AIDS is a problem mainly because we do not accept that sex is as basic a need as sleeping and eating. An unwritten belief consistently held by this and many other cultures that sex is sinful, that pleasure will and should be punished, and that pleasure-seeking is at best frivolous and at worst satanic, has made us sex-sick.
How cultures value and regulate sexual expression explains a great deal about AIDS and why it still continues to haunt the world. AIDS thrives upon the sex sickness of cultures including ours. How else can you explain a preventable sexually transmitted illness sweeping across the world? A society's inability to even talk about the behaviors involved in its transmission because they involve sex best explains the medical disaster of a viral illness killing more people than any epidemic in the history of the world.
It is easy to identify the sex sickness of our society. Sex education classes showing videos of sexual activity would be picketed, while video games having children practice killing people and videos normalizing violence are ignored as part of normal American culture. Everett Koop, appointed U.S. Surgeon General by President Ronald Reagan, insisted to no avail that grammar school children learn the facts about safer sex. He was speaking out against the cultural illness. His failure to make a dent led David Satcher, Assistant U.S. Surgeon General under President Bill Clinton to have to warn over a decade later that the epidemic "will kill more people than any of the terrible conflagrations that have marked this century." (Journal of the American Medical Association, 4/28/99, email@example.com).
America's sex sickness also explains how the Boston Globe series on AIDS in Africa could dismiss the problem as the sex sin of "promiscuity" in its primary headline to explain United Nations' Secretary's General Kofi Annan's announcement that AIDS is killing five thousand Africans every day. (The Globe did not mention that, according to the Treatment Action Coalition of South Africa, the country gives out seven condoms per sexually active person per year, that condoms cost more than most people could possibly afford, and that American-based pharmaceutical companies sued to stop South Africa from making cheap copies of American antivirals.) Our sex sickness also explains how the United States chose to ignore the success of Holland's sex positive efforts to teach young children about safer sex which have led to the lowest HIV rate in the world. The rate in the USA is three times higher.
This sex sickness makes it impossible to be honest and accurate about anything related to HIV. For example, over the past 15 years of the epidemic, how often have we heard the idea that AIDS is making people afraid of sex and that this destruction of the joy of sex is a major reason to find a vaccine and cure for the illness? Every other reason to fight AIDS is put forth -- deaths, the loss of productivity of young people, the orphaning of children, the economic effects of the disease. But not the damage AIDS does to having sexual fun, for fun is suspect and sexual fun is sinful in our culture.
Our sex sickness does us harm in many additional ways. For example, after 15 years of the epidemic we don't know accurately how risky various sexual practices are and under what circumstances. Studying what serodiscordant couples do and don't do would be a powerful way to evaluate what sexual practices are least risky, as such couples have one partner HIV infected and the other not. It is widely believed that such a study was never financed by the NIH in order to accommodate the influence of an increasingly anti-sex Congress. The only information we have is from a limited survey pioneered by Dr. Kenneth Mayer of Brown University. It was privately funded, and ended after 5 years, having gotten all the information that a small study can provide. What is so unfortunate is that sex will happen anyway -- and in the absence of more knowledge, people guess what practices might be safer.
Some that can use condoms don't. People who are not using a condom have assumed that not ejaculating inside a partner is useful in helping protect both parties from HIV. For many years the use of nonoxynol-9, a spermicide present in some condom lubricants, was believed to reduce the chance of HIV transmission. The only study suggesting this was privately done on a small scale in Amherst, Massachusetts. Some studies suggested otherwise but no real analysis on the possible appropriate uses of the drug or any other drugs in lubricants have been done.
Only now, 15 years after the epidemic has begun, are any microbicides being tested in a few people. But not in a way which will tell us if they work. The lack of the development of microbicides, easy to make but expensive to test, is best explained by noting they are by definition efforts to find ways to have safer sex. As a result, there has been no political voice for what is obviously a method that validates and supports sex.
This sex phobia is reflected in many ways, but one ironic way results from the invention of Viagra. Viagra is a safer sex drug. One of the most significant stated reasons for non-use of condoms is that for many men condoms cause them to lose erections, but not with the use of Viagra. An analysis of this contention could be done and we could rationally decide if the anecdotal reports are correct. If they are, Viagra and other drugs that help maintain erections would reduce HIV transmission, and should be funded by HIV programs.
We ought to be able to admit that sex is an important part of our lives. We ought to be able to admit that studying how to have sex safely is urgently needed. It is sad that so obvious a hypocrisy is allowed to kill us. For, if we did not really believe and want sex, if it were not really a tremendously important activity for all of us, then how do we explain the fact that after the FDA approved Viagra in April of 1998, it sold more pills during its first two weeks than any drug in history? Shall we pretend it is simply because people like the taste?
(This Boston AIDS Writers Group panel consisted of David Scondras, Robert Krebs, Stuart Pynn and Jon Hultgren. Dr. Kenneth Mayer provided us with material on discordant couple studies. The ideas expressed in this article are those of the Boston AIDS Writers Group and do not necessarily reflect the opinions of AIDS Survival Project. The AIDS Writers Group is coordinated by Search for a Cure, a non-profit HIV Treatment and Education organization. If you have any questions or would like to receive the Reasons For Hope Series in its entirety you can contact Search for a Cure at 58 Burbank Street, Boston, MA 02115. They can also be reached by phone at 617-536-2474, by fax at 617-266-0051, or by email at firstname.lastname@example.org. Visit their website at www.searchforacure.org.)