The little blue pill once promoted by Bob Dole has become a party pill in the Valley gay scene — one that could be leading to the spread of HIV here, according to local health workers.
"In the bathhouses and clubs there are three questions: Hey, do you want Viagra? And do you want a line (of cocaine) to go with that? And how about some ‘poppers’ (alkyl nitrites)?" said Kevyn Holloway, an HIV health educator who lives in Ahwatukee Foothills and visits such places socially.
An ongoing survey taken in gay bathhouses, bars and bookstores in Pima and Maricopa counties by Body Positive, the Phoenix-based HIV and AIDS resource and outreach center, is finding that 40 percent of the men surveyed know they are HIV positive.
In the past year, 200 men have been surveyed, and half of those who are HIV positive — or 20 percent — also use Viagra. Half of those men have a prescription and use the drug to counteract the side effects of HIV medication and the virus. The other half of HIV-positive men who visit gay bathhouses, bookstores and bars abuse Viagra, mixing it with illicit drugs for prolonged sexual activity.
"They’re enhancing their party," said Scott Haverstock, outreach worker for Body Positive, which receives state and federal funding and is the largest provider of HIV and AIDS services in Maricopa County. "(Viagra) allows for more sex, and unfortunately more sex often means more partners and risky behavior — and that’s where HIV transmission comes in."
Limited statistics have been collected about the trend. There are no known surveys about Viagra abuse within the Valley’s heterosexual community. The phenomenon was reported in the December issue of the medical journal International Association of Physicians in AIDS Care and has been the subject of San Francisco Department of Health surveys.
One San Francisco survey found that men who use Viagra engaged in more risky behaviors, and HIV-positive men who use the drug were far more likely to use it with illicit drugs and engage in unprotected sex with multiple partners.
Brian Helander, executive director of Body Positive, said it is important to stress sex education, not Viagra use.
"I think it’s the individuals who should be responsible — whether they’re using Viagra or not. The disease can be spread whether they’re using Viagra or not," Helander said. "I have a problem tagging a moral spin on the use of Viagra."
Haverstock, who conducts the Body Positive survey, said his figures are based on men he counsels in Maricopa and Pima counties. Haverstock said he counsels all the gay men he encounters, because national studies have found that about half of gay men who do not know their HIV-status test positive for the virus.
There are 189,000 gay men in the Valley, according to the Greater Phoenix Gay and Lesbian Chamber of Commerce.
HIV-positive men who don’t take Viagra under the direction of their doctor to counteract the effect of HIV drugs, which can cause impotency, use the drug to party, Haverstock found. They mix it with alcohol, methamphetamine and "Ecstacy" — all of which impair judgment and cause impotency. This latter group is more likely to buy Viagra on the Internet or in Mexico, Haverstock said.
"If their physician prescribes it to them, I’m confident the physicians are having a conversation with people to make sure these individuals know it’s their responsibility not to transmit HIV," he said.
Dr. Kenneth Fischer is a Phoenix-based family practice doctor and HIV specialist who has treated 350 patients with HIV or AIDS. About 300 of those patients are men, and he’s prescribed Viagra to about 50.
"My position is to give patients good information so they can look out for their health care and the best interest of their partners," Fischer said. "I am not the sex police. The responsibility falls on individuals to take care of themselves."
Barbara Renphal is a pharmacist at the Apothecary Shop of Phoenix, an independent pharmacy that specializes in HIV treatment. The majority of her patients live in Scottsdale and Phoenix. She is unsure how to best approach her patients about safe sex issues.
"I would prefer a patient with HIV who comes in with a Viagra prescription have a good supply of condoms," Renphal said. "Because of all this controversy you assume everyone is well informed. But you can never know."
Bruce Porter, Arizona Department of Health Services’ HIV and AIDS prevention coordinator, said his staff is aware of Viagra abuse in Maricopa County’s gay male community. But aside from encouraging condom use, the trend has not been explicitly addressed by the 11 county and community programs under his direction.
"All we can do is keep delivering the message about having safe sex," Porter said.
Some, however, say that the drug contributes to safer sex practices.
A lot of people are using Viagra because it enhances sensation for condom users, Fischer said. Therefore a prescription encourages HIV-positive men to practice safe sex, he said.
"Some urologists I know think (giving an HIV-positive man a Viagra prescription) is like giving a homicidal person a loaded gun," he said. "I don’t think that’s completely true. They’re either going to stop taking their medications or stop using condoms because of marginal impotency."
Survey says . . .
A 2000-01 survey of 844 men registered at the San Francisco Department of Health’s STD clinic found:
• 56 percent of gay or bisexual men who used Viagra got it from a friend, rather than a health care provider.
• 43 percent of gay or bisexual men reported using Viagra with "Ecstacy," 28 percent combined it with methamphetamines, and 15 percent consumed it simultaneously with "poppers" (alkyl nitrites).
• Gay and bisexual Viagra users reported having on average 5.4 sex partners in the previous two months, compared with 3.5 partners for gay or bisexual nonusers.
• 30 percent of gay or bisexual HIV-negative Viagra users reported having unprotected sex with someone who is either HIV positive or does not know their status — twice as often as gay or bisexual nonusers.
SOURCE: Centers for Disease Control and Prevention