May 7, 2013
This article originally appeared on PositiveLite.com, Canada's Online HIV Magazine.
It's morning, I open my eyes
And everything's still the same
I turn to the guy who stayed last night
And ask him, "What's your name?"
-- "So Many Men, So Little Time," Miquel Brown, 1983
I must admit, when I read this title quote by the much-lauded British performance artist and TV personality David Hoyle, I thought it must be something from a late eighties politician, and one not exactly gay-friendly. In fact, the very gay David Hoyle said it in 2007, on the day before World AIDS Day and on the flyer for a night at the Royal Vauxhall Tavern in London, was added the following text:
All over Vauxhall they are fucking without condoms. All over Vauxhall they are dancing till Tuesday morning. All over Vauxhall they are taking G, K, C, V and E [that's GHB, ketamine, cocaine, Viagra and ecstasy]. All over Vauxhall they are dying.
Depending on your viewpoint, this was either in your face, plain speaking by a prophet with street cred; or the outburst of a gay artist, exhausted and frustrated by the hedonism of the scene in which he performs.
Let me try to put this in context. The numbers of new HIV infections in the UK have remained more or less the same between 2001 and 2011, despite awareness and sexual health education having reached practically all young people. So somehow, the message which is understood by everybody is not being translated into action between the sheets. Despite the current youth culture being brought up with the mantra that safer sex saves lives, HIV cases are just as high as 15 years ago and are being fueled by rampant alcoholism and drug abuse within the gay scene itself.
Now I can't judge; I was young too once but sex, drugs and alcohol are a powerful cocktail and the potential for harm is self-evident on the gay scene. In Britain particularly, there is a cultural expectation amongst young people, both straight and gay, to get wasted on either drink, drugs or both. Sex is the climax to the evening but by that time, rational thought is by definition diminished.
There has been a spate of drug-induced deaths in gay saunas and clubs recently but even this hasn't deterred people from giving in to peer pressure and the weight of gay social expectation. More stories are appearing of horrible situations where a partner who has been on GHB, suddenly dies straight after sex. Apart from that and despite the lurid publicity many young people also seem to agree with the following from Time Out:
Several younger gay men I've spoken to in the past few months have argued that HIV is no big deal. They've heard about combination therapy, they've seen the ads with muscular men climbing mountains and they've jumped to the conclusion that life on antiretrovirals is one long picnic. There are even the fatalistic few for whom contracting HIV is seen as some sort of rite of passage, or a stepping stone toward having lots of unprotected sex without having to think about the consequences.
On the other side of the coin, Hoyle's sentiment from 2007 is echoed in a recent article by Matthew Todd in the Guardian, titled "The Roots of Gay Shame." He says, "If you didn't think you were worth caring about in the first place, why would you care if you caught HIV?"
The rise in HIV infections among older guys shows that the problem is not confined to the "live hard, die young" generation. In the older age groups, the causes may lie more in a rejuvenated sex life thanks to erection enhancers than the gay scene in which even the fittest older guy struggles to keep up. The risk-taking, though, is proportionately as high. Maybe the older you are, the stronger the feeling that you've dodged the bullet so far, why should it change now? My HIV specialist shakes his head, bemused at the sheer lack of logic regarding new infections in the 45+ groups. After all, it's not as if they've not seen what can happen and no age group is better educated. So what's going on in the gay psyche -- both young and old -- that shuts out reason at crucial moments?
Was David Hoyle right? Are we part of a massive, subconscious suicide cult? Do we really have an uncontrollable problem that nobody's talking about? We can surely assume that if it is happening in UK cities, other urban conurbations across the world will be similarly affected.
It may not be helpful to take the moral high ground either. Many people will be quick to jump on the "serves 'em right" bandwagon and people living with long-term HIV may also wag stern fingers but it can't be as simplistic as that. Maybe it's good that LGBT insiders like David Hoyle are criticizing behavior from within the scene, however much it sounds like he's betraying his own by speaking to the world at large. However, he's not alone. All sorts of people from club owners to social workers are quietly bemoaning the consequences of unbridled hedonism and asking for it to be talked about at least. The point is that it's not done to be a whistle blower in any social group but in this case something is clearly going on within the scene and could threaten resistance to the virus if it gets out of hand.
