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May 7, 2008

Killer Gay Sex!

by Tony Valenzuela

Sexually Irresponsible Gay Men?

The New York Patient was terrified and weak when the news of his virus broke on February 11, 2005.  In an ominous press conference declaration, Thomas Frieden, MD, commissioner of the New York City Department of Health and Mental Hygiene, announced the discovery of a strain of HIV that was “difficult or impossible to treat” and that “potentially, no one” was immune.  At 46 years old, the Cuban-born man believed that he would die and bought a cemetery property in a family plot in Florida.  It was an arduous yearlong climb out of precarious health, six months before his viral load fell to undetectable levels or before he could leave a bedridden life to take short, exhausting walks in his Manhattan neighborhood.  Having plummeted to a dangerously low 28, his CD4 cells inched upward gradually until November 2006, when they climbed above 200 where they’ve remained since.

The health commissioner’s press conference incited terror of the return to the AIDS-as-death-sentence days of the ’80s and early ’90s so that the anomalous story of one man’s potent infection turned into a universalizing gay morality tale.  Activist Larry Kramer called the New York Patient a “total and utter asshole” in the New York Observer then suggested to Gay.com that “one thing is certain: We must make all efforts to de-eroticize anal sex.”  Historian Charles Kaiser went further, telling The New York Times, “A person who is HIV positive has no more right to unprotected intercourse than he has the right to put a bullet through another person’s head.”  And Michael Weinstein, president of the Los Angeles-based AIDS Healthcare Foundation, told the Advocate that the New York Patient was “indicative of a subculture of self-destruction and carelessness about our health.”  These are just a few examples of dozens like them where the crystal meth context of the New York Patient’s infection is incidental to pointed assumptions about gay sex: self-destruction, suicide and murder have been ascribed to sex between men long before meth crowded headlines.

The moral panic that ensued over the New York Patient’s personal sex life was one familiar to those of us who have observed, or participated in, these paroxysms of anger since the mid-1990s, when it became clear among researchers that gay and bisexual men would not, for reasons simple and complex, use a condom every time, even though they use them far more often than heterosexuals.  The trail of high-profile, high-drama explanations that have attempted to make sense of continued HIV infections often have more in common with folklore and tabloid journalism than with sound research.  For over a decade, activists have engaged in rancorous debates over barebacking, circuit parties, “gift givers” and “bug chasers”, men on the down low, resurgent syphilis and of course, crystal meth, to name a few, all highlighting the complacency at best or depravity at worst of gay men in the age of HIV—and all aired in deliciously lurid detail by a mainstream news media that survives on a steady diet of spectacle.  In other words, we had been through this before, over and over again.

The representation of the sexually irresponsible gay man as the driving force behind new HIV infections has been a recurring theme in both mainstream and gay media despite evidence to the contrary.  According to the Centers for Disease Control and Prevention (CDC) in 2005, the year the New York Patient learned he had AIDS, rates of HIV infections nationally among Latino men were up to three times higher than among white men.  Infection rates among African-American men were up to eight times higher than among white men.  No other group in the U.S. is affected by the HIV/AIDS epidemic as severely as black gay men.  Although African Americans represent only 13 percent of the U.S. population, they account for 49 percent of new HIV infections and 50 percent of new AIDS diagnoses.  In a June 2006 literature review from the American Journal of Public Health, researchers tested a dozen hypotheses as to why this might be among black gay men in particular, ranging from rates of unprotected sex and drug use to awareness of HIV status.  What researchers found was a powerful argument contradicting public health’s idée fixe that the epidemic rests on individual bad behavior.  Black gay men reported less risky sex on average than white gay men and similar rates of drug use.  But black men also got tested for HIV less frequently and were more likely than white gay men to be unaware of their HIV infection.  They had irregular access to good health care and higher rates of STDs – all proven risk factors for HIV transmission.  Perhaps most importantly, the sexual networks of black gay men tended to be other black men, increasing their chance of HIV infection among a population already challenged by high levels of HIV. 

In another notable study, this one from the September 2007 edition of the journal Sexually Transmitted Diseases, researchers at the University of Washington, Seattle, found through two large population-based surveys that gay men had similar rates of unprotected sex as heterosexuals but that the HIV epidemic among gay men in the U.S. remained strong because anal sex is more conducive to the transmission of HIV than vaginal sex.  Heterosexuals maintained the same sexual roles (male insertive and female receptive), while gay men often switched roles, giving HIV a greater likelihood for back-and-forth routes of transmission. 

What does it mean that the same levels of sexual risk in heterosexuals, in gay men in general, and in black gay men specifically, result in vastly different rates of HIV infections across these groups?  Structural dynamics far outweigh individual behavior in determining the American HIV epidemic.  And yet the meth “party ’n’ play” guy, the circuit boy, the so-called bug chaser, is almost always nameless, faceless but presumed to be a middle-class gay white urbanite with the skills and knowledge to keep himself HIV negative.  If the fear over new infections is what’s ostensibly behind this rapt concern, why is this “reckless” gay man paid so much attention when, by leaps, the brunt of HIV disease, the real number of men infected is above all else determined by a lack of access to health care and by poverty in the United States?  HIV continues to be misrecognized as a disease of gay debauchery, which would imply that gay men of color are many times more irresponsible than gay white men, who are many times more irresponsible than heterosexuals: That’s the cloaked assumption when HIV incidences are framed around sexual irresponsibility.  When writer Dan Savage proposes that the state come after those who infect others with HIV “out of malice or negligence” so that the state can recoup “drug-support payments—thousands of dollars a year for treatment to keep them alive, comparing drug costs to child support payments—he is unwittingly suggesting another layer of penalty to populations who are disproportionally at the punitive receiving end of the criminal justice system.

Am I saying reckless gay men don’t exist?  Of course not, but sexual irresponsibility is not a gays-only disorder. Nonetheless the burden of scrutiny and explanation weighs most heavily on gay men of all races.  Arguably most HIV infections are due to negligence, as are the myriad diseases caused by smoking and overeating.  We don’t base health care policy on merit.  Whatever tiny minority of people exists with a malicious intent to infect others with HIV, it’s a dangerous fallacy to pin the thrust of infections on a willful disregard for health.

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  comments 16 - 16 (of 16 total)     << < previous

Michael, Haslett, 2008-05-08 13:50:01
I think it is so terrible because even our leaders are the same way, they think about two men together having sex a terrible things, but if it is two women together they think it is neat. Why is it that men have to be treated so differently when it is known that they have sex with other men.

comments 16 - 16 (of 16 total)     << < previous

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