At the World AIDS Conference in Geneva, attendees were fascinated by the city and the conference itself. But something frightening was defying the charm of the international exhibits and sense of global community. You could see it on our faces, just beneath hopeful smiles. It was as if any good news about research advances could not keep our minds off the fact that new infections rage on and cocktail drugs are beginning to fail.
I found the news so grim, in fact, that I believe AIDS prevention groups should be ready to cut a deal with people at risk -- and here I speak to gay men -- and throw away some principles that are more politically correct than truly effective.
For instance, prevention education has always geared itself to getting you to stop high risk behavior and use condoms "every time." Reality check: if you are having anal sex with more than one partner, then Geneva data shows that less than half of you have been 100% safe in the last six months. I would encourage those of you who maintain this level of safety to continue, but have only one request of those of you who don't. Be safe a little more. If you never use condoms, promise yourself you will use spermicidal lubricant every time. If you sometimes use rubbers, use them a little more often. If you only do it bareback with spit, promise yourself to start pulling out ... a little more often. If you take this frank advice as permission to be less safe, you're missing the point. If we could all raise the bar on our risk behavior, countless infections could be prevented.
Another rule has failed us miserably. The notion that we should rely less on disclosing our HIV status to sexual partners, and behave as if "everyone is positive" has had exactly the opposite effect. Everyone is behaving as if their partners are negative. Tonight, in a queer bedroom near you, anal sex will begin with no one grabbing a rubber. Bachelor Number One will think his partner must also be negative, while Bachelor Number Two will figure his partner is also positive. The virus will take advantage.
The concept is based on distrust -- why bother asking when they'll probably lie to you -- rather than believing someone who tells you their status. That's incredibly cynical. We should abandon this strategy and start sharing our HIV status with tricks. Whether you are positive or negative, say it. Say it. Whatever the status combo, behavior will probably change (for the better) when partners know HIV status. Yes, some positive guys may get rejected as a result -- so will some negatives -- but getting turned down by some stranger is hardly the crucial issue here.
There has been a lot of emphasis on understanding self-esteem issues among gay men, and what leads them to engage in anonymous encounters. This scrutiny of gay men's psyche should be left to social anthropologists and has only complicated prevention efforts, especially since prevention programs have never been properly equipped to deal with such issues. If you've had a bad childhood, have low self-esteem, or aren't comfortable with your sexuality, then I sincerely hope you come to terms with it in your lifetime but I want you to start having safer sex now. We are confusing empathy with permission.
Likewise on trying to understand anonymous sex. Gay men over thirty have witnessed the most gruesome deaths of our generation and yet are still having sex in dark rooms and at bath houses. I don't care to waste time moralizing about it or trying to understand why, I just want them to lower their risk while they're there.
Finally, if you are an HIV negative, sexually active gay man, you deserve a frigging medal. Chances are you are more than merely lucky; you have had sex carefully and have lowered risks. You should be proud. Do not allow yourself to believe that HIV positive men deserve more "attention" from our community than you do. And let's face facts, men. If you were infected in the last several years, it isn't likely that the condom broke or you were abused or you had bleeding gums at the wrong time. You probably screwed up.
Fortunately, services and sympathies will always be there for HIV positive men. What's missing is our taking every opportunity -- as friends, as lovers, as service providers -- to lift up negative men who have struggled to remain that way.
Geneva demonstrated that the treatment advances of the last few years are losing their luster. Drug failure rates are piling up and new infection rates are rising among gay men again. The scariest news of all -- that a viral strain that is resistant to all known drugs is actually being transmitted -- is the most ominous sign of the future. Partly because patients have had trouble taking their drugs regularly (adherence), their virus has become resistant to everything they were prescribed. As Anthony Fauci said in Geneva, the spread of this strain could set back research to 1985. Anybody want to see that horror show again?
AIDS is playing a joke on those who stupidly believe that catching HIV only means having to take a bunch of pills every day. If someone with a resistant strain infects you, you won't benefit from those drugs that you thought were making life simply fabulous for people living with AIDS.
You'll just get really, really sick and then die.
Mark S. King is an AIDS educator and writer living in Atlanta. He can be reached at firstname.lastname@example.org.