In this queer autoethnography [a research paper in which the writer explores his or her personal experience and connects that experience to wider cultural, political and social meanings], I track the development of HIV prevention and sex in my life. I delve into the era before HIV infection, after my HIV diagnosis, and then again with the knowledge that my HIV is stable and not infectious.
These eras point to the creative ways that individuals and communities construct sex lives around HIV narratives. Rather than static equations of risk and actions, HIV prevention could be considered a dynamic process. Through this study, I map out dialogue that must continue to happen about sex and substance use, within the LGBT community and the HIV community.
Public service announcements, community education sessions, stultifying school classes, gossip, and pornography taught me about gay sex. Each of these crafted similar stories: use a condom for EVERYTHING—even mutual masturbation and oral; anal was the proof of actual sex happening; and sex was simple and straightforward. These points remain neither helpful nor accurate. Condoms were not something found in my imagination of male bodies nor in furtive looks through underwear catalogs. Anal sex did not come easily for me, and the stuff that happened before anal seemed more fun. I wanted to dally in the foreplay, but the condoms got in the way.
I saw the Gran Fury piece “Kissing Doesn’t Kill” in the now defunct Out/Look magazine while an undergraduate. The three multiracial polysexual couples featured in the piece were kissing, and this was a welcome message in early 90s HIV panic. Whereas I was inundated with instructions about condom use, there was significantly less about sexual acts and intimacy that would not involve latex wrappers. There was a dearth of material that featured the men I was attracted to, as well as the men who resembled me. Where was a language for sex—the kind I was having and the kind I wanted?
I learned how to have gay sex through the act of doing it.
HIV 101: Use a Condom!
Without a knowledge base in established public health institutions, the first populations most vulnerable in the HIV epidemic—GLBT people, sex workers, and people who use drugs—had to develop strategies for preventing the spread of the disease. This work was both political and creative. The art collective Gran Fury created several posters and ads with overt sexual and political messages.
“Kissing Doesn’t Kill” appeared as a poster and a bus ad in New York City. The full line, “Kissing Doesn’t Kill: Greed and Indifference Do,” stretches across the top above three couples: an interracial heterosexual one, an interracial gay one, and an interracial lesbian couple. They playfully kiss above the line “corporate greed, government inaction, and public indifference make AIDS a political crisis.” While these situate the poster as political critique, my twenty-year old self found the kissing a revelation. This was an intimacy that was safe when sex itself was deemed “unsafe.” The art inspired me to think about sex acts that do not transmit HIV, to allow myself the freedom to kiss as many people as I wanted, and an affirmation that not all intimate acts produced an incurable, infectious disease.
My first HIV job was running a creative arts-based prevention program for young gay men of color—an initiative occurring in San Francisco at the time. We believed that our community had the cultural knowledge to address HIV vulnerability, and that community organizing was the praxis. The poet Marvin White and I came up with these classes while looking at sale items at the art store, brainstorming until an exercise emerged. For one, we brought magazines and small boxes (on sale) along with our regular supply bag. We asked the twelve queer youth to construct “safer sex” kits—to put anything they would need to feel safe during sex in the box. My program manager said it was not HIV prevention unless we instructed them to put in condoms. I explained that all of the boxes had condoms and lube, but they also included a vast array of objects such as: pages from the Bible, the phone number of their closest relative, a bullet, a transit pass, and keys to a lost home. These items created a narrative of safety that goes beyond latex.
In the 2000s, the HIV prevention programs in the United States had a dramatic transformation in the United States Centers for Disease Control and Prevention (CDC) Diffusion of Effective Behavioral Interventions (DEBI) initiative. The kinds of creative work that we pioneered in HIV prevention was no longer fundable. The DEBIs were proven effective through published randomized control trial-testing and then adapted from research to implementation through a team of CDC experts. The DEBIs underwent significant change over the years—from heavily restrictive in terms of sticking to the randomized control trial eligibility to permitting a wide range of options in terms of adapting for populations, transmission risk or social media platforms (which did not exist at the time of randomized control trials). The DEBIs limited the kind of creative work that was present in HIV prevention. Rather than a community-driven language about sex, desire, HIV and health, the DEBIs presented a proscribed manner of dealing with risk, transmission, and risk reduction. All of the interventions included an emphasis on condom use or abstinence.
