Session 13 - Sexual health and Drug use
a) Queer times - Quare drugs
Mick Quinlan
Gay Men’s Health Project, Eastern Health Board, 19 Haddington Road, Dublin 4, Republic of Ireland Phone no: +353 – 1 660 2189 / 660 2227 Fax no: +353 – 1 668 0050
The Eastern Board (EHB)
When the Gay Men’s Health Project was founded in 1992, a year before homosexuality or anal sex between men was decriminalised in the Republic of Ireland, the EHB were already beginning to take on the issues around gay, bisexual men and other manners of sex in men. The EHB covers Dublin City, County Kildare and County Wicklow: an area with a population of 1.3 million. The board is made up of politicians, doctors and pharmacists. It is a political board so if a chief executive officer or a project decides on a policy there is an election by the board. It has a management structure and a programme manager for different programmes such as mental health, AIDS, drugs, children and families etc.
The AIDS and Drug Service
The ‘AIDS and Drug Service’ began in 1988 with four staff. They looked at the need for a needle exchange and set up the first needle exchange programme in Dublin in 1989. The service gave low dose methadone to 50 people and it set up a HIV testing site. In 1990 it started to grow and it now has about 200 employees. In 1999, there were 3 sectors under the ‘AIDS Drug Service’: Dublin South and Wicklow, Dublin south-west and Kildare and Dublin north side. In February 2000 the project will be changing to a health authority. Instead of one big sector, there will be three sectors similar to the ‘AIDS Drug Service’: the area operation manager, senior outreach and senior counsellors. There are 26 outreach workers, 10 education officers and 36 counsellors, staff nurses, 189 GP’s involved in dispensing etc and 190 pharmacists.
Dublin itself had a huge drug problem particularly in the 1980s, when very little was done. There are an estimated 15,000 intravenous drug users in Dublin, mostly concentrated in working class and disadvantaged areas, which is quite a big proportion of the population. There is a huge waiting list for people to get treatment and there are nearly forty satellite clinics for methadone treatment, rehabilitation and a young persons programme.
The ‘AIDS Drug Service’ consists of 12 needle exchanges in Dublin, an addiction centre, a bus, etc. There are also special projects: one for women in prostitution, or ‘women sex workers’, and one for the Gay Men’s Project. The Gay Men’s Health Project Drop-In Centre operates from 19 Haddington Road, and on Tuesday and Wednesday evenings it provides HIV testing, hepatitis B testing and STI screening. No appointment is needed and the service is confidential and free. In 1998 for example, it was visited by 1,757 men and 347 of those were ill. There has been a continuous increase since 1992 and in 1999 the number of visits was up by 30%.
The service provides emergency assessment, counselling, screening for HIV and hepatitis and methadone treatment. It also offers medical treatments for warts etc, medical examinations, support advice and sexual contact tracing advice. It is hoped that in the year 2000 there will be two full-time counsellors to provide long-term counselling to people who are living with HIV or AIDS, their partners, friends and family, and also to gay men about other issues around sexuality, relationships and drugs, etc. Free condoms and information are issued. There is a television in the waiting room and free tea and coffee is available.
Research
Research of 481 gay and bisexual men was carried out in 1992 and this helped to set up the project. It was found that whereas 50% were using condoms all or most of the time, 25% were only using sometimes and 25% were not using them at all (for different reasons). More importantly, of the 481 men, only 40 had ever had a hepatitis vaccination and only around 14% had ever had an STI screen. This showed that there was a need for a targeted service to gay and bisexual men. A qualitative survey of 27 men in 1997 on the subject of prostitution also highlighted issues around STD and HIV testing. On the 2nd and 3rd of December 1999, the first ‘Male Prostitution Conference’ in Ireland, was held in Dublin, in view of setting up a service.
The study of the attendance at the Drop-In is ongoing and issues of young men and drug use are being looked into. Workshops and training are provided on the subjects of safer sex, peer training, sexuality (particularly on homophobia), drugs and prostitution. The service deals with statutory and voluntary agencies. The participants are bisexual men, community groups, the EHB and other health professionals and probation welfare. It is a very popular clinic.
The outreach role involves networking and community development linked in with health. The lesbian, gay and bisexual centre has a Gay Health Network and meetings are set up with the police and LGB societies about ‘queer bashing’ or anti-gay violence. Research is also carried out. The project is involved with events such as ‘Pride’ and the Phoenix Park, linking in with all different areas and public sites like pubs and clubs.
The Gay Health Network
The Gay Health Network was established in 1994 by the project and some voluntary groups. The members of the network are Rainbow Project (Belfast); Southern Gay Health Project (Cork); Poz Ireland which is for HIV positive men; Gay HIV Strategies which is a lobbying group for the Gay and Lesbian Equality Network; Open Heart House for people living with HIV and AIDS; some hospitals; Ana Liffey Drugs Project and Gay Community News. The Network meets quite regularly and works particularly on publications and research. The Gay HIV Strategies has a national brief that supports local groups and links health boards and Government bodies’ strategy. The Network services are prevention, health promotion, publications, research and training, etc.
