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Hugs not Drugs (or both)

MoS july 2019 hugs not drugs march

Not everybody uses drugs in the same ways and this is especially true for the LGBTQ community. Are different approaches to harm reduction needed? 

Sex. Drugs. Carly Rae Jepsen. This is the iconography that tends to be massaged into mainstream conceptions of gay culture. Depictions in TV/film see us railing lines of MDMA and sniffing poppers at our Kiki clubs. The more grim scenes – always accompanied by a harrowing score – might show us smoking meth and dosing GHB at the neighbourly chemsex soirée (who’s bringing the brie?).

Stereotypes are little things. They help confirm the biases we want to see in the world and make it difficult to consider that behind every trope is a real person with an individual set of values, histories and behaviours.

But they must tap into something. For example, it is a truth universally acknowledged that a gay person walks at a furious speed. While it’s certainly true that while some stereotypes are funny and mostly harmless (gays are speedy walkers, love iced coffee, can’t drive), others can be pretty dangerous.

The dangerous ones exploit already deeply set judgements and cast a sinister shadow over our community, sweeping us further into society’s margins. This practice is called stigma: the process by which we make people feel bad, unwanted, disgusting for their behaviours and values. Over time this stigma stews inside of us until it becomes shame. And shame can be a real killer.

Why do gays walk so quickly?

My guess is it’s a hangover from our days of stealthily walking away from our bullies after intermediate school. Others argue it’s our most widely used mode of transport (we can’t drive). One hypothesis theorised that “we constantly have ‘Toxic’ by Britney Spears (143 bpm) playing in our heads whereas straight people have ‘Closer’ by the Chainsmokers (95 bpm)”. A symptom of all that iced coffee?

Then again, it could be the drugs.

I look myself in the eye and wonder when am I getting it together ... Lord it’s been forever since it felt right.

Brendon Maclean, Hugs not Drugs (or both)

DRUGS

There will always be questions when a topic is taboo – people are often most curious when something carries stigma. Immediately we’re seduced by those prickly stereotypes. Why is this trope of drug use in the Rainbow community so popular and visible? Is it just gay men, or does it extend to the broader community? Which drugs are we using? Is there anything specific about our culture in Aotearoa?

Let’s start with some data (although it’s far from complete).

A 2012 analysis of global trends of “drug use among men who have sex with men”. It noted an overall higher prevalence for illicit drug use. And there were key patterns within that use: most drug use was episodic (weekly/monthly) as opposed to daily; gay men are not a “homogenous group” as prevalence was even higher in further marginalised groups (e.g. ethnic minority men); drug use tended to be higher in larger urban centres as opposed to rural areas; and the prevalence of injecting drug users (IDU) was typically low (rarely climbing over 5%).

Locally, a 2017 study led by Dr Peter Saxton from the University of Auckland found persistently high drug use with gay and bisexual men in New Zealand. The dataset of 3211 participants – collected from a 2006 community-based Gay Auckland Periodic Sex Survey and a web-based Gay Online Sex Survey – presented a number of key findings. Over half of the participants (55.8%) reported drug use within the last six months (the base male population of NZ sits at around 23%). Cannabis was most favoured (37.9%), followed by poppers (36.7%), ecstasy (16.5%), amphetamine (10.5%), methamphetamine (7.4%), LSD (6.6%), cocaine (6.1%), GHB (5.3%) and ketamine (4.4%). Partially consistent with global findings, prevalence was higher for men living in urban centres (Auckland, Wellington, Christchurch), those living with HIV, and those who identified as Māori (though use was less common in Asian-identified ethnicities).

While the study provides a vital backbone, a lot has happened in the 13 years since the data was collected. Australian research has shown that drug use between 2006 and 2011 had fallen by about 8% – with a noted 30% decline for club drugs such as ecstasy, speed, crystal meth and ketamine. Cocaine, GHB and the use of erectile dysfunction medications (EDM) have, however, noted a sharp increase. Still, drug use is clearly higher than the base population group.

Data is currently being prepared by Saxton to give a more up-to-date snapshot. It’s already been done in Australia where the 2016 Australian Following Lives Undergoing Change study observed that 17.3% of adult men had used any illicit drugs (2.5% for crystal methamphetamine), while 50.5% of adult gay/bisexual men in the study reported drug use in the last six months (12% for crystal methamphetamine).

