• The following messages are intended to be consistent with 1) Public Health's core philosophy of engagement, and 2) the basic tenets of harm reduction. They are structured to recognize and support positive, incremental behavior change driven by the client's willingness and ability to adopt such changes.
• Messages should be delivered in a tone and intent that avoids blame or parental judgement. Stigmatization makes it more difficult for clients to talk honestly about their behaviors, and shame often only induces further drug use or risk behavior.
• The following messages should also be reinforced with previously adopted HIV/STD prevention messages for all MSM.

• If you don't use, don't start.
• If you do use, seek help to reduce or stop use.
• If stopping isn't an option, act consistently to reduce sexual risk and protect general wellbeing in accordance with the guidelines below.

To men who don't use or may be curious about using:

• Don't start. Crystal meth is highly addictive and dependency can develop quickly, even if you think you can control your use.
• Using crystal regularly can cause tooth loss, excessive weight loss, paranoia, brain damage, and impotence.
• Using crystal also impairs judgement about sexual choices and greatly increases your risk of acquiring HIV.
• Despite popular perception, most gay/bi men do NOT use crystal.
• You can have a great, satisfying sex life without crystal. Most gay men do.

To men already using:

• Seek help to reduce or stop crystal use.
• Get tested for HIV and STDs every three months.
• Before you get high:
  • Plan for sexual safety BEFORE you get high. Decide how and with whom you want to have sex. Make a commitment to disclose/ask about HIV/STD status and use condoms once you're high.
  • For bottoms, insert a Reality condom before getting high or leaving your house for sex.
  • Pack plenty of condoms and lube. Put them where you won't forget them once you're high.
• While you are high:
  • Eat, drink extra water, and sleep.
  • You CAN play safely and use condoms even while you're high. Most men do.
  • Prolonged sex on crystal leads to excessive friction and can cause condoms to break or dry out more quickly. Change condoms every hour.
  • Use more water-based lubricant than usual.
  • Crystal use in combination with other drugs such as Viagra, poppers, and Ecstasy can cause serious and even life threatening health problems.
• Keistering (or booty bumping) is not a safer way to do crystal. It can seriously damage your bowels or anus which may make it difficult to engage in anal sex and increase your chance of acquiring HIV.
  
• If you're not injecting, don't start. Reject offers from sexual partners to inject you or show you how to inject. Injecting greatly increases your chances of HIV, STDs, hepatitis C, abscesses, other soft tissue infections, and social/sexual rejection.
  
• If you're using crystal and you don't take these precautions consistently, your chances of staying HIV negative are slim. Especially if you inject.

For men who inject:

• Nearly one half of all MSM who inject crystal are HIV+. This is more than any other group of MSM.
• Seek help to stop or reduce crystal use.
• Use a new, sterile syringe every time you inject or divide drugs. You can acquire sterile syringes at the needle exchange or at pharmacies without a prescription.
• Do not share syringes, cookers, or other paraphernalia with other users or sex partners.
• If sterile needles are not available, proper use of bleach can kill HIV (3 step method). Bleach is not proven effective against HBV or HCV.

For HIV-positive men:

• Using crystal meth can contribute to faster HIV progression, increased chance of neurological damage, worsened immune function, and/or higher viral loads.
• Using crystal does NOT increase T-cells or boost your immune system. These are myths.
• Your chances of successfully managing your HIV increase greatly the sooner you stop using crystal.
• Crystal can have bad interactions with many HIV meds.
• While you're high, you may forget to take your meds or follow food and water guidelines. This can make your meds less effective and increase your viral load.
• Be honest with your doctor about your drug use. If you can't, get a new doctor. Talk about whether taking HIV medications while you're still using is right for you.