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contents 04 setting the scene 06 what are we like? 07 why do we like getting high? 08 thinking it over Originally written and published by the Camden and Islington Good Sexual Health Team.

10 cutting down

Original design and illustrations: Steve Edwards Photographs: Emma Rose, Steve Edwards, Mark Glenn and Camden and Islington digital assets. Models: Appearance in this booklet is no indication of a person’s HIV or other infection status.

14 making changes

All models are over 18. Updated for the Pan London HIV Prevention Programme in 2009 by GMFA.

22 playing safe with drugs

© GMFA 2009 Redesign: Gary Bigahooni Kime Additional Photography: James Stafford GMFA – the gay men’s health charity Charity number: 1076854

36 sex & drugs 46 HIV & drugs

Company limited by guarantee: 2702133 GMFA projects are developed by positive and negative volunteers. To volunteer or donate, call 020 7738 6872 or visit www.gmfa.org.uk/aboutgmfa. The information in this booklet was correct on 1 December 2009.

52 listings 54 drug chart 03


setting the scene Most gay men use drugs of one kind or another. We might use coffee to wake us up, fags to calm us down, alcohol to relax with, poppers for sex or ecstasy for dancing. Some of us use a lot more drugs than this – and some a lot fewer. But we do know that quite a lot of us worry about what and how much we use. The 2005 Gay Men’s Sex Survey (GMSS) found that more than 20% of gay men sometimes worry about their recreational drug use – and more than 30% sometimes worry about how much alcohol they drink. If you’ve ever worried about these things too – even a little – then this booklet is for you. We take drugs for all sorts of reasons: to get high; to chill out; to feel part of the crowd; to feel comfortable in the company of other men; to lose our inhibitions. You don’t have to have a serious drug or drink problem to find this booklet useful. You may just want to drink less or take pills less often – to have high days and dry days. 04

Maybe you can’t imagine having sex without being off your face. Or maybe you’re worried because you know that, when you’re out of your head, you sometimes have sex that’s not as safe as you want it to be. This booklet can help you to take stock of your drug use. It gives tips on cutting down or stopping. It has advice on how to use drugs more safely and how to help ensure you have safer sex even when you’re wasted. It tells you which combinations of drugs and/or alcohol can be dangerous and which drugs to avoid if you’re on certain HIV treatments. This booklet also tells you where to go if you want more advice, support or information. There are lots of organisations and people who can help without judging you, whatever your worries.

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what are we like? According to Wasted Opportunities, a report on drug and alcohol use among gay and bisexual men, from Sigma Research in 2009, three quarters of men have used at least one recreational drug, other than alcohol. The most commonly used drugs, aside from alcohol, were amyl nitrite (or poppers), cannabis, cocaine and ecstasy. In general, gay men are more likely than other men to use recreational drugs. Only our alcohol consumption seems to be on a par with the population as a whole.

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Of course, alcohol and drug use aren’t spread equally throughout the gay population. Some of us don’t drink, smoke or take recreational drugs, while some of us do all three. The 2005 GMSS found that you’re more likely than other gay men to use drugs if: • you’re in your 20s; • you live in London; • you’re HIV-positive; • you live with friends, rather than on your own, with family or a lover; • you have a lot of sexual partners.

why do we like getting high? The obvious answer is: because it can be fun. Drugs can give you feelings of intense pleasure. They can enhance feelings of friendship and intimacy with other gay men. They can make you feel at one with your fellow revellers. Another obvious answer is: because we can. It’s no surprise that gay men living in London are the most likely to be drug users. In London, there are more gay venues than anywhere else in the country, more places to buy drugs and more places to take them.

for the first time without having a drink or two. But alcohol is no more a guarantee of great sex than any other drug. Drink too much and your judgement goes right out the window, along with your ability to get it up. There’s one aspect of our drug use that we are maybe reluctant to acknowledge. Drugs can take us out of ourselves; they can take us away, for a while at least, from our everyday lives.

Many men believe that taking drugs will enhance their enjoyment of sex. It’s true that some drugs can make you feel horny. But that’s no guarantee of great sex, since most of those drugs also tend to make it more difficult for you to get a hard-on.

The Wasted Opportunities report found that some men use drugs – and alcohol – to escape negative or distressing feelings, such as loneliness and unhappiness. The majority of the men talked about using substances to relieve boredom and isolation or to help them sleep.

Alcohol is popular because, among other things, it makes us feel less inhibited. It’s a great icebreaker. Many of us find it almost impossible to pull or to have sex with someone

We’re not saying that all gay men are depressed. We just want to encourage you to think about how your drug and/or alcohol use affects your life. 07


thinking it over Some men manage their drug use better than others: they might stop at a couple of pills or a line of cocaine on an occasional Saturday night. Some have higher tolerance levels than others and some don’t need much time to recover from a weekend binge.

But if you regularly find yourself missing work, not seeing family and friends, thinking about drugs a lot, feeling depressed or unwell for much of the time or having sex that isn’t as safe as you’d like it to be, it’s time to stop and take stock of the situation.

To help you focus on your drug and/or alcohol use, read the following statements and think about whether they apply to you. • I sometimes worry about the amount I drink. • I can’t imagine having a good time without drink or drugs. • I sometimes use one drug to overcome the effects of another. • If I run out of drugs, I feel anxious until I get more. • When drinking with friends, I’m usually the first to be ready for another. • I sometimes worry about the possible effects on my health of the drugs that I take. • I quite often phone in sick on Mondays. • I drink more than I like to admit, either to myself or others. • I sometimes take drugs just because my friends are taking them. • I only feel relaxed enough to have the sex I want when I’m high or drunk. • I’m usually too shy to approach men unless I’ve had drink or drugs. • I sometimes worry about sexual risks I might have taken while drunk or high on drugs. 08

Did any of the statements ring true for you? If the answer is yes, you may want to do some thinking about how your drug or alcohol use is affecting the rest of your life. And you may decide to try and make some changes.

You might want to: • cut down on your drug or alcohol use; • stop mixing drugs and alcohol; • take more control over the sex you have while on drugs or alcohol; • make sure that you don’t forget to take your HIV medications on time; • make friends outside the club scene; • stop using drugs altogether.

You don’t have to make sudden major changes. It may be easier to make changes slowly, cutting down gradually to a level of alcohol or drug use that you feel OK about. The next section has ideas for ways to do this. 09


cutting down There are lots of practical things you can do to help you cut down on the amount of drugs or alcohol you use. The suggestions that follow are just that – suggestions. Some of the ideas might seem obvious, but they’re still worth trying.

