Clouding judgment -The Meth Menace

Mark, who spoke on condition that his last name be withheld, says that scars from the '80s, when AIDS swept through his peer group, are still reminders of the casualties of that era.

"In 1984, it was like a light went out in the world...," the 44-year-old real estate portfolio manager says. "It was 10 or 11 years of just total darkness, and all of this self-loathing and feeling like somehow, this was a universal punishment on people with gender-specific sexual orientation."

With the advent of protease inhibitors, the cocktail of drugs that slow AIDS infection, the panic surrounding AIDS has been somewhat quelled.

"The way that pharmaceutical companies have marketed the medication in the gay media gives the impression that the virus isn't that bad," Signey says, referring to ads of healthy, athletic men. "In the meantime, it has made it seem like something you can take a pill for, but this is not something that a pill makes disappear. The life these people lead while on medications is really difficult. These are not easy drugs to tolerate."

Plus, they require 95 percent adherence, something that doctors say is almost impossible when using crystal meth. Missing pills can cause the virus to mutate, increasing the danger that patients will become resistant to their medications.

"A high percentage (of patients) are not adhering," Kuhn says. "Among heroin addicts, I have found the adherence factor to be much better than with crystal meth. With crystal meth, they go on a run, and it's rare that they take their medications faithfully."

Paul Duncan, 51, who used meth on and off for about 20 years, lost all sense of time.

"When I'm high, the last thing I'm thinking about is taking my meds," he says. "You're just not focused on anything. Your mind is racing. Your heart is pounding. You're just looking for that party."

Elizabeth Eastlund, substance abuser mental health coordinator at CARE, says that about 30 percent of patients she sees use meth for reasons aside from sex. Some, she says, rely on it to cope with side effects from AIDS medications, such as fatigue and depression.

"I think people are also just tired," she says. "We're kind of coming from the perspective of working with people who are already positive and have spent years and years practicing safe sex. They just get tired, tired of thinking about it each and every day."