To my mind, however tempting it may be to come over as "outraged from Amsterdam," this isn't a cut-and-dry moral issue. Very few people actively set out to catch the virus and there's never been so much information available on every social platform. So why is a substantial group of LGBT people rushing lemming-like off the cliff despite knowing a hundred reasons not to?
I've got to disclaim here: many people go out socially, have a few drinks, meet someone and have safe sex with them -- everything in moderation. Not everybody is socially reckless and having unsafe sex; the virus would be out of control if that were true. So I'm not talking about those who follow the "rules" and live fulfilled and happy lives but the rise of a hedonistic culture which leads to a carpe diem attitude and if they get something, too bad. Enough people are spreading the virus to keep the statistics at a stable high. It's almost as if for every ten converts to safe sex, ten "refuseniks" emerge to take their place and then the stats never improve.
It surely has to be a social issue, with a very strong sexual component attached. You're bought up in a society that still discourages homosexuality and encourages normality. You discover you're gay and are immediately confronted with dilemmas over what to do about it. You may have a tough time with your family and at school and via school peer pressure, may take to distractions like drugs, alcohol and smoking even before you hit the gay scene. Heterosexual youth culture sees getting wasted as a rite of passage and then, with hormones raging, you take your first tentative steps onto the gay scene, where your insecurities are quickly masked by the availability of everything in the candy store. You then learn how to mask rational thought with excessive drink and party drugs and before you know it, your trousers are round your ankles, without a condom in sight.
So that's maybe how it starts but god knows there are enough social messages and pressures to make you think twice. So why do so many ignore them and willfully seek out yet more thrills without brakes? Even "normal" STDs like gonorrhea, chlamydia and syphilis don't stop them in their tracks: antibiotics for a few days and then back on the scene but it's only a matter of time for many before the law of averages kicks in and hepatitis and HIV take their disease dossiers to the next level. Even then (and here lies the great unspoken problem) people aren't deterred by disease; as long as it doesn't kill them, they carry on regardless. Why do they do that? Very few people can be sanctimonious about it; most people with HIV have slipped up somewhere (and not just once) and rejected reasonable behavior. So what drives us to indulge in irresponsible behavior; irresponsible for ourselves and irresponsible for others?
Maybe we underestimate what my ex-partner used to call "the power of the cock," and the nature of the sexual act itself. We all know that there's a point of no return with sex and especially sex with strangers. You're condom-aware throughout the encounter until the point where you're going to do it or not and then desire, lust and your sex-drive determine your decision making and sometimes, the sexual urge is just too strong. We're built that way by nature; remember the original idea was to beat off the competition and procreate like bunnies to extend your own section of the gene pool. It's one of the most powerful human autonomic reactions and very difficult to resist "in the moment." If you have to break off to put a condom on, not only do you lose the moment and a part of the excitement but you have to have enough willpower to overcome "the power of the cock." For many, the very act of putting a condom on is enough to lose them their erection and nobody likes that. So although we know we should and must, it's not easy and your mind has to be at its most rational to do it every time. Put yourself in the situation where you're on recreational drugs to get you through the night, possibly drunk as a skunk and you've exchanged "the look" with a hottie heading for the darkroom. All you want to do at that point is have sex; the urge can be irresistibly strong, especially if fueled by GHB and the rest. It takes a strong mind to unwrap both condom and lube packets and roll it on, with every chance that your bee has buzzed off to another flower. Morally we all know it's wrong but it happens and the blame has to be shared between the person himself and the social pressures around him. It's maybe those social pressures -- the drink, the drugs and the social mores -- that allow sexual impulse to overcome rational thought but it's just as likely to be your own biological urges.
I think that maybe if we're being realistic we will never achieve 100% safe sex behavior and maybe we should be satisfied if the current HIV new infection statistics for each country remain stable. Aiming for the total eradication of HIV transmission, as the HIV organizations trumpeted last year, can only come as a result of a cure or a vaccine because people's behavior isn't going to change, however much you confront them with the facts.
This sort of thinking is of course blasphemous in the eyes of health organizations and socially conscious HIV groups. We feel we have to strive for the elimination of HIV but considering social behavior in certain groups across the world, I'm personally not sure if we can by trying to change behavior alone. Moralists can preach that we need to return to taking personal responsibility for our actions but take a step into a modern gay club and you can count on the fingers of one hand how many eyes that stare at you aren't glazed, or hyperactive. Party drugs rule! Pragmatism and not preaching is what we need.