ON ALCOHOL The Department of Health (DoH) recommends that adult men should not regularly drink more than 3-4 units of alcohol a day, and have at least two alcoholfree days after a heavy session to recover. Regularly drinking more than the recommended units greatly increases your risk of cancer, liver cirrhosis, strokes, impotence, depression and heart disease – among many other conditions. If you want to know more about the physical and mental health implications of excess drinking, visit www.alcoholconcern.org.uk. Try to remember what you’ve had to drink in the past 7 days and add up the units – or keep a diary of what you drink over the next 10

7 days. The results may surprise you. If you find that you would like to cut down the amount of alcohol you drink, here are some ideas about how to do it: • Decide before you start drinking how much you want to drink – and try to stick to it. Keep track of how much you’re drinking, if you can. Don’t get frustrated if you can’t keep to your plan – you can try again next time. • Eat something before drinking, even if it’s just a sandwich on the go. Having food in your stomach will make you drink less, and can also help prevent you getting drunk so quickly. • If you’re in a group that’s buying rounds for each other, don’t be afraid to drink slower and skip a round, or to have a non-alcoholic drink for one round. You could also drink half pints rather than pints. • If you prefer spirits, have a single rather than a double. • There’s a lot of social pressure to drink: if you ask for just a half pint, your mates might ignore your request and come back from the bar with a full pint. It’s

One pint of ordinary strength lager (Carling, Foster’s)

2 units

One pint of strong beer (Stella Artois, Kronenbourg 1664)

3 units

One pint of ordinary bitter (John Smith’s, Boddingtons)

2 units

One pint of best bitter (Fuller’s ESB, Young’s Special)

3 units

One pint of ordinary strength cider (Woodpecker)

2 units

One pint of strong cider (Dry Blackthorn, Strongbow)

3 units

One 175ml glass of red/white wine

2 units

One 250ml glass of red/white wine

3 units

One pub measure of spirits One alcopop (Smirnoff Ice, Bacardi Breezer, WKD, Reef)

1 unit 1.5 units

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a good idea to make sure your friends know you’re serious about trying to cut down. • Start drinking later in the evening and avoid happy hours. The bars and clubs want you to spend money, so they make all kinds of tempting offers, like a drink with double spirits for just an extra pound. If you were only planning on having a single, then stick to your plan. • Try drinks that have less alcohol content: instead of wine, have a spritzer (wine with sparkling mineral water), or swap lager for a shandy or a low-alcohol beer. • Some people choose to drink alcoholic and non-alcoholic drinks alternately throughout an evening. Drinking water is especially good for this, because it helps keep you hydrated and dilutes the alcohol in your system. • When drinking wine at home or at a party, use a smaller glass. Finish your whole glass before having more and don’t let people top you up – it makes it harder to keep track of how much you’ve had.

friends and stick to it. • Don’t get drunk before you start taking drugs. You’ll be less able to think clearly about the drugs you’re taking. • Don’t buy lots of drugs at once. If you have them in your pockets, it’s easy to take more before you’ve even thought about it. • Cut down on how much you take. For example, if using ecstasy, take just half a dose rather than a whole one. • If your friends suggest taking more drugs, remind them that you’re cutting down and have set yourself a limit.

BALANCING DRUGS, ALCOHOL AND THE REST OF YOUR LIFE Coming up with ways to cut down on drugs and alcohol is easy. Putting them

into action is the hard part. Finding the right balance for you just means making sure your drug and alcohol use doesn’t affect everything else in your life. • Think about the feelings you get when you’re high: is there any way to get that same pleasure in a different way? Plan to do something new, some activity you’ve never tried before. • Tell your friends that you’re trying to cut down and ask them to help you do it. • Take a weekend break: stay home and have

friends around for dinner and a DVD. • If you know you feel a bit low a couple of days after getting high, and you usually turn to drink or drugs in an attempt to lift your mood, break that routine. Plan ahead; arrange to do something with a friend that day – such as a trip to the gym. • Don’t try to give up all at once, especially if you’ve been using drugs several times a week. And if you’re regularly using more than one drug, don’t try to cut them all out at the same time – tackle them one by one. Set a realistic goal and stick to it. • Perhaps the best advice is: don’t give up on your goal because you find it hard. If you slip up, it’s OK; learn from your mistake and move on.

ON DRUGS If you are going to take drugs on a night out: • Decide in advance how much you are going to take. Tell your 12

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making changes Drinking alcohol and using drugs can give some men ‘chemical confidence’ – inhibitions melt away and you’re more willing to approach someone you’re attracted to and chat them up. Or you’re more likely to respond to someone else’s come-on. If you feel that you’re unable to get together with other men (whether it’s for a date or a shag) without being high or There are a couple of great free workbooks that can help you build the relationships you want and deserve. Both are written by counsellors from PACE, which promotes the health and wellbeing of LGBT communities in London. The first is called Getting Ready. It aims to help gay men improve their self-esteem and figure out what they want from their relationships. The second booklet is called Getting What You Want in 14

drunk, think about the reasons why. Have you ever thought about trying to meet someone you like when you’re sober? For lots of gay men, meeting a nice guy, asking him out, becoming boyfriends, hanging on to him and making a relationship work can seem like the hardest thing in the world.

Friendships and Relationships. It helps gay men develop the skills and strategies to make their connections with friends and lovers stronger, more fulfilling and more fun. These and many other booklets covering a range of health-related subjects for gay men in London can be downloaded at www.gmfa.org. uk/booklets. Printed copies of most of the booklets featured on this website can be picked up free from the health information racks in gay bars and clubs around London. 15


DO SOMETHING DIFFERENT There are many ways to find new mates, boyfriends or sexual partners that don’t (necessarily) involve drink and drugs. Websites like Out Everywhere (www. outeverywhere.com) have thousands of members. There are chat rooms to explore, profiles to peruse, men to meet. Or you can go to GMFA’s online guide to Gay Sports Clubs and Social Groups at www.gmfa.org.uk/theguide. It lists more than a hundred different teams, groups and clubs that are looking for new members. The website www.gaytoz.com is also a good place to find gay organisations, including those that offer help to gay men who are concerned about their drug or alcohol use. GMFA (the gay men’s health charity), THT (HIV and sexual health charity) and PACE (project for advocacy, counselling and education) are three London-based organisations that offer courses and seminars for gay men. There are many to choose from, so finding one that interests you shouldn’t be a problem. For a list of courses currently being run by all three organisations, visit www.gmfa. 16

org.uk/gwk. You can book a place online via this website or by using the contact details below. PACE workshops look at different aspects of gay life, from bars and cruising to sex and relationships and everything else in between. 020 7700 1323 www.pacehealth.org.uk GMFA runs skills and informationbased courses on topics such as friendships, stopping smoking, and sex and sexual health. 020 7738 3712 www.gmfa.org.uk/national THT runs various groups in London with topics including drug use, sex addiction, and HIV and Hep C. 020 7812 1773 PACE and the Edward Carpenter Community organise residential weeks and weekends away: workshops, courses and retreats led by experienced volunteers, professional advice workers or counsellors. 0870 3215121 www.edwardcarpenter community.org.uk

FIND A COUNSELLOR OR FACE-TO-FACE SUPPORT Sometimes it can really help to

talk face-to-face with someone about your drug and alcohol use. Talking with a trained counsellor has the advantages of preserving your anonymity and guaranteeing confidentiality: you can open up, talk about your thoughts and feelings and know that the counsellor will listen and try to help without judging you. Workers at Antidote (London’s LGBT drugs and alcohol service) can help you decide if counselling is right for you, and counselling is also available there. Antidote offers a drop-in service on Thursdays from 6.30pm-8:30pm at 32a Wardour Street in Soho. Antidote offers a range of other services in addition to counselling. These include information, advice and support for men dependent on GBL (Gammabutyrolactone) – many of whom have been turned away from GPs and drug services. SMART MUSCLE is Antidote’s drop-in service for people using performance and image enhancing drugs such as steroids. This service offers information on how to use and stack steroids more safely and appropriately, safer injecting practices and needle exchange, general harm reduction 17


and access to liver function tests. It’s open every Tuesday evening from 6pm-9pm, 31 Wardour Street in Soho. 020 7437 4669 (for all Antidote services)

The counselling service gives you the space to talk about safer sex and learn how to reduce risks and change behaviour that you are unhappy with.

