Drugs and sex

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Someone who is trading sex for drugs might find it difficult to set limits on what they are willing to do. Anyone using drugs is less likely to remember about using protection, or to care about it. Substance use and abuse is inherently dangerous, regardless of sexual orientation and practice. It can negatively affect physical health and compromise personal well-being. Drug use, itself, is considered a significant risk factor for the transmission of STDs, though it is not always regarded as such. Awareness to the effects of party drugs is necessary to reducing the prevalence of these diseases, which can cause lifelong effects and death.

Lifestyle factors

Lifestyle factors common to many gay men may exacerbate the inherently dangerous use of street drugs. For example, bars are prominent in the social landscape of many LGBT communities, and alcohol is equally common at circuit parties. Mixing party drugs with alcohol can not only cast aside discretion, it can be deadly. Furthermore, while drugs like "poppers" increase heart rate and relax muscles, they also dilate blood vessels and cause the heart to pump blood vigorously. When used prior to anal sex (as they often are) they increase the risk for anal bleeding and STDs if an anal tear or sore is present. The following is a list of primary and secondary risk factors associated with drug use:
  • Abundance of dangerous homemade synthetics on the street (made from paint thinner, cyanide, etc.)
  • Dependency (need for more in light of the withdrawal effects of many party drugs, which include lethargy and depression)
  • Heart attack, stroke, respiratory failure (dangerous effects of drugs combined with the rigors of physical exertion and sex)
  • Heat stroke, exhaustion, severe dehydration (with dancing, especially in venues with inadequate climate control)
  • Hepatitis and other STDs (through unsafe sex and sharing contaminated needles)
  • HIV and AIDS (through unsafe sex and sharing contaminated needles)
  • Incarceration (illegal possession of controlled substances)
  • Increased risk for anal bleeding
  • Long-term neurotoxicity (permanent nerve damage, mental illnesses)
  • Unconsciousness, seizures, death (resulting from mixing drugs or mixing drugs and alcohol)

Physiologically

These drugs may cause cardiovascular, nervous system, and respiratory distress.

Drug interactions

Some street drugs interact with medications. The liver breaks down some medications used to fight HIV, especially the protease inhibitors and the non-nucleoside analog reverse transcriptase inhibitors. It also breaks down some recreational drugs, including alcohol. When drugs and medications are both "in line" to use the liver, they might both be processed much more slowly. This can lead to a serious overdose of the medication or of the recreational drug. An overdose of a medication can cause serious side effects. An overdose of a recreational drug can be deadly. At least one death of a person with HIV has been blamed on mixing a protease inhibitor with the recreational drug Ecstasy.

Crystal and sex

There is definite connection between the use of crystal and an increased chance of contracting HIV or an STD. The raven study conducted by Public Health of Seattle and King County in 2001 have shown that almost 47% of gay and bisexual guys who inject crystal are HIV positive. The potential for getting HIV or an STD is less related to sharing needles, works, and cookers, and more related to having unprotected anal sex.

Ecstasy and sex

A study of 169 men at three predominantly gay nightclubs in New York City indicates a link between the club drug ecstasy and unsafe sex. According to the study in the American Journal of Psychiatry, roughly one-third of the men said they used ecstasy at least once a month, and these individuals were much more likely to have unprotected anal sex than other men. Dr. Robert L. Klitzman, the study's lead author, suggests that the drug--which produces feelings of happiness and closeness--may cause people to take greater sexual risks, or the men who take it may be natural risk-takers. The authors note that more than 50 percent of the men who discussed their sex lives said they had had unprotected anal sex at least once in the past 12 months.

Injection drug use and sex

Half of all new infections with HIV now occur among injecting drug users (IDUs), according to a review of 1996 data from the Centers for Disease Control and Prevention (CDC). Sharing needles with an infected person or injecting any substance with an unsterile needle is probably the most direct way to become infected. (Sex partners of people who shoot drugs are also at greater risk if they have unprotected sex.) IV drug users should never share needles, works or cookers. Sharing equipment also spreads hepatitis B and hepatitis C, and other serious diseases.

Drug users should be advised that stopping all drug use, including drug injection, is the most effective way to reduce their risks for contracting HIV/AIDS and other blood-borne diseases, including hepatitis B and hepatitis C. However, not every drug user is ready to stop using drugs, and many of those who stop may relapse. A variety of HIV/AIDS prevention strategies to protect against becoming infected are available for individuals who may be considering or already injecting drugs. These are described in a hierarchy of HIV/AIDS risk-reduction messages, beginning with the most effective behavioral changes that drug users can make:

  • Stop using and injecting drugs.
  • Enter and complete drug abuse treatment, including relapse prevention.
  • If you continue to inject drugs, take the following steps to reduce personal and public health risks:
    • Never re-use or "share" syringes, water, or drug preparation equipment.
    • Use only sterile syringes obtained from a reliable source (e.g., a pharmacy or a syringe access program).
    • Always use a new, sterile syringe to prepare and inject drugs.
    • If possible, use sterile water to prepare drugs; otherwise use clean water from a reliable source (e.g., fresh tap water).
    • Always use a new or disinfected container ("cooker") and a new filter ("cotton") to prepare drugs.
    • Clean the injection site with a new alcohol swab before injecting drugs.
    • Safely dispose of syringes after one use.

As the hierarchy shows, drug injectors can best reduce their risks by stopping all drug use. If they inject drugs, they should always use sterile supplies and never share them. When this is not possible, cleaning and disinfecting techniques should be considered. Full-strength bleach is the most effective disinfectant when safer options are not available.

However, sterile, unused injection equipment is safer than previously used injection equipment disinfected with bleach (1). Drug users should never share their other injection equipment, such as cookers, cottons, rinse water, and drug solutions prepared for injection. Sharing these materials presents an important but often overlooked HIV transmission risk.

Guidelines for sex with drugs

So how should we plan for our next sex with drugs experience? With a guide... and be guided by these simple guidelines:
  1. Learn what triggers you to have unsafe sex. When do you party? Is it when you are depressed? Drunk? Tweaked? Identifying your triggers might help you come up with strategies that can help keep you sexually safer.
  2. Talk with your friends about the sex you are having. Then create a sexual safety plan and have your friend(s) help you stick to your plan.
  3. Bring up the topic of STD and HIV with your sexual partner (s) and try to disclose your own HIV/STD status before you engage in sex.
  4. It is best if you get vaccinated for hepatitis A & B.
  5. Try to reduce the number of partners you have sex with.
  6. Ask your partner(s) what they are into sexually and establish each others' sexual boundaries before you are involved in the heat of the moment.
  7. If you make a mistake and do something unsafe, don't get down on yourself. Spend some time thinking what occurred, or what was different those times and try to resolve how you will avoid the situation the next time.
  8. Always have condoms and lube within easy access.