Two men hold rainbow flags against a greyscale backdrop of rally participants

While drug use data on gay and bisexual men continues to increase, research on lesbian and bisexual women is less available. Men have historically been the focus of research due to other health-related issues such as HIV, meaning more have entered academic institutions with greater understanding and specialisation in gay/bisexual men’s activities. And women have largely been neglected in data collection and analysis. In her book Invisible Women: Exposing Data Bias in a World Designed for Men, Caroline Criado Perez examines the deep effects of the absence of women in the creation of most societal norms.

While literature on illicit drug use for lesbian/bisexual women is scarce, a report by the Alcohol Healthwatch NZ, Women and Alcohol in Aotearoa/New Zealand, showed key differences within drinking. The review – which included focus groups and interviews with 41 women’s health and welfare providers – concluded that lesbian/queer women were more likely to drink (at least weekly) than their hetero counterparts. This is in line with data provided by the 2015/2016 New Zealand Health Survey (NZHS): prevalence for heterosexual women sat at 76.5% but was much higher for women identifying as lesbian and bisexual (91% and 89.5%, respectively). (It’s interesting to note that prevalence rates for heterosexual [84.2%], gay [84.1%] and bisexual [80.1%] men were all roughly similar.)

When thinking through drinking norms, Alcohol Healthwatch maintained that “lesbian and queer women’s communities have grown around alcohol venues, and alcohol often plays a role in coming out”. Their assessment of “hazardous drinking” pointed towards housing, violence, and employment – variables that catalyse problematic drinking, make seeking treatment more difficult, and are further weighted for lesbian/queer women when accounting for higher levels of discrimination. The review advised a need for targeted, identity-specific programmes to help support women through problem drinking.

The review also reiterated that no data was found on transgender women’s drinking or substance use in New Zealand. In fact, very little research has looked at health issues pertaining to transgender, intersex or gender-diverse populations at all. This is disappointing, but, honestly, unsurprising: little oxygen is given to Rainbow community members outside of gay, cisgendered (more often than not) white men. Much can be explained by the relative privilege that gay cis white men have over others in the community, amplifying their experiences and narratives. But pedestaling their voices as if they’re representative of the entire community does a massive disservice to the unique experiences (and specific health-related issues) of those who aren’t cisgender, male or white.

Two women hold a giant flowing rainbow flag along with a pink placard reading "heart our lesbian, bi and queer sisters", against a greyscale backdrop of rally participants

We’ve gotta do better. We must stop siloing our Rainbow identities and start learning from each other’s experiences. 

The next step is to champion the work of those committed to making a difference for the subset of their own community.

There is good news. Survey data is currently being collected by Dr Jaimie Veale (senior lecturer in psychology at the University of Waikato) and Jack Byrne (a health and human rights researcher based in Auckland). The Counting Ourselves project is “an anonymous community-led health survey for trans and non-binary people living in Aotearoa New Zealand”. Information from the survey helps illuminate any differences in mental and physical health (including substance use), as well as depicting diverse experiences towards stigma, discrimination, violence and access to healthcare. These results will help to create a more gender-affirming healthcare system.

The other important data gap is with Takatāpui – Rainbow Māori. Led by associate professor Leonie Pihama, the Honour Project Aotearoa will “investigate the life experiences of Takatäpui to gain insight into understandings of health and wellbeing and investigate issues of access, provision and appropriateness of the health care services to this specific Māori community”. Research from this project will give a better understanding of substance use, prevalence rates and motivations to better inform the public health sector.

A number of theories have attempted to explain why drug use tends to be higher in Rainbow communities (again, attention is paid to gay/bisexual men). The most popular – or perhaps, digestible – places emphasis on minority stress: we’re more likely to experience discrimination, bullying, stigma, shame, so we’re prone to use drugs as self-medication. This maps neatly onto partnering statistics that spotlight higher rates of depression and anxieties within the community.

Another thesis is “cognitive escape”, momentary disengagement from everyday stressors in search of chemical bliss, and “combating loneliness” – drugs make us feel more connected, our relationships more intimate.

Much of our culture is centred on the bar and the club for community and pleasure. A 2013 Australian study noticed that the link between minority stress and substance use wasn’t as consistent as first hypothesised: young people who face lower levels of stigma and internalised homophobia were more likely to drink and take club drugs. They reasoned that lessened stigma/homophobia allowed the sample to engage in more community activities – the gay bar – which normalises their substance use.

It’s also worth remembering that some of us drink and take drugs because… drinking and taking drugs is really fun. It’s admittedly enjoyable to lose yourself a little, see the world in a brand new way, heighten your physical and emotional experiences. People have done it for hundreds of years.

