health_coming_out_the_drug_closetLife in the closet can be suffocating, but there are many reasons that force people to remain secretive: prejudice, discrimination, internalised homophobia, fear of rejection. Yet coming out of the closet is generally a liberating experience for most people once the first step is taken. But it is a process and often it is one that is never totally completed.

At first we have to come to terms with ourselves. Then slowly we might come out to a close friend or family member. As we become more self-confident about who we are, we might decide to come out to more people. But even the most out and proud of us are still in the closet when it comes to certain people. Not everybody is completely comfortable coming out at work and there may be certain family members who are best left in the dark.

Sexual orientation is not the only thing that we need to come out of the closet about. For many people, it may be difficult enough to deal with being gay. But what if you are gay and HIV-Positive? You might feel that the stigma associated with HIV is too great to disclose your status to too many people.

There is another thing we may need to consider coming out about, and that is recreational drug use. It is one of the last remaining taboos and nobody wants to talk about it.

Recreational drug use and abuse is rife in the Western Cape, and no less so in the microcosm of our gay community. The use of certain recreational drugs has serious health implications yet there remains a great sense of denial and this denial means we fail to acknowledge its rampant use and abuse, and fail to appreciate what a significant problem this is.

There is a further level of denial amongst users, who think that they can handle the drugs. On yet another level, what about the Crystal Queens in Green Point who look down their noses at the tik abusers in the Cape Flats, unwilling to admit that it is the same drug with the same dangers and consequence.

There used to be a popular saying that “the closet kills” and in the case of recreational drug use, without sounding alarmist, this can be very true. The underground and surreptitious nature of drug use, linked to the illegality of drug use, makes dealing with the specific health issues related to drug use difficult.

The first step to solving a problem is to acknowledge that there is one. It is not only the users who need to come out, so do the authorities and the health providers. Prohibition does not work. Access to information and education do.

So what can we do about it? For over a year now Health4men have been running a Harm Reduction Programme for recreational drug users in Cape Town. There are many misconceptions about the programme, and it has been controversial at times, but it is a logical progression of what the organisation does.

Every day, as individuals, we practice some form of harm reduction. Wearing a seat belt while driving a car is an obvious example. Another is using condoms and lube when having sex to prevent transmission of HIV and STIs. Harm reduction does make sense and has been proven to be effective world over. So why not apply it to recreational drug use?

In the field of sexual health, harm reduction is often closely associated with the use of recreational drugs and the levels of abuse are high amongst gay men, especially as many drugs are associated with the enhancement of sexual pleasure. Our work amongst the gay communities in the Western Cape has helped us to both understand and confront the risks associated with drug use as an organisation. We are out of the closet about drugs.

Some guys use drugs to make them feel horny or to give them added confidence. Others use drugs to make the sex feel more intense and to make the sex last much longer. Some guys even avoid having sex unless they’re wired on chems.

Because substances reduce inhibitions and impair judgement, they often influence who we have sex with, what sex acts we get into, how roughly we play and the duration of the sex. Irrespective of your HIV status, the sex you have when you are using chems can be very risky for your health. When under the influence, you may forget or be tempted not to use condoms and lube, increasing the risk of getting HIV and other STIs. Regular drug use also impairs the immune system and HIV and Hepatitis C are easily spread by sharing needles.

Health4Men’s Harm Reduction Programme aims to limit HIV and STI transmission and to prevent especially non-injecting drug users from adopting this exceptionally high-risk behaviour.

The programme does not in any way encourage non-drug using men to start taking recreational drugs. On the contrary, by acknowledging the scale of drug abuse and addressing this by providing appropriate information to men who are already using recreational drugs we are encouraging responsible sex and better health outcomes

The programme includes the dissemination of topical information to gay and bisexual men, with referral points for treatment and care and free harm reduction packs for people who use drugs. Another important aspect has been to educate the staff at various gay and gay friendly venues in Cape Town’s Gay Village about the programme and what to do if a customer gets into trouble after drug use.

We cannot stop people taking drugs, but harm reduction services as offered by Health4men have the potential to decrease drug use over time. The first step for all of us is to be honest about the situation in our midst. It is time to come out about drugs.

Evan Tsouroulis is a contributing writer for Health4Men, a project of the Anova Health Institute NPC. Health4Men’s harm reduction programme is supported by our Dutch partner, Mainline and funded by Aids Fonds. This article represents Evan’s personal views.

For more information visit the Health4Men website. Or pick up a copy of their drug related fact sheets from Health4Men, 24 Napier St, Green Point, or from the Ivan Toms Centre for Men’s Health, Victoria Walk Rd, Woodstock.

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