Gays Debate Radical Steps to Curb Unsafe Sex

New York Times ^ | 2/14/05 | Andrew Jacobs

[Callahan]

After all the thousands of AIDS deaths and all the years of "Safe Sex Is Hot Sex" prevention messages, it has come down to this: many gay men who know the rules of engagement in the age of AIDS are not using condoms. As news of a potentially virulent strain of H.I.V. settles in, gay activists and AIDS prevention workers say they are dismayed and angry that the 25-year-old battle against the disease might have to begin all over again.

While many are calling for a renewed commitment to prevention efforts and free condoms, some veterans of the war on AIDS are advocating an entirely new approach to the spread of unsafe sex, much of which is fueled by a surge in methamphetamine abuse. They want to track down those who knowingly engage in risky behavior and try to stop them before they can infect others.

It is a radical idea, born of desperation, that has been gaining ground in recent months as a growing number of gay men become infected despite warnings about unsafe sex.

Although gay advocates and health care workers are just beginning to talk about how this might be done, it could involve showing up at places where impromptu sex parties happen and confronting the participants. Or it might mean infiltrating Web sites that promote gay hookups and thwarting liaisons involving crystal meth.

Other ideas include collaborating with health officials in tracking down the partners of those newly infected with H.I.V. At the very least, these advocates say, gay men must start taking responsibility for their own, before a resurgent epidemic draws government officials who could use even more aggressive tactics.

"Gay men do not have the right to spread a debilitating and often fatal disease," said Charles Kaiser, a historian and author of "The Gay Metropolis." "A person who is H.I.V.-positive has no more right to unprotected intercourse than he has the right to put a bullet through another person's head," he said.

While not endorsing specific strategies, even mainstream organizations like the Gay Men's Health Crisis support the idea of trying methods that would have been anathema a few years ago. "It makes a community stronger when we take care of ourselves," said Ana Oliveira, the organization's executive director, "and if that means that we have to be much more present and intervene with people who are doing this to themselves and others, then so be it."

For many others, however, even talk of such steps provokes hand-wringing. "We don't want public health vigilantes going out and taking matters into their own hands, particularly if it means breaching the confidentially and civil rights of people with H.I.V.," said Jon Givner, the director of the H.I.V. Project at the Lambda Legal Defense and Education Fund. "Frankly, I find it pretty scary."

Whether such ideas gain acceptance, the fact that activists are even thinking about curbing gay sexual freedom is a huge shift.

In the early years of the AIDS epidemic, gay men protested attempts to close down bathhouses and strenuously opposed efforts by health officials to trace those infected with the virus. Until now, those advocates, driven by concerns about privacy and the stigma associated with the disease, have successfully fought off efforts to impose a traditional public-health model for tackling the spread of the virus.

"You have to remember that was the era when Jesse Helms and others were saying that gay people got what they deserved, and that the government shouldn't spend any money to help them," said David Evans, an H.I.V. treatment advocate who writes about prevention. "There was a time when people thought, 'Oh my god, they're going to put us in camps.' "

Such fears have faded in recent years, thanks in part to laws that protect people with AIDS against discrimination. Although the number of AIDS-related deaths has plummeted since the advent of a more potent class of drugs in the mid-90's, the rate of new infections has remained unchanged at about 40,000 cases a year, frustrating many advocates.

That frustration has been ratcheted up by the growing popularity of crystal meth in New York, which many say has led to an abrupt increase in unsafe behavior and a spate of infections. Although exact figures are difficult to determine, a recent survey of gay men found that 25 percent had tried crystal meth in the last few months.

Those frustrations were given voice in November by Larry Kramer, the playwright and activist who himself has AIDS, in a widely discussed speech at Cooper Union in which he criticized gay men for their behavior. "You are still murdering each other," he said then. "Please stop with all the generalizations and avoidance excuses gays have used since the beginning to ditch this responsibility for this fact."

