The Ins and Outs of Gay Sex (40 page)

I
had never seen him before.
I glanced down at the intake form all new patients fill out and saw that his complaint was a rash.
No, he’d never had it before, and no, he hadn’t changed his diet or switched laundry detergents.
Every question I asked searching for possible causes was met with a no.

He lifted his shirt to reveal red blotches covering his torso.
“It definitely looks allergic,” I said.
No telltale scabs to suggest bug bites, and the fact that his genital area was spared made an STD unlikely.

“As I said, Doc, I only eat pure foods, nothing processed.
Organic vegetables and fruits, free-range poultry, no meats.
I even use hypoallergenic soaps.”

“
Where’d you get your tan?”
I asked before giving up and sending him to a dermatologist.

“The Pines.
I have a share there.”

I smiled.
Now it made sense.
“Only organic, natural foods, right?”
I asked.

He sighed and gave me a weary nod.

“Well, how about drugs?
Use any of them?”
His face reddened and I didn’t wait for an answer.
“Ecstacy, K, poppers?”

He nodded yes to each, and his eyes widened.
“You think that’s what gave me the rash?”

“I know
that’s what gave you the rash.
You’re so fastidious about your diet only to swallow pills filled with garbage every Friday and Saturday night.”

“But I gotta dance.”

Drug use and abuse has always been prevalent within the gay community.
Drugs don’t have to be illegal to be abused or addicting.
Alcohol and nicotine are legal, while others, including tranquilizers, diet pills, and narcotic pain medications, are controlled and obtained with a doctor’s prescription.
And all have a high abuse potential.
Before discussing each drug individually, let’s examine certain principles that apply to each.
Although the makeup of “legal” drugs is tightly regulated by the Food and Drug Administration, illegal drugs are not.
Most are manufactured in home laboratories and cut with anything from talcum powder to baby laxatives; occasionally the additives are more harmful than the drugs themselves.
Inconsistencies with respect to purity and quantity of drug in each tablet or vial also contributes to the danger and unpredictability of illegal drug use.
One pill barely touches you, while the next lands you in a coma.

Drugs you take, whether legal or illegal, alter mood and perception by changing chemical balances within your brain.
These changes, while producing desired and often pleasurable effects initially, leave your brain depleted of necessary substances when the drug wears off.
What started out as a pleasurable ride turns into a nightmare before it’s over.

Drugs, whether prescribed or not, can also become addictive, leaving you crippled by something that started out to be just a kick or mood raiser.
Addiction often has a biological or genetic basis and begins so gradually that most men don’t even know it’s happening until it’s too late.

Drugs are also a major enemy in our fight to eliminate HIV.
By altering chemicals in our brains, drugs distort
judgment.
What might have been a safe sexual encounter dissolves into reckless abandon as you focus on your high and getting off instead of getting protection.
A recent medical survey polled gay men in Philadelphia and asked them why they had unprotected anal sex.
Almost a third of men attributed their failure to use condoms to drugs or alcohol.
In addition to impairing judgment, drugs can decrease sensation.
A sexual act that you might have stopped because of pain is suddenly tolerable.
But when the drugs wear off you’re left with a bleeding rectum or torn nipple.

Swallowing one pill affects any other pill you’ve already taken.
We call this phenomenon of a medication increasing or diminishing the effectiveness of another a drug interaction.
Pharmacists and drug companies keep data banks of potentially dangerous drug interactions and warn you if your doctor prescribes medications that shouldn’t be taken together.
Fine and good for prescription drugs, but no data bank tells you if the Ecstacy you’ve just swallowed is going to negate the protease inhibitor you took an hour before.
Illegal drugs are not cataloged by dangerous interactions, making combinations a crapshoot.
When drugs potentiate each other, a much lower dose can become an overdose.

As we wash down that pill with vodka or beer, most of us forget that alcohol is a potent depressant.
If you’re already bombed, alcohol in your blood can combine with another drug you take to put you into a life-threatening situation.
Something you tolerated in the past may have an entirely different effect after you’ve been drinking.

In the case of pills, size does not matter.
In other words, that tiny pill or small sip can knock you on your ass.
Most of us look at a pill and figure it’s small, so how much harm can it do?
You might even be tempted to try two, only to wind up in some emergency room.
Don’t be misled because a liquid is clear or a pill is tiny.

A drug’s potency depends on how much reaches your
brain and is affected by how you take it.
When you inject a drug, the entire amount hits your brain immediately, making even a small dose highly potent.
A pill, on the other hand, must be digested, so absorption into your bloodstream is a more gradual process.
The amount reaching your brain at any given time is less than when a drug is injected, but its effects last longer.
Smoking or snorting also gets a drug into your bloodstream faster than if it’s swallowed.
Shooting, snorting, or smoking a drug makes it more potent, and as such, your danger of overdosing increases.

Drug use adversely affects your nutritional status and immune system.
You skip medications and forget to eat because you’re too out of it.
You dance right through one dose of your antiviral medication, then sleep through the next.
Drug impurities stress your immune system and harm healthy T-cells.
Added together, these side effects conspire to make HIV-positive patients susceptible to falling T-cell counts and rising viral loads.

There is a chemical basis to many psychological disorders, and drugs can worsen these conditions.
If you’re prone to depression and swallow that little pill, you might be nearly suicidal by the time it wears off.
Medications prescribed for psychiatric disorders also can have potent interactions with abused drugs.
Be careful, because the antidepressant you’ve recently started may combine with that hit of K and cause an overdose.