This fun is also political. Kane Race, professor of gender and cultural studies, argues in his ‘Party Animals’ his chapter in The Drug Effect: Health, Crime and Society, that dance drugs have a rich history in the collective gay identity as a mode of “urban belonging”.

Two women hold colourful placards reading "healthcare is a human right!" and "We have always been here" and a rainbow flag, against a greyscale backdrop of rally participants

Then there’s chemsex. Party ‘n’ play feat Tina and Gina. Some of us take drugs (typically methamphetamine and GHB) because they enhance sexual pleasure.

Samuel Andrews works at the NZ Drug Foundation as harm reduction projects adviser and is completing a masters of health science with a focus on reducing drug-related harm within the gay community. He’s currently researching the chemsex scene in New Zealand. “The current thinking is that there’s a lower prevalence than Australia and the UK as drugs are less available and more expensive,” he says, noting there are also fewer gay-friendly urban locations. Berlin, London and Sydney – places where chemsex largely occurs – have more dense gay populations.

This might be where many of you stop reading – shake their heads, scoff, cast judgement. Because what’s more taboo and terrifying than a whole lot of gay orgy sex fuelled by a cabinet of Class As?

I’m sorry to say that’s a big part of the problem. Because judgement prevents understanding, which is a barrier to preventing unsafe behaviour.

Chemsex carries risk. There are higher incidences of STIs and higher risks of exposure to HIV. But much of this could be mitigated if we treated issues with substances through a health model – harm minimisation – instead of following the same tired recipe we have for centuries: judge and jail.

When someone recognises they have a problem there remain significant barriers to seeking treatment and asking for help.

“Judgement is at the top of the list there,” says Seb Stewart, community engagement manager at the NZ AIDS Foundation. 

The fear of being judged or misunderstood can stop someone seeking help in their tracks.

That fear of judgement extends to places that are designed to provide treatment.

“Fifty percent of gay men have never disclosed their sexuality to a GP, so – for sexualised drug use anyway – there’s already a barrier to opening up to a doctor that you’ve been having sex on meth (or whatever chems) with men,” says Stewart.

There’s also a “lack of Rainbow-specific services, lack of sensitivity to Rainbow populations across all services, and no established referral pathways between sexual health and addiction treatment services”, says Andrews. “For chemsex a big barrier is the high level of criminalisation from drug-related crimes… for people who seek treatment, it requires disclosing drug use as well as what are considered extreme sexual practices.”

Resources are now being prepared for the New Zealand context.

“Ending HIV is about to launch an online chemsex harm-reduction resource,” says Stewart. “We are also currently planning a methamphetamine harm-reduction programme for men who have sex with men – Re-Wired, based on a successful Australian programme by Thorne Harbour Health – which will provide a framework to assess personal meth use and check in on whether they want to review, reduce or stop their meth use.”

HUGS

In 1961 a drug was introduced to Aotearoa that radically altered our relationship to bodies and broader culture. Within five years of introduction, 40% of its target populace became users. Today, it’s relatively cheap: $5 will last six months. And while feminist analysis correctly raises eyebrows as to why no alternative has been formulated for men, it’s difficult to disregard the impact of the contraceptive pill: a symbol of sexual liberation, a disruptor to our understanding of gender, biology, sex.

It’s worth taking a step back and thinking more discursively around drugs, extending our ideas on use and effect. At its most basic definition, a drug is any chemical you take that affects the way your body works, and with this in mind, we can start seeing how they can provide joy and liberation.

Pre-exposure prophylaxis (or PrEP) is an example. Taken daily, the use of these antiretroviral drugs significantly reduces the risk of becoming infected with HIV during unprotected sex – by 99%. Obviously the little blue pill won’t shield you from other STIs, so condoms are important, too (though condoms might not protect you from gonorrhea of the throat. PSA: testing regularly and being open about your sexual health is the best form of treatment).

At 99% effectiveness, PrEP is being heralded as a liberating force for HIV negative men, but there’s still a long way to go to ending discrimination. “As it is now a funded medication, access to PrEP is improving,” says Stewart, “but we still run into similar barriers for LGBTQI+ people seeking services that require them to out themselves, and sometimes even blatant homophobia from conservative doctors.”

In New Zealand, a three-month supply of PrEP will only cost you $5 if you meet the Pharmac criteria. A small investment to ensure increased sexual safety.

