UC San Diego

Methamphetamine use and HIV disease are large and intertwined problems in American gay communities. This is particularly so in San Diego, where both meth and HIV have been endemic for three decades. Because meth use is associated with not just the spread of HIV and other STDs, but also with petty and violent crime, the public health and law enforcement agencies have responded with substantial, but sometimes ineffective efforts. The effects of these efforts on meth-using HIV+ men who have sex with men (MSM) have been studied in hundreds of publications, but little of it is qualitative, and rarely in the literature are political and economic forces discussed, except in relation to demographic categorizations of study participants. Thus an examination of the subjectivities of men in three major HIV risk categories - HIV+, MSM, meth using - helps to understand their experiences and the results of the institutional response to their problems. After doing 14 person-centered ethnographies of HIV+ MSM who use meth and spending two years doing participant observation in the institutions charged with focusing on this population, I have concluded that the efforts to stop HIV infection and meth addiction among gay men has had an unintended consequence : the social abandonment of HIV+ meth addicted MSM to an underfunded, ineffective, but mostly well-meaning healthcare system, in addition to a moralistic, hostile, and deeply flawed law enforcement system the goals of which are at odds with the health of addicts and the results of which are at odds with both public safety and law enforcement. This is neither the fault of the addict nor the fault of the institutional response, but rather a complex and chaotic interaction between destructive behavior of the addicts and a morally confused, haphazard, and under-funded neoliberal collection of organizations that comprise anti-meth apparatus. The subjectivities of these men have been constructed in a fraught environment of pity, anger, fear, and loathing, which has led them to a lived experience of suffering and constant struggle