In an interview, Mr. Kramer said on Sunday that the warning of a possibly aggressive new strain of H.I.V. confirmed his fears and filled him with a sense of hopelessness. "Even in the days of the worst infections, no amount of prevention seemed to work, and that's probably the scariest thing of all," he said.

Even if the warning turns out to be a false alarm, many AIDS experts say it is only a matter of time before a supervirus does emerge.

"You can't have a core group of people having sex with large numbers of people without amplifying any sexually transmitted disease that enters the system," said Gabriel Rotello, author of "Sexual Ecology: AIDS and the Destiny of Gay Men." "I don't have any doubt that a resurgent H.I.V. epidemic will hit the gay population in the near future," he said.

It is this fear of a drug-resistant virus that has driven some who track the spread of AIDS to suggest a more aggressive approach to prevention. Walter Armstrong, the editor in chief of Poz, a monthly magazine about AIDS and H.I.V., said the traditional fear-based model of prevention was at best only a temporary solution, especially if no supervirus outbreak materializes. A more effective way, he said, would involve gay organizations using traditional public health measures, such as more widespread screening and a partner-notification effort to track users of crystal meth who have been infected recently.

"Why would it not be possible to get them together to communicate to each other, and then to their sex partners, that lives are being put at risk by reckless behavior?" he asked. "I think there are ways to do interventions ethically, sensitively and compassionately. There's a huge window of opportunity between criminalization and empty prevention messages."

Still, others remain wary of such measures. Walt Odets, a clinical psychologist and the author of "In the Shadow of the Epidemic: Being HIV-Negative in the Age of AIDS," said he thought such intervention smacked of a witch hunt.

He and others said it would be more effective to try to identify the underlying causes of drug abuse and self-destructive behavior, including the difficulty of living in a society that rejects committed gay relationships while condemning homosexuals for having sex outside those relationships. Gay men, he said, are using methamphetamine as an antidepressant.

Many health experts suggest a more vigorous return to conventional H.I.V. prevention. Isaac Weisfuse, the city's deputy commissioner of health, said his agency was planning to place information banners on gay Web sites and devote more money to hard-hitting ads about methamphetamine use.

Others, like Mr. Rotello, were less optimistic. Until people really believe an unstoppable virus is out there, he said, they will continue to indulge in unsafe sexual practices. "People are not going to modify their sexual habits in ways that are difficult or unpleasant until they see their friends dying again," he said. "And to me that's just an unbelievably depressing thought."

[gidget7]

anal sex is so dangerous, committed relationships are not really that much different than multiple casual ones in terms of health risks for homosexual men. All you have to do is look at average life spans for homos that die with AIDS and those that die of some other causes and the spread is very small (seem to remember that it is about 2 years).



The human body is not designed nor conditioned to accept anal sex. It just isn't. When it's forced anyway, against it's own conditioning, how can anything come of it BUT diseases? Because of the cross contamination, alone, its ripe for infection and a breading ground for just about anything.

[Future Snake Eater]

hey are using it as a stimulant to increase their already hypersexual behavior.

One in the same, my FRiend. They use meth to accentuate their craziness so they can escape their rapidly-approaching depression.

I'm convinced that being gay is, 99.9% of the time, a symptom of deeper psychological problems--some treatable with drugs, others with the right shoulder(s) to cry on.

However, this is far too unpopular a view, and they will continue to demand we surrender ourselves and our children to their depravity.

And if anyone thinks I don't know what I'm talking about, my brother-in-law is gay, and he and his "friend" fit this profile to a "T."

[NotJustAnotherPrettyFace]

"Gay men do not have the right to spread a debilitating and often fatal disease," said Charles Kaiser, a historian and author of "The Gay Metropolis."

This is pretty much the same exact thing Mayor Bloomberg said in the last couple of days as well!

[thoughtomator]

I think the scope of homosexual male promiscuity far outdoes anything heterosexuals engage in. I have never known or heard of any man who had a hundred female sex partners over the course of three months.

[gidget7]

This is pretty much the same exact thing Mayor Bloomberg said in the last couple of days as well!



He sure did! These HIV positive people are walking around with a deadly weapon.

