AIDS Fighters Face a Resistant Form of Apathy

NY Times ^ | April 3, 2005 | ANDREW JACOBS

[neverdem]

Where have all the condoms gone?

Don't try looking at the Monster, the Hangar, Starlight or Barracuda. On a recent evening, these and more than a dozen other Manhattan gay bars were well stocked with free going-out guides, but not a scrap of literature about H.I.V. prevention or the perils of crystal meth. As for condoms, the frontline defense against sexually transmitted diseases, only one establishment stocked them - behind the bar.

As part of his graduate course work at New York University, Michael Marino set out last winter to compare the AIDS prevention efforts of New York and London. He was troubled by what he found. At most New York bars, and even at some bedrock gay and AIDS service institutions, educational pamphlets and free condoms were hard to find, if not impossible. In London, Mr. Marino found them easily.

"No wonder things are getting so out of control here," he said.

Condoms, which still can be found in vending machines at a handful of places, were once given away by the bucketful. While no one believes free condoms will completely halt the spread of H.I.V., their disappearance from bars, the equivalent of a town hall for some gay men, is a telling indicator of how much steam has been lost in the fight against AIDS.

Although the city health department's recent warning about a rare, possibly more virulent strain of H.I.V. has caused a stir among gay men, many AIDS activists hold out little hope the news will prompt substantial or lasting changes in behavior. They point to the continued popularity of methamphetamine, which has contributed to a rise in condomless intercourse, known as barebacking, and the widespread apathy in which H.I.V. is seen as a nuisance, not a potential killer.

Compounding this laissez-faire attitude, they complain, are drug company advertisements that gloss over the disease's effects by portraying patients as the picture of perfect health.

Locally, at least, the statistics paint a mixed picture. The number of new H.I.V. infections among men who have sex with men declined slightly from 2001 to 2003, according to the most recent figures available, although in much of the country that number has been rising. But AIDS service providers, pointing to a recent spike in syphilis cases and the rise of methamphetamine abuse among gay men, fear it is only a matter of time before New York faces a new surge in infections.

The challenge is far more complicated than handing bar patrons informational brochures and telling them to be good, prevention specialists say.

"Just because folks are well informed doesn't mean they'll necessarily make the wisest choices in terms of their health," said Dr. Ronald O. Valdiserri, who oversees AIDS prevention at the Centers for Disease Control and Prevention. "This is true of all humanity, not just gay men."

The reality that gay men continue to have unprotected sex has been vexing health experts for 20 years, although the struggle became even more daunting in the mid-1990's, when a new class of medications sharply reduced death rates and fed the misconception that AIDS is only about as troublesome as the flu.

And then there are those who disdain condoms. With the specter of imminent death gone, the idea of using condoms has become an annoyance for many. "Let's face it, sex with a condom is not as good," said Dr. Robert L. Klitzman, a psychiatrist and professor at Columbia University. "Sex is supposed to be an incredibly intimate moment, and it's not as intimate when there's a piece of plastic between you and your partner."

There is a growing sense that the traditional sloganeering about condoms and club drugs is about as effective as birth-control campaigns that rely on abstinence. The only hope for changing behavior, public health experts and psychologists say, is to recognize and address the underlying factors that propel men into risky situations. Loneliness, alienation and self-hatred, they say, are the real culprits that need to be addressed.

But others, describing such talk as naïve, say it makes more sense to stress personal responsibility. Demonize crystal meth, stigmatize unprotected sex and remind people that living with H.I.V. can be grueling, or worse. An important first step, they say, would be to stop running pharmaceutical ads that portray people with AIDS as carefree and virile.

Other ideas include following the lead of the San Francisco health department, which is seeking strict limitations on the availability of erectile dysfunction drugs that counteract the impotence induced by crystal meth and encourage the spread of sexually transmitted diseases.

Many AIDS activists in New York, describing current public service campaigns as toothless and ineffective, say bus ads and billboards should remind people that AIDS is a devastating and entirely avoidable illness.

Many prevention advocates agree that only a creative, ever-changing arsenal of tactics can reduce the number of new H.I.V. infections. They point out that it has taken years and millions of dollars to change public attitudes about tobacco and seat belts, and even now reasonable people lapse into old ways.

"Everyone knows smoking is bad for you, but we still print those health warnings on cigarette packs," said Kwame M. Banks, a consultant specializing in prevention work. "People need to hear these messages 100 times a day. That's the way these things work."

