinhibition ranged from a general feeling of relaxation and freedom in sexual situations to a willingness to perform sexual acts that were seen as risky, ‘kinky’ or forbidden when they were not under the influence of the drug. For some, the experienced disinhibition took them to situations where they felt a loss of control.
For many men, crystal meth produced a general feeling of sexual freedom – physical and psychological – that afforded a more comfortable sexual experience. Physical relaxation, particularly of the anus muscles, was often welcome for men who tend to experience pain during receptive anal intercourse when not under the influence of substances. The following interaction between the interviewer and a somewhat shy and sexually inhibited participant – Rafael (34 years old, restaurant worker, born in Mexico, HIV+) – describes the benefits of anal muscle relaxation under the influence of crystal meth. Note the underlying meaning of the text, even though the word ‘anus’ or other equivalents (‘ass’, ‘butt’) are not explicitly mentioned:
INTERVIEWER: And what did the speed feel like?
RAFAEL: It felt good. It helped me to relax when it comes to – you know, when it came to the sex part.
INTERVIEWER: It helped you relax?
RAFAEL: Yeah.
INTERVIEWER: How so?
RAFAEL: Mm, I … very tight person. You know, not uptight. You know, tight within my … Maybe by stress or –
INTERVIEWER: You mean physically tight?
RAFAEL: Yeah.
INTERVIEWER: And it helped you loosen up?
RAFAEL: Yeah.
INTERVIEWER: And that was good for sex?
RAFAEL: It was great, yeah.
INTERVIEWER: How?
RAFAEL: Well, it was, you know, you just, you just relax and enjoy – you know, enjoy it.
INTERVIEWER: Enjoy what?
RAFAEL: Enjoy you know, the performance of it.
More typically, the perceived disinhibition was experienced as a willingness to do or go to places men would not normally do or go to when not using the drug. Some spoke about daring fantasies that they could enact with a new sense of courage under the influence of crystal meth: ‘You can be wild and wish I could have a third buddy here and a great time… I’ll tie you up and all those wild fantasies come up’ (Martin). But more often than not, the narratives indicated that most men have a set of personal limits regarding sexual activity – limits about acts, persons and places – but that limits were trespassed when under the influence of crystal meth. Typically, the limits had to do with some kind of sexual activity that was seen as ‘kinky’ or ‘hardcore’, but sometimes they referred to trespassing limits around safer sex:
It definitely puts you in a mindset where you feel safe enough to go somewhere where you shouldn’t normally go, whether you’re, you’re going to be the bottom or you’re going to be the top or you’re going to be dominant, you’re going to be this or you’re going to have sex with different men all night at a sex club … When I do speed or recreational dugs, it leads me to not use condoms. It gives you a false sense of what you are doing like, you know, say you do it with somebody and you’re in a close environment, it makes you relax with that person. It lets all your fears go away and so you don’t use condoms and maybe the sex, the sex is a little rougher and a little more dangerous.
(Antonio, 37 years old, self-employed small business accountant, born in the USA, HIV+)
Not infrequently the disinhibition felt like a new sense of liberation, power and aggressiveness in the sexual domain, perhaps in reaction to having in the past felt guilty or ashamed about sexuality or sexual body parts:
I become even more hardcore. Sexual risks and inhibitions are totally gone. I become empowered in feeling, like, I can take on the world or anyone that fucked with me. It can be an euphoric rush. You can feel it in your ass, in your balls, where it heats them up all of a sudden. It did help me explore my ass at one point when I refused to even think I had an ass.
(Angel)
It is important to note that, with few exceptions, men spoke not about being forced by the drug to trespass previously set limits. Rather, they spoke about a place they wanted to go to (or acts they wanted to do), but did not dare to for one reason or another. With crystal meth, they found a new sense of courage and safety that allowed them to do or go to those places. Thus, for the majority of those interviewed, particularly for those with less frequent use, there was a sense of personal agency rather than a sense of losing control under the influence of crystal meth:
Speed will take you there when you want to go there, you are like, like it gives you an excuse to like be freer with yourself which is a good thing, but I mean then it does, definitely does take you to the area where you can be unsafe too.