DASL (Drug and Alcohol Service for London) can arrange counselling. There are gay counsellors available. 020 8257 3068

The mentoring programme allows HIV-negative men who struggle with safer sex to talk to another gay man, one-to-one, about the challenges they face in staying HIV-negative.

Drinkline is the national alcohol helpline, available 24 hours, 7 days a week. Callers can get information about counselling services across the UK. 0800 917 8282 If you want to find a counsellor independently, make sure you ask questions before arranging an appointment. Find out what approach they take with people who want help with drink or drug use. Some counsellors will help you follow a 12-step programme to get over an addiction. Others will help you talk about why you use drugs and help you explore ways of cutting down or managing your drug use better. Or you may want to find a counsellor to help you work on different or more general issues. Free counselling, mentoring and health trainer services are provided by the GMI Partnership in London. 18

GMI Health Trainers offer you oneto-one, tailored support and guidance in making decisions around your sex life, knowledge on reducing risk for STIs and HIV as well as information about sexual health and other services that you may want to use. 020 8305 5002 www.gmipartnership.org.uk THT offers courses and counselling services for gay men in a oneto-one or group setting. Are You Losing Control? is an eight-week programme for gay men who have lost control of their use of drugs and alcohol. 020 7812 1777 www.gmfa.org.uk/gwk PACE is a good source of counselling information. They maintain a register of private counsellors, including many who are gay or lesbian. 020 7700 1323 www.pacehealth.org.uk 19


London Friend offers support and counselling. Helpline 020 7837 3337 (Tuesdays, Wednesdays and Fridays, 7:30pm-9:30pm). www.londonfriend.org.uk The East London Out Project (ELOP) offers low-cost counselling services. 020 8509 3898 www.elop.org

FIND A 12-STEP FELLOWSHIP Listening, learning and getting support from other drink or drug users (or former drink or drug users) is helpful if you’re trying to stop drinking or using drugs altogether. At 12-step fellowship meetings, which are free and open to anyone who has a desire to stop, people share their histories and problems and support each other to stop drinking or taking drugs. Many 12-step fellowships have meetings for gay men. You might prefer to attend these. Some 12-step meetings are designated ‘open’, meaning you can bring a friend with you for support. Check the AA website for details or ring the national organisation for more information. You can also call to talk to a counsellor or fellow user for support. 0845 769 7555 www.alcoholics-anonymous.org.uk 20

Narcotics Anonymous is for drug users and has LGBT-specific meetings. 0845 373 3366 (24 hours a day, 7 days a week) www.ukna.org Cocaine Anonymous is for people who use cocaine and crack. 0800 612 0225 (10am-10pm, 7 days a week) www.cauk.org.uk

FIND AN OUTREACH WORKER If you find contacting a counsellor or a support group difficult, you could ask a sexual health outreach worker to refer you. Health trainers from the GMI Partnership regularly visit gay pubs, clubs, and other venues popular with gay men, across the capital. If you see them when you’re out and about, say hello. They are there with information and advice to help you. Get in touch with them if you’d like to know venues the teams are visiting next. 020 7791 9318 healthtrainer@gmipartnership. org.uk www.gmipartnership.org.uk 21


playing safe with drugs Most people who use drugs and alcohol don’t want to stop using them entirely. However, they probably wonder if they could manage their use differently. Here are some ideas for ways to limit the harm drugs can do.

PLAN YOUR EVENING • What drugs are you going to take? • How much are you going to use? • Where are you going – the club, the sauna, staying home? • Who will be with you? • How are you feeling physically and emotionally? Thinking ahead can help you stay in control of your experience. If you’re feeling run down, upset or depressed, think about how taking drugs might affect you – some drugs can make negative feelings worse.

EDUCATE YOURSELF Find out about the drugs you’re taking: what the drug should feel like, what the side-effects are and how much you should take. Do you know what will happen if you take several drugs together? The more drugs you throw into the mix, the 22

more unpredictable the effects (see page 26).

TAKE CARE OF YOUR BODY Drinking and taking drugs can cause harm in indirect ways – for instance, from lack of sleep or not eating well. Lack of sleep, in particular, can cause problems. Get lots of rest before getting high, especially if you’re taking a stimulant such as speed, cocaine or ecstasy. If you do stay up late and lose sleep, it’s a good idea to try and make up for it by sleeping longer on subsequent nights. And you should think about eating a meal a few hours before you start drinking or taking drugs. Stimulants can raise your body temperature. When you’re in a warm environment like a club, you’re going to start sweating. You need to replace the water lost in this way – so drink a little water occasionally. Be aware that when you are wasted you might not make good

decisions about, for example, taking more drugs, using condoms or even crossing the road.

KNOW YOUR DRUGS Can you trust your dealer? Can you guarantee that this score is the same strength as the last? Do you know what it has been ‘cut’ with? Making street drugs is not a precise science – and you have no way of knowing either how strong the drug you’ve bought is or exactly what’s in it. Tablets sold as ecstasy often contain other drugs, such as ketamine or cocaine – and may not contain any MDMA at all. Crystal meth is often made using any of a number of toxic chemicals such as iodine, acetone, red

phosphorus and paint strippers. And there have been reports that cocaine is often cut with phenacetin, a banned painkiller that has been linked to liver and kidney cancers. Whatever you take, whoever you got it from, try just a bit to start with: it’s 23


better to take too little than risk an overdose.

KNOW YOUR TOLERANCE It depends on the individual: some guys use just half a pill for an entire night while others seem to need more. The amount you take can depend on what the drug is and how often you take it. The more often you take a drug, the more of it you’ll need to take to get the effect. Remember – if you haven’t taken a particular drug in quite a while, you don’t need as much to get high. Give the drug a chance to work before you think of taking more.

KEEP YOUR FRIENDS CLOSE You’re there to look after each other. Tell your mates what you’re going to take, so they can help you in an emergency. Some drugs (GHB or ketamine, for example) might make you sleepy or feel sick – especially if mixed with alcohol. Don’t lock yourself in the toilet – your friends won’t be able to help you if you start to vomit, choke or pass out. If you don’t like the way you’re feeling, tell your mates and 24

ask them to keep an eye on you. Likewise, try and keep an eye on them.

