I am Dr. Réjean Thomas. I'm not an expert on addiction, but rather sexual health. I'm going to talk to you about the link between amphetamine addiction and the current epidemic of sexually transmitted infections, or STIs, HIV and hepatitis, particularly in downtown Montreal.
The Clinique médicale l'Actuel has been in existence since 1984. We are located in Montreal's Gay Village. So we have gone through the entire AIDS crisis and seen extraordinary progress.
What I'm seeing in the office today is catastrophic. It's something I didn't see three or five years ago. Increasingly, we have begun to see use of crystal methamphetamine, or crystal meth, in a population that is quite different from Saskatoon, but with the same harmful effects. Our clientele is made up mainly of gay men who don't have substance abuse problems. This population is relatively well-educated and financially comfortable.
Slowly, for all sorts of reasons that are difficult to understand, crystal meth has arrived in the Village. Every day we see at least one, two, three, four or five patients with severe addiction. The problem with this drug is that addiction occurs rapidly. People are losing their jobs. They are businessmen and people between the ages of 16 and 72 who have lost everything and are being thrown out on the street.
This drug also creates a sexual addiction in individuals. We have to work on this double addiction, which makes it difficult to treat these patients. I have very few patients who have managed to get off crystal meth; it's a very long process. When these people in the gay community use detox resources, there is a lack of understanding of this double addiction, which leads to what we're seeing today.
For example, in 1998, there were three syphilis cases for all of Quebec, whereas now there are 1,000 a year. There isn't much AIDS prevention in Canada and Quebec, either. At first, this was most common among gay men, but now, women, some of whom are pregnant, have syphilis. Some children are even born with the disease.
The same is true for hepatitis C. In these groups, there are more and more cases of sexually transmitted hepatitis C, whereas it has always been said that this disease is transmitted more through blood and injections. The epidemic context is quite important, not to mention the human problems Dr. Butt mentioned, the psychoses and all that.
I have provided you with some data. Currently, we have about 2,500 patients with HIV and nearly 3,000 patients who are now taking what is called pre-exposure prophylaxis, or PrEP. It is HIV preventive treatment for gay men who we consider to be at high risk after asking them questions. Nearly 30% of people undergoing this treatment practice “chemsex”, meaning that they have sex under the influence of hard drugs. We aren't talking about cannabis or alcohol, but just hard drugs such as cocaine, GHB or crystal meth. Thirty percent of our customers is huge.
Evidently, you have to ask questions. People don't tell us that right away. Often they are our patients, and we learn this by asking questions. This drug is very insidious. People start smoking a little, like those who used to use cocaine from time to time at one time. Now people become completely dependent quickly, and it destroys their lives.
In addition, 30% of this clientele is under 30 years of age. These people use very strong drugs and earn a very average income. The most commonly used drugs are cocaine, ecstasy, crystal meth and ketamine. Our customers use very strong drugs. These 30% of our patients who practice “chemsex” have many more sexual partners, 34 partners in the past year. They have much more unprotected anal intercourse and are at high risk of contracting an STI after 12 months.
On average, these patients have almost 50% more STIs than people who don't use drugs.
Our data really show that our preventive treatment is aimed at a clientele already at high risk. It must be said that the treatment is very effective. We have no cases of HIV among all these patients. We have seen a reduction of nearly 50% in current HIV cases in the last two years.
We have incredible treatment, but at the same time we have clients with addiction, sexual addiction, STIs and HIV problems. I am talking about clients who are HIV-negative, but we see the same thing with our clients who are HIV-positive.
Sometimes people come in who stop their treatment—they are too unstable—and even do not take PrEP. This has difficult consequences: it is a very heavy clientele for which we have very few resources. We really manage to support these people between us, as doctors and nurses. We work with dependency centres, but their staff are not necessarily familiar with or comfortable with this clientele. There is really a twofold problem. This is what we see in at the Actuel clinic.