In the Blood: Sero-Sorting
After my HIV-diagnosis, sex changed. I became nervous with HIV-negative men, stumbling with condoms as if they were proof of my disease. I refused medication based on the fear that people would know about my HIV-status. I grew anxious about disclosing my HIV-status, especially online. I would not identify on a sex site that I was living with HIV because I thought it would follow me everywhere. My profile would go from “safe sex only” some days to “no preference.”
A decade ago, I met Antonio through one of those sites. He was sweet, a mixed-race Black and Latino man, well-built and soft in a way that made me want to hold him. It was delightful to make him shiver and moan—as if intimate touch with another man were still new. He was not shy about anal sex and quickly pulled me into position. When the condom came off at one point, he insistently tried to continue. I held him tight and murmured, “If someone wants to use a condom, you should let them.” He froze. I kissed him and put on another condom. I had not told him I had HIV; I had not asked him about his status. Because of his age at the time, I presumed him to be HIV-negative. After this awkward moment, we met twice more.
Based on our interaction, I was not surprised when Antonio called me a few years later to confess he had tested positive. I admitted my own diagnosis and promised to be there for him. The last we spoke he had fallen heavily into substance use. Most of his stories were scattered moments in time, seemingly unconnected in any linear way. I wanted to keep in touch, but his number was disconnected a few months later. Would it have made a difference if I had met him after he had sero-converted? I’m embarrassed to admit yes.
Soon after I first met Antonio, I chose to be completely out about my HIV status. I discovered that avoiding disclosure took more labor than I wanted to commit. By being out about my own status, I became easier for other men living with HIV to find—for friendship or intimacy or support. I was fortunate to live in cities where I could meet a community of people living with HIV. The process of sero-sorting—actively choosing sex and intimate partners based on common HIV-status—is another act created within the HIV community that never made it into CDC-recommended guidelines for preventing the spread of HIV.
Changing Rules: Viral Suppression
At the Positive Women’s Network-USA Summit in 2014, more than two hundred women living with HIV—and a few allies—gather to address needs, identify goals and develop work plans. It’s a powerful group of people building a sacred place for women living with HIV to celebrate, vent, heal and find community. I’m lucky to be invited to a roundtable on talking about race in diverse coalitions. After, I attend a workshop on new areas of HIV prevention—viral suppression, non-occupational Post-Exposure Prophylaxis (nPEP) and HIV Pre-Exposure Prophylaxis (PrEP). During the presentation, a woman stands up and says that even though she is virologically suppressed, her partner takes PrEP and they use condoms. “Why?” the moderator asks. “Because I can’t believe I’m not infectious,” she admits softly.
The pain beneath this statement is startling. I can’t believe I’m not infectious. How many of us carry this weight? I’m not the only one in the room who tears up. After decades of being afraid of HIV, of acquiring it and then being nervous about contagion, of not feeling good enough for another person to desire or love, the information around virologic suppression is almost too much to accept.
Multiple studies have demonstrated that virologic suppression reduces the infectiousness of HIV significantly. In essence, when a person’s HIV is undetectable under a viral load test, then there is not enough active HIV in the system to transmit. Viral suppression is being touted as a practical cure to the HIV epidemic: if everyone with HIV were virologically suppressed, the logic goes, then no transmission would occur. This discursive strategy assumes that virologic suppression is a static space, and once achieved, a person stays suppressed.
Sexually active persons are faced with another HIV dilemma and even more questions about HIV prevention activities. Considering viral suppression as an indicator of non-infectiousness, what is the practical difference in being HIV-negative or living with undetectable HIV? How does this impact my own sex? Does viral suppression mean that the condoms are off? Is there a point to sero-sorting anymore? Why do gay men still use the identifier DDF (“drug and disease free”) on online sex ads?
