Is Fear the Best Way to Fight AIDS?
The hundreds who crammed into a lecture hall in New York City's East Village in November 2004 expected to witness the next Great Moment in gay politics. We'd just gotten creamed in the elections, public health officials were reporting yet another troubling surge of new HIV infections among gay men and Larry Kramer was to take the stage and tell us all how to get things, well, straightened out--just as he had twenty years ago, when he helped create both the Gay Men's Health Crisis (GMHC) and ACT UP. But Kramer was in no mood for a second coming.
"Grow up and behave responsibly," the famously cranky 70-year-old playwright and activist railed as he lectured young queers about how we'd brought this apocalypse upon ourselves. "Can't I get stoned and bareback one more time?" he said, mocking gay men's supposedly nihilistic desire for drugs and unsafe sex. "No, you can't! Are you out of your fucking minds? You kids want to die."
If you've paid even passing attention to the conversation about gay men and our sex lives in the year since Kramer's tirade, you may think he was putting it mildly. In June the Centers for Disease Control and Prevention unveiled yet another batch of jaw-dropping statistics about gay men and HIV: We now account for 45 percent of all people living with the virus in the United States. Between 1999 and 2003, new infections jumped a whopping 47 percent among 20- to 24-year-old gay and bisexual men. And in one study of gay and bisexual men in five major cities, CDC researchers found 46 percent of African-Americans were HIV-positive.
It's not just HIV. Last month, the CDC noted that syphilis rates are up in America for the fourth straight year--driven by infections among gay men, who went from being 5 percent of all diagnosed cases in 1999 to 64 percent in 2004. We've passed gonorrhea back and forth so much that nearly one-quarter of cases diagnosed among gay and bisexual men last year were drug-resistant, compared to just under 2 percent for straight folks.
And all of this data comes on the heels of a frightening announcement in February about a potential new HIV superstrain in New York City--a bug resistant to almost every available drug that rapidly progressed from infection to illness. The local health department has since backed off the claim; researchers never identified any other cases, which means it was likely a routine manifestation of the oft-documented ways in which HIV behaves oddly in some bodies. But the hysteria the health department's announcement caused revealed the profound anxiety--and real anger--percolating among those charged with stopping AIDS among gay men.
Kramer has been making a living on the political extremes for decades, but his screed last winter is not so far out of step with today's gay mainstream. The scorched-earth speech was reprinted in Kramer's well-received book, The Tragedy of Today's Gays--a turn of phrase Focus on the Family's James Dobson must be kicking himself for not having coined first. Words like "suicide" and "murder" come up with increasing regularity in conversations about HIV prevention. One story in the New York Times's weeklong orgy of superstrain coverage cited unidentified gay activists who planned to raid parties and clubs where they suspected unsafe sex went on.
The frustration is understandable. From grassroots activists to government officials, everyone's stumped on how so many gay men could once again be putting themselves in harm's way, after two decades of targeted prevention that significantly reduced HIV infection rates in the late 1990s. The haphazard explanations vary--it's the Internet; it's crystal meth; it's those "down-low" straight black men who secretly fuck other guys, too--but underpinning each is a belief that we've lost our fear of this thing, and we've got to get it back. "Fear did work in the '80s," one activist told a packed public forum weeks after the superbug announcement. "Anyone who says it didn't is lying."
It's an odd sort of nostalgia. And it's one that glosses over a critical question that has been lost in the recent tussle of emotions over gay men and AIDS: How much of the problem is HIV prevention itself? Gay anal sex has been inextricably linked with the disease for nearly a quarter-century now. Faced with the daunting task of slowing HIV's spread, public health workers and gay activists alike have saturated gay public space with a singular message: Be careful. What you do in bed can kill you. A generation of queers has come of age alongside this safety campaign--Generation AIDS, as I like to call us-- and many of us are having trouble bridging the gap between the complicated emotions driving our sex lives and the simplistic solutions we've been asked to embrace.
Public health's primary prescription for gay men seeking healthy sexual lives has been to "use a condom, every time." If you value your life, protect it. The prevailing assumption is that those of us who know the stakes and yet still don't protect ourselves clearly have a problem, are somehow deviant. Why else would we risk our lives just for sex?
Bay Area psychotherapist Walt Odets, author of a controversial mid-1990s book on gay sexuality in the AIDS era, In the Shadow of the Epidemic, says this notion has infected our prevention efforts with an impossible, and ultimately defeating, double standard. Odets argues that by refusing to acknowledge the utterly natural reasons why a gay man may long to eschew protection during an act in which vulnerability is so central, we establish an unattainable standard--protected sex forever, until, um, marriage?--and create stigma for those who can't live up to it. "That does just what it did to homosexuality--which is push people into the closet," he concludes. "The feelings about unprotected sex get acted out impulsively and more dangerously than they would have."
Too many HIV prevention programs, he argues, are rooted in the assumption that sex between men is just empty calories. Sure, we can have it, but it's not worth taking any chances. "Gay men are sort of loath to assert the importance of sex," Odets says. "Unprotected sex is important in a lot of ways," he insists. "Why isn't it obvious to people that someone coming inside you can be experienced as intimacy? It's obvious for heterosexual couples. But if gay sex is just this perverse recreation, then it's not worth any risk."
Gay New York's experience with the potential new strain of HIV is illustrative of this double standard. The New York City Department of Health repeatedly cited a survey in which researchers found that only 45 percent of gay men said they'd used a condom the last time they'd had sex. The implication is that we are making unusually risky sexual choices. But no one ever mentioned that this was actually a higher rate of condom usage than either straight men or women reported in the same survey.
