Tweaking Tips forParty Boys Michael D. Siever, M.Ed., Ph.D. The Stonewall Project Division of Substance Abuseand Addiction Medicine UCSF Department of Psychiatry at San Francisco General Hospital
NEON Needle and Sex Education Outreach Network a project of the Seattle Counseling Service and the Seattle-King County Dept of Public Health
NEON • Needle Exchange & Condom Distribution • Peer Educators • Amphetazine • Butthole Buckaroo • Tweaker’s Guide to Safer Injecting • Other Posters and Brochures
Outreach • Peer Educators • Amphetazine • Butthole Buckaroo • Tweaker’s Guide to Safer Injecting • Other Posters and Brochures on Specific Health-related Themes • Cotton Fever • Abscesses • Endocarditis • Reality Condoms
Weekly Skills Building and Harm Reduction Support Group for Active Users Weekly Groups at Stonewall Recovery Services Abstinence Group Contemplation Group Safer Injecting Workshops Provider Training Destigmatizing tweakers
Gay Men’s SpeedWorking Group • Community Activists • HIV Prevention Workers • Substance Abuse Workers • Public Health Workers
Gay Men’s SpeedWorking Group • Call attention to epidemic • Pressure Department of Public Health • Brainstorm Strategies for Prevention & Treatment
Community Forums • Came from community • Then picked up by STOP AIDS Project • Provided non-judgmental forum for users, former users, and friends, partners, and family of users • Called attention to problem
Crissy Campaign • Media campaign by STOP AIDS Project • Raise consciousness and foster communication • Both prevention and treatment goals • Aimed at “Club Kids,” Young Gay and Bisexual Men, Queer Boiz
Talking Walls • Placed in the community • Large sheets of white-painted plywood for people to tag/graffiti • Solicited thoughts and feelings of community • Provided visible ongoing community forum
"Cause sex was never better""Paper plates are better""The psychotic sex of course""Ahh -- the energy""I am woman, I am invincible""I can put big things up my butt""Because it's crystallicious""It makes the insecure feel pretty!! And it's so important to us to be pretty"
Focus Groups • Funded by Community Substance Abuse Services of SF DPH • Organized and developed by Gay Men’s Speed Working Group • Included active users, former users, those in and those out of treatment, and those in and out of treatment
Focus Groups • Groups of four to eight participants reflecting diversity of ethnicity, age, income, and neighborhoods • Diversity also in means of ingestion and use patterns • Some has been through treatment, some not
Focus Groups • Two groups – actively using speed and did not perceive as a problem • Two group – actively using speed and had made some attempts to stop • One group – had made attempts to reduce or stop that weren’t yet successful • One group – had made attempts to reduce or stop that were self-defined as successful
Results from Focus Groups • Programs should be designed specifically for gay and bisexual men who use speed • Ability to set own goals, provide harm reduction, alternatives to total abstinence • Non-judgmental approaches needed • Reluctance to be defined as “addicts” needing “treatment” • Explore relationship between speed use and sex • Explore relationship between speed use and HIV
Community Based Response to Epidemic Methamphetamine Use Substance Abuse Treatment on Demand
THE STONEWALL PROJECT An integrated substance use, mental health, and HIV counseling program for gay, bisexual, and transgender men who use methamphetamine
Theoretical Basis • Harm Reduction • Stages of Change • Motivational Interviewing • Relapse Prevention • Cognitive Behavioral Therapy
Harm Reduction A philosophy, model, and set of strategies that reduces drug-related harm without creating further harm to active licit and illicit drug users, their families, and communities affected by drug use. Drug-related harms include HIV/AIDS and other infectious disease, overdose, illness, death, dysfunction, violence, and community disintegration.
Principles of Harm Reduction Harm reduction is a set of practical strategies with the goal of meeting drug users “where they’re at” to help them reduce any harms associated with their drug use. Because harm reduction demands that interventions and policies designed to serve drug users reflect specific individual and community needs, there is no universal definition of or formula for implementing harm reduction.
Continuum of Use • No use • Occasional, recreational or casual use • Regular use • Misuse, abuse • Dependence, addiction
Regardless of Placement on Continuum of Use, There is a High Risk for HIV, STD, Hepatitis Transmission
Tweaker.orgAn Innovative Outreach Project for Gay & Bi Men who Use Crystal • Peer-Educator Project • Internet-based • Street and Venue Based • Harm Reduction