“As long as adherence is kept up and there is an understanding that PrEP cannot prevent STIs other than HIV, PrEP is a valuable tool for people engaging in chemsex,” explains Stewart. “There are currently no known negative drug interactions between common recreational drugs and PrEP.”

It’s also important to recognise that the same drugs used in PrEP – emtricitabine/tenofovir – are used in HIV’s treatment. “Undetectable viral load… UVL… U=U… whatever name you want to use, this is one of the most important HIV discoveries in the history of the epidemic,” says Stewart.

“If a person living with HIV is on successful treatment and their viral load becomes undetectable (unable to be detected with a standard blood test), then HIV cannot be transmitted sexually.”

Take a moment to reread that last paragraph again. Memorise it. Tell your family and friends. Because despite these developments, this drug cannot cure stigma.

In 2014, research looked at New Zealand’s attitudes towards people living with HIV. While the vast majority of respondents understood that HIV could not be transmitted through touch or sharing food, 56% still admitted they’d be uncomfortable with having their food prepared by someone living with HIV. While drugs like PrEP are liberating people in wildly important ways, there’s still a long way to go in curing ourselves from the ailments of discrimination, stigma and shame.

The way we classify what a drug is – what it looks and feels like, and whether it legal – is complicated but simultaneously arbitrary. Coffee and cocktails are, by definition, drugs, yet they don’t fit so nicely under the umbrella term as ketamine or cocaine. Their legal and social status helps them to become normalised and accepted into culture, whereas conceptions of Class As are typically laced with fear (surely we’re all familiar with the urban legend of the girl who took ecstasy and drowned after drinking too much water).

Why the differences? Because our relationship to drugs is pinned to what we understand from our legislative systems and our social norms. This is more or less understandable when considering risk and effect (alcohol and tobacco are still statistically our most fatal drugs and they’re still very legal).

The law is a living and breathing system; a reflection of the dominant values anchored to our status quo. These values aren’t entirely representative of our population and tend to err towards the most privileged and powerful (white, male,  historically religious, straight).

The next problem is that just as the law is a reflection of our values, so too do our values become reliant on our laws. We grow up fearing and stigmatising drug users because of the law’s heavy hand, blind to nuance, critique and deeper interrogation. 

We grow up fearing and stigmatising drug users because of the law’s heavy hand, blind to nuance, critique and deeper interrogation.

This brand of legal puritanism lends itself to a cyclic, punitive and limited vision for broader society. This is something we in the Rainbow community are all too familiar with.

——

In 1961 – the same year the contraceptive pill swept through Aotearoa – our Crimes Act saw an important revision. In place of life imprisonment, the penalty was reduced to a maximum of seven years in prison for any two consenting adult men found to have engaged in sexual acts. It’s difficult to describe the amount of intergenerational trauma, shame and violence these laws have scarred onto our community. The fact that our very existence was written into law as obscene, abhorrent, dangerous – that our stigma and shame was legitimised by the state – is devastating. It wasn’t until 1986, when the Homosexual Law Reform Act was passed, that sex between consenting adult males was recognised just as their heterosexual counterparts.

The enactment of our criminal codes isn’t exactly dripping in justice either. Māori are disproportionately represented in our criminal justice statistics, “to an alarming degree”, reports the Department of Corrections, admitting that bias within the system could account for the numbers. As of March 2018, 50% of our prison population identified as Māori.

We also don’t have to look very far throughout history to note where discrimination and stigma was legitimised via the very institutions that were supposedly set up to “protect” us. It was only on 25 May this year that the World Health Organisation stopped classifying transgenderism as a ‘mental disorder’.

The 2019 Wellbeing Budget saw a great win for our trans community with the government dedicating $3 million to increase access to gender-affirming surgery. This medical recognition will ensure that transgender people are steps closer to respectful health care across New Zealand. Gender Minorities, a predominantly volunteer-run organisation, has resources on how transgender Kiwis can access hormone replacement therapy (HRT). But while HRT has made vital contributions to the health of transgender people, it’s interesting to note that these are the very same drugs used – without consent – on intersex children to enforce binary gender.

This is precisely why binary thinking isn’t useful. Just as our bodies, genders and sexualities float fluidly along a spectrum, so too do the social constructs and societal consequences of our drug use. The Pill sparked an era of sexual liberation for women who could escape the bondage of their biology, but modern research looking at its longitudinal effects has found evidence of a link between hormonal contraceptives and depression. There’s no good vs bad, there’s merely a delicate balancing act cutting throughout consequences and contexts.

