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Sep. 26--WASHINGTON -- Richard Gallo's experience is shared by thousands of men who sometimes find other men through e-mail messages that read: "Do you want to PNP?" It stands for "party and play." To party, they take crystal methamphetamine, which reduces inhibitions but also their ability to have sex. To play, they pop Viagra at the same time. Gallo, a 28-year-old Boston resident, said he had many such sexual encounters.
That worries public health officials who say the drug combination promotes risky, unprotected sex with multiple partners.
Drug companies and government agencies, including the Food and Drug Administration, are scheduled to meet today and tomorrow in Maryland to discuss how the erectile dysfunction drugs Cialis, Levitra, and Viagra might be contributing to the transmission of HIV and other diseases.
Gallo, who worked in the porn industry, received hundreds of Viagra pills for free. After work, he popped them to party and play.
"We're talking days. Days, not hours," he said. One drug-fueled sex marathon lasted "10 days in a row," he recalled. "No eating, no sleeping." Gallo, now sober for a year, said taking the drugs together made him feel "invincible."
They are also potentially deadly.
Last year, a New York man was infected by a strain of HIV that overwhelms almost every drug treatment. The source of his infection: Sex with two Connecticut men who warned him they were HIV-positive. A doctor said crystal meth impaired the New York man's decision-making.
In cities across the nation, including Boston, reports of new cases of sexually transmitted diseases between men are on the rise. One reason, some health officials say, is the misuse of Viagra.
Dr. Jeffrey D. Klausner of the San Francisco Department of Public Health said that city was poised to eliminate syphilis in 2000. Now, there are thousands of new cases. He said gay men seeking treatment for sexually transmitted diseases report an average of 18 partners in the prior two months.
His research also links erectile dysfunction drugs with risky sexual behavior and an increase in sexually transmitted diseases in Chicago, Los Angeles, and New York. Klausner said drug companies should curb free samples and limit refills of erectile dysfunction drugs, which are used by more than 20 million American men.
Klausner, who filed a citizen petition with the FDA to address problems caused by misuse of erectile dysfunction drugs, wants federal drug regulators to step up efforts to thwart their illegal distribution, perhaps calling them controlled substances.
"The FDA, actually, can do a lot," he said. "They can require the manufacturers to do more education at the population level. They can require the manufacturers to educate the doctors and the prescribers. They can encourage the manufacturers to modify their advertising and marketing efforts."
Pfizer Inc., manufacturer of Viagra, has promoted educational outreach, including a "safe sex" message that is more tailored to the general population than to gay men who have high-risk sex.
"We strongly support efforts to prevent the spread of STDs and HIV through education of safe-sex practices, including the use of condoms," said Michal Fishman, a Pfizer spokeswoman.
Ken Mayer, medical research director at Boston's Fenway Community Health, said an educational push targeted at gay men who use drugs to enhance sex could also help dispel the growing perception by some that HIV is a manageable, not fatal, infection.
According to the results of a recent one-year study, 18 percent of Boston men seeking treatment for a new sexually transmitted disease said they used Viagra during the preceding month. Nearly 8 percent had used crystal meth, and 10 percent had used Ecstasy, a drug that makes users feel euphoric.
But Mayer said he is uncertain whether drug companies would embrace his idea of advertising the health risks for men who use erectile dysfunction drugs in combination with other substances.
"I think there is a real reticence on the part of these companies to do this kind of advertising, because they don't want their drugs to be perceived as 'gay' drugs. But in reality, I think this data says they are," Mayer said.
Dan Shames, director of the FDA's division of reproductive and urologic drugs, is scheduled to participate in a panel at the Maryland meeting that will seek to examine who is responsible for stemming the worrisome trend. "We're sympathetic, but not sure what our particular agency can do," Shames said.
The FDA can require stronger warnings on labels, but such instructions are geared toward prescribed use of the drugs, not for when they are taken with substances like crystal meth.
"As far as FDA and labeling is concerned, a lot of this is really, really off-label," Shames said.
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