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Cruising with Lazarus

Why Do We Tolerate People Who Are HIV Positive and Spreading the Disease?

July 2002

"We have all these programs and HIV prevention people are scratching their heads saying, 'How can we help people with HIV?' When it is all said and done it's up to the community to say, 'we just don't want HIV to spread.'" So says Thomas J. Coates, Ph.D., Professor of Medicine, Epidemiology, and Biostatistics and Director of the Center for AIDS Prevention Studies (CAPS). For the past 17 years, Dr. Coates has worked to keep the AIDS research agenda relevant as the epidemic unfolds. The National Institutes of Health, Family Health International's USAID-sponsored AIDS prevention project, the World Health Organization, and the U.S. Congress seek his advice on AIDS research.

Coates is a respectable, quotable dude who's been trying to draw attention to the fact that HIV infections have been steadily rising among gay and bisexual men across the country for the past several years. Last spring, at a University of California HIV forum in San Francisco, a frustrated Coates admonished the gay community to change its attitudes toward the disease and toward people who are HIV positive. "We are so used to thinking of HIV-positive people as victims, we are afraid to think of an HIV-positive person as responsible," said Coates, who is HIV-positive. "Why do we tolerate people who are HIV positive and spreading the disease?"

The gay community has never really wanted to address that last question. In order to have a discussion about why we tolerate HIV-positive gay and bisexual men who knowingly spread the virus, we'd have to talk about accountability and responsibility -- two words that imply our behaviors actually have ramifications.

God forbid that sexually active gay and bisexual men should take a hard, objective look at our behaviors. That wouldn't be nearly as much fun as a circuit party, a night at the bathhouse, or having your best gay buds over to watch the latest episode of "Queer as Folk." Nope, I'm afraid that when it comes to HIV prevention many gay and bisexual men have given up, stopped caring or quit listening.

It's now been twenty-one years since HIV reared its complex, virulent head. In the early days of the epidemic, the gay community rallied. We took this virus seriously at a time when the doddering occupant of the White House conspicuously failed to mention AIDS in public. We protested when the nation's news media attempted to fan the flames of hysteria with superficial reporting. We acted up when our so-called religious leaders claimed AIDS was God's wrath upon wicked homosexuals. We demanded that the medical community treat us, funeral homes respectfully bury our dead and that America stop blaming us for this damn virus.

But perhaps the most important thing we did was talk about prevention and sexual choices, and this led to safer sex messages. Still, as someone who lived through the crisis and chaos of the 1980s, I sincerely believe that sheer, unmitigated fear is the only thing that made HIV prevention work in the first place. Fear, after all, is a reliable motivator. Faced with unrelenting disease and death, gay men developed and adopted safer sexual practices resulting in a steady decline in infections. Today, however, most prevention specialists agree that yesterday's fear has dissipated and the urgency surrounding HIV decreased substantially after 1996 when AIDS drugs began to make a difference in both treatment and ultimately the way many view HIV disease.

Now, our past prevention success is increasingly undermined by three things -- a government determined to eradicate explicit prevention programs and impose unrealistic, sex-negative, pro-abstinence nonsense upon the American public; pharmaceutical companies promoting AIDS drugs through glossy and calculatedly deceitful advertising erroneously depicting HIV disease as more of a nuisance than the incurable, chronic, fatal condition it really is; and an insidious, growing apathy about HIV among gay men.

It's easy to blame the usual suspects -- sexphobic government bureaucrats and profit-motivated pharmaceutical executives -- but it's the gay community's own ambivalence and indifference that's most shocking.

HIV prevention educators are telling us they've hit a wall and safer sex messages from the 1980s, tweaked for the '90s, no longer have much effect on gay and bisexual men. Worse, young, homosexually active black men who don't identify as gay or bisexual ("on the down low") are not listening to prevention messages they perceive to be designed for white gay men -- a tragic situation resulting in the grim prediction that, without intervention, one in three black men will be infected by age 29.

So what needs to happen? First, let's just admit that the original HIV prevention and education model is outdated. That model generates a specific type of prevention intervention, "information messages," which have been the core of prevention work since the mid 1980s. What's now clear is that information is necessary, but not sufficient to change sexual risk behavior. HIV transmission isn't caused by people not knowing how to use a condom; believe me, I can show a gay or bisexual guy how to do it once and he'll get it. Nope, HIV transmission among gay or bisexual men is caused by all kinds of emotional motivations that influence sexual decision-making -- things like depression ("Why should I bother with condoms; I just don't care anymore."), and grief or guilt ("My friends are already infected and my lover is dead; I might as well join them.")