Many argue that there are obvious differences between recreational drugs and those used for treatment of medical conditions. Except the line is becoming blurred. MDMA is used as treatment for PTSD, ketamine is being considered to treat severe mood and anxiety disorders, and LSD to address depression and addiction.

Perhaps it’s not really about the drugs at all. Perhaps it’s our relationship with them.

Illustration of a man holding a placard reading "My body my choice" against a greyscale background of  rally participants. One man faces him down with hands on hips.

OR BOTH

Kathryn Leafe has over 20 years’ experience in drug and alcohol services in both New Zealand and the United Kingdom. She currently sits on the board of the International Drug Policy Consortium, has served on the board of the NZ AIDS Foundation, and is former executive director of the New Zealand Needle Exchange Programme.

“Internationally, HIV prevalence among people who inject drugs is 13%,” explains Leafe in her TEDx talk ‘The war on drugs isn’t working. Here’s a better way’. “In New Zealand, largely due to the early introduction of needle exchange, it is just 0.2%.”

She calls for a radical reimagination of the system: “We have to get real if we want to reduce drug harms. Addressing the drug problem is more than new equipment, health services and counselling… it’s about housing, employment, poverty… it’s about economic and social reform.”

But it’s also about the decriminalisation and regulation of drugs, something that The Global Commission has advocated for in its recognition that moving towards a model of harm minimisation is imperative.

“People who use drugs should not be criminalised,” argues Leafe. “Our drug laws are not based on any logic related to the harms that the different drugs cause. Alcohol remains one of our biggest problems today and if suddenly discovered tomorrow would be a Class A.

“We have to accept and understand that most people use mind-altering substances. The vast majority never experience difficulties and that amongst the small percentage that do, the poor, young people, our Māori, Pacific and Rainbow communities are overrepresented.”

Standing alongside Kathryn’s advocacy for a health-first approach to drug use is former New Zealand prime minister, Helen Clark. Clark, a member of the Global Commission on Drug Policy, has been publicly vocal about the need to rethink our measures – particularly on the need for pill testing at music festivals.

“We have to look at the evidence of what works – and if we looked at Portugal or Switzerland or any number of countries now, we see more enlightened drug policies, which are bringing down the rate of death and not driving up prison populations,” Clark told a conference at parliament last year.

Portugal pops up time and time again – and for good reason. In 2001 it decriminalised all drugs. It then noted a severe reduction in overdose, HIV diagnosis, and drug-related crime.

In 2020 New Zealand has an opportunity to put these issues into public discussion with the cannabis referendum. This will be a time when we can speak openly about stigma, shame, discrimination – but also joy and liberation. We can bust the binaries that surround the taboos, and answer some of those burning questions with authority on the data.

——

Looking back at our history, it’s clear that the Rainbow community has always been pretty good at walking. This June marked the 50-year anniversary of the Stonewall riots when the New York gay community rose up against their treatment by police. It’s a time to reflect on the moment we decided to push back against institutionalised power and control. We’d had enough. We knew that the status quo wasn’t serving us.

To commemorate those who fought for our rights, we decided to take to the street – to walk – in Pride, each and every year.

Whether it’s about who we love or how we love, HIV treatment or rights to gender affirmation, drug use and health minimisation, we need to keep positioning ourselves ahead of the curve.

We’ll always keep walking. And pretty quickly, too.

Reaching out for help

Anyone in the LGBTQ community worried about their drug use can reach out to get help.

Rewired is an 8-week support group for people rethinking their relationship with meth run by the NZ Aids Foundation. Starts 18 July, Auckland. nzaf.nz/rewired

SERVICES THAT CAN HELP

AIDS Foundation: 
Free confidential counselling
www.nzaf.org.nz
0800 802 437 to request an appointment

Alcohol and Drug Helpline: 
24/7 confidential free phone,
text and live chat service
alcoholdrughelp.org.nz/helpline/
Call 0800 787 797 or text 8681

Alcoholics Anonymous:
www.aa.org.nz/map.html

Drug Help:
Online self-help and stories of
New Zealanders' recovery drughelp.org.nz

Ending HIV:
Information on how to be safer as well as book an HIV rapid https://endinghiv.org.nz/

OUTLine:
Confidential and affirming LGBTIQA+/Rainbow telephone peer-support line and face-to-face counselling
Call 0800 688 5463

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