Tragically, it happens every day. For the better part of the last decade, the success of gay-run campaigns urging safe sex – using condoms to prevent the spread of HIV, the virus that leads to AIDS – was a point of pride for homosexuals. By 1985 the spread of AIDS appeared to be in check in the gay community. Even in heavily gay San Francisco, the epidemic’s rate of transmission fell to almost zero. But after years of vigilance, many gay men like Michael T. are not always using condoms. And a second wave of the AIDS epidemic is well underway.
In a 1991 study of men who have sex with men conducted in 16 cities around the country, 31 percent of respondents had engaged in unprotected anal intercourse within the previous two months. In San Francisco, a 1993 study reported a sharp rise in the annual rate of HIV infection among gay men under 30, to almost four times the overall rate in 1987. National Institutes of Health-funded researchers project that, at current rates of infection, a majority of 20-year-old gay and bisexual men nationwide will eventually have the virus. African-Americans and Latinos face the greatest danger.
As the grim statistics rise for a second time, gays are looking less to science and to government to place blame and find solutions. This time, the emphasis is on the community itself. Educators are focusing on the culture of gay sex, searching for ways to encourage monogamy, bolster self-esteem and tackle the despair that they believe leads to men putting themselves at risk. At the start of the epidemic, when people like playwright Larry Kramer and the late journalist Randy Shilts called for the closing of the bathhouses where much unsafe sex took place, they were shouted down. And until recently anyone who questioned anonymous sex might have been derisively labeled a “sex negative” puritan, says author-activist Michelangelo Signorile. But because of the current crisis – and a resurgence in sex clubs – promiscuity is being questioned in more and unexpected quarters. To prevent the spread of HIV, one activist has even suggested voluntary segregation, for sexual purposes, of men who have the virus and those who don’t.
Some AIDS advocates have also accused the gay leadership of neglecting AIDS to push a broader political agenda. Beginning with the election of Bill Clinton in 1992, community leaders began taking up the rights of homosexual couples and gays in the military. Under the brief tenure of director Torie Osborn, the National Gay and Lesbian Task Force slashed funding for AIDS work – 25 percent of its total budget – to zero. In April 1993, when gay leaders went to the White House for the first time, AIDS wasn’t on the agenda. “We weren’t on the phone saying, “We have to dump AIDS’,” Osborn says now. “It was unconscious. I found myself a part of a massive AIDS abandonment.” But Urvashi Vaid, Osborn’s predecessor as task-force director, insists the number of Washington gay AIDS advocates actually increased during the same period.
One of the strongest calls for a new safe-sex approach comes from Signorile. In the latest edition of the gay magazine Out, Signorile, a self-described safe-sex advocate, reveals he consented to unprotected intercourse after a night of partying in Honolulu. In his cautionary article, Signorile doesn’t attack promiscuity outright, but suggests gay men take a look at their sexual relations and check for self-respect and compassion. “The way that gay men sometimes treat each other we call liberation,” he says. “If it were men treating women that way, we would call it degradation.”
In 1993, Dana Van Gorder, a San Francisco city-hall aide, organized focus groups of 119 men to plumb their motivations for having unprotected sex. Low self-esteem and desire for intimacy topped the list, followed by the irrational but commonly felt sense that all gay men will eventually get HIV and die, even those who know to use condoms. Van Gorder understood the results viscerally. Even though he’s HIV-negative, he’d seen so many friends die that he himself had given up hope of surviving. He started having unprotected, dangerous sex.
Van Gorder was lucky. By turning to his straight friends, he found a supportive peer group that helped restore his optimism. “Gay people are so accustomed to seeing people [become HIV-positive], they often can’t deal with it in one more of their friends,” he says. “But if I pick up the phone with my aunt in Marin County, the first thing she wants to know is how I’m doing.” Van Gorder, now the gay and lesbian health liaison for the city of San Francisco, is writing a prevention campaign he hopes will help HIV-negative men, many of whom feel guilty, better appreciate their good health.
The standard “condom every time” safe-sex message makes sense medically, but some critics say it may be doing great psychological harm. Through consistent testing, partners in monogamous relationships can credibly establish their HIV status. Yet a long-term HIV-negative couple is told to continue using condoms, just as if they were carrying the virus. That may not be necessary, says Walt Odets, a Berkeley psychologist with a large gay practice. But, he believes, for fear of stigmatizing men who already have the virus, traditional gay AIDS prevention plans ask everyone to “pretend they are [HIV] positive for the rest of their lives.” That gives gay men no incentive to form and stay in safer monogamous relationships, says Odets. It also contributes to the fatalism that Van Gorder describes, and possibly to sexual risk-taking.
The architects of current AIDS prevention vehemently reject Odet’s critique. Ron Stall of San Francisco’s Center for AIDS Prevention Studies says the real obstacles to better prevention efforts are homophobia and a lack of resources. In California, where gay men and bisexuals account for 77 percent of the AIDS caseload, only one in 10 prevention dollars has gone to campaigns targeted at homosexuals, according to a recent study. Under Clinton, the increase in federal prevention funding has quadrupled, but the content of education programs is still restricted when it comes to talking about sex. Before the Centers for Disease Control released a $50,000 grant to underwrite a gay AIDS-prevention meeting last July in Dallas, all materials used were vetted for language “promoting homosexuality.”
To safeguard their lives, more gays will have to confront the new crisis in AIDS prevention, says Benjamin Schatz, executive director of the gay Association of American Physicians for Human Rights. “If people think we can bury the statistics, we’re soon going to be out there burying more bodies.” Once, by looking inward for answers, gays nearly stopped the spread of AIDS in their community. Now they must do it again.
