The clubs were always dark. Corners were darker. Daniel Robison would walk through obscure doorways, high on crystal meth, as the sexual urges rushed through him. Nights melted together as Robison, HIV-positive and a frequenter of sex houses and bathhouses, sought to satiate the temporary sexual freedom he felt while high.
"I was in it for the pursuit of sex," Robison says. "The first few months into my HIV diagnosis, I thought, 'No one is going to want me, so I might as well do this now.' "
That was in 1994. Robison, now 46 and living a healthy life, sometimes wonders how he survived. For 14 years, he dabbled in the "party and play," or PNP, culture. Also known as chemical or "chem" sessions, PNP is a term often used to describe situations where gay men get together, usually through the Internet, to use crystal meth and have sex.
Robison's first year on the drug, he says, "spun out of control" when he essentially stopped taking his HIV medication, and his body began "falling apart." He was hospitalized for several weeks.
"I pretty much couldn't walk for a year," he recalls. "I wound up with several of my organs being infected. I shouldn't have made it out of that hospital."
For a year after his hospital stay, Robison said others helped to bathe him, feed him — even change his catheter.
Still, Robison says he persisted in using the highly addictive drug for years in bathhouses and sex clubs, where he says disclosing one's HIV status is not the norm — or even expected. The usual rules don't apply, he says.
"I just assumed everybody was a part of it when I was in a sex club," Robison recalls. "When you're high, you just don't ask or expect those questions. I don't think people even give it a thought."
The drug sometimes acted as Robison's emotional crutch. "It felt good because, for me, I was not confident, and I didn't feel good about myself," he says. "Suddenly, on the drug, I was going out and meeting new people, and people were noticing me. But, I mean, that drug is going to kill you."
Crystal meth use in the gay and bisexual community soared at the turn of the millennium in Los Angeles, and Robison was a part of that. Experts say the transmission of HIV in Los Angeles County went hand in hand with the PNP subculture. But intervention and prevention efforts aimed at stopping the spread of HIV have seen success.
Cathy Reback is a senior research scientist who heads clinical trials at the Friends Research Institute, which runs the Friends Community Center, a gay-specific treatment center for methamphetamine and other drug abusers in Los Angeles.
According to Reback's research, from 2000 to 2005, about 50 percent of substance-using gay or bisexual men in the Hollywood area said they had used methamphetamines in the last 30 days. Newer data show that those numbers dropped between 2006 and 2011 — plateauing at about 20 to 30 percent.
Experts are quick to point out that heterosexual people abuse meth as well, but HIV's transmission rate is significantly lower in the straight population because HIV is so much less prevalent there to begin with.
"It's still a gay man's disease in L.A.," Reback says. HIV in Los Angeles differs greatly from HIV in New York, she says. The virus is largely transmitted through injection drug use in New York and other major American cities. But in Los Angeles, it's mostly spread through sex.
The 2011 L.A. County Annual HIV Surveillance Report shows that 83.7 percent of people living with HIV are men who have sex with men. And participants in PNP culture are at even greater risk. Research shows that gay men using meth have double the risk of becoming HIV-infected compared with gay men who do not use the drug, says Steven Shoptaw, director of the Vine Street Clinic, a center for meth research and treatment.
Shoptaw, who is also a professor of family medicine, psychiatry and biobehavioral sciences at UCLA Medical Center, has worked with Reback to conduct clinical trials for addicts to treat their biological drug dependence.
Crystal meth is an addictive stimulant that affects the central nervous system, releasing excessive levels of dopamine, the brain's natural reward system. It increases alertness and energy, heightens one's sense of self-esteem and ups one's sex drive.
But abusing the drug can soon take a grisly toll on the mind and body. Shoptaw and Reback say studies have shown that HIV-infected meth users often have trouble with one of the most important things in their lives — sticking to their anti-retroviral medication routine. Then there are the severe physical side effects of meth addiction: Erratic and violent behavior, sleep problems, convulsions, intense mood swings, "meth mouth" (rapid and horrific tooth decay), erectile dysfunction known as "crystal dick," even cardiac arrest.
"Drug dependence on methamphetamine and cocaine is one of the major reasons for cardiovascular events in younger people," Shoptaw says.
Why take such terrible risks?
Mike Rizzo, head of the L.A. Gay & Lesbian Center's Crystal Meth Recovery Services, says he often sees a correlation between meth abuse and gay men who battle internalized homophobia. The drug temporarily allows these men to feel more comfortable in their own skin.
Because of the overblown sense of confidence created by the drug, Reback says that outpatient treatments at the Friends Research Institute focus on providing patients with behavioral methods to engage socially and sexually — without relying upon methamphetamines.
"Sometimes their sexual identity is so tied to their meth use that we focus on treatments to reframe that mindset," she says.
Robison finally had had enough and walked away from his addiction seven years ago after his partner was arrested for selling the drug. While he says he doesn't miss being high, he does, at times, miss the sexual aspect.
"Before I started using, I never had good sex," Robison says. "Now I don't even know how to have sex like I did when I was high. I'm afraid of it, a little bit."
Rather than overcoming discomfort toward sex on his own, the drug did the work for him, he says.
He has been celibate for the seven years he's been clean. He's not opposed to the idea of having sex again, but now he's "being patient about it," and he wants to have a quality relationship first.
Instead, he concentrates on staying healthy through a strict diet, getting ample sleep and following his medication regimen.
In 2007, Robison took another major step forward. He began volunteering at Being Alive, a peer-driven agency on Santa Monica Boulevard in West Hollywood, which specializes in supportive services for people living with HIV/AIDS, because he "wanted to do something."
In 2011, Robison was hired as a programs manager at Being Alive.
Now, every day, he consults with people similar to himself — HIV-positive men who may or may not be using crystal meth — to get them access to proper health care, food and housing. He feels that, after a life of so much chaos, he's finally found his purpose.
"Every day I get up and go to work, I think 'I'm still alive,' " Robison says. "I can't believe it.'
"I'm totally healthy right now," he says. "Thank you, universe."