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Laying It Bare: Gay Men and Unprotected Sex in the Age of HIV/AIDS

June 23, 2010

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Conclusions

fogcityjohn: Well, gentlemen, we're coming towards the end of our time. I would just, at this point, like to ask each of you if you have any final thoughts that you would like to leave our listeners with on this topic. Anything we haven't gotten to? Something you want to expand upon? Why don't we start with you, Walt?

"Every time a state passes a regulation against gay marriage, we're going to have more people infected with HIV. ... The association of HIV with black men involves some of the same kinds of issues. We can't expect to abuse people and then have them take care of themselves."
-- Walt Odets, Ph.D.

Walt Odets: Well, I would just kind of sum up something that we've been talking about -- and that is that, for example, on an issue like gay marriage, which has been so much in the news -- every time a state passes a regulation against gay marriage, we're going to have more people infected with HIV. This goes back to the whole, broad wellbeing of the community. That kind of stuff is hateful and destructive. The association of HIV with black men involves some of the same kinds of issues.

We can't expect to abuse people and then have them take care of themselves. But we have a very broad societal problem in this country. And the HIV epidemic is, in part, simply an expression of that. And I think that that societal situation is something that has to change. It's inhumane and inexcusable that we're still talking about those kinds of issues.

fogcityjohn: Agreed. Rashad Burgess?

Rashad Burgess: I would actually start off really saying that it's, one, important that we, as Americans, recognize the value of gay men, in all of our lives, in the many facets of our lives -- whether it be the business owners, whether it be folks' uncles, or family members, other types of family members, the partners that gay men have. Because it is a community that, it's imperative, understands that their lives -- and as a gay man, that our lives, and my life -- is worth saving.

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It is important to recognize that HIV is still a real problem for gay men, in the context that gay men are still getting infected. I mean, still represent a significant portion of the epidemic. Nearly two-thirds of the infections amongst men in American happen amongst men who have sex with men. And in some populations of gay men, particularly African-American gay men, nearly half the population, based on some of our data, is HIV positive.

And so it is really, really imperative that we, as a community, are having this type of discussion, from the place that our lives, one, are worth saving. But also that it's based in reality, that HIV is a real issue, and that we have to be willing to deal with it and face it ... and wrestle with what does it mean to be working very diligently and hard at preventing HIV -- getting HIV -- for 20 and 30 years.

The last thing I would say is that we have to be willing to think about new strategies. You know, looking at structural interventions, looking at what does it mean to really be thinking about having gay men really utilizing the treatment, optimizing the benefits of treatment, so that we can reduce the viral load, which impacts transmissibility. And so this is really an important issue. We're not out of the woods, in terms of HIV infections amongst gay men. And gay men that think they don't have to deal with this anymore are not well informed, from where I sit.

fogcityjohn: OK. Jeff Parsons?

Jeffrey Parsons: I think one of our biggest challenges is reengaging our communities to get re-involved in this issue again. In the '80s, you know, the gay bars had condoms everywhere. They had posters. They were doing eroticizing safer sex workshops in the back rooms. It was a real community-oriented effort to try to address the situation of HIV in the gay community.

I think part of the challenge to do that in 2010 is that the gay communities, as they used to exist, don't necessarily look the same. You've have such migration of gay men, particularly into broader communities, into the suburbs, into young gay men who don't necessarily just go to gay bars; they often go to mixed or straight bars with their straight friends. And there's not as much of the sense of community defined geographically.

And so I think we really need to look towards building relationships with our allies, building relationships with broader communities, to readdress and reengage about issues related to HIV in our communities.

Walt Odets: The thing that Jeff was talking about, about reengaging the community in prevention, is certainly a very important issue. But we've had, since I've been involved in the epidemic -- you know, since the mid-'80s, actively involved in prevention work -- we've had a pattern where, every time we get a hopeful treatment, we abandon prevention. We can see a very clear ... There was a four-year cycle, up through about 1990, where we had four years of prevention, four years of hopeful treatment that then was announced a failure, and so on.

And we have to find some way to integrate hope about treatment, and support for positive men, with prevention for negative men. And we've never been able to do that.

In 1996, prevention completely collapsed. There was no interest in it at all. And we've been riding the protease inhibitors. They have, in fact, transformed the character of the epidemic. They are a huge improvement over what we had before '96. But they have stifled prevention. Prevention in the context of successful treatment can feel like raising doubt about the efficacy of the treatment, and pulling support away from men who are positive.

That's the thing we've never been able to do. And we're still not doing it. We still don't know how to integrate that. When we do prevention, we're saying it's better to be uninfected. And that feels hurtful to positive men.

fogcityjohn: Well, I think, as a positive man, I can tell you, Walt: It is better to be uninfected.

Walt Odets: But at an emotional level, it can be alarming, and hurtful.

fogcityjohn: Yeah.

Walt Odets: And feel abandoning. And we have to find some way to do both of those things.

fogcityjohn: Well, gentlemen, I want to thank all of you for joining us today. I feel in a way that we have only scratched the surface of this topic. It's a very, very important one.

But again, I want to thank you for being here today. And thanks to all of our listeners for joining us, and for TheBody.com, this is fogcityjohn, signing off. Thank you.

This transcript has been lightly edited for clarity.

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