One of the things I’ve been doing a lot of recently is reading emails from supporters around the world. I’ve heard tragic stories of loss and love, courageous stories of survival and encouraging stories of hope and happiness. While I’ve heard from all types of people, the majority are from men and women living with HIV. We are a community who’ve been through something life altering and that brings you closer together even from thousands of miles apart.

But there’s an undercurrent in so many of the messages: meth. I was expecting to hear from a lot of people who have come through meth or are still grappling with meth. What I wasn’t expecting is just how many have meth and HIV in the same sentence.

My encounters with meth started in late 2002, at the beginning of the “meth epidemic” that swept through major cities around the country. And my meth use mirrored the timeline of the epidemic, with the largest number of people using meth being recorded in 2004-2005. In a 2004 CDC study, the rate of use among gay men in San Francisco, Los Angeles and New York City was 22%, 16% and 14% respectively. That’s an astounding number: nearly a quarter of all gay men in San Francisco in 2004 were using meth. In 2005, the Center for HIV/AIDS Education Studies and Training (CHEST) did a study of men in New York City. Their findings indicated that MSM (men who have sex with men) who used methamphetamine were THREE times more likely to contract HIV through receptive anal intercourse than MSM who did not use the drug.

Now you might think “Oh it’s 2015, surely we’ve gotten away from meth, I’ve only ever heard of it from watching Breaking Bad.” And though the numbers have decreased since 2004 — 13%, 13% and 6% in 2011 according to the CDC study I mentioned above — I would venture to say that the rate of infection amongst those who use meth is the same today as it was then. In a Seattle study by the National AIDS Treatment Advocacy Project released in 2013, meth-using MSM were 5.2 times more likely to be diagnosed with HIV than MSM who did not use the drug. In other words, MSM who used meth accounted for up to 20% of all new infections during that study.