THINK ABOUT THE WEEK AHEAD Some drugs stay in your body for several hours or even days after you take them. If you’re going to take drugs on a Saturday night, will you be able to get up and go to work on Monday morning? Do you have any big meetings at work or exams at college? Can you afford to take a day off? A bit of planning can help you have a safer, more enjoyable experience.

MIXING IT How many different drugs do you take on a night out? Some men report using several different drugs during the course of an evening. They might start off with some ecstasy, then take some GHB on the dance floor, do a couple of lines of cocaine to keep going, then take some Viagra, then poppers, and then smoke some cannabis to chill out at the end of the evening – as well as any alcohol they might drink along the way. This can be very dangerous. See the chart overleaf for details of which drugs interact badly. 25


THIS DRUG… DOES NOT MIX WITH… Alcohol

Cocaine Crystal meth

Ecstasy

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All other recreational drugs. Yes, we know that most recreational drug users like a drink too, but there are dangers. Alcohol can increase the effect of other drugs – for example, alcohol combines with cocaine in a way that intensifies its effects but also increases the risk of a heart attack. Alcohol also affects your judgement: the drunker you get, the easier it is to forget which other drugs you have taken and how much. And vice versa – the drugs you have taken can mask the effects of the alcohol, and you can end up drinking much more than you intended.

THIS DRUG… DOES NOT MIX WITH… GHB/GBL

All other recreational drugs. GHB/GBL does not mix well with any other drug, particularly alcohol and ketamine. Deaths from GHB/GBL have tended to be as a result of mixing it.

Ketamine

Most other recreational drugs, especially ecstasy and speed. Ketamine is a powerful anaesthetic that is dangerous when combined with other drugs, including alcohol.

Poppers

See alcohol and speed. Viagra – these two drugs together put an extra strain on the heart. Crystal meth can make you feel like having sex for hours, but it inhibits a man’s ability to get an erection. Viagra enables men to get and maintain erections. Taking the two drugs together leads some men to fuck for longer, which increases the likelihood of condom failure. Ecstasy (see below). Too much water – or too little. Make sure you keep hydrated, but don’t overdo it, as ecstasy can temporarily inhibit the body’s ability to produce urine. Drink no more than a pint of water or non-alcoholic liquid an hour, sipping it at regular intervals rather than drinking it all at once. Speed, crystal meth – combining ecstasy with either of these puts extra strain on the heart, and you risk overheating.

Speed

Viagra or any prescription drugs which lower blood pressure (e.g. beta blockers, ramipril and amlodipine). Poppers lower your blood pressure, so avoid mixing with drugs (including Viagra) which have the same effect. You may suffer a severe drop in blood pressure, causing you to pass out or, in extreme cases, suffer a stroke. You should also avoid poppers if you have anaemia, glaucoma, chest or heart problems. Ecstasy (see above). Cocaine – although it’s unlikely that cocaine and speed will be taken together, since they have such similar effects, they are a toxic combination.

For information on the possible harmful interactions between recreational drugs and anti-HIV medications, see page 47.

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COPING WITH AN OVERDOSE No matter what drug someone takes, there are some common signs of an overdose: vomiting, breathing problems, seizures or fits, loss of consciousness. Would you know what to do if a mate overdosed? Here are some basic things to remember: • Alert someone in authority immediately: a security guard, a bartender, DJ, door person. Venues must have a first-aider on site – it’s the law. • Someone needs to call an ambulance right away – do it yourself if you have your phone. If the person has passed out, don’t wait to see if he’ll come round: ACT IMMEDIATELY. • Put him in the recovery position: lying on his side with one hand under his cheek. If he vomits, he’s less likely to choke in this position. It also keeps anything from draining from his nose into his lungs. • Check that his airway is clear and his tongue isn’t obstructing it. Make sure his chin is not pressed down against his chest so he can breathe easily. • Check to make sure he’s breathing. If not, you need to start mouth-to-mouth resuscitation. If 28

you aren’t familiar with how to do this, find someone who is. • If someone has overdosed, his body temperature may be dangerously high. If he feels hot to the touch, use a damp cloth to cool him down until medics arrive.

SAFER INJECTING Injecting is the most dangerous way to take recreational drugs. Once you’ve injected the drug into your vein, it gets to your brain in seconds. Overdosing is all too easy. And there is an additional danger of contracting HIV or Hepatitis C if you share injecting equipment with others. One trend reported by Antidote, the lesbian and gay drug and alcohol service, is that its clients who use crystal meth are increasingly moving from smoking or ‘piping’ the drug to injecting. This increases the risk of getting HIV or Hepatitis C. And if you do contract Hepatitis C, you may not be able to start treatment for the virus until after your drug or alcohol use is under better control. If you’re going to inject, it’s crucial that you know where the syringe came from. Did you remove it from the packaging yourself – or could someone else have used it? Each 29


syringe should only be used once. A used needle could have blood on it, and if you stick it into your body, another person’s blood will go directly into your bloodstream. This will put you at high risk of being infected with Hepatitis C or HIV. There are many places you can go for advice about safer injecting, for example www.exchangesupplies.org. Click on Drug Information, then Handbooks. The Hungerford Drug Project operates a mobile needle exchange service, taking used syringes and providing new, unused ones in return. Hungerford Drug Project 020 7436 4404 Antidote, the lesbian and gay drugs and alcohol service, also teaches safer injecting practices. 020 7437 3523 There is a pharmacy needle exchange programme in London, to provide clean injecting equipment to intravenous drug users free of charge. To find out which pharmacies participate in the scheme, call: 020 7381 7700

SAFER SNORTING The inside of the nose is very 30

fragile. It’s made of mucous membrane: a type of skin that absorbs a drug and lets it into the bloodstream very quickly. If you’re going to snort a drug, try to prepare it in conditions that are as clean as possible. Check the consistency – it needs to be like talcum powder. Anything larger will cause you a lot of pain and could seriously damage the inside of your nose. The biggest health risk here is from sharing snorting instruments, such as straws, ‘bullets’ or rolled-up bank notes. There are often small droplets of blood inside the nose as a result of snorting. When a straw is passed around, that blood can find its way into someone else’s nose – and into their system. There isn’t a significant risk of HIV transmission from sharing straws, because there isn’t enough blood present to transmit the virus. But there is a risk of transmitting Hepatitis C, a potentially deadly virus. Hepatitis C causes liver damage, tiredness, weakness, nausea and depression. There is no vaccine against Hepatitis C. For more information, look at the STI information at www.gmfa.org. uk/sex 31


SMOKING Whether you smoke cigarettes, rollups, cannabis and tobacco or pure cannabis, you’re putting yourself at increased risk of lung, mouth and throat cancers and other heart and lung diseases.

32

gay men. For details, visit www.gmfa.org.uk/quit. For more information about smoking and its effects on your health, visit: www.gmfa.org.uk/ quitsmoking.

There is some evidence that HIV-positive people who smoke are at increased risk of becoming seriously ill.

Your GP can also give help and advice or you can call the NHS Smoking Helpline on 0800 022 4332.

