POZ Exclusives : Killer Gay Sex! - by Tony Valenzuela

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May 7, 2008

Killer Gay Sex!

by Tony Valenzuela

Deficits Approach to Gay Health

“If I fault any aspect of our response, it’s not anticipating what a media frenzy this would engender,” said New York City Health Commissioner Dr. Thomas Frieden, to whom I spoke by phone. “With 20-20 hindsight, one can easily say, ‘Well, you should have been able to anticipate that talking about a strain this bad and a guy who had lots of anonymous sex was going to get this kind of media attention.’ We didn’t anticipate that.”

When Frieden told me this, I wondered how he could have neglected to consider the last 10 years of intense media attention over the barebackers, the bug chasers and so on.  The supervirus story only added the latest chapter to this established plotline. “There was a sentiment at the time that said we had unintentionally added to the demonization of the gay community as being sexually irresponsible.  That certainly wasn’t our intent,” he told me.

It is never the intention of public health departments or HIV community-based organizations or the CDC to demonize, stigmatize or otherwise undermine the trust that gay men ought to have for these institutions.  They are, in fact, institutions filled with gays and lesbians.  And yet frequently, and at times with astonishing callousness, straight and gay health officials stigmatize gay and bisexual men, thus undermining their trust.  We are in an era in the gay community when messages aimed at gay men by our community-based organizations (CBOs) are barely distinguishable from those of public health departments or the CDC, from which the majority of funding funnels downward.  As I recently heard it described, CBOs have been colonized by the CDC.

“If you look at the range of interventions that the CDC makes available to health departments and community-based providers,” said George Ayala, director of education at AIDS Project Los Angeles and the former director of the Institute for Gay Men’s Health, “they almost all begin with the assumption that there’s something not right with gay men – there’s a skills deficit, there’s a knowledge gap, there’s something wrong with the way men think about themselves as gay men and as sexual people.”  I met with Ayala in Philadelphia during the National LGBT Health Summit, where he was both a speaker and participant.  “Gay men have high knowledge of HIV and AIDS.  They have information about how to minimize their exposure to HIV.  They know how to use condoms.  They don’t always want to.  The idea that somehow we’re operating at a deficit is really problematic.”

This deficit approach to gay men’s health is pervasive and compounded by public health’s resistance to acknowledge gay men’s sex practices in ways most relevant to their lives.  Three years ago Ayala received a CDC grant to collaborate with Gay Men’s Health Crisis (GMHC) on an intervention called the “Tunnel of Love,” a four-part workshop series for gay men on anal health. The theory stated that if gay men are helped to develop agency and knowledge over their bodies, they would be in better positions to make healthier choices for themselves, especially in the face of possible risk.  After Ayala was granted the award, the CDC balked—“as if they had just realized what they were supporting,” he told me.  “They got so nervous they asked us to change elements of the intervention and curriculum.  I got long e-mails from the CDC project officer, who kept saying things like, ‘I don’t understand why this would be an HIV prevention program when you’re not telling gay men to abstain from anal sex.’”  The project officer insisted he change the intervention to have a component discussing the virtues of abstinence.  His reason?  He didn’t want the CDC in a position where the intervention could be scrutinized by conservative members of Congress.  “We said, ‘We’re not willing to do that,’” Ayala told me, “so we gave the money back.  We had no choice.” 

The problem here is obvious: Most community-based organizations are in no position to give grant money back to the CDC.  Strings are unambiguously attached to gay health policy, and this shortchanges gay and bisexual men. 

The most recent hullabaloo surrounding a UC San Francisco study that warned of a gay sexually transmitted drug-resistant staph infection, or MRSA, centered around comments by its lead author, Binh Diep, PhD, who was quoted as “very concerned about a potential spread of this strain into the general population.”  Predictably, Concerned Women for America issued their own press release after UCSF’s, titled, “Gays May Spread Deadly Staph Infection to General Population.”  After intense pressure from a few community activists, the UCSF Department of Public Affairs issued a tepid apology on their website, stating, “We regret that our recent news report…on MRSA USA300 with public health implications contained some information that could be interpreted as misleading.  We deplore negative targeting of specific populations…”  Indeed, considering MRSA also affects school children, football players and prisoners, the widely reported study focused on “sexually active gay men.” 

In the case of the New York Patient, the high-pitched rhetoric surrounding his story in 2005 rested, among other things, on the fact that he carried a multidrug-resistant strain of HIV feared, as is now a common theme in the public health–media dyad, to be a harbinger for the future of AIDS (or staph or gonorrhea or TB).  Some activists and prominent AIDS researchers accused the New York Health Commissioner of fear mongering for calling a press conference over a single case, given that similar examples of fast progressing, multidrug-resistant HIV had been documented before, including one by Julio Montaner, MD, in Vancouver a few years earlier in men whose viruses were now under control. 

How much of a threat is the type of multidrug-resistant HIV that afflicted the New York Patient?  In 2004, the CDC started the Variant, Atypical, and Resistant HIV Surveillance (VARHS) system in 11 states to study the prevalence of drug resistance.  According to VARHS’s data from early 2007, 10.4 percent of individuals newly infected with HIV showed resistance to at least one HIV drug available at the time.  Only 1.9 percent of new HIV infections show evidence of multidrug resistance, defined as resistance to at least one medication in two or more classes of drugs.  Of these individuals, 1.4 percent had resistance to drugs in two classes, and 0.5 percent to drugs in three classes—this was the unfortunate and very rare level of resistance of the New York Patient’s HIV.

“Did this turn out to be a supervirus that was uncontrollable? No, of course not,” Martin Delaney, executive director of Project Inform in San Francisco, told me by phone. “Was it untreatable?  Of course not.  And I just wonder how much harm was done by it.  How much more hatred and vilification was stirred up against the gay community?  How much dissention within the gay community of groups with different views?”

Though the New York Patient was in full support of the press conference and says he was treated well by public health officials, he was nonetheless anguished by his depiction in media.  Everyone knows the press run toward fire, and there’s no resolving here the corrosive effect this has on public dialogue.  What’s more troubling is how readily media take their cues about misbehaving gay men from the gay community itself.  There was no shortage of prominent gay activists, health officials and writers uncritically feeding both the apocalyptic scenarios surrounding the New York Patient or his presumed disreputable character. 

I write this knowing many excellent people and programs that work on behalf of gay men’s health, folks who debate the unintended consequences of the deficits approach to gay health and the professionalization of HIV activism whose affect has marginalized ordinary gay men who bring their own practices, concerns and desires to the discussion and influence of health policy.  I would argue we are losing a larger battle concerning gay and bisexual men’s autonomy over their bodies and the right for gay men to claim meaning for their sexual practices that resist the narratives of pathology.

In these examples I am not denying the harm that HIV and its treatments can cause.  But the use of disease as terror, invoking the worst-case scenarios and placing gay men on continual red alert, is a failed strategy by health officials that will continue to widen the gulf between them and the ordinary men they purport to serve.  Activist Michael Petrelis recently asked on his blog, “Will 2008 be the year in which the gay community finally demands an end to health scares whipped up against us, based on flimsy and questionable evidence? Are sexually active gay men and our health advocacy groups willing to say ‘no more alarmist wolf-at-the-door’ approaches to gay health?”

That is yet to be seen.

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Search: Tony Valenzuela, barebacking, supervirus, Thomas Frieden, Larry Kramer, Michael Weinstein

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