Officials at Haymarket Center, Chicago's largest substance abuse treatment agency, have combined federal AIDS grants with substance abuse grants from other agencies to fashion a holistic approach to what they experience as a singular epidemic involving substance abuse, mental health issues, HIV and other STDs. But such a comprehensive approach is not easy. Government funding for substance abuse treatment is dropping steadily. Private funding for AIDS prevention, much of it from the gay, lesbian, bisexual and transgender community, does not include money to treat and prevent substance abuse. "The gay community right now doesn't look at club drugs as a problem," said Dan Lustig, assistant clinical director at Haymarket.

"Ninety-five percent of the people we see who are HIV-positive become positive under the influence of alcohol or drugs," Lustig said. Haymarket health workers, who treat more than 15,000 clients a year, do not need studies to realize that HIV prevention, if it is to stem the steady tide of infections, must focus on substance abuse among men who have sex with men.

While some gays insist they use club drugs only on weekends or special occasions, Lustig said, "Our weekend users turn into weekend plus Mondays," he said. "They hit treatment after it goes into Thursdays."

The center was founded in 1975 by a Catholic priest and a doctor who wanted to change the way recovering alcoholics were treated. But along the way, Haymarket officials followed the linkages from alcoholism to other substance abuse problems among their clients. By the mid-1990s, that path led the center into HIV prevention, treatment and case management.

"We do HIV education and prevention for every person who comes through our door," said Kenis Williams, health education coordinator. The vast majority of Haymarket's gay and bisexual clients, Williams and Lustig said, tend to repeat risky behavior as part of a cycle that often includes internalized homophobia and fear of others' reactions to their gay inclinations.

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