Gay men's use of methamphetamine has aroused great anxiety. In some countries such as the USA and Australia as many as 40% of gay men use this drug, while use is lower in others such as the UK. However, across all these countries gay men's use of other substances such as alcohol, poppers and cannabis surpasses that of methamphetamine. Recent evidence from case-crossover studies suggests that use of not only methamphetamine but also of alcohol, cannabis, poppers, cocaine, amphetamines and Viagra is associated with increased risk behaviour during episodes of anal intercourse. However national drugs and alcohol strategies do not refer to gay men, drug treatment services tend to focus on opiates and do not target gay men, and HIV prevention for gay men rarely mentions use of substances other than methamphetamine. This is a missed opportunity given the evidence for the effectiveness or drug treatment and prevention interventions, and evidence that such interventions can be tailored to gay clients. © 2008 Informa UK Ltd.