Previously PnP referred specifically to playing whilst under
the influence of crystal methamphetamine, also known as crystal, meth or tik
and as tina by many American gay guys. This highly addictive drug is associated
with a marked sense of well-being and a significantly increased sex drive,
culminating in marathon sessions of disinhibited and often bareback sex. Nowadays
the term PnP includes any mind-altering drug used during sex, including khat,
but excludes alcohol.
In South Africa countless gay men are using recreational
drugs for sexual purposes and for many, using drugs and having sex have become
synonymous. Besides the reality that some men have become incapable of having
sex without drugs, the association between the two clearly plays a very
significant role in the HIV pandemic within our community. This extends beyond
new HIV infections; many guys on HIV treatment don’t take their ARVs when they
indulge in PnP which results in them developing resistance to their treatment.
In addition, their viral load isn’t suppressed and they may continue to infect
others with HIV while exposing themselves to STIs such as syphilis or
gonorrhoea.
We can’t simply tell gay men to stop being irresponsible and
to stop using drugs. The problem is far too complex to simply go away. Instead
we need more focused harm reduction campaigns to mitigate the substantial physical
and mental health damage caused by PnP. Those who don’t use recreational
substances obviously need to be supported in their stance in order to counter
the significant peer pressures they may be exposed to. Guys who are already
using party drugs need to be encouraged to limit their intake, to avoid mixing
various drugs and to avoid injecting drugs. The guys who are already injecting
need information on harm reduction related to this behaviour, such as the high
risks of hepatitis C from shared needles. We’re clearly dealing with complex
dynamics related to dependence and addiction and it is imperative that anyone
using drugs must be encouraged to come clean or to undergo drug-related
counselling or even rehab.
The bottom line is quite simply that even if you do indulge
in recreational drugs this is no excuse to be irresponsible regarding your
sexual health. Using drugs is not a mitigating factor for men to have high-risk
bareback sex. Plan your escapade in advance; have plenty of condoms lying
around prominently as visual reminders to play responsibly, and latex-friendly
lube. Talk to your partners before you get high in order to negotiate and agree
on what will be, and won’t be acceptable and stick by this plan. If you’re on
ARV treatment set an alarm on your phone to remind you when to take them.
Health4Men’s Cape Town clinic is initiating a harm-reduction
programme addressing PnP, and drug use in general, among gay men in partnership
with the Dutch organisation Mainline and sponsored by Aids Fonds. This includes
extending the clinic’s already functional needle and syringe-exchange
programme, a large-scale educational
campaign, offering vaccinations against hepatitis and referral to appropriate
gay-friendly resources.