If you want to reduce the harm smoking can cause, consider some or all of the following: • Cut down on the number of cigarettes or joints that you smoke; • Don’t smoke a cigarette or joint right down to the end; • Use a roach or filter when you roll a cigarette or joint; • Don’t inhale deeply or hold the smoke in your lungs - this especially applies to cannabis smokers, who tend to inhale more deeply and hold the smoke for longer than cigarette smokers; • Try replacing some of the cigarettes you smoke with nicotine patches or gum.

THE LAW

The only sure way to avoid the damage caused by smoking is, of course, to give up. GMFA runs regular Stop Smoking courses for

Steroids are classified as Class C drugs – but the authorities will not prosecute someone for using them.

It’s easy to forget, especially when you’re on them, that drugs can get you into trouble with the law. The government places drugs in three classes, depending upon the severity of the punishment for possessing them. Class A drugs attract the most serious penalties; Class C the least. Frequent re-classifying of these drugs means the legal position can change. It’s up to you to make sure you know the score. Selling or dealing any drug carries a more severe penalty than possession.

33


PENALTY FOR POSSESSION

DRUGS CLASS A: Ecstasy, LSD, heroin, cocaine, crack, magic mushrooms, amphetamines (if prepared for injection), methamphetamine (crystal meth)

Up to 7 years in prison or an unlimited fine or both

CLASS B: Amphetamines, Cannabis, Methylphenidate (Ritalin), pholcodine

Up to 5 years in prison or an unlimited fine or both

CLASS C: Tranquilisers (such as Valium), some painkillers, anabolic steroids, GHB/GBL, Ketamine

Up to 2 years in prison or an unlimited fine or both

The same is true for tranquilisers such as Valium. However, if you are caught in possession of them (or any other Class A to C drugs) in larger amounts than seem reasonable for your personal use, you could be charged with ‘intent to sell’ (dealing) – which could mean a large fine or even imprisonment. Viagra and other erectile dysfunction drugs can only be legally obtained with a prescription from your doctor. There are many websites that claim to sell Viagra – but a 2004 study showed that about half the 34

Viagra sold online is fake. As with steroids, if you are caught with large quantities of Viagra, you could be charged and prosecuted for ‘intent to sell’. Poppers and solvents are sold in many stores. However, poppers are labelled ‘aromas’ or ‘room odourisers’ so that shop owners can avoid being prosecuted for selling them as recreational drugs. Shop owners can refuse to sell solvents if they think the customer is going to use them to get high. It is also illegal to sell solvents to under-18s.

MORE INFORMATION The Home Office website has more details about drugs and the law. www.homeoffice.gov.uk/drugs You can get legal advice from Release, an organisation that specialises in the relationship between drugs, the law and human rights. 0845 4500 215 ask@release.org.uk www.release.org.uk

GALOP is the LGBT community safety charity. While most of the group’s work aims to help LGBT people report hate crime, GALOP can also provide help for LGBT people who have been arrested or are having other problems with the police. 020 7704 2040 www.galop.org.uk 35


sex & drugs When you’re drunk or high, it’s easy to forget about condoms – even if you insist on using them when you’re sober. Several surveys have found that gay men who use drugs are more likely to have unprotected anal sex than gay men who don’t. Drug users are also more likely to have had an STI (sexually transmitted infection). Drugs can help us become a ‘different person’, someone we wish we could be: more confident, rougher, more butch, friendlier, sexier. Some men do different things sexually when they use drugs than they would if they were sober. Before you take any drugs, tell yourself you’re only going to have safer sex – then stick to your decision. Not taking too much or too many drugs will help you to do this. You know that feeling you get sometimes when you’re out partying? When you think, ‘I feel great – and I don’t feel wasted’? 36

That’s when you need to hold back. If you’re drinking, have a soft drink rather than another pint. If you’re on drugs, don’t have another line or pill.

DON’T BE ROUGH Alcohol and most drugs can make you feel slightly numb, so you don’t notice pain as much. When they’re high on drugs, some men have rougher sex than they would have usually. Rough sex can easily damage your cock or tear the lining of your arse. This can facilitate the transmission of HIV and other STIs.

YOU DON’T HAVE TO FUCK Some men want to fuck with all their partners, some men don’t enjoy fucking, and some men want to fuck with some partners but not others. Fucking is not the only thing you can do, and it’s not compulsory. Oral sex carries much less risk of picking up or passing on HIV or other STIs. Wanking each other is even safer. You might sometimes feel pressured to have anal sex – and might be persuaded to fuck because it’s what the other guy wants to do. But you can say no. There are 37


plenty of other things to do – show him a good time your way. Remember – you have the right to control what happens to your body.

HAVE CONDOMS AND LUBE HANDY Using condoms is the best way to avoid picking up or passing on HIV or other STIs during anal sex. Remember to carry a couple of condoms and sachets of lube with you when you’re out clubbing. They don’t take up much space in a back pocket, jacket pocket, sock or shoe. At home, keep your condoms in a convenient place near the bed. If you know you don’t have condoms at home and you’re taking someone back there, ask at the bar for a Freedoms condom pack. Don’t be afraid to ask – that’s why they’re there. Drugs – especially stimulants like cocaine or crystal meth – can make you want to fuck for longer periods of time. It’s important to use plenty of water-based lube – and keep re-applying it. Change the condom every 30 minutes if you’re fucking for a long time. Check the condom every 38

so often (whether you’re top or bottom) to make sure the condom hasn’t split.

SEX, DRUGS AND HIV It is impossible to tell if someone is HIV-positive or HIV-negative just by looking at them. Around 1 in 12 gay men in London are HIV-positive, and at least a quarter of them don’t know it. Negotiating safer sex requires clear communication. This can be difficult enough in regular circumstances. When you add drugs and alcohol to the mix, it can be even harder to communicate about safer sex. Knowing this, you could make a firm decision when you’re sober about which kinds of sex you’re happy to have. Then, when you’re drunk or high, you may find it easier to remember your intentions and stick to them. Physically, drugs and alcohol can affect your body’s natural defences against HIV infection. Alcohol and most drugs cause dehydration – which can affect the mucus inside your arse. You’ll need to use extra lube if you’re fucking – otherwise the inside of your arse could get damaged, which makes it easier 39


for HIV to enter your body. For more detailed information about HIV and how it is transmitted visit www.gmfa.org.uk/sex or pick up a copy of Semen, Sex & HIV in the health information racks in most gay pubs and clubs in London.

GET CHECKED OUT It’s a good idea to visit a sexual health clinic regularly. How often you go depends on how many partners you’ve had. Doctors recommend that you get checked out every 6 to 12 months. If you have lots of sexual partners, you should probably go every 3 months. If you have any symptoms, make an appointment immediately. For full listings of sexual health clinics in London, and links to clinics around the UK, visit www.gmfa.org.uk/ clinics. You can go to any UK sexual health clinic you like: it doesn’t have to be the one closest to your home.

