Keep the bathhouses, lose the shame: the problems of increasing HIV infection and rampant crystal use among gay men are intertwined, argues PATRICK MOORE, so they need to be attacked in tandem. The first steps are to combat the self-loathing attached to gay sexuality and to reach out to sexually active gay men where they meet.

After enduring decades of devastation, the gay community is now witnessing a new generation of young men becoming infected with HIV, seemingly oblivious to the death and suffering that they might have escaped. We also see middle aged gay men, having survived HIV thus far, endangering both themselves and others with unsafe sex. We are told that this phenomenon is largely the result of a new crisis: crystal meth addiction. But crystal abuse is only one symptom of a malady called self loathing, which feeds on the denial, separatism, sexual repression, and untreated grief that now permeate gay life in America.

It is no coincidence that gay crystal use began to expand rapidly at about the same time that "the cocktail" began to make HIV seem like less of a death sentence, throwing many gay men back into life with absolutely no preparation. Men who had assumed their lives were over had to find new ways to feel erotic and vital while coping with grief, shock, and the heavy side effects of their medications. The emotional impact of AIDS on their lives left these men with little investment in their own future, let alone that of the negative men with whom they were having sex. For a few hours or days, crystal's intensity could erase the pain of the past and the fear of the future.

Many older men who had somehow escaped HIV infection but had watched loved ones die in their arms were equally damaged and disconnected. The rituals of marches, funerals, and volunteering had suddenly stopped, taking with them much of the sense of unity that had marked the '80s and early '90s. Alone again, we were expected to pick up the shards of our shattered lives. Crystal, along with other drugs and alcohol, offered a chemically induced sense of belonging.

As a community, we haven't yet figured out how to make sense of what happened to us during the first decades of the AIDS crisis, let alone come to terms with the fact that it is still happening. We just want to move on. We are lacking in new spiritual rituals, targeted services, and the honesty that might help us deal with our grief. Most gay men age 40 and under have lived their entire adult sexual lives under the shadow of AIDS, forever linking sex and self destructiveness in our minds. Yet we have no public spaces to discuss these messages because we rarely discuss sex anymore. Gay sex is now seen either in terms of monogamous marriage or shameful promiscuity. Our sexual self repression (as reflected in media images of neutered gay men) creates an atmosphere of fear and shame around sex that stifles healthy exploration.

Young gay men coming out into the current atmosphere of fear, resentment, and superficiality can hardly be blamed for an inability to make healthy sexual decisions. Their choices are clouded by the fact that crystal is widely available, costs little, and produces a kind of sexual high particularly attuned to the thrilling self-destructiveness of youth. It is vital that older generations who were directly impacted by the first decades of the AIDS crisis undergo the process of understanding, in a complex and compassionate way, both our own self-destructive behavior and the reasons for the current wave of infections in the young. Without this understanding, it is entirely likely that we will close our minds, hearts, and wallets to those now becoming infected.

But compassion seems to be in short supply these days. The commercialization of gay life and the ongoing problem of racism make it easier for gay Americans to care for those suffering with HIV in Africa than to acknowledge that 10% of black gay men in America are now infected with IIIV. A significant number of these men don't identify as gay, making outreach to them difficult and minimizing the kind of personal connection that characterized early AIDS services in the United States. The U.S. AIDS establishment has perpetuated the misleading and damaging message that "AIDS is no longer a gay disease." In fact, in the United States of America, gay men still make up about half of new infections. As a group with highly specific sexual problems and a record of addiction, jumping on the "We Are the World" bandwagon does not make sense in terms of the kind of research, education, and prevention gay men need here.

So how do we deal with the immediate crystal problem? Let's hope that we can one day acknowledge the emotional damage wrought by the AIDS crisis, develop services to deal with it, and sanction a wide range of sexual lifestyles instead of using marriage to create a system of "good gays" and "bad gays." Let's even dream of a day when the gay community and the black community will work together to help young black gay men feel that they are of value. Both strategies could begin to eliminate the systemic disease of self-loathing that creates addiction.

As for immediate education efforts, the straightforward message of condom use that many AIDS organizations currently broadcast is not wrong so much as it is simplistic. Most agencies remain wary of explicitly addressing how men who are using drugs actually have sex. Nearly 25 years into the AIDS crisis, gay men are well aware that condoms prevent HIV transmission, but all of the sate sex knowledge in the world is beside the point when you've been up for three days on crystal and self-destruction has become the world's biggest turn-on.

Viable education programs do already exist and must be expanded. During the time I served on the board of the Van Ness Recovery House in Los Angeles, I learned a fundamental lesson from Kathy Watt, the program's executive director. She told me, "We operate on the assumption that people should have the opportunity to have the sexual experience they are looking for, but in a safer way. We need to meet them where they're at."

HIV infection results from crystal not just because gay men are out of control but also because of the physical conditions specific to crystal use. Men on crystal often have mouth sores from grinding their teeth, for example, and oral transmission of HIV is more likely for them. That's a level of information rarely provided in prevention campaigns or mainstream research.

The men we need to reach are not hanging out at the local community center. They're at the sex clubs. We cannot afford to shut down or "alienate these businesses. They represent our best educational forum.

The Van Ness Recovery House works inside bathhouses and sex clubs to provide education that acknowledges drug use and helps clients negotiate safer ways of having sex in a dangerous environment. The Van Ness House also has a stringent ethics policy: Outreach workers are strictly prohibited from sexual behavior in venues where they've worked (or might work in the future) because blurting the line between participant, and educator can lead to disaster. Also, the same workers staff the same club week after week so that patrons can develop a level of trust and be encouraged to discuss difficult issues. Most important: HIV prevention workers are cross-trained in drug counseling (a rarity in outreach programs) so that they can provide a message truly targeted to their clients.

If we want to deal with the crystal problem, let's deal with it immediately by expanding such existing programs. Fortunately, many of these have honesty as a core component of their effectiveness, so perhaps our efforts will have the added benefit of getting us to look more carefully at the river of problems coursing beneath the glittering surface of contemporary gay life.

Moore is the author; most recently, of Beyond Shame: Reclaiming the Abandoned History of Radical Gay Sexuality (Beacon Press).