The reality, of course, is that HIV transmits more easily via anal than vaginal sex, and given existing infection rates, an HIV-negative gay man is far more likely to encounter the virus in the course of even a run-of-the-mill sex life than anyone else. But many young gay men are paralyzed by public health's zero-sum choice between a life of risk-free eros and the apparent hedonism of picking when and where to take chances. Overwhelmed by the twin realities of the dangers we face and the risks we desire, we simply stop making choices at all. The result is the sort of passive decision-making about risk that characterizes many ordinary sexual encounters.
Both in popular media and in the sober halls of HIV prevention confabs, an archetype has emerged for the gay man who takes sexual risks. He's a guy driven by reckless impulse, blinded by his lust for sex and drugs. "These men are just out there being perverted," says Odets of the emerging popular image. "It's like they're shooting squirrels out of the back of their truck." That's certainly the picture the New York City Department of Health painted of the man who tested positive with its supposed new strain: a fortysomething who had had sex with "hundreds" of people, many of whom he couldn't identify, and all while tweaked on crystal meth. Shocking stuff, to be sure. But are we all this whacked-out when we skip protection?
I worried Geoffrey might be when I replied to his Manhunt.net profile. "Brooklyn in the morning and late evenings, Midtown Manhattan by day," he wrote, making clear just how often he's available for sex. "Looking to get plowed." But for Geoffrey--a gangly, soft-spoken 25-year-old--this is more the stuff of fantasy than action. "I just like to have people e-mail me and tell me I have a nice ass," he admits with an embarrassed giggle. "Is that wrong," he earnestly asks, "that it makes me feel good to have people tell me they like my ass?"
Geoffrey has had sex with about twenty guys in the past five years. Some have been protected, others not. He's never set out to bareback. Indeed, when he tells me about it he quickly admonishes himself, as if to beat me to the punch--he let so-and-so fuck him raw, "stuuupidly." Still, Geoffrey finds it hot when it happens. A big part of what he likes about "bottoming" is feeling like he's given up control; in the course of doing so, sometimes he agrees to sex without insisting on a condom.
Alex, a bubbly 19-year-old, makes similarly passive decisions about unprotected sex. His sexual language is all about the other person--he bottoms "for" guys, lets guys "do it to" him. "I think it's because I like to please," he says in explaining his language and his decisions. "I think, If they're looking for sex alone, I won't do it. Like the dancer--we hung out, he's a smart person, he's black." After a few dates, Alex let the dancer "do it to" him bareback. "It wasn't that we wanted to date, but neither of us were just looking for this one-night stand." That was enough to build trust for Alex.
Alex's and Geoffrey's bundles of conflicting emotions get short shrift in our public conversation about HIV, reducing them to the sexual caricatures Kramer and others have painted, to our tweaked-out supervirus carrier. But is there more?
"Does this individual feel good or not so good about the kind of sex he wants to have? What motivates this individual's substance use? I mean, there are all sorts of things about this person that I wonder about," mused AIDS Project Los Angeles's George Ayala during a tense community forum weeks after the supervirus announcement. "We often treat these issues in decontextualized ways. And there's a way in which we objectify gay men as we talk about our responses to HIV that is problematic for me, and that we really need to actively address if we're going to get to the root causes."
Instead, public health officials and gay leaders are increasingly focused on the seemingly easy answer: Make people afraid again and they'll follow the moral code for twenty-first-century gay sex, in which no risk is acceptable and any risk is depraved. That not only creates an impossible standard; it also fails to deal with another complicating factor, what the CDC calls "HIV prevention fatigue." In short, many Generation AIDSers are tired of hearing about it.
Just outside of the hall where Kramer lectured his queer heirs last winter, New York's East Village was at the time witnessing an explosion of overtly sexual public parties--a cultural moment that has since shrunk under the health department's intensified scrutiny. Hundreds of young gay men flocked to reclaim the sexual freedom that AIDS killed. Promoters like Daniel Nardicio aimed to bring back what one of his fliers called the "magical" era when "there were no diseases, cocaine wasn't addictive, and The Mineshaft was open all night." Nardicio's parties attracted a lot of attention--both good and bad--and he slowly embraced the notion that he must also worry about disease. So for a while he partnered with GMHC to deploy "Chase, the condom boy"--a studly go-go boy who circulated carrying an old wooden cigarette-girl box stacked with condoms and literature.
This sort of sex-positive response to risk is woefully rare in HIV prevention. That's in part because it is potentially illegal. Since 1992 federal rules have forbidden the use of CDC funds to "promote" sex, and most prevention campaigns are funded at least in part by the Feds. During every Congressional session, right-wing lawmakers use this rule to browbeat gay-focused prevention work, cowering both community groups and local health departments. During the Bush Administration's first term, those lawmakers urged Tommy Thompson's Health and Human Services to closely police prevention campaigns targeting gay men. Harassing audits produced the desired result: They fostered an environment in which both the groups who develop prevention campaigns and the case workers who shepherd them through the government's grant-making process self-censor.
The result of all of this has been a decades-long, one-sided conversation on gay sex--all death and no life. Indeed, rather than supporting the GMHC partnership with Nardicio, city authorities shut down the party where it took place, ensuring only that the same behavior would take place somewhere else with no public health presence to reduce risk.
But rather than demand more sex-positive talk in HIV prevention, gay and AIDS politicos are ready to stoke fear. Of course, Alex, Geoffrey and others like them are already plenty afraid. Geoffrey says that's a good thing; as is, he's shocked he hasn't caught a serious STD yet. "It's like, Whew!" he says. "But that's why we use condoms, right? Because we're afraid of something, because we know that sex could kill you."
Yeah, except when we don't use them.