Still, when it comes to H.I.V. and AIDS, some wonder whether it is time for a new strategy. Perry Halkitis, a psychologist at New York University who studies the relationship between drug use and sex, believes that many gay men who engage in risky behavior are grappling with profound mental health issues.

"People are not taking risks because they're stupid, or because they wake up one day and say, 'I'm going to take a risk today,' " Dr. Halkitis said. "They do it because the sexual risk fulfills a need, or somehow makes them feel better about themselves."

He and others say any successful fight against H.I.V. must deal with depression, substance abuse and low self-esteem, problems that studies have shown affect gay men at disproportionately higher rates.

"Many people might argue that as a community, we suffer from post-traumatic stress disorder because we're so ostracized by society," Dr. Halkitis said. "Being rejected by family, by our churches, and these days by our government most certainly has an impact."

That emotional fragility has been compounded by the trauma of the 1980's and early 90's, when sickness and death permeated the lives of so many. Peter Staley, a veteran AIDS activist, said it was no coincidence that some of the first people in New York to pick up crystal meth habits have been men 35 to 45 years old.

"We are the long-term survivors who watched friends die, who never thought we'd live to have a midlife crisis," said Mr. Staley, who is H.I.V.-positive and himself a recovering meth addict. "Then the new medications came along, and suddenly everyone returned to their old lives and people moved on to other issues, like gays in the military and gay marriage. Where was the communal processing of the emotional hell we had just gone through? I think as a result we're a deeply scarred group."

While such scars can lead to substance abuse, psychologists say the internalized homophobia and deep-seated feelings of low self-worth are just as powerful. That is where the allure of crystal meth kicks in. Those who have used the drug say it tends to blot out feelings of vulnerability, boosts self-confidence and imbues them with a false sense of connection to strangers.

Then there are the "bug chasers," H.I.V.-negative men who actively seek infection. Although such men are thought to be few in number, mental health experts say the phenomenon reflects the intense alienation that many gay men feel. Louis Pansulla, a psychoanalyst who runs gay therapy groups in New York, said younger men, in the generation that missed the darkest days of the AIDS crisis, believe that infection will win them membership into a clique, albeit one coping with a dreaded disease.

"It's almost a longing to belong, even though it's a completely unconscious thing," he said.

Michelangelo Signorile, the host of a gay-themed talk show on Sirius Satellite Radio, takes a less nuanced view: "If everyone in your group is beautiful, taking steroids, barebacking and H.I.V. positive, having the virus doesn't seem like such a bad thing."

It is for that reason that Michael Weinstein, president of the AIDS Healthcare Foundation, believes the disease is due for an image makeover. He cites a hard-to-miss ad in last month's Out magazine that is embedded with a tiny audio chip and features two robust men on a beach. Opening the magazine sets off the trill of a ringing phone and a man's voice essentially saying he is having too much fun to worry about his chronic illness. Mr. Weinstein has asked the ad's sponsor, Bristol-Myers Squibb, to stop using the ad for the drug, Reyataz. A spokeswoman said the company was re-examining its advertising campaigns.

"People are in such denial about how serious H.I.V. is," Mr. Weinstein said. "Unfortunately, the best prevention is seeing people die."

Of course, frontline prevention workers hope to avoid a new wave of deaths. At Gay Men's Health Crisis, prevention workers are planning a series of events that seek to promote "connectedness and community."

Others are creating antidrug messages that masquerade as packets of meth that can be dropped on dance floors. A series of subway ads unveiled by the state for the first time shifts responsibility to those who are already infected.

And then there are people like Daniel Carlson, a former marketing executive who became so disgusted by the number of men soliciting unprotected sex online that he and a friend started a group to combat the prevailing ethos about sex and drugs. In the past two years, the group, H.I.V. Forum, has organized a half-dozen town hall meetings on crystal meth and unprotected sex that have drawn packed houses.

"I know it sounds touchy-feely, but if we could just emphasize a little bit more community and brotherhood," Mr. Carlson said. "We have to decide whether we're going to be selfish or whether we're going to care about one another."

[neverdem]

From low self esteem to gays in the military and gay marriage, this article seems to run the gamut.

[neverdem]

FReepmail me if you want on or off my health and science ping list.

[ClearCase_guy]

"We have to decide whether we're going to be selfish or whether we're going to care about one another."

I think that's going to be a reaaaalllly tough decision. [/sarcasm]

Face it, fellas, it's a Culture of Death. You know the risks. And you don't care.

[Thebaddog]

Abstinence? Was the word abstinence used in the article?