Let's acknowledge a few facts: sometimes a lack of self-assertiveness or low self-esteem creates sexual risk ("I really wanted to be with him, but he refused to wear a condom, so I just gave in and let him have his way."); for lonely gay men who may lack intimacy in their lives, sex may be a quick fix they'll take any way they can, safe or not; and we can't ignore the dizziness and denial that allows some gay men to proclaim, "I've been having unsafe sex for years and I'm still negative -- I must be immune!" No, honey, you're just lucky, and if you say that one more time out loud I'm going to personally shake the snot out of you.

In other words, gay and bisexual men lead complicated lives and their sexual choices are extremely personal and complex; that's why well-meaning, fear-based, but ultimately simpleminded information messages like "Wear a Condom Every Time" have now entered the Dead Catch Phrase Hall of Fame along with "Whoomp! There it is," "Well, isn't that special" and "Have a nice day."

It's time for gay and AIDS service organizations to shift away from basic latex condom education to a more comprehensive sexual education approach for gay and bisexual men as well as men of color who have sex with men but reject those labels. Furthermore, we need to look at the totality of gay and bisexual men's health, from fitness to substance abuse and mental health. If we take a look at the broader health and wellness issues for gay and bisexual men it should help reduce the number of new HIV infections.

Since it's evident that prevention methods are failing, maybe we should be asking twentysomething gay and bisexual men, "Why aren't you afraid of HIV?" If we don't start that dialogue, young gay men will likely conclude, if they haven't already, that the epidemic is over and all HIV infection means is that you start taking pills. If we don't tell them about drug resistance, side effects and the inevitable health problems created by the drugs themselves, who will? It won't be those homophobic politicians we love to hate. We may be tired and burned out, but those of us who have been dealing with safer sex and no cure for 15 or 20 years still have some work to do. To leave any of this up to the government is going to spell genocide for gay men, who remain the population most likely to get infected by HIV in the United States.

Now let's return to the question posed by Tom Coates of the Center for AIDS Prevention Studies: "Why do we tolerate people who are HIV-positive and spreading the disease?" Well, now that's a brainteaser. The gay community doesn't seem to have a problem speaking out about most things we find wrong or morally reprehensible, like that whole "gays in the military" thing, or the ban on gay marriages, or the vicious beating and death of Matthew Shepard. It's only fair to let gays serve in the military if they can pass rigorous training and wish to defend our country…the institution of marriage has certainly survived all these thousands of years despite the fact that 50% of their marriages end in divorce, so it's hard to imagine gays making Holy Matrimony any worse…and wouldn't any decent individual, gay or straight, be able to see that there is no justification whatsoever for two straight men beating another man to death just because he's gay?

So then, why do we tolerate HIV-positive gay and bisexual men who willingly and knowingly spread HIV? Well, I think maybe it's because the gay community is way better at evaluating and judging the behaviors and character flaws of straight politicians, religious leaders, and obnoxious talk show hosts like Dr. Laura. When it comes to critiquing ourselves it's usually a bunch of whining about how Rosie O'Donnell should have come out of the closet sooner or the nasty stigmatization of those gay boys who belong to the Log Cabin Republicans. I really don't understand how Rosie and a bunch of gay Republicans can generate more animosity than irresponsible gay creeps who lie to their sexual partners about being HIV-positive or just let them assume they're HIV-negative so that sex will happen.

It's also pretty callous of us to shrug off the new infections by suggesting that the newly infected should have "been more careful" or "ought to know better by now." This is the equivalent of telling rape victims they deserve their fate for wearing a tube top or walking on a bad street. I'm of the opinion that if you aren't willing to disclose that you're positive to potential sexual partners, or you lie about it, or you bareback someone because they trusted you and conveniently failed to ask your status, then you're nothing more than a sexual terrorist and I hope you get caught, confronted, fined ridiculous sums of money, jailed, chemically or surgically castrated, released back into society but forced to register as a sex offender wherever you live.

So much for my politically incorrect opinion; Tom Coates has a more scholarly approach. "Gay liberation is about sexual freedom and HIV prevention is about restraint," says Coates. "Until HIV is eradicated in our community, gay liberation cannot reach its potential. HIV will sap the longevity of the community. We need to ask, 'Does the community as a whole want this to happen?' Prevention has got to go back to the community. The community has got to say it is not okay to spread HIV," he says. "Until that is done, nothing is going to change."

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This article was provided by AIDS Survival Project. It is a part of the publication Survival News.
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