HOW TO COPE WITH A SLIP-UP PEP (post-exposure prophylaxis) is a drug treatment which may prevent someone who has been exposed to HIV from becoming infected. 40

If you’re HIV-negative and think you may have put yourself at risk by having unprotected anal sex with someone who may be HIV-positive, then you need to know about PEP. If you’re HIV-positive and you had unprotected anal sex with someone who may have been HIV-negative, then you need to tell them about PEP. PEP involves taking anti-HIV medication for a month. But it must be started as soon as possible after the risky sexual encounter – and definitely no more than three days (72 hours) afterwards. PEP should be available at most sexual health clinics. Phone and ask for an urgent appointment, explaining why you need one. If your clinic is closed (it’s the weekend, for example) or you can’t get through, call the A&E (or casualty) department at your nearest hospital. You will only be given PEP if the clinic thinks you have been at risk of exposure to HIV – and if you haven’t left it more than three days before getting in touch. You can get lots of information about PEP, including instructions on accessing PEP and what to do at a clinic or A&E department at www.gmfa.org.uk/ pep. 41


GET THE FACTS ABOUT SEX There are many places to get information about safer sex. A sexual health adviser is always a good source: for listings of sexual health clinics in London, visit www.gmfa. org.uk/clinics or call THT Direct on 0845 12 21 200. You can also find information about safer sex online at www.gmfa.org. uk/sex or by calling London Lesbian and Gay Switchboard on 020 7837 7324, or by talking to a GMI Health Trainer on the scene.

SEXUAL HEALTH COUNSELLING There are many organisations that offer specialised counselling. Some focus on sexual health while others offer therapy for couples. Counsellors can help examine how drugs and/ or alcohol are affecting your sexual health. The following services are free to gay men in London: The GMI Partnership’s Counselling Service offers talking therapies which are 42

43


designed to assist men who have sex with men. This service is open to all men who have sex with men regardless of HIV status who have concerns with adopting or maintaining safer sex and HIV risk reduction behaviour and is free of charge. counselling@gmipartnership.org.uk www.gmipartnership.org. uk PACE has a dedicated Sexual Health Counsellor and offers couples counselling as well. 020 7700 1323 www.pacehealth.org.uk THT is another good option. It offers sexual health counselling as well as counselling for men with diagnosed HIV. 020 7812 1777 The Naz Project offers sexual health counselling for Black, Asian and other minority ethnic gay men and men who have sex with men. 020 8741 1879 44

45


HIV & drugs

DRUG

INTERACTS WITH...

POSSIBLE SIDE-EFFECTS

Alcohol

fosamprenavir (liquid formulation)

The liquid formulation of this protease inhibitor has a type of alcohol in it already. Doctors recommend you avoid mixing the two. Drink in moderation with any other anti-HIV meds.

Crystal meth and Speed

All common protease inhibitors, including: fosamprenavir (Telzir); atazanavir; indinavir; lopinavir; nelfinavir; ritonavir; saquinavir; tipranavir.

Most HIV medications increase the strength of the meth – though not quite as much as with ecstasy. Your blood pressure and heart rate can rise rapidly and you can dehydrate quickly.

Ecstasy (or MDMA)

All common protease inhibitors (see above).

Combining ecstasy with any protease inhibitor greatly increases the amount of ecstasy: it’s usually about 3 times stronger. When you do this too often, you can damage your liver and kidneys.

GHB/GBL

All common protease inhibitors (see above).

There is concern that protease inhibitors could amplify the effects of GHB/GBL, making you more likely to lose consciousness, have seizures or vomit.

Speed All common protease inhibitors (see above).

Protease inhibitors might cause a buildup of steroids in the blood. This could increase the negative side-effects of steroids: mood swings, liver damage, hair loss, etc. Check with your doctor before starting a course of steroids when you’re taking anti-HIV meds.

Valium

All common protease inhibitors (see above).

Valium can have a much stronger effect when you’re taking protease inhibitors – so much so that doctors say you should never, ever mix the two.

Viagra

All common protease inhibitors (see above).

Doctors recommend that you take only a half-dose of Viagra.

Having HIV means paying close attention to your health. The virus affects your body’s ability to fight off illnesses. When you’re taking recreational drugs, you’re often not getting proper sleep or nutrition. This has an impact on your immune system: when you’re feeling tired and run down, you’re more likely to come down with an infection. Additionally, some recreational drugs react badly with anti-HIV medications. This chart lists some common recreational drugs and their possible interactions with anti-HIV medications. 46

As for crystal meth above.

Steroids

47


Cocaine, cannabis, ketamine and poppers don’t have any known interactions with anti-HIV medication. But that doesn’t mean they won’t have any negative effects. There are very few scientific studies on how recreational drugs and HIV medications interact. Most of the evidence comes from real-life cases, such as the London man who died in 1996 from taking ecstasy whilst on ritonavir. Tests showed he had the equivalent of 22 ecstasy tablets in his blood – when he actually only took 2 or 3 tablets. Without any real scientific studies to go by, mixing drugs and HIV medications is a guessing game. It’s important to remember that each person’s metabolism is different. Since there’s no way to know exactly how your body will respond, if you do choose to take drugs, it’s a good idea to try a smaller amount of a drug at first and see

48

how you feel. This is particularly important if you’ve only just begun to take anti-HIV treatments, because you will have especially high concentrations of the medications in your blood. You might want to check with your HIV doctor for the latest information on drug interactions. Be open and honest about any recreational drugs you take – your HIV doctor is unlikely to be surprised or shocked, and should be happy to give advice about how particular drugs taken in combination could affect your overall health. Here’s another thing for HIVpositive men to remember: when you get high, you’re more likely to forget to take your medication on time. Correct adherence to your medication schedule is very important. Missed or late doses can mean that your HIV develops resistance to the drugs. If you’re not sure how long you’re going to be out partying, bring a few extra doses of your meds. Put them in your pocket or keep them in your jacket in the coat check. Having them handy might help you remember to take them. 49


COMPLEMENTARY MEDICINES Ten percent of HIV-positive gay men in London take complementary or alternative medicines that are potentially dangerous to their health. If you are HIV-positive, it is important that you tell your HIV doctor if you are taking or planning to take any complementary or alternative medicines. Some popular herbal remedies, such as garlic capsules, kava kava and St John’s wort, reduce the effectiveness of some anti-HIV drugs. St John’s wort, for example, which some men use to combat depression, reduces the concentration of protease inhibitors and some other anti-HIV drugs in the blood. Do not use St John’s wort if you are taking any of the following: indinavir, warfarin, cyclosporin, digoxin, theophylline, other protease inhibitors (saquinavir, nelfinavir, ritonavir), non-nucleosides (efavirenz, nevirapine) and anti-convulsants (phenytoin, carbamazepine, phenobarbitone). 50

Many HIV-positive gay men take echinacea because it is known to boost the immune system. Given that HIV damages the immune system, taking echinacea seems, on the face of it, like a good idea. In fact, over-stimulating the immune system can also overstimulate HIV and increase the amount of virus in your blood. If you are taking, or thinking of taking, echinacea, consult your HIV doctor first.

medications and their negative interactions with recreational drugs, other prescription medicines, vitamins, etc. The i-base Treatment Phoneline can explain all about the various HIV treatments and medications in language that’s easy to understand. 0808 800 6013 (Mondays to Wednesdays, 12noon-4pm). info@i-base.org.uk www.i-base.info

Other alternative remedies may also cause allergic reactions or other adverse side-effects. Hops, kava kava, passion flower and valerian should not be taken with alcohol, for example. All these drugs have a sedative effect that is increased by alcohol.