[traderrob6]

GRRRRRRRR typical NYT stinkin cowpie. If you don't by now know enough to protect yourself from risky behavior, you have alot bigger problems than conntracting AIDS

[GSlob]

"Abstinence? Was the word 'abstinence' used in the article?"
Judging by how much they abstained from using it, it WAS used in writing the article.

[little jeremiah]

Homosexual Agenda Ping.

This really comments on itself. All the doozies - the best one is that "gays" take meth, try to get AIDS, bareback, have promiscuous anonymous "sex", become drug addicts, are mentally unstable and suicidal - all because nasty society, churches, and families reject them. Internalized homophobia.

Well, gang, what do you think of that?

If it's true, than those who faithfully believe in and try to serve God should all have the same or worse behaviors, since we're much more "marginalized" and hated than homosexuals. At least by the MSM and TPTB.

Let DirtyHarryY2K and me know if you want on/off this pinglist.

[Izzy Dunne]

"If everyone in your group is beautiful, taking steroids, barebacking and H.I.V. positive, having the virus doesn't seem like such a bad thing."

Is your life really so worthless ???

[An American In Dairyland]

The word abstinence was indeed used in the article but ONLY in reference to how heterosexuals fail at abstinence. Here it is:

There is a growing sense that the traditional sloganeering about condoms and club drugs is about as effective as birth-control campaigns that rely on abstinence.

[neverdem]

Abstinence? Was the word abstinence used in the article?

Yes, it's 14th paragraph/sentence.

"There is a growing sense that the traditional sloganeering about condoms and club drugs is about as effective as birth-control campaigns that rely on abstinence."

[AEMILIUS PAULUS]

Anything but self-governance. Further, the public is to pay for the instruments of vice. Better to pay for the lash, the whip and the knout!

[Tall_Texan]

As for condoms, the frontline defense against sexually transmitted diseases,...

Well, that's the problem right there. Gays would rather have a backdoor defense to sexually transmitted diseases.

[Cicero]

"Where have all the condoms gone?" Sounds like a 60s rock tune.

The author develops the sneaking suspicion that gay New Yorkers are . . . just . . . a . . . little . . . teensy . . . bit . . . crazy.

But how can that be? I thought the American Psychological Association voted they are just as normal as apple pie.

[ReadyNow]

I am starting not to care at all about gays, HIV, etc., except about their greatly deleterious effect on the rest of us.

Does that make me a homophobe?

[Stopislamnow]

So, if we continue to marginalize the homos, they will bugger themselves into non-existance?

And they want to be called "normal"?

Let the marginalization continue apace!

[mabelkitty]

All that Federal money those AIDS charities are getting is being used for circuit parties - can't buy condoms and print literature when one has to provide camp Queen B-listers with tina appetizers.

[AmericanChef]

-prevention workers are planning a series of events that seek to promote "connectedness and community."-

Seems to me there's just too much connectedness going on. Male/female sex has an automatic control: the female. Male/male has none. The men might be gay, but they're still men. Predators. Sex is more urgent than safety.

[little jeremiah]

Considering all the promotion that homosexuality is getting in public schools via "Gay/Straight" clubs, Days of Silence, "gay" counselors and so on, various corportaions' "diversity training" and sponsorship of the homosexual agenda, and ACLU pushing "gay" everything all the time, Hollyweird homo-promo, and more (just the tip of the iceberg), homosexuals are not only not marginalized, they're practically mandatory.

The only way homosexuality could get any more face time would be if it WAS mandatory.

[Nick Danger]

"AIDS has had a long run at the top of the charts. But like all diseases, people lose interest in it. If they haven't gotten it by now, they figure they probably won't.

Besides, we got this Marburg virus now that makes your skin fall off in chunks and blood squirt out your ears. It's hard to get excited about something that might kill you in ten years with pneumonia, when something like that is on the loose. That one's riding a rocket to the #1 disease.

Our current #1 is the Bird Flu, which some scientists say will kill us all by a week from Wednesday. But after fans burned a few million chickens during its last appearance in North Korea, Bird Flu appears to be headed down as well.

Be sure to tune in next week. Will Marburg take the #1 spot? Will Ebola make a comeback? And just what has SARS been doing in the studio for the last year?

[AQGeiger]

Male/female sex has an automatic control: the female.

That is hilarious.

Male/male has none. The men might be gay, but they're still men. Predators. Sex is more urgent than safety.

And this is very observant. Combine that with the fact that many gays truly want to contract HIV because they think the infection is what will connect them with the gay community, and all the money in the world could not educate this population into behaviors that avoid disease.