Research
The research found that the issues of alcohol, drugs and sex are not only particular to Ireland but also other countries, especially to do with gay and bisexual men. When doing outreach work you come across men who are quiet, who can not formulate words, and who can not negotiate safer sex, never mind negotiating going out and dancing. The whole issues around alcohol and drugs are marginalisation and discrimination and what that does to an individual. Therefore people resort to coping mechanisms not only for fun but also to survive. In the pubs and clubs they are starting to use different drugs along with alcohol, and that raises all kinds of different issues.
In the 1992 study, the sexual orientation of the men who responded was 89% gay, 9% bisexual and 4% other. A lot of men who have sex with other men do not identify themselves as gay and do not receive the message that we give out to gay or bisexual men. When asked if any drugs ever resulted in unsafe sex, 162(45%) said alcohol, 88(28%) said ‘poppers’, 50(17%) said cannabis, 18(7%) said ‘speed’, 18(7%) said cocaine, 12(6)% said ‘ecstasy’ and only 10(4%) out of all of those had ever injected or used hard drugs, so there were quite a small number of heroin users and injectors. There are actually more men than that but they do not all come onto the scene or do not all admit it, because they are marginalised from the gay community, the drug users community and the intravenous drug using community. This just shows you the range and popularity of drugs.
According to their classification, the orientation of male prostitutes was 59% gay, 22% bisexual and 19% heterosexual. 25% had used alcohol, cannabis, ‘poppers’, ‘speed’, valium, ecstasy, diazepam, anti-depressants, cocaine, ‘acid’, heroin, methadone, glue and other drugs. Another 48% of the respondents have identified the use of drugs and alcohol with sex work. Many used a cocktail of drugs and over 40% had injected drugs in the past. Of these, five had shared needles, six had availed of the needle exchange and seven had received drug treatment. Nearly equal numbers of each, 33% in total, had used heroin and 59% had experienced homelessness.
The Rainbow Health Project in Belfast, a peer group for gay and bisexual men, surveyed 195 gay and bisexual men, 91%(179) of whom were gay, 9%(16) bisexual. Alcohol, ‘poppers’, cannabis, ‘ecstasy’, ‘speed’, LSD, ‘magic’ mushrooms, cocaine, temazepam, heroin, ketamine, Prozac, mescaline and oestrogen were used. A lot of people from Belfast go to London and England rather than Dublin, so some of the drugs that are popular in the north of England and in London come to Belfast rather than to Dublin. Therefore there is not much ketamine or Prozac in Dublin itself and Viagra is only starting to come on the scene.
Dublin
In 1998, a poster about drugs was put in the ‘Gay Community News’ which publishes 12,000 copies free every month. The advert had a picture of an eye with tears coming down and the name of all the drugs, with the slogan ‘Queer times – quare drugs’. ‘Quare’ is a Dublin colloquialism. Since 1993 and decriminalisation, the gay scene in Dublin has ‘mushroomed’, with more younger men and women coming on to it. There are a few more clubs, but some are more restrictive than others.
There is a great atmosphere in the clubs but linked into that is the issue of having drugs. It is important to get information out without being a kill-joy so that people feel safe to come to you. Rather than saying "stop", maybe it is better to just stand back and look at what you are dealing with, and then see where you can go for support. There is pressure on the agency because it has to supply a service or refer responsibility to the ‘AIDS Drug Service’ and EHB.
The counsellors need to be aware of the issues around homophobia and heterosexism. They need to be able to create environments to work with lesbian, gay and bisexual drug users of all different shades who need support. This is up to the general health services and the voluntary services. There are government-funded, community drug teams and local outreach workers, not involved with the Health Board, to take on gay and bisexual issues. ‘Queer times – quare drugs’ is a funny way to just get the message out and then we say that some drugs can cause serious health problems.
We advise how substances can effect a person’s weight, damage the immune system and higher/lower blood pressure. If transgender people are on hormone treatments, they may experience confusion, dizziness, erratic breathing, collapse and over heating. The main message was how to reduce the risks and use substances safely, for example "use low doses" and "try not to mix and make cocktails". The mission statement for the ‘AIDS Drug Service’ and the ‘Health Board’ is to provide a drug free environment but to say ‘no’ or ‘give up drugs’ is a total waste of time. A campaign was run by Steven Harding, an Education Officer in the South sector of the Health Board, and this was copied in Dublin. Steven Harding has actually done some work and training with staff and clubs such as the campaign with ‘Unity’’, and their slogan "say KNOW to drugs" was used in our campaign.
Other Projects
A Prostitution Conference took place on 2nd and 3rd December 1999 and an HIV Prevention Conference on 4th December 1999 included international speakers discussing the issues around drugs. The Gay Health Network and the Gay Men’s Project set up a Gay Peer Action group. There are half a dozen men who meet regularly every week. They are anonymous and are supported by outreach workers who provide support and training, but generally the group is facilitated by coming up with ideas, such as wearing t-shirts, giving out safer sex packs and safer sex booklets. They decided that the first campaign would be around drugs and alcohol and they have designed and printed cards to give out in clubs. Thus they will hopefully establish themselves as a peer action group and also make links with the community. Luckily our philosophy of listening to and working with the community is encouraging community development.
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