"OF THE MANY REASONS I HAD UNSAFE SEX WHILE HIGH ON CRYSTAL, I THINK THE MOST PROFOUND WAS SIMPLY THAT I WAS LONELY. METH GOT ME CLOSE TO MEN AT CLUBS AND IN BED, AND UNSAFE SEX ALLOWED ME THE DEEPEST CONNECTION POSSIBLE."
- Kevin Koffler, POZ magazine

Although methamphetamine has been available as a 'dirty' recreational drug in the US for many years, its use by gay men throughout the Nineties was confined mainly to the AIDS-afflicted suburb of West Hollywood in Los Angeles, though not necessarily as a sex aid. Temporarily erasing inhibitions while also intensifying the user's focus in whatever activity he is engaged in, crystal was commonly - and still is - used as an aid to boost confidence and alertness simply in order to survive in the ruthlessly competitive and cut-throat movie capital. Crystal wasn't widely popular as a sex drug back then due to its constrictive effect on blood vessels, which made erections difficult to sustain for most users.

A little blue, diamond-shaped pill changed all that when, in 1998, Viagra arrived amid a blaze of hype and publicity, instantly providing the solution to "crystal dick" while also boosting sexual prowess and longevity. Once dismissed as a drug for "lost souls", seemingly overnight crystal became the ultimate aphrodisiac, paving the way for non-stop sex marathons with multiple partners lasting anything up to several days. Like a time bomb waiting to explode, Viagra fuelled crystal's insidious spread out of Los Angeles' gay ghetto and eastward across the States. Now crystal has its sight set on Europe...

Consumed in sexually-charged environments such as at night clubs, private parties, saunas and sex clubs, the focus on - and desire for - sex becomes extreme and compulsive, opening the user up to previously unrealized desires. Subsequently, a generation of gay men has emerged for whom the most important part of their lives is derived from the next crystal high and otherwise unthinkable, boundary-less, anything goes sex.

Once exclusive "tops" can become insatiable "bottoms" under the influence of crystal due to the total disintegration of the user's inhibitions and the anaesthetizing effect caused by his detachment from his feelings. A plethora of group, "fisting" and other extreme sex videos have emerged from California over the last few years capitalizing on the demand for crystal-induced "pig" sex, with many of the actors themselves clearly under the drug's influence.

Because crystal desensitizes the abuser, sex between "tweakers" - irritable, paranoid individuals who have not slept for several days - is rendered 'mechanical' and devoid of a free-flowing exchange of feelings and emotions. Where only one participant is a user he will effectively 'feed' off the other's higher energy levels, rendering the non-user drained and listless. Tweakers become conditioned to using crystal for sex and can no longer contemplate sex without it, while former abusers have difficulty readapting to crystal-free sex.

Viagra's arrival coincided with the emergence in the late Nineties of internet sex sites like Men 4 Men, which are tailored to make sex a commodity as easy to order as door-to-door pizza. A sizeable core group of users of these sites have inadvertently emerged who remain on-line 24 hours a day looking to "PnP" (party and play) with fellow tweakers, and who are up-front in their preference for unprotected "BB (bareback) action". "Binge partying", where the abuser is typically awake for four straight days, crashes the following three, then starts the whole cycle again, is driven by his compulsive desire for sex, which in turn is driven by his constant craving for crystal meth.

Inevitably, the union of crystal and Viagra has significantly accelerated the risk of HIV transmission across the States due to the abuser's initially elated but false sense of invulnerability which can detach him from a sense of responsibility to himself or his partner. The availability of protease inhibitors has been typically, though deludingly, cited as justification for such behavior in recent years.

Even when safe sex is practised, there is a compounded risk of friction tears to the protective shield due to "condom fatigue" resulting from the significantly more vigorous, sustained and aggressive nature of crystal/Viagra-induced sex. Crystal and Viagra are also to blame for the recent explosion of syphilis infection in gay men across the States.

Paradoxically, a minority of HIV-positive men use crystal meth because its anaesthetizing effect serves to counter the unpleasant withdrawal symptoms from the endless drugs they need to consume to stay healthy. This, and the rediscovered appetite for sex that crystal induces, they argue, makes crystal's equally devastating side effects a price worth paying.

HIV-positive people who have unprotected sex with each other while high on crystal - or otherwise - ignore the possibility of catching or spreading more virulent and drug-resistant strains of the virus. Reinfection - or "superinfection" - can destroy the immune control built up fighting the original strain, and such behavior is seriously jeopardizing the progress of AIDS vaccines already in development. Recent studies suggest that between 10-24% of new infections may now be with drug-resistant strains of HIV.

Crystal is by far the worst recreational drug possible for those infected with HIV for other reasons:

• The mind-impaired abuser frequently forgets to take his time sensitive dosages of HIV medication, opening the door to viral replication and even mutations that resist the current AIDS drugs
• Crystal is a long-acting stimulant and far more immunosuppressive than HIV, leaving someone's immune system suppressed for days on end
• Its ravaging of the body's immune system caused by missed meals, vitamin depletion, weight loss and disrupted sleep can trigger the onslaught of full-blown AIDS in HIV-positive people
• A Ohio State University study has shown that methamphetamine stimulates HIV replication in brain cells as much as 15-fold

Despite these risks, a recent US study revealed that 47% of gay male crystal abusers were knowingly HIV-positive, while 60% of gay men seeking treatment for their addiction at Los Angeles' Friends Health Center were found to be HIV-positive - more than three times the HIV rate for gay men in LA. In San Francisco, a third of all gay men surveyed reported using Viagra.

Crystal and Viagra have triggered an epidemic of HIV-conversions across the States since the start of the new Millennium. In LA alone, over 75% of new HIV infections are crystal-related. Alarmingly, crystal is now regarded as the major cause of HIV-conversion among American gay men in their late thirties - the generation that escaped the AIDS-strewn Eighties and Nineties - while the average age of meth users is 33, the age of someone who grew up bombarded with endless safe sex messages.

Even those previously assumed to be immune to catching HIV due to a rare protein in their cellular make-up are at risk. Increasing numbers of these people who failed to catch HIV despite years of numerous unsafe sexual encounters have HIV-converted since becoming addicted to crystal, the unique - some would describe as "God-given" - protective protein in their systems having been destroyed by the drug.

The alarming rise in crystal/Viagra-induced HIV and syphilis infection over the last couple of years has served to undo much of the tireless work of safe sex campaigners in America since the start of the AIDS pandemic, with new rates of infection now higher than at any time since the early Nineties. It is for this reason that the lethal bond of crystal and Viagra is being dubbed, in some quarters, "The new gay plague".