The National Alliance of State and Territorial AIDS Directors (NASTAD) in the United States has described the increased use of crystal methamphetamine among men who have sex with men (MSM) as a “public health crisis.”¹ However, outside the United States, evidence concerning recreational drug use and it implication in the rising rates of sexually transmitted infections (STI) and HIV among MSM is much more patchy.^2–4 In the United Kingdom, data on changing patterns and practice of recreational drug use in the post-HAART era are incomplete, often disjointed, and generally inconsistent.^5–7 If, as seems apparent from reports from other industrialised countries, there are important emerging issues concerning recreational drug use and MSM, then there is an urgent need in the United Kingdom to address the deficit in our knowledge. We set out a case for redressing the gap in our evidence base and propose simple strategies for developing better surveillance of this key behavioural aspect of STI/HIV transmission risk.

WHAT DO WE KNOW ABOUT RECREATIONAL DRUG USE IN MSM?

In North America and Australia the contribution of crystal methamphetamine and other recreational substance use to high risk behaviour is becoming an increasing focus of public health research.^8,9,10,11 Crystal methamphetamine (CMA) is a potent stimulant drug, chemically related to amphetamine. It is similar to cocaine in its euphoric effects; but CMA is more potent, much cheaper, and longer lasting (the half life of cocaine is 50 minutes while that of CMA is up to 12 hours).¹² Recent community studies have revealed important associations between the growing popularity of CMA and other recreational drugs and an apparent sexual culture shift towards more high risk behaviour.^4,13,14

Although prevalence of use in individual studies varies, there is substantial evidence of widespread recent (3–6 months) non-injecting …