Members Present: Emma Kaywin (Co-Chair), Rasheed Ford (Co-Chair), Raffi Babakhanian, Vanessa Decamps, Billy Fields, Arthur Fitting, Steve Hemraj, Susan Mellender, Freddy Molano, Cesar Nuñez John Schoepp, Marcy Sedlacek, Shavonn Stallings
DOHMH, PHS, NYS, CHAIN, Guest, and Present: Doienne Saab, David Klotz, Michael Navejas, Kimbirly Mack, Johanna Acosta, Adrianna Eppinger-Meiering, Sara Kramer, Paul Kobrak, Connor Reynolds, Bryan Meisel, Gina Gambone, Scott Spiegler, Cristina Rodriguez-Hart, Grace Mackson, Francis Silva, Laura Moya Adams, Gus Angelopoulous, Julia Cohen ,Maiko Yomogida
Agenda Item #1:
Welcome/Moment of Silence/Minutes/Announcements:
Emma K. and Rasheed F. opened the meeting. A moment of silence was held. The November meeting minutes were approved with no changes.
Agenda Item #2:
Topic Presentations
Presentation # 1 – Understanding Crystal Methamphetamine Use among Men Who Have Sex with Men
Paul Kobrak (NYC DOHMH HIV Prevention Program, Bureau of Hepatitis, HIV, STIs) presented on the use of Crystal Methamphetamine (Crystal Meth or Meth) among men who have sex men (MSM). He provided an overview, describing the substance’s prevalence among MSM, its association to increased sexual intensity, and the increased risk of HIV transmission. He also highlighted meth’s negative mental and physical health impacts and the limited availability of effective, and sustainable treatment options. Additional concerns associated with meth use include physical damage to the teeth, heart, and brain neurotransmitters. Meth use is often connected to condomless sex, challenges with adhering to HIV antiretroviral therapy and difficulties in achieving viral suppression. Paul K. also discussed the limited evidence on the effectiveness of behavioral therapies or medications for treating meth dependence. The presentation referenced a CDC survey, which showed that between 2014 and 2017, crystal meth use increased from 2014 to 2017 for Black and Latino MSM compared to their White peers.
Paul K. discussed the results of a NYC DOHMH qualitative study, conducted to examine the motivations and challenges of meth use, with the goal of informing the implementation of NYC Health Department programs like the Re-Charge program. This study interviewed 27, 18 or older, MSM who used meth in the past 6 months, to identify recurring themes, experiences, and insightful content among the sample population.
Key findings with recommendations for providers included:
- Sexual Pleasure and Meth: Meth use enhances sexual experiences, decreases pain but may also lead to risky behaviors, such as condomless sex.
- Coping with Stigma: Some participants used Meth to overcome internalized stigma around gay sex.
- Health Risks and Challenges – (Condomless Sex and PrEP): Participants noted severe physical and mental health effects; acknowledging increased sexual desire but the difficulty for some to maintain an erection and potential dissatisfying sexual encounters. Meth use complicates safe sex practices, but PrEP mitigates HIV concerns with decreased condomless sex crating opportunities for HIV and STI transmission. Given the FDA approval of PrEP, Meth made sex more appealing and feasible without the fear of getting HIV.
- Health Risks and Challenges – (Mental Distress): Various participants said that ingesting small amounts of meth gave them the self-confidence or helped them focus. Some participants described experiencing mental distress, physical damage, and social isolation related to meth use; the regret in using if they were informed of the negative consequences prior.
- Black and Latino MSM Unique Experiences: Meth use has increased among Black and Latino MSM, who face unique stigma and social challenges. Some participants disclosed that their first experiences with meth occurred while having sex in situations involving money, rent, food, or drug exchange, often reflecting economic and sexual exploitation.
- Supportive Counseling: Trauma-informed, non-judgmental, harm-reduction-focused counseling creates a space for open discussions about meth use. This approach also addresses related challenges such as, mental health, trauma, instability, and social isolation.