THT Direct offers support and information to help HIV-positive people make decisions about their treatment and medications. 0845 1221 200 (Mondays to Fridays, 10am-10pm; Saturdays and Sundays, 12noon-6pm). www.tht.org.uk

Positiveline is run by the Eddie Surman Trust for HIV-positive people who are having a difficult time coping with their status. Volunteers are available to chat and can offer referrals for counselling. 0800 169 6806 (Mondays to Fridays, 11am-10pm; Saturdays and Sundays, 4pm-10pm). eddiesurmantrust@hotmail.com www.eddiesurmantrust.org.uk

HELP & SUPPORT There are several websites with extensive information about HIV drug interactions. Check www. aidsmap.com first: it’s the UK’s most extensive resource for all information on HIV and AIDS. Type ‘recreational drug use’ into the search engine at the top of the page. Another website to check is www. hiv-druginteractions.org: it lists all the most common anti-HIV 51


listings

LGBT DRUG & ALCOHOL INFO ANTIDOTE 020 7437 3523 www.thehungerford.org/antidote.asp WRECKED AGAIN (young people) 020 7702 0002 wreckedagain@dasl.org.uk HIGH NRG @ THT (young people) 020 7803 1684 www.tht.org.uk/nrg nrg@tht.org.uk

DRUG & ALCOHOL INFO DRUGFUCKED http://drugfucked.tht.org.uk FRANK 0800 77 66 00 (open 24 hours) www.talktofrank.com DRUGSCOPE www.drugscope.org.uk

SEXUAL HEALTH CLINICS FOR GAY MEN You can visit any UK sexual health clinic you like: it doesn’t have to be the one nearest your home. For full listings of all sexual health clinics in London, visit www.gmfa.org.uk/ clinics or call THT Direct on 0845 12 21 200.

RELEASE www.release.org.uk THE SITE www.thesite.org/drinkanddrugs KNOW YOUR LIMITS www.units.nhs.uk

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53


WHAT DOES IT DO?

WHAT ARE THE HEALTH EFFECTS?

WHAT IS IT?

WHAT DOES IT DO?

WHAT ARE THE HEALTH EFFECTS?

Alcohol – A powerful liquid drug that comes in a variety of types (spirits, beers, wines). It’s a depressant, which means that it slows down the workings of your brain and body. See page 10 for maximum daily recommended units.

Small amounts produce feelings of wellbeing, heightened confidence and a lowering of inhibitions. As more is drunk, the depressant effect becomes more pronounced and the after effects more severe.

Short-term: dehydration, low blood sugar, upset stomach and poisoning (hangover). Long-term effects of misuse can include: brain damage, heart disease, stroke, stomach disorders, liver damage, fertility and mental health problems, impotence, cancer, pancreatitis.

Ketamine – A powerful anaesthetic used on both animals and humans, it depresses the central nervous system. It comes either as a clear liquid that’s injected, a powder that’s snorted, or in tablet form.

Users feel detached and remote, lose bodily sensation, experience hallucinations. It is often used for anal sex and for fisting. Because of its anaesthetic effect, users can be injured during sex and not feel it.

Risk of vomiting, choking, breathing problems, loss of consciousness. Users can freeze, unable to move or communicate at all. Long-term effects: anxiety, memory loss, emotional disturbances. Risk of HIV transmission from rough or prolonged sex.

Ecstasy (MDMA) – A stimulant sold in tablets or capsules or sometimes powder. MDMA powder is usually snorted and is much stronger than the pills (which are very likely to contain speed, caffeine or other substances in addition to – or instead of – ecstasy).

Ecstasy keeps you awake for hours. Sound, colours and touch seem more intense. Ecstasy can stimulate feelings of serenity and emotional closeness with other people. But it can also make users feel anxious, panicky and confused.

Dancing around in hot clubs can cause users to become dehydrated or overheated (see page 22 for advice). Users can feel depressed when ‘coming down’ from the drug. Longterm health effects can include paranoia, depression, panic attacks and memory loss, as well as heart, kidney and liver problems.

Cocaine – A plantderived stimulant. Comes as a white powder that you snort. Effects peak at 15-40 minutes, then diminish rapidly. Users can take several doses in the course of a session. Higher doses inhibit erections.

Gives a quick rush. Users feel more powerful, alert, confident and talkative. They can also suffer from dry mouth, sweating, racing pulse. After coming down, they can feel exhausted and depressed.

Puts a massive strain on the heart. Regular use harms the nasal passages, sometimes severely. Coke suppresses the appetite, so regular users may be undernourished. Risk of heart attack and a range of mental health conditions. Overdosing can cause death.

GHB (Gammahydroxybutyrate) – A colourless, odourless liquid that has powerful sedative and anaesthetic effects. The drug’s strength can vary and it can be difficult to judge a safe dose.

Small amounts can make users happy, sensual and uninhibited. As more is taken, the sedative effects become stronger and users can feel sleepy.

Nausea and vomiting, muscle stiffness, disorientation. Recent cases of collapse and even death from GHB have been the result of overdosing or of mixing it with alcohol or other depressant drugs.

Poppers (Alkyl Nitrites and Amyl Nitrites) – Strongsmelling, yellowish liquid sold in small bottles. Users inhale the fumes from the bottle. Often sold in shops as ‘aromas’ or ‘room odourisers’.

Raises heart rate and gives a strong, immediate ‘head rush’. Dilates blood vessels, lowering blood pressure. Relaxes the anal sphincter. The high only lasts a couple of minutes.

People who have heart problems or who take high blood pressure medication or drugs for erectile dysfunction, such as Viagra or Cialis, should never use poppers. Can cause dizziness, nausea, vomiting and headaches. Can make it difficult to keep an erection. Can burn the skin and could be deadly if swallowed.

Crystal meth (Methamphetamine) - A very powerful and addictive stimulant drug. Usually comes as a powder that’s snorted or a crystal that’s heated and smoked. Can also be injected. It is made from toxic chemicals: iodine, acetone, red phosphorus, paint strippers.

It can make you feel exhilarated and aroused. Smoking it gives a rush similar to crack but much longer lasting. Sex tends to be harder and last longer. Users may feel detached, aggressive and more willing to take sexual risks.

Causes rises in both heart rate and blood pressure, as well as mental health problems such as agitation, paranoia, psychosis and aggression. Users suffer from lack of sleep, and can feel weak and depressed long afterwards. Risk of HIV transmission from rough or prolonged sex. Regular use can lead quickly to dependency. Users often experience gum disease and tooth loss.

Viagra (also applies to Kamagra, Levitra, Cialis) – Antiimpotence drug in tablet form that causes extra blood to flow to the penis. Often used to counter the erectionkilling effects of other recreational drugs.