I am virally suppressed. I do not know if I believe I am not infectious. I don’t know if it’s just the HIV, or if this is a burden carried under my distinctly ethnic skin my whole life. My queer body has never signified the all-American “boy next door.” The HIV added another layer.
A new story. During 2015, I am on the board of CLAGS: The Center for LGBTQ Studies, and filmmaker Richard Fung gives our annual Kessler lecture. At the event, a friend brings a very cute man. We end up having dinner afterwards. Over Korean BBQ, the cute man queries, “So are you on PrEP or do you use condoms?” I respond, “Neither,” and realize we are meeting outside my public HIV life. Panic starts. He asks, “Aren’t you worried about HIV?” “Not really,” I say, “that ship has sailed.” Later he wants to know if I’m virally suppressed and he gets happy. “Good. I don’t like using condoms.”
Before you pass judgement, you didn’t even ask what kind of sex we’re having.
Re-Creating Safer Sex
There’s the rub. To engage in discussions about HIV and vulnerability means to have meaningful dialogue about sex and drug use. This is difficult in the United States. We have to do the work of defining the ways that we are comfortable with sex and substance use and vulnerability—by ourselves and with another person. We have to adjust to discomfort. We have to make a language out of our desire and pain. We have to witness others’ fumbling attempts. We must make space for compassion, even in sex and substance use.
Invited to attend a New York City Department of Health and Mental Hygiene focus group on gay men in New York City and HIV, I am surprised that the HIV Assistant Commissioner, an esteemed African American woman known for her work with children with HIV, has chosen to run the group. She charges into the questions, most of the room is comprised of people who work at organizations contracted by the health department. I get frustrated at the safe answers in the room, people deferring to the Health Department authority around unpleasant realities of gay men and HIV prevention. “What about condoms?” she asks. “I can’t remember the last time I used one,” I declare loudly. She sputters, “What? But you have HIV? How can you infect other people? It’s so irresponsible!” “You didn’t ask if I was virally suppressed, if I was having anal sex, if my sex partners already have HIV. As a medical doctor, I’m surprised at the limits of your HIV discussion.”
We are again in a moment when the answers will emerge from the community and not from the CDC or other health officials. The LGBTQ community is faltering in this HIV prevention step. The more moralistic elements of the community that had organized against “raw” sex (anal sex without a condom) and substance use cannot seem to comprehend the ways that HIV transmission can be disrupted. In their world, the condom is the only answer possible in sex—not necessarily pleasure or the need to not be alone. There is little discussion of socio-economic class and trauma, the variation in region and racial background that can define so much of what needs healing. Some continue to use DDF on their profiles, proudly proclaiming an identity that carries no more obvious danger than my own. I pass them by quickly.
I still disclose before having sex, but am unsure if it’s necessary. I feel responsible for taking antiretroviral medication, but only for my own health, not to protect anyone else. There are more than 30 states with antiquated, poorly-worded laws that place more onus on the person living with HIV in a wide range of interactions (including but not limited to sex). They demand that we disclose or refuse contact, on penalty of imprisonment, regardless of the physical, emotional, and sometimes financial danger that can put us in. But I do not live in those states.
I will meet the men who will help figure out this new era of HIV prevention. I will learn from doing it. I will write about it for you.
Andrew Spieldenner, PhD, is assistant professor of communication studies at California State University, San Marcos, chair of the United States People Living with HIV Caucus, and research director of the U.S. implementation of the GNP+/NA HIV Stigma Index.
Acknowledgements: The author would like to thank Tony Adams and Derek Bolen for the invitation and challenge to write queer autoethnography about HIV and sex. This paper emerges from conversations with Robert Vazquez-Pacheco, Jeffrey Escoffier, Giovanni Huaccamayta-Jauregui, and Daniel Brouwer. I am indebted to them, to the men involved in these acts, as well as inspiration from the work of Gran Fury.
This was originally published in a slightly different form as: Spieldenner, A. R. (2017). Infectious sex? An autoethnographic exploration of HIV prevention. QED: A Journal in GLBTQ Worldmaking. 4(1): 121-129.