(Antonio)
For a selected few, however, the experience was one of loss of agency and control:
It can really make you do things that I wouldn’t, I can lose a little self- control, in what I do and how far I go.
(Armando)
I got real high and I got really horny, so horny that it was out of control. It was very out of control. It’s like I could have fucked forever.
(Cesar, 29 years old, sales clerk, born in the USA, HIV-)
Throughout the interviews, men often spoke of negative side effects of crystal meth use on their sexual lives. The negative effects ranged from loss of erection ability to damaging their genitals as a result of repeated and prolonged sexual activity:
I couldn’t get nobody, and I couldn’t get an erection any more, I was so sore that, I kept playing with myself at home, and I rubbed it so sore, it became raw, that’s how bad it was. It didn’t feel good afterward.
(Juan, 36 years old, unemployed (on public assistance), born in the USA, HIV+)
Speed makes you horny, but the thing is you can’t fuck for too long. Sometimes you get red and like swollen … on your genitals, on your dick or your pussy or whatever, your booty hole. You just fuck for so long, it gets raw.
(Ricardo, 23 years old, textile librarian, born in the USA, HIV+)
It was also clear from the narratives that the intense sexual appetite and the frequent and prolonged sexual activity were not conducive to intimate and warm connections with sexual partners. In most cases, sex under the influence of crystal meth was described as different from intimate, romantic encounters. For many, crystal meth was an obstacle to socialising or to the kinds of interactions that build relationships. The descriptions of sexual episodes were mostly focused on the physicality of the sexual experience, mostly on its intense and prolonged nature, with many descriptions portraying sexual partners simply as objects of sexual satisfaction:
I have a lot of sexual energy and I’m just, I’m just looking at men like they are pieces of meat.
(Armando)
It’s funny because I probably have a better time, chance, if I really like someone, being nice to them and talking them into like going out to dinner or whatever. Under the influence of drugs I don’t know what to say, I stumble, I’m nervous, and all I think about is sexual gratification and wanting this person, wanting to use this person for sexual gratification.
(Luis)
I get horny, you know, and I just want to bust a nut. I don’t want no fucking hi’s no bye’s, no conversation. I want to go in there, I want to bust a nut. I’m going to leave you know. I don’t want no relationship, I don’t want no fucking friendly conversation. I don’t want breakfast, I don’t want dinner. I don’t want nothing, you know. All I want to do is give my cock a wash after I’m done.
(Ramon, 32 years, assistant manager, born in the USA, HIV-)
For most of the participants, consistent with research findings to date, there was a clear connection between the use of crystal meth and sexual practices that could lead to HIV transmission:
When I do crystal, because of the higher sex drive that it arouses within me, I’m more apt to have unsafe sex when I’m on that particular drug … the few times I have slipped up has been primarily because of that drug.
(Roberto)
We interviewed some men who were, at the time of the study, in recovery from frequent and dependent use of crystal meth in their recent past. Those men spoke about the great sex they had under the influence, particularly at beginning stages of use or at times of moderate use. But those men looked back at their sexual experience under crystal meth as being ‘not real sex’ or ‘clouded’ by the drug. Some expressed that they have learned to have ‘even better sex’ without the drug:
I used to think that I felt the sensation of having sex better with drugs, but I’ve learned to feel it even better without drugs, and I don’t mean to say – I enjoy it both ways – but I prefer it not with drugs, because again your mind gets clouded. And I don’t want to go back to the same old behaviour with drugs and what it can do – I’m tired of that kind of madness.
(Ignacio, 36 years old, administrative assistant, born in the USA, HIV-)
The qualitative findings described in this chapter allow a closer look at the subjective experiences of a group of Latino gay men in San Francisco who engage in sexual activity under the influence of crystal meth. The findings reveal the presence of very strong sexual effects while under the influence of this powerful stimulant, in particular, unusually prolonged states of sexual arousal and prolonged sexual activity.