Recommendations for Providers:
1. Harm-Reduction Strategies: Encourage safer use and gradual reduction in smaller amounts.
2. Support Services: Link clients ready to quit to appropriate resources.
3. Promote Sexual Health: Ensure access to PrEP and regular STI testing.
4. Address Underlying Issues: Tackle trauma, stigma, and socio-economic factors contributing to meth use.
In conclusion, Paul K. emphasized the importance of providing tailored, stigma-free interventions to reduce harm and support MSM in managing meth use effectively. He also noted that the study’s limitations included a small, non-representative sample which described a range of men’s experiences and understandings around meth use, but not general tendencies among NYC men who have sex with men.
Presentation # 2 – NYC DOHMH Crystal Meth Harm Reduction Services (MTH) Program Overview
Bryan Meisel, (NYC DOHMH HIV Prevention Program, HIV Care and Treatment Program, Bureau of Hepatitis, HIV, STIs) presented an overview of the Crystal Meth Harm Reduction Services (MTH) Program, aimed at reducing HIV and improving treatment outcomes among Black and Latino men and transgender women who have sex with men, aiming to reduce HIV infections and improve HIV treatment outcomes. MTH provides harm reduction services, including health education, mental health support, and linkage to medical services like PrEP, PEP, and HIV treatment. Its program structure uses a status-neutral approach by offering services to both HIV-negative and HIV-positive participants. The program is funded through local (NYS and NYC) and federal funding (RWPA) streams, operating across three sites in NYC, with one offering clinical services.
The core services of the program include:
• Counseling for substance use and mental health.
• Social support services (e.g., housing, food assistance).
• Medical services, including STI testing and HIV care.
• Health education on harm reduction and health management.
Program successes:
• 179 client enrollments.
• Established safe spaces and a supportive community.
• Successfully connected clients to essential services like housing and psychiatric care.
Program challenges:
• Difficulty engaging HIV-negative meth users.
• Limited access to private spaces for outreach.
• Space constraints for providing services.
Overall, the program’s harm-reduction approach and flexible model have proven effective in addressing the needs of crystal meth users while promoting overall health and well-being.
Bryan M., described the recent changes to the new MTH program model which includes a shift away from underutilized clinical services, the addition of evidence-based interventions such as, “Healthy Conversations” and “Seeking Safety.”, and the expansion of mental health counseling offerings.
Presentation # 3 – Impact of a NYC Harm Reduction Program Tailored for Populations Using Crystal Methamphetamine
Connor Reynolds, (NYC DOHMH HIV Prevention Program, HIV Care and Treatment Program, Bureau of Hepatitis, HIV, STIs) presented on the research findings of the Crystal Meth Harm Reduction Services (MTH) Program. He described the study’s utilizations of the RE-AIM framework (reach, effectiveness, adoption, implementation and maintenance) to evaluate and measure the program’s success for the following: enrollment, meth use, PrEP use, service utilization, seroconversions among others among MSM, transgender people who have sex with men, and people of color within this groups.
Results found that 54% of participants were people with HIV (PWH); 97% identified as cisgender men. Connor R. also reported that meth use decreased significantly among participants reassessed (91% at intake vs. 44% at reassessment). In addition, to a slight increase in PrEP use (47% at enrollment to 58% at reassessment).
Challenges:
- Difficulties engaging HIV-negative meth users.
- Limited private spaces for outreach.
- Low reassessment participation restricted broader conclusions.
Successes:
- Enrolled 545 participants, successfully reducing meth use for most reassessed clients.
- Connected clients to critical services (housing, PrEP, mental health care).
- Created safe, supportive spaces for participants.
In conclusion, Connor R. discussed the importance of increasing PrEP uptake and investigating the factors behind HIV seroconversions for populations disproportionately impacted by meth use and HIV.
NAC members and presenters emphasized the highly addictive nature of Crystal Meth but also how the frequency of use and reasons for use vary per person. Members acknowledged that reducing or stopping Crystal Meth use was particularly challenging for those who are facing various life challenges and instability. The group emphasized the importance of addressing the factors that influence health outcomes such as, social determinants of health, psychosocial issues, and internalized stigma (e.g., sexual orientation) through tailored, holistic-harm reduction interventions programming for priority populations most heavily impacted by Crystal Meth use and HIV. Adjournment
