To take each of these points in turn:

(1)"Harm reduction"- that is, needle exchange and bleach disinfection- has proved successful with heroin users, in lowering the risk of HIV transmission. It may be less so with "speed" users. Heroin use is characterized by routines: injection at the same times each day, in the same manner, with the same fellow-users, and using the same connection to obtain the drug. Into such routines, habits of safer practice can be introduced. By contrast, speed use is highly episodic- "runs"- and may very well involve a variety of partners, in a wide variety of venues, and ad hoc arrangements for injection. Furthermore, there is a high likelihood of energetic sexual contacts with new partners. Finally, there is much "mixing" of risk groups, particularly in regard to sharing of paraphernalia between straight and gay/bisexual males. Because of the strikingly different format of "speed" use as compared to heroin use, I am skeptical of "harm reduction" as effective HIV prevention for speed abusers.

(2)Treatment of speed abusers can be effective HIV treatment in that it leads people to stop injecting drugs- but what treatment modalities are really effective? We should be skeptical of the claims of treatment programs which may get their "speed" clients to stop using while they're in treatment. What about after discharge from treatment?

I propose as a hypothesis that the only "treatment" for speed abusers with real long term efficacy is abstinence-oriented, peer-support groups either on a formal Twelve Step model, or as an informal reconfiguration of friendship networks toward relationships which support abstinence. As a partial step in the latter direction, I submit to you a copy of an article by Dr. Craig McDermit, a clinical psychologist, who suggests ways that friends of gay speed abusers can be a part of an "abstinence support network".

(3)Can we discourage young people from starting the abuse of speed? I think so, providing the campaign is credible and motivating. Focus groups of current and recent abusers are a critical first step. I believe the materials that would emerge from such focus will be quite unlike the wordy pamphlets we've favored in the past. The key, rather, will be a few words or images which convey believably the nastiness and ugliness of speed abuse. It could be as simple as "Tweakers Suck!" stickers and soundbites abundantly spread among the highest-risk subcultures. The goal is credibly to destroy the favorable image of "speed" which now prevails in those subcultures.

(4)Time is of the essence. If we appoint committees to meet month after month to study and worry about this issue, and if it's next November before any meaningful plan is launched and money is spent, we will in my opinion have wasted about one-third of the remaining "window of opportunity" open to us. For "speed epidemics" come and go much faster than "epidemics" of other substances; 1996 is one of the peak years, and is a vastly more important timeframe for action than 1991 (before the current surge in use began) or 2001 (when that surge will most likely be well behind us).