June #24 : A Second Look - by Richard Berkowitz and Joseph Sonnabend, MD

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Table of Contents

Nowhere Else to Go

Great Escapes

Gotta Light?

The Great Sex Debate

Made in Japan

Clipped Wings

The Vinyl Solution

Into the Woods

Hazel's House

Open Windows

S.O.S.-June 1997

Mailbox-June 1997

Ad Lip

A Higher Standard

Just Not Like a Prayer

Who's Sore-y Now?

Say What-June 1997

Devil to Pay

Web of Cries

On Pins and Needles

Fatal Attraction

Cocktails for Kids

To B or Not to B

Pot Doc Stalked

Obituaries

Alexander the Great(ish)

POZ Picks-June 1997

Skin Traders

Absolutely Fabregas

Barbarians at the Gates

Borders on Madness

A Second Look

Painful Truths

Before the Revolution

Riding Bareback

The Fleecing of Oprah

Barrier Blues

Mixed and Matched

To Tell the Truth

The Borders of Health

Road Trip Grub Tips

Following Your HAART

TLC for Your Largest Organ

Art and Soul

Farewells



Most Popular Lessons

The HIV Life Cycle

Shingles

Herpes Simplex Virus

Syphilis & Neurosyphilis

Treatments for Opportunistic Infections (OIs)

What is AIDS & HIV?

Hepatitis & HIV


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June 1997

A Second Look

by Richard Berkowitz and Joseph Sonnabend, MD

The inventors of safe sex weigh in

Sexual Ecology must be commended for its accurate analysis of how widespread changes in sexual behavior among gay men in the '70s propelled the spread of AIDS. Hopefully, today Gabriel Rotello won't be maligned for publicizing this as we were (with Michael Callen) in 1981; back then, the gay leadership that had unwittingly encouraged the very behaviors that led to this tragedy dismissed any suggestion that lifestyle played a role in AIDS. Like Rotello, we pointed out the health risks in a way of life that promoted the spread of STDs, before the invention of safe sex. It's on this issue of safe sex that we part. Rotello believes gay men cannot practice safe sex consistently enough to prevent a second wave of AIDS, and essentially calls for the end of promiscuity. In 1981, we agreed. But now that safe sex has been shown to work, we believe the most important task is to encourage gay men who are at risk to practice it.

The prospect of a second wave gives Sexual Ecology its urgency. While there is little hard evidence to support such a disaster, the possibility should force us to redouble our efforts to keep sex safe. According to Dr. Thomas Coates, director of the UCSF's AIDS Research Institute, new HIV infections in San Francisco fell to an estimated 650 in 1994 from a high of 8,000 in 1982. He attributes this dramatic reduction to community-based HIV prevention programs targeted to gay men. The rates of rectal gonorrhea-the best indicator of highest-risk sex-remain at all-time lows nationwide. In 1982, some 2,000 cases were reported in New York City; in 1995, there were fewer than 30. San Francisco reported around 5,000 cases in 1982; 1994 saw fewer than 80. Rotello cites a study indicating an "alarming" increase in rectal gonorrhea in Washington state in 1989. Had he checked rates after 1989, he would have found a continuous decline; changes in one year cannot indicate a steady trend. Even when Rotello acknowledges this decline, he contends that because rectal gonorrhea is curable, falling rates do not argue against a second wave. If there was a second wave by the early '90s, surely we'd be seeing increases in rectal gonorrhea-and we are not.

In practice, safer sex has included oral sex wihout condoms (and without ejaculation), and while risk to an individual cannot be excluded, safe sex has curtailed the epidemic. We must therefore continue to emphasize the need for safe sex; this may now be easier as it is finally admitted that AIDS will not become a heterosexual epidemic. Hopefully, the vast amounts of money wasted on nontargeted campaigns like "America Responds to AIDS" and educating non-IV-drug-using heterosexual men at very little risk can now be directed toward gay me (particularly young gay men), women at risk and needle-exchange programs.

Rotello cites a study showing that the reduction in unsafe sex in the late '80s, if sustained, could "reduce...the rate of HIV infections below the epidemic threshold"; however, if unsafe sex rises by even a very small amount, HIV transmissions would persist at epidemic levels. One has two choices in reponse to this. Rotello urges the gay community to establish institutions that reward sexual restraint, monogamy and marriage. On the other hand, we can use this information to continually instruct gay men on the crucial importance of safe sex. If we choose Rotello's prescription, it had better work: Otherwise we'll be in worse trouble because of the de-emphasis of safe sex implicit in the message that it hasn't worked. Attempts to modify sexual behavior at the level called for by Rotello have been notoriously unsuccessful. There is an inherent danger in Rotello's proposals to forestall future infections. For those for whom monogamy and sexual restraint are unworkable, the failure to respect the diversity of sexual expression will doom them to a life of shame, guilt and AIDS.

Sex is one of life's joys and central to one's being. We shouldn't allow ourselves to return to the miserable repressions that once ruined so many lives. For example, a recent Canadian study found that among all young men 18 to 27, gay and straight, those who are celibate are far more likely to try to harm or kill themselves than those who are sexually active; the highest rate was in celibate gay male youth. Could it be that the same old inhibitions, meanness and conservative influences drive the new Puritanism hiding behind Sexual Ecology's facade of concern for the future health of gay men? AIDS is a terrible reality, and sex can no longer be as free as it once was. But in encouraging safety, we must also make it clear that the need to modify certain behaviors is not an attack on sex.



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