Viewpoint -- Four Percent and Counting
When we talk about HIV prevention for gay men, what I think we are talking about is keeping uninfected gay men uninfected. It is intolerable that a generation of young gay men now growing up are becoming infected with HIV at a rate of up to 4 percent a year. That may sound low to you, but at that rate one half of the gay men who are now 18 years old will be infected by the time they turn 30. We cannot afford another generation of losses and death. Men who are 30 years old shouldn't have to be care partners or have their lives revolve around medications, diarrhea, and fighting off wasting infections. If we do nothing else as a community we have to prevent another generation of men from becoming acculturated to HIV as a norm.
Whatever progress we've made in terms of HIV treatments and the fight for the rights of people with AIDS to live as long and as well as possible, without discrimination or stigma, if we take HIV prevention seriously, the bottom line is a painful one: HIV is undesirable...in all of our lives. That's difficult to say, because for guys living with the virus there is a real struggle to keep a tenuous hold on feeling okay about being infected. People with HIV aren't undesirable, but the virus is. We might as well throw in the towel on HIV prevention unless we can say that living with HIV should not be a normal way of life for the next generation of gay men.
And because there's something implicitly hurtful about that division, we in the gay community feel conflicted about HIV prevention. If I as an HIV-negative man draw the distinction, I'm conscious that someone who's HIV-positive is going to feel that I'm saying there's something wrong with him. The reality is there is something wrong; you have to live a different life because you have a potentially fatal virus. HIV does change people's lives.
What is so seductive about reducing HIV prevention to what is now called the "condom code" is that it papers over some of these painful distinctions: it allows us a way to feel that HIV status doesn't make a difference; to pretend we are all the same; to act as if having a fatal virus doesn't even make a difference in our sex lives; that we don't have to deal with disclosure; and most painful of all, we don't have to deal with the meanings of the differences between being positive and negative.
When gay sex or gay sex venues are publicly attacked, we become defensive. We say that safer sex works, that using condoms prevents the spread of HIV and it's true. But prevention isn't just about safer sex and condoms; it's about saying "I'm uninfected and I don't want to get infected," or "I am infected and I don't want to infect someone else." Condoms are one means to that, but they're only a means. As crucial as having a condom in your pocket is the acknowledgment that the sex you are having is a powerful and important experience for you, and that you are conscious that you risk getting infected or infecting someone else. Condoms don't make that go away. You may use a condom, or have a conversation and decide to "Test, Test, Talk, Trust" or decide that sucking somebody is a risk that you can live with, but it's the consciousness of both the value and the risk that is prevention.
How do we know that living with HIV has become a kind of norm in our lives? I know it because it's hard in the world where I live to say out loud, "I don't want HIV." Too many friends have the virus. When the subject turns to prevention, it's easier to talk about condoms, condoms, condoms and categories of risk and the debates around monogamy or gay marriage but not about why an uninfected man wants to stay uninfected or why an infected man would wish that he was not infected, or how a man who recently seroconverted experiences anguish and disappointment.
Our need to appear absolutely sex-positive shuts down our curiosity and anxiety in a way that is not unlike those who would shut us down with preaching and moralizing. Am I the only one tormented with nagging curiosity, anxiety and doubts when I learn another friend has seroconverted? My silence -- our silence -- establishes a norm of not talking about these painful thoughts and feelings that most of us are experiencing. Our silence only isolates us from each other.
Why is this so important to say now? Because we're being saturated on all sides with marketing by pharmaceutical companies that makes combination therapy seem as normal as using Claritin. Where are the ads making HIV prevention visible? Lack of funding, and transit authorities that won't allow pictures of two men touching, make that impossible.
Stories in the media about barebacking and bugchasing sensationalize our sex while most of us can't really talk honestly about why getting fucked is such a powerful experience and why we might want to do it without using a condom. Masking itself as a new prevention tool is post-exposure prophylaxis; though still unproven, it is a potential bonanza for the pharmaceutical companies. Not only will HIV-positive guys be on AIDS drugs, but now they have a whole new market of anxious guys who don't even know their HIV status buying these medications.
So what do we need to be doing in HIV prevention? Most of our discussions of sex revolve around damning or defending it, which rarely gives us the opportunity to talk about our own mixed feelings, about our desires, and the way we put them into practice. We've all witnessed -- and many of us have participated in -- protracted and frustrating debates about oral sex or closing bathhouses or taking doors off cubicles or multiple partners. Yet we know that if a man who's not a hemophiliac or injection drug user is going to get infected, it's most likely he's going to get infected through unprotected receptive anal sex. If a group of HIV-positive guys sit together in a group, one of the things they are most likely to know about each other is that each of them has gotten fucked and one of those times it changed his life forever.
Fucking and getting fucked are powerful and important experiences for many of us. Some of us do it and are anxious about it; others of us deny ourselves the pleasure because of our anxiety about HIV; others make decisions about risk for other people. Let's talk about that. About how each of us looks and feels as a man getting fucked, about how a relationship changes when we get fucked or about how I might want to give somebody my ass but not my life.
Conversations about this are so important because they can't be done anymore with a slogan. There is no single narrative that can contain all of our experiences of desire, of sex, of relationships, of HIV. The sex lives, experiences and relationships of many men -- particularly Black and Latino men -- have not been reflected in global gay narratives.
We live in a city that's incredibly diverse and fragmented. Many gay and homosexually active men are more attached to a loose network of friends or connections in a homosexual subculture than to an abstract conception of "community." Many of us active in a community don't have our sex there. Our sexual lives, what each of us feels is real sex, are different from one another, and change during our lives. For some of us, having someone come inside us is the only real sex, while others can say "on me, not in me" with no more discussion than that.
So what am I suggesting? That we move beyond latex education to the real, messy complexities of sex education. For example, a lot of times we approach safer sex like it's something we just have to resolve to do on our own. That's partly true, but it's not just your mind that's involved. Sex, safer or not, happens with someone else -- whether that relationship lasts ten minutes, two years, or a lifetime. And while some of us may identify with a role or one particular sex practice, the reality is that most of us change what we do depending on who we're with. And what we do or don't do changes the relationship. So it's not enough to say "I'm a top," or "I don't get fucked," or "I don't let anyone come in my mouth" -- because in certain circumstances or with certain people, maybe you'll change your mind.
You can be gay and proud, and still split off aspects of your sexual life, wrapping them up so that they don't mix with the other roles you play. A lot of us like that split, enjoy the excitement or secrecy of it or the feeling of being pulled out of our life or of the feeling of power we get from slipping out of one life into another. But the decisions we make in one part of our lives have consequences in other parts of our lives.
Talking about these experiences helps us to become conscious of them, as unerotic as that may be. Frequently, what people say about unsafe sex is "it just happened." Yes, but how? You were there. Walk me through it.
If this were the seventies we'd probably call this kind of thing consciousness-raising. And that's probably what we should call it again. What we need are consciousness-raising groups that electrify us and force us to sit up and think about what we're hearing others say or hearing ourselves say...out loud.
Reprinted with permission by Gay Men's Health Crisis, Inc. ©1997
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