The use of crystal meth is clearly related to men’s desire to enhance their sexual experience, and users report not only intensely pleasurable sexual activity but also sex that is freer, less inhibited and more focused away from mental distractions. There are also pronounced effects of crystal meth use on anal sex, not only because the drug relaxes the sphincter muscles but also because men experience a set of warm physical sensations around their anus that help them recognise it as an organ of sexual pleasure. Notably, while many men described engaging in receptive anal sex for its pleasurable sensations, very few spoke of it as a substitute for insertive penetrative sex when experiencing erection problems, as is commonly assumed.
It is commonly believed that a major drawback of crystal meth use is its interference with erectile function, and some men indeed spoke about it, but more often than not they spoke of having ‘instant’ erections that ‘lasted for hours’. The narratives, however, revealed other sexual effects of crystal meth that can be considered uncomfortable or detrimental to men’s sexual health, wellbeing and pleasure; some of these negative sexual effects are seldom documented in the literature. For example, men spoke not only about the pleasures of prolonged sexual arousal and activity, but also reported that the increased and prolonged arousal (sometimes labelled as ‘hunger’) was often experienced as a source of tension and discomfort that could not be easily alleviated.
Men spoke about the need to masturbate multiple times in an attempt to satisfy a sexual hunger that did not go away, to the point of physically damaging their penises. They spoke of a sexual desire that could not be easily satisfied and were at times self-deprecatory when they portrayed themselves as compulsively cruising the streets or the internet in search of sexual satisfaction. In addition, men spoke of how the intense states of sexual arousal interfered with different social and interpersonal aspects of sexual encounters, indicating that the extreme focus on sexual satisfaction did not allow interactions that were more cordial, intimate or caring for the other person(s).
The changes of perception that occur when under the influence of crystal meth tend to be subjectively experienced as liberation from sexual taboos and as an increased sense of comfort and safety in sexual activity. At the same time, most men recognised that a drug-induced sense of safety could backfire by placing them in situations of danger, including a higher risk for HIV transmission. Some of them spoke of an extreme aspect of disinhibition that was experienced as a loss of sexual control, but at present it is not clear whether the perceived lack of control is related to a larger trend towards more frequent and dependent patterns of drug use and abuse. A remaining research question is how the generally positive experience of disinhibition can develop into an experience of loss of control under the influence of crystal meth. Research is needed particularly to understand how occasional use turns into patterns of use that can be considered addictive and accompanied by a general perceived loss of control. Regardless whether they reported loss of control or not, the majority of men in the sample acknowledged that they were more willing to act sexually unsafe (unprotected), with a false sense of power, invulnerability and safety that the drug provided.
Most men reported a sense of personal agency to their crystal meth use throughout the in-depth interviews, suggesting that the drug allowed them to do things they would like to do sexually or go to sexual places they would like to go, but find difficult to do without it. For many, the drug allows them to engage in different types of sex acts and explore different sexual situations, that they have labelled as ‘kinky’, ‘hardcore’, ‘raunchy’ or ‘dirty’. The narratives suggest that this stimulant drug might be particularly useful for men who tend to be sexually shy, inhibited or who experience sexual shame and discomfort for reasons related perhaps to their socialisation in a homophobic, hetero-normative society. Also, because many gay men, including Latinos, come to San Francisco for a sense of sexual freedom and openness about their homosexuality, it is possible that many of these men use the drug in order to fit into a sexual culture that in general terms frowns on sexual inhibition. It is imperative, therefore, that we as gay men engage in a critical reflection about the complex relationships between our experiences of homophobia and our patterns of drug use. Moreover, we must critically observe and analyse elements of our sexual cultures that can be, for some, a bridge to sexual liberation, while for others a path of social and cultural conformity that can be ultimately self-destructive.
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