By David Duran
A discussion panel agreed last week that a disturbingly high number of gay men are usually under the influence of alcohol or another substance when engaging in sex.
In gay society, a bar is considered to be a staple place to meet up. For many years, bars were the only public place gay men could go to meet other gays. But while under the influence of alcohol, people tend to have sex more often and are less likely to use condoms or are less likely to use condoms correctly. Culture gives mixed messages about sex and how gay men communicate.
Those were the key points at an HIVision forum February 16 hosted by the San Francisco AIDS Foundation.
Alcohol has been referred to as the forgotten drug and the panel discussed that at the forum, held at the LGBT Community Center. According to Dr. Susan Buchbinder, with the Department of Public Health, there is a real range of use with alcohol in the community and it has some significant similarities and differences when compared to other drugs.
"It has a big impact on many organs of the body if used to excess. It interacts with medications and how one metabolizes those medications," said Buchbinder.
Michael Siever, Ph.D. added, "Most people don't think of alcohol as a drug but it has the most deadliest consequences." According to Siever, director of behavioral health sciences at SFAF, alcohol use is considered black or white. Most people either tend to think it's not a problem in their life or they are an alcoholic. There is no happy medium.
Panelist Chris Hastings, owner of the Lookout bar, gave the perspective of a community small business owner.
"Bars have always been a safe space for our community and it is my responsibility to be more community focused," he said.
The focus of the night was the use of alcohol by someone living with HIV.
"HIV and alcohol work synergistically, that leads to more brain tissue destruction," said Buchbinder, director of research for the health department's HIV prevention section. She believes the biggest issue among those living with HIV is if they are drinking too much and not adhering to taking their medication.
It was pointed out that doctors have no problem getting their methamphetamine or other hard-core drug user patients down to undetectable viral load levels but the hardest to get to an undetectable level are those with a severe alcohol problem.
E. Maxwell Davis, Ph.D., who moderated the panel, said that the assessment tools providers are using are not helpful or effective when deciphering if a patient is abusing alcohol.
"In a routine HIV appointment with a provider, there just is no time to ask about drinking or the consequences involved," Davis said. Clinicians just don't seem to have enough time with their patients since they are overloaded with appointments in one day.
"The whole care system needs to radically change. You need doctors to start listening," said Buchbinder. She noted that doctors often take immediate action of increasing medications or changing regimens without really looking more into the causal issue, which in turn could be more social or psychological.
"We need a different type of care that is not physician centered," she said.
The long-term effects of alcohol on mental health are often overlooked.
"The goal when drinking is to not think about what is really going on and to mostly, forget," said Siever. Most drink to forget about their responsibilities. Alcohol can cause major isolation, which is already an issue with HIV patients, he said.
"The negative impacts of alcohol may not be problematic immediately, but over time," added Buchbinder.
San Francisco offers many services for the LGBT community, including for those having issues with alcohol. But, weaving together alcohol use and HIV prevention is something the city is lacking.
"About 13 percent of people living with HIV would be qualified as alcohol dependent," stated Davis, an assistant professor at California State University, East Bay.
Buchbinder emphasized that it's important for people to know that if they drink on a day-to-day basis, they should still take their meds, that in the long run, it's healthier.
Over the next year and a half there will be a new developing study in three Castro bars and one South of Market bar. The Pacing Alcohol Consumption Experiment is a study being done by the Stop AIDS Project, which is now part of the AIDS foundation.
The study, which is being spearheaded at the Lookout in the Castro, consists of a five-minute exit survey and breathalyzer as well as a follow-up online survey aimed to capture what the bar patron did after leaving the establishment. The study hopes to find what patterns of alcohol use are in the community. Since the study began, there has been an interest among bar patrons, mostly due to the breathalyzer. It's intriguing and sparks interest as well as conversation, which is also a goal of the study, said Jen Hecht, with Stop AIDS.