David Hoyle and others see it differently. They believe that there's something much deeper behind it all. It's claimed that the apparent lemming-like behavior among our youth groups stems from shame and self-loathing, rather than outside influences like drugs, drink and hormones. It sounds like a very old-fashioned concept, stemming from the days when staying in the closet was more the norm than the exception. LGBT society was bombarded with messages that it should be ashamed of itself and its behavior was disgusting to decent, god-fearing folks. It's not something that you would expect to hear in these days of gay marriage and Gaga birth certificates that prove we were born that way. So what do they mean when they link HIV infection to shame and loathing on the gay scene?
The theory goes that internalized shame leads to compulsive behavior and this is applied to LGBT people in the following ways:
Children are brought up to believe that sex and sexual relationships are wrong and sinful and gay sex sends you immediately down to Satan's sin bin.
When they're old enough to make relationships, society barks at them from every corner like rabid dogs that any relationship they might make has no value and actually causes a breakdown of society.
They learn that some people hate them enough to make their lives a misery of social network sites, or even attack them physically on the street.
They see cases of teenagers killing themselves out of horror at what they've become.
So it's believed that people turn to compulsive behaviors to either compensate for, or hide from their real selves. People become addicted to drink, drugs, smoking, porn, promiscuous sex, etc. This then leads to situations such as those on the gay scene, where safety is found in numbers and solace in collective substance abuse and sex. These feelings then become so embedded, you hardly know they are there. Becoming infected with HIV becomes a sort of culmination of the lifestyle and when it's too late to turn back, people get a sort of perverse pleasure in the fact that they were right all along and their shame and guilt has led to this "deserved" punishment.
The British and gay pop singer Will Young claimed recently that his own shame at being gay led to dysfunctional relationships and an addiction to porn. Now Will Young seems like an okay guy and someone fairly typical of his generation but is his claim purely personal or representative of many? On the face of it, you would think that most of the sorts of behavior that go on in many areas of the "scene" are hardly symptomatic of shame and guilt. It looks to be more the result of a sort of arrogance and fuck you attitude which young people have had since time immemorial. Add to that the feeling that you're immortal when you're young and you have to ask whether guilt plays any part at all, never mind a subconscious collective suicide wish!
That's the theory and although I may have described it far too simplistically it sums up what many people believe. Although I'm sure that many people carry guilt around with them like a Prada purse and some of them become compulsively obsessive, it by no means explains the problem, except as a sort of moral judgement based on amateur psychology. Why can't we accept that young straight or gay people these days are just out for a good time because with the pressure that society brings to get a job and have more "stuff" than the next man everybody needs an escape?
Possibly the only difference between gay and straight twenty-somethings is that three letter acronym HIV. It's such a loaded term that the pressure from society that it's evil and morally reprehensible leads to what all youngsters have always done: they do the opposite! When their own "elders" preach the plague years and bitter experience and every gay site on the planet tells them to avoid HIV by all means possible, of course a percentage are going to rebel and do their own thing. After all, they're immortal, right?
Maybe we need a more pragmatic approach to unsafe sex; accept it will happen and aim research at newer and more direct forms of prevention (effective antiviral lubes for instance). Ease up on attacking the morals of those who indulge in reckless behavior and concentrate on creating barriers to the virus, while at the same time taking active steps to change people's recreational stimulant use. Stop treating HIV prevention as a moral issue maybe and concentrate on killing the virus.
It's no good lecturing young people that they don't know what they're getting themselves into because a significant proportion will get themselves into it whatever you do. At the same time, I'd wager there isn't an LGBT person on the planet who hasn't felt guilty, or ashamed, or angry at some point at the cards they've been dealt but by no means have all of them ended up with HIV through reckless living as a result.
The title of this article is a brilliant sound bite but in my opinion not very strongly grounded in the truth. I'm beginning to believe that the best policy is to mop up afterwards, do our best to give unbiased advice and a safe environment and go for the throats of drug dealers and exploiters just interested in making a buck. It may sound heretical to many but we're all aiming for the same result; it's just the approaches that are open to debate.
Read Dave's blog, HIV, Neuropathy and More: Avoiding Becoming a Nervous Wreck.