It enables the user to get and keep an erection. Like poppers, it lowers blood pressure. There are concerns that recreational use could lead to dependency on it to achieve an erection at all.

Headaches, upset stomach, stuffy nose and blurred vision. If your erection doesn’t go away after 4 hours, you need to see a doctor immediately. Mixing Viagra with poppers, cocaine, speed or crystal meth is risky and could cause a heart attack.

WHAT IS IT?

54

55


ERGO is a health research organisation that would like to find out more about readers of this booklet. The information gathered from this survey will help establish the types and levels of need gay men have in London in order to help plan the best and most useful HIV prevention services. The survey asks questions that highlight any needs that individuals personally might have for a range of information, advice, individual and group support services presently available. Please take a few minutes to complete the questionnaire, providing as much information as possible, and return it by post. Many thanks. 1. Please tell us how you got this copy of the booklet: Picked up in a GU clinic Picked up in a gay pub, club or bar Picked up in a sauna Downloaded from a GMFA website From a GMI Partnership health trainer From another HIV or sexual health service (please specify):

2. How many times have you had the result of an HIV test in

the last 12 months? None Once Twice 3 times 4 times 5 or more times 3. What do you believe your HIV status is? Definitely HIV-negative (I don’t have HIV) Probably HIV-negative Not sure/don’t know Probably HIV-positive Definitely HIV-positive (I have HIV) I don’t want to say

Continues over the page


4. And what is this belief based on? Please choose the option that most closely applies. I have tested HIV-positive I think I am HIV-positive although I have NOT had a positive test result I have tested HIV-negative and have NOT fucked or been fucked by ANYONE since my last negative test I have tested HIV-negative and have NOT fucked or been fucked EXCEPT WITH A REGULAR PARTNER since my last negative test I have tested HIV-negative but HAVE fucked or been fucked since my last negative test I have never had an HIV test and I think I am HIV-negative because I have NEVER fucked or been fucked without condoms I have never had an

HIV test and I think I am HIV-negative because I have ONLY RARELY fucked or been fucked without condoms I have never had an HIV test and I think I am HIV-negative because I have ONLY fucked or been fucked without condoms WITH A REGULAR PARTNER Other (please specify):

5. In the last 12 months, how many men have you fucked or been fucked by without using a condom? None 1 2 3 or 4 5-29 30+

6. Have you had a sexually transmitted infection (STI) in the last year? Yes No If yes, which of the following STIs have you had? (tick all that apply) Gonorrhoea Syphilis Chlamydia Other (please specify):

7. Some of the following statements are true and SOME ARE FALSE. For each of the following please tick whether you think it is true (T) or false (F) or don’t know (?).

T F?

Most gay men with HIV get it through anal sex

A properly used condom will normally protect you against HIV transmission A gay man who is HIV-positive would always tell me they have HIV before having sex without condoms You can’t get HIV if you are the active/ insertive partner in anal sex HIV can be passed on during anal sex even when no one cums Oil-based lubricant is safe to use with condoms for anal sex You can always work out someone’s HIV status by how they look or what they say

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There is a course of medicine you can take immediately after exposure to HIV to lessen the chances of HIV infection

8. How do you feel about becoming/being HIV positive? For each statement below please say whether you agree (A) or disagree (D) or are not sure (?).

A D?

I don’t think about it I don’t really care about what happens to me It’s just a matter of luck It’s too late for me to change anything It’s not such a big deal any more I worry about it but it doesn’t stop me taking risks

Other (please specify):

9. How do you feel about using condoms? For each statement below please say whether you agree (A) or disagree (D) or are not sure (?).

A D?

I choose my partners carefully so I don’t need to use condoms each time Condoms don’t work for me Using condoms takes all the fun out of sex It’s not my job to look after other people, it’s their look out Sometimes I don’t use them – I can’t help myself

After sex (or the next day) I often experience guilt, shame or anxiety about the level of risk I took Other (please specify):

10. How often do you end up having anal sex without a condom after you have said to yourself you were not going to? I have not had anal sex without a condom since deciding not to [go to question 12] Once or twice ever Once or twice a year Every 2-3 months Once a month or more I used to have sex without a condom but don’t any more I have never said to myself that I will not have anal sex without a condom

11. Thinking about when you have fucked without a condom in the last 12 months, which of the following factors played a part in your having anal sex without a condom? Please tick all that apply. I had been drinking I was using drugs I was very upset I was going through a bad time in my life I got carried away in the heat of the moment It felt better without a condom He didn’t want to use a condom and I went along with it I knew he had HIV We’ve both been tested for HIV and were negative I thought it would be ok with this person He was worth it It was with a regular partner I never use condoms with

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A condom wasn’t available I was at a sauna, sex party or similar place In other circumstances (please specify):

12. In an average month, how many times do you have anal sex using a condom? None [go to question 14] Once Twice 3-10 times 11-20 times 21-30 times More than 30 times 13. In THE LAST 12 MONTHS how many times have you had a condom break, slip or otherwise fail while you were using it for anal sex? Never Once Twice 3-5 times More than 5 times

14. Do you now feel that you need more information about any of the following? Please tick as many as apply. How HIV is transmitted Safer sex What to do after a possible exposure to HIV Advice on how to use condoms effectively Advice on how to use condoms consistently How to improve sexual choices Strategies for preventing HIV transmission How to cope with situations where you get carried away How to get more control over the sex that you have None of the above Other [please specify]:

15. To what extent would you be interested in using any of the following HIV prevention or sexual health resources or services? Say whether you are not interested (N), possibly interested (P), or very interested (V).

N PV Reading booklets

Other (please specify):

16. After reading this booklet, do you feel you know more about any of the following? Answer a) Much more, b) A little more, c) No more.

A BC

Reading leaflets Website Newsletter

Calling a helpline

Talking with another gay man who understands your situation

Talking with a trained professional Having counselling

Talking with a group of gay men in the same situation as yourself

Having an HIV or other STI test

How to minimise the risk of HIV transmission HIV testing How to minimise the risk of transmission of STIs How to cope with drug and alcohol use to reduce the likelihood of unprotected anal intercourse Post Exposure Prophylaxis

17. Please tell us briefly in your own words what specifically you have learned

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from this booklet.

18. As a result of reading this booklet, are you likely to do any of the following? Answer a) Much more, b) A little more, c) No more.

A BC

Avoid unprotected anal intercourse Use a condom for sex Have an HIV test Cope better with drug and alcohol use

19. We want to know if HIV prevention services are reaching gay men across the whole of London. Please let us know your borough of residence:

20. We also want to work out how many gay men are using HIV prevention services

and resources across London. Because you are likely to be invited to fill in more than one instance of this survey, we need to make sure that we don’t double count you when estimating levels of need and service use. To help us do this please give us the following information which we hope will create a unique code that you can remember but which can NOT be traced back to you. First two letters of your mother’s first name The number of the day of the month you were born on First two letters of your own first name When you have completed the questionnaire please post it to:

ERGO, Freepost ERGO Consulting No postcode or stamp is required. Many thanks.


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