Although your typical fantasy image of a gay man may be one who is young, handsome, virile, and impervious to harm, most of us don’t fall into that category—and not just because of HIV.
We have diabetes, high blood pressure, heart murmurs, and many other medical conditions that you’d never guess from outward appearances.
Abused drugs affect many other organs besides our brain.
In addition to your glorious high, that pill might raise your blood pressure
to dangerous levels, stress your heart with rapid or irregular beats, or poison your kidneys.
If you already have medical problems, the added stress can be enough to tip you over the edge.

Yes, alcohol is a drug—the most widely abused drug in this country!
Although it may feel otherwise, alcohol is actually a depressant and anesthetic.
When you take a drink, your stomach and intestines rapidly absorb the alcohol.
As it reaches your brain, alcohol slows nerve impulses, at first eliminating your inhibitions.
As blood levels rise, you may feel happy and garrulous, but you lose the ability to perform complex neurological functions.
Your balance falters and you have difficulty walking, dizziness, slurred speech.
You might even find yourself in a sexual situation you would otherwise have avoided.
Continued drinking slows your breathing, and you can slip from stuporous sleep into a coma.
Your danger increases when the depressant effects of alcohol combine with the same properties in other medications.
Alcohol and narcotics are a particularly deadly combination, because together they can stop your breathing.

As we all know, you’re likely to experience what is commonly referred to as a hangover the morning after a night of heavy drinking.
You feel tired and depressed, and your head won’t stop pounding.
Dehydration is common because your body needs water to break down the alcohol.

Alcohol is metabolized by your liver, and heavy abuse can cause dangerous inflammation called alcoholic hepatitis.
With long-term abuse some men develop cirrhosis and liver failure.
Alcohol can adversely affect other medications broken down by your liver (such as protease inhibitors) and
damage many other organs, including your stomach (causing ulcers or gastritis) and pancreas (pancreatitis).

Alcohol’s abuse potential is great, and unfortunately there are no clear-cut boundaries among social, moderate, or problem drinking.
Alcoholism develops insidiously, with the victim often the last to know.
The task of steering him to treatment usually falls on friends and loved ones.
There are no easy ways to tell a partner that he is a substance abuser, and he probably won’t listen.
Prepare to bear the brunt of his anger as he struggles to come to terms with his addiction.
You’ll
both
need help.
Fortunately, excellent programs like AA (Alcoholics Anonymous) and Al-Anon (for partners of alcoholics) have made great strides in controlling the impulse to drink.

Manufactured from cocoa leaves, cocaine can be snorted, injected, and even smoked (crack).
When mixed with heroin and injected intravenously, it is called speed-balling.
In its medical form (that’s right, doctors prescribe it), cocaine is a potent anesthetic and it constricts blood vessels.
Many ear-nose-and-throat specialists use it to shrink and anesthetize swollen nasal passages before operating in that area.
Once cocaine enters the bloodstream, it blocks nerves in your brain from taking up the potent chemicals dopamine, norepinephrine, and serotonin.
Doctors have identified two distinct phases of a cocaine “high.”
Phase 1 is characterized by an initial rush of euphoria accompanied by insomnia, anorexia, and in some men hallucinations and paranoia.
When your hallucinations become tactile you have what is commonly called the cocaine bugs.
In addition to affecting your neurological system, cocaine also raises your blood pressure and pulse, occasionally to dangerous
levels.
In phase 2 cocaine can cause irregular heartbeats, heart attacks, seizures, and stroke.

After a coke binge you enter a withdrawal state, which is essentially the opposite of your high—euphoria is replaced by a depression that can lead to suicidal thoughts.
You might also experience periods of binge eating and sleeping.
Your withdrawal lasts far longer than your high, sometimes stretching for several days.
In addition to suffering dangerous cardiac effects, long-term cocaine abusers often destroy their nasal passages and may have lingering psychological disturbances.
Cocaine is definitely addicting.

Amphetamines, commonly called speed, are similar in chemical structure to dopamine (a brain chemical essential to nerve transmission).
Like cocaine, amphetamines, whether injected, smoked, or snorted, produce an initial state of euphoria, insomnia, and hyperactivity replaced by depression (even to the point of suicide) and marked need for sleep during withdrawal.
Crystal, a commonly abused amphetamine, also causes rapid heartbeats and may lead to addiction.
Men who use crystal say that it makes them horny, but beware:
Impotence or a poor erection are just as common.

MDMA, a synthetic amphetamine better known as Ecstacy, is extremely prevalent in the gay community.
For many men it is the fuel that keeps them dancing all night long, as they feel happy and less inhibited.
They find themselves able to talk to strangers they otherwise would have thought unapproachable.
Unfortunately, Ecstacy is often viewed as harmless when in fact it can be quite dangerous.
In addition to producing desired euphoria, tremors, insomnia, and sweating are frequent side effects.
While dancing the night away in a hot club you could sweat yourself into
serious dehydration.
Take too much Ecstacy and you expose yourself to dangerous irregular heartbeats, seizures, stroke, or hyperthermia (too high body temperature).
As with any drug, when you land from your glorious high, no doubt you’ll find yourself at the opposite end of the emotional spectrum; the dancing queen who’d talk to anyone is a bitched-out, depressed, exhausted monster the morning after—and it can take two days to recover while your brain slowly replaces depleted chemicals.
Medical research has shown that prolonged use can lead to permanent destruction of brain cells, and Ecstacy also can have dangerous interactions with other medications.
Beware of combining Ecstacy with Prozac or MAO (monoamine oxidase) inhibitors, another class of antidepressants.
There are even reports of death after taking Ecstacy with a protease inhibitor.