[rottndog]

I have never known or heard of any man who had a hundred female sex partners over the course of three months.


Ever heard of: Magic Johnson, Wilt Chamberlain, Mick Jagar,... etc.?

[gidget7]

I think the scope of homosexual male promiscuity far outdoes anything heterosexuals engage in. I have never known or heard of any man who had a hundred female sex partners over the course of three months.



I agree. Immoral behavior, but none in the same scape. And now that I am totally grossed out, I am going to bed. Enough of this for one night!!!

[Asfarastheeastisfromthewest...]

Exactly and that is why I think it important to refute any hint of a suggestion that the health problems of homos will all go away if only they were 'encouraged to have long-term, stable, monogamous relationships'. Hogwash - those in the long-term relationships (which are about as rare as homos at a Bible study) are only marginally healthier.

[guitarist]

#3 is a good comment by you. Congrats. You make more sense, and are smarter, than this NY Times writer, and the fellows he quotes. But, on the other hand, that isn't saying much!

[thoughtomator]

Okay, so maybe a handful of huge stars at the height of their fame and fortune have done the same... the exceptions prove the rule, that this is not behavior found in normal people. This guy wasn't some movie star, he was an unknown bloke, and he still found a hundred or more different partners over three months.

[NotJustAnotherPrettyFace]

I'm surprised this person didn't say "IT'S BUSH'S FAULT" as well. Sheesh.

They already tried that with Reagan. How well I remember that........

[rottndog]

I think you'd be surprised at what many "normal" people would do when elevated to that stature. True, they would still tend to be the exception and not the rule, but not by much.

I think it's all a matter of being raised with high moral standards, and expectations and demands of keeping to the same via peer pressure and stigmatism. Of course "moral standards" leads to talk of God and religious principles, but these things are no longer allowed into the discussion.

Ultimately, we reap what we sow, and the homos are doing lots of reaping.

[andysandmikesmom]

Your suggestion would not work with those who come into nursing homes, with HIV...I worked in two different nursing homes, and we were told straight out, that if someone came into the nursing home with AIDS we would not be told that fact, even tho we had to care for them...instead, it was expected that in all cases we would always use 'Universal Precautions(hand washing, use of protective gloves, and protective clothing), when dealing with any resident of the nursing home, and in that way we would also be able to protect ourselves against any HIV infection...

Now it has been a couple of years since I have worked in the nursing homes, so things may have changed, but I am just relating how things were when I worked there last, which would be 1998....

Whenever a new resident came into a nursing home, the charge nurse would always tell us what was wrong with the resident, which makes it easier for everyone, the RNs, the LPNS, the Aides, the Therapists, to deal with the resident and their particular problems..

But HIV was always treated differently...we were not allowed to know if someone was HIV positive...but of course, we always found a way around actually saying out loud that someone was HIV positive...the nurse would say something like the new resident had a 'blood borne pathogen', and then the nurse would really stare at us, and say, "Do you understand what I mean?"...and that always meant that the new resident was HIV positive....we were just not allowed to say it out loud....

And I think this is really wrong...most healthcare workers, try to always use 'Universal Precautions'...but sometimes incidents happen, like a resident may fall, and you rush to help them, and in your concern for them, may not take all the precautions needed to protect yourself...it can happen...and if you dont know for sure that a resident is HIV positive, some health care workers may not be as careful as they should be...

I dont know how this works out in hospitals...I just know that in nursing homes here in Washington State, it is(or was at least until 1998)a matter of confidentiality, and HIV positive status is not supposed to be revealed...but with the population living longer, and more and more people needed care in a nursing home, you may be taking care of someone with HIV positive status, and not actually be aware of it...

[Selkie]

"He and others said it would be more effective to try to identify the underlying causes of drug abuse and self-destructive behavior, including the difficulty of living in a society that rejects committed gay relationships while condemning homosexuals for having sex outside those relationships. Gay men, he said, are using methamphetamine as an antidepressant."

No gay men who are insecure about thier looks and/or age have turned to methamphetamines.
I know this as a fact because I have several gay friends in the NYC area.

