Provider Roles

Now that we have a foundational understanding of why Black and Latino MSM use crystal meth and some of the conditions and perceived risks, let’s talk about what providers know, and who Black/Latino MSM would recommend having these discussions.

Non-clinical providers are more likely to, and more confident in, discussing crystal meth use.

We learned that the people who were most confident discussing crystal meth use tended to be people who were working in the field on a variety of both health and social issues (e.g. outreach workers, health educators, and case managers) versus clinical providers who were tasked with medical service provision. Two thirds (67%) of providers said they knew where to refer someone for support services related to harm reduction programs.

“[Doctors are] definitely not knowledgeable. I think it is new to more general physicians and the ones you just go to get a physical don’t know much about it. The ones that I realized are a little bit more sensitive are the mental health providers, especially the ones specifically geared toward LGBTQ patients … they are the ones that don’t make you feel stigma … cause I felt like I have been stigmatized for it.” — Black, South (Age 35)

“My case manager was very welcoming.” — Black, South (Age 32)

Providers are not asking about crystal meth use.

We learned that the majority of providers said they were unsure if Black and Latino MSM were using crystal meth. Only half (54%) of providers said they brought up drug use if it came up naturally in conversation.

“Even when I go to meetings that’s not something they ask me, like ‘what other drugs have you done’, It’s never crystal meth. I think it’s a new ki in the community, they are not really competent with that.”

“We need to stop separating. It’s kind of like [meth] is separated from all the rest of them. Even with my own experience of going to the doctor, I was asked about every other drug except crystal meth, because you’re assuming that because I have Black skin or my skin is darker that I don’t have access to that.” — Black, South (Age 38)

There is room for more education about crystal meth use and the intersections with Black and Latino MSM.

Providers acknowledged they need to learn how to be more culturally competent and sensitive when working with Black and Latino MSM who use crystal meth in order to develop trust not to perpetuate stigma.

“The one time I was injected, where I had the negative reaction and went to the ER, I was waiting with everyone and I was talking to the doctor and told him straight up ‘I injected meth a couple of days ago and I am having this reaction’ and I forget what he said, but he kind of made a joke out of it and was kind of ‘maybe you should stop using meth’. And I get that, I understand that, but that comment and attitude is not helping me at all and it is making me feel really stupid right now in front of a lot of people.” — Latino, West Coast (Age 25)

Providers recognize that this is tied to other needs.

We heard that providers said that they didn’t have information about the intersection of mental health and crystal meth use and resources for people experiencing homelessness/survival sex that may be related to why people are using crystal meth.

“The most compassionate thing to do is to ask to get to the root. Not making it about the drug use because when you make it about the drug use it goes back to that stigma and shame … It would be helpful if providers were aware of the higher possibility that Latino and Black men can experience barriers to access, like language barriers or knowledge of resources … I’ve seen some places offer bus tickets or vouchers. I think that is really good and providers should do that. If providers use questionnaires that they ask questions it would be useful to ask about income, to ask about job stability. I think asking about that is super important because when you don’t have a job it can also be very depressing and creates a sense of being stalled. Feeling down and low about not having a job made me start using more and then in turn I would not be looking for jobs … providers should ask Black and Latino men about their prospects, how do they feel themselves and give them the option of come out of the scene.” — Latino, West Coast (Age 25)

“Physicians need to ask more questions. Recently when I went to get PreP the physician asked me ‘Is this a concern to you? (his crystal meth use)… Would you like to be connected to mental health services?’ and I said ‘yes’ but was never connected. It is extremely important if they are going to be asking or connecting people to mental health resources they should actually follow up.” — Latino, West Coast (Age 25)

Tips & Takeaways for Providers

For Non-Clinical Providers

Clinical providers can be intentional about asking Black and Latino MSM about crystal meth use. Brush up on some of the reasons why people may use crystal meth and the cultural context for use (e.g. party and play, intimacy) to be more well-rounded.

Partner with providers who are already confident and have trust/rapport building skills. Connect with your local harm reduction program, LGBTQ centers and providers, and other outreach teams that may connect with this community.

For Providers Asking About Crystal Meth

Don’t assume. Always include crystal meth on your list of drugs you ask about. Because of the perception that crystal meth use is a “white people,” “strung out” drug, Black and Latino MSM who are using crystal meth even occasionally don’t feel like there’s space to talk about their needs with providers unless they bring it up themselves.

For Educators

Stigmatizing experiences perpetuate distrust. The only way to move forward is to be open to learn more about diverse reasons Black and Latino MSM use crystal meth, what purpose crystal meth has in their lives (provides opportunities to feel pleasure and have fun, allows them to connect to each other and experience intimacy without feeling shame) and ask them how they can support them/offer them referrals to other supportive services such as mental health or harm reduction services.

For Intersections with Mental Health or Homelessness

Crystal meth use is complicated and is a symptom of other needs including unmet mental health needs and sense of belonging/connection and self-worth, and housing security and social stability.

Providers need to build up a strong network of referral sources to address these other underlying issues and support a warm hand off and follow up by building these partnerships where you know Black and Latino MSM who use crystal meth will be treated with respect.

Listen, refer and follow up. We heard that one of the key parts of developing trust and rapport is to “not let us fall through the cracks.” Following up on referrals is helpful to be sure that your participant is able to get the services they requested — and it also shows that you care.