Thirty years ago, no one knew for certain what caused AIDS, let alone how to prevent it. Yet three forward-thinking men—Joseph A. Sonnabend, MD, and activists Michael Callen (who died in 1993) and Richard Berkowitz—typed up a 40-page manifesto titled How to Have Sex in an Epidemic that introduced the concept of safe sex. We spoke with Berkowitz about their historic booklet, which you can read in its entirety on

What was so revolutionary about your concept of safe sex?

One of the pleasures of gay sex was that we didn’t have to worry about preventing pregnancy, so what was revolutionary was the idea of gay men using condoms. We also [felt it was important that] safe sex advice must go hand in hand with celebrating…gay sex, and anal sex in particular, which we did.

How did people react to the booklet?

For fans, it offered clarity amid the confusing and contradictory advice that was out there. For those who hated our booklet….our writings had emphasized the role, in driving the epidemic, of greatly expanded opportunities for sex with many different partners. This was helped by an urban explosion of commercial sex establishments after Stonewall. Apparently, the gay leadership didn’t want any attention drawn to this. As Larry Kramer said in Sex Positive [a documentary about Berkowitz], we couldn’t talk about that “if we were going to get people’s sympathy.”

Today, we’re in the midst of redefining safe sex. What are your thoughts on biomedical prevention such as pre-exposure prophylaxis (PrEP)?

I’m inspired by gay men who have found ways to have safer sex without condoms, such as serosorting. Some ways are less risky than others, but that’s for informed consenting individuals to decide for themselves. But as Sonnabend said to me recently, “Condoms have a track record, and nothing else has.”