[twas]

"Gay men do not have the right to spread a debilitating and often fatal disease,"

Good heavens. We have been arguing this point for 25 years now and gay groups have demanded that AIDS was not a health issue but a "civil rights" issue.

After 25 years, they have finally admitted they were wrong.

[Richard Kimball]

Other ideas include collaborating with health officials in tracking down the partners of those newly infected with H.I.V. At the very least, these advocates say, gay men must start taking responsibility for their own, before a resurgent epidemic draws government officials who could use even more aggressive tactics.

Whoa! The radical homosexual activists have discovered the concept of contact tracing? They've discovered the concept that, when I suggested it in 1989, Walter Cronkite's daughter personally accused me of wanting to brand their foreheads? The same contact tracing that's USED ON EVERY OTHER SEXUALLY TRANSMITTED DISEASE?

Wow. I wonder how they ever came up with that idea?

[vaudine]

Nancy R. had the answer--Just say no!

vaudine

[TenaciousZ]

I'm sorry about your brother.

[esoxmagnum]

I read an article here some time ago that explained how AIDS was a badge worn by many gays.

My understanding was they go have parties, and the one person who doesn't have aids, willingly accepts it and has sex with all the other AIDS infected gays, so he can be "part of the club" so to speak.

I wish I could recall the name of the article because it was quite an enlightening look into the twisted minds of these people.

Furthermore, I have little sympathy for most of these women who have sex with gay men. I'd like to say I do, but for all these liberal women who find gay men attractive, well you get what you get, and don't tell me you don't know he's a flamer. If you can't tell they are gay, then blame your parents for being too PC in the household, or blame yourself for not doing your homework on the mans friends and family before you slept with him.

Teach your children abstinence, not condoms, not birth control, not timing methods. Teach your girls to keep their legs shut till marriage and teach your boys "don't touch unless you intend to buy it, and if you touch, you better damn well buy it".

Thats the sex ed talk I instill in my kids now. Period. End of story.

[Richard Kimball]

I know that it's changed for emergency workers. If we have an exposure during a call, at least in Texas, we notify the hospital, and they draw blood and do a complete battery of tests. However, universal precautions are a good idea. I quit teaching CPR in the early nineties because I was told that the only thing the American Heart Association would allow us to say was that "no person is known to have contracted AIDS from properly doing CPR. I asked the instructor how many times he'd done CPR on someone with AIDS. He admitted he'd never done CPR for real. I told him I worked in downtown Austin, Texas, in emergency services, and that working on someone with AIDS wasn't hypothetical to me, it was Tuesday. I then mentioned that many people with AIDS weren't simply suffering from AIDS, but had secondary infections, including tuberculosis and hepatitis. Both of these diseases are easily communicable doing proper CPR.

Most people in the later stages of AIDS, at least if they're in bad enough shape to be in a nursing home are pretty identifiable. It's a horrible disease in the later stages. Kaposi's sarcoma causes huge black spots to appear on the body, they waste away to skin and bone, and generally have picked up so many secondary diseases that they sound like the smoking lounge in an emphysema clinic.

Contact tracing is going to be minimally effective on homosexual men, though, because so much of the sex is anonymous. Often, the sex is through gloryholes in porno movie houses, and the men never see anything except what sticks through the wall. Also, according to several surveys of homosexual men done around 12 years ago, over half of the men with AIDS said they would not tell a potential partner they were infected, because they were afraid of "ruining the moment."

Not to wax religious on this, but I think this is the definition of being in bondage to sin, and indicates the grip homosexuality has on men, even though they claim they "love" other men. Over half of the men surveyed were willing to risk condemning a man they claimed to love to a slow, painful, rotting away death for a half hour or so of pleasure.

Kaposi's sarcoma

Some hetero men aren't any better. I know of three women, one caught herpes, one chlamydia, and one venereal warts from men who didn't tell them they had sexually transmitted diseases. Of course, I probably know a lot more women that this has happened to, these are just the ones who confided in me.