Community Summit: Group B session

This group explored issues related to emotional health and recreational use of substances in conjunction with sexual activity. There was a clear consensus that these issues are linked and must be dealt with holistically.

1.	Group experience with this issue Most group members had experience working with GBM, and felt that depression and drug use were connected. Drugs and depression were seen as related to a lack of GBM acceptance and homophobia in our culture; people medicate themselves against the pain of rejection from families and society. However, drug use was seen as both a matter of self-esteem and an issue of choice. There was a general sense that club drug use was high, especially at circuit parties. Alcohol was viewed as the #1 problem, crystal methamphetamine second. Drug and alcohol use was seen as a phase that many GBM go through. Group members perceived that emotional/mental health/substance use were underfunded compared to physical health.
2.	What messages are needed in the community? The group felt that empowerment messages should be promoted, through models such as Gay City. Perhaps people could be moved through the drug use phase of their lives more rapidly. Maybe some people could be prevented from using drugs, but abstinence models were deemed unacceptable. The group believed there was a need to embrace talking about sex with the community in a positive way.
3.	Who would be appropriate messenger? The group felt that, to be most effective, the messages should come from community institutions, not Public Health. However, Public Health needs to be involved in message development and support of message dissemination.
4.	What kinds of programs would be most effective? The group felt that the community must respond with more services. Education and skill development are needed. We should teach GBM to recognize factors that can increase harm. Need to build on current harm reduction messages and strategies. Studies suggest that persons in treatment decrease risk behaviors by 50% once they are clean and sober. Some suggested that programs should invite people to engage or talk first, then provide them with education and messages. In addition, we need to develop norms around GBM culture and daytime activities, as opposed to the norm of nighttime activities linked to alcohol and drugs, bars and getting stoned. We need to help people reframe their identities in the present GBM bar culture norm, stressing that there's more than just drugs and sex. We must be proactive rather than wait until people seek help. Written materials addressing these issues should be available for GBM and their families.
5.	What barriers do we face? The group felt that money is definitely lacking. In addition, community attitudes around drug use are a barrier. The population has no enthusiasm for messages around reducing drug use. Dealing with this issue is a process akin to growing up. Most people have fun using drugs before they acknowledge that it is even a problem. The drug war has caused lots of damage by diverting funds from demand reduction (prevention and treatment) towards supply reduction. The resulting increase in incarceration rates has diverted funds from public health to corrections.
6.	Is the community aware of this issue? The group was highly aware of these problems, but most people felt that the community's response to the issues of substance abuse (both individually and collectively) suggested high levels of denial and lack of involvement in these issues.
7.	Who else should be involved? The alcohol companies that contribute to the problem need to ante up to help solve the problem. The group felt that alcohol was the most commonly used substance.

Recommendations:

Develop new and/or revamp HIV prevention and care programs serving GBM, with emphases on emotional health, depression and chemical dependency issues. Programs should be community driven, with Public Health as an active partner/catalyst.
Identify collaborative partners to help fund programs. Local bars, chat lines, circuit party promoters, and national alcohol companies should be involved.
Convene a community coalition to focus on integration of emotional